I am a 28-year-old woman who is afraid of everything. I have never been able to get my driver's license. I can't hold down a job outside my home. I don't like crowded places, and I'm finding myself less open to meeting new people or trying new things. I'm married to a wonderful man who has taken good care of me for 11 years, but I am feeling guilty about how little I contribute. Recently, my sister was diagnosed with depression and is now on medication. She and I have realized that our family has a history of depression. I'm planning to see someone about my problems as soon as my health insurance kicks in, but I'm wondering if depression is really what I have. I don't always feel depressed. I just feel worried all the time. And afraid. And, at times, angry. Is it depression? Phobias? Or am I just lazy?

B.L.

I can't say for sure what you're experiencing without conducting a thorough (face-to-face) evaluation. But the fears and worries you report, along with the related behavioral difficulties, suggest the possibility of some kind of anxiety disorder. I'd definitely recommend your seeing a psychologist or other mental health professional for an assessment and treatment recommendations.

Psychotherapy and other behavioral interventions are usually, in the long term, more effective for anxiety than is medication -- and certainly more effective than medication alone, which doesn't address the psychological roots of problems such as you describe. I'd recommend trying psychotherapy or counseling first, before (or even instead of) medication -- especially antianxiety medication, which can foster physical and psychological dependence. (See psychiatrist Edward H. Drummond's book Benzo Blues: Overcoming Anxiety Without Tranquilizers.)

One possibility is to read some books about anxiety, panic and/or depression and see if any of the descriptions and recommendations seem to fit you. Some books to consider in addition to Benzo Blues are An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder by Elke Zuercher-White and Feeling Good: The New Mood Therapy by David Burns.

There are good psychological and behavioral treatments available for anxiety as well as depression, and I encourage you to seek further consultation and recommendations about your options. Unfortunately, if you think psychotherapy may be helpful for you, you may have to fight your health insurance company to get reimbursement for it. These days many insurance and managed care companies are pressing individuals with psychological problems to take medication -- often prescribed by physicians such as internists or gynecologists who do not have extensive training in mental health assessment, diagnosis and treatment.

When psychotherapy is warranted, insurance companies may limit the treatment to only a handful of sessions. Sometimes that's enough to address the problem, but it often takes people longer to establish a good relationship with a therapist and to understand and address the myriad factors that can contribute to emotional difficulties. As a result, some people decide to pay for any psychotherapy on their own, rather than using insurance, in order to increase their choices and control over the process.

Keep in mind that insurance companies' bottom-line concern is to curtail costs and generate profits for their stockholders. Your quality of life and personal well-being are far too important to be dependent upon the financial concerns of an insurance company.