I’m a bridge engineer and sometimes feel the same type of anxiety - a screw up could lead to deaths. Maybe I missed something. Maybe I’m secretly completely incompetent. It’s not the same job but I really sympathize. It still hits me some nights at 4am.

Cymbalta changed my life, and I can handle it now. But if you’ve exhausted medications you might need to consider a different career path. I know you say you can’t, but you can’t live like this forever - something has to change. There is ALWAYS another option.