I'm sorry to hear of your experience. While I understand you've had difficulty in obtaining one thus-far, I would second possibly trying a medication. It may be worth trying another doctor, but generally, if you communicate in plain, albeit stringent, terms that you have a truly debilitating anxiety and/or feeling of depression, most doctors- including simple primary care physicians- will prescribe a medication without much of a second thought. SSRIs (Prozac/Fluoxetine, Zoloft/Sertraline) are generally first line in cases such as these, though there are indeed other options such as those suggested in a prior comment (Beta-Blockers like the mentioned Propranolol can help a lot with physical symptoms, like tremors, though they don't address/affect mental state).
Such that you can make an informed choice, though, here's some additional information regarding SSRIs that I wrote for a previous individual (some of it applies to medications generally). Much of this information is stuff doctors are trained to communicate to their patients, though many often don't for whatever reason. I'd encourage that you read it as some of these points are significant and are things you should be aware of, though do note I'm not a doctor myself. I wish you the best.
- SSRIs work very well for some, though not everyone. Approximately one third (33%) of patients achieve a (near-)complete remission of depressive symptoms, another third experience some partial benefit, and the last third have little-to-no response/change. That antidepressants may or may not work doesn't mean you should or shouldn't try them, especially if you've nothing else to lose.
- After starting an SSRI, it generally takes 2-6 weeks for the medication to become effective. This onboarding process, while temporary, is sometimes characterized by side effects such as increased anxiety, panic, insomnia, gastrointestinal issues, and fatigue.
- SSRIs often cause side effects such as emotional blunting, lowered libido, insomnia, and reduced REM sleep, among other things. While frightening when written out, these tend to be manageable and worth dealing with if the medication is otherwise working. If side effects are intolerable at this point, however, a determination related to continuing/discontinuing the medication should be considered by the individual.
- If things are well on the medication, one should generally stay on an SSRI for a period of ~6 months after a remission of depressive symptoms to prevent relapse. While staying on a medication dramatically longer than this is not the end of the world, it does unnecessarily expose you to the aforementioned side effects for longer and it can make discontinuation harder. Likewise, one shouldn't rush to discontinue a medication prematurely / if things aren't 100%. Basically, it's important that patients regularly (every few months) reassess whether the medication is still necessary
- Medication is, for most, only a partial aid; these are not magic pills and they often can't fix the circumstances one's life. Effort needs to be put forth by the individual to improve things for themself independent of the medicine lest they end up medicated for longer than they would otherwise need to be. Therapy while on medication bolsters the treatment efficacy dramatically.
- When ready to discontinue, one should taper. Tapering is the gradual reduction of a medication's dose and is often integral in preventing discontinuation / withdrawal symptoms with SSRIs. Often, tapering manifests through a halving of the medication every few weeks until the lowest manufactured dose is reached. One can request and continue with a liquid formulation if they wish to be extra careful, though this isn't always necessary. While all doctors are trained in the tapering process, they don't all engage it without being asked. Generally, though, it's very much worth tapering in order to avoid withdrawal / discontinuation symptoms.
- Antidepressants with very short half-lives (e.g. SSRIs like Paroxetine/Paxil and SNRIs like Cymbalta/Duloxetine & Effexor IR) are less commonly prescribed, but are very difficult to discontinue and can have significant withdrawal effects. Generally, they should be avoided if possible as other medications in the same classes with longer half lives exist and accomplish largely the same things.
- Benzodiazepines (these are different from SSRIs and include Alprazolam/Xanax as examples) are also occasionally prescribed for severe anxiety. As such, it may be of benefit to note that benzodiazepines should almost always be used only acutely/occasionally and almost never daily. Chronic (daily), long-term benzodiazepine use is associated lasting negative effects that other medications don't have, so I figured I mention it just in case.
