Dear Abby, I'm looking for a good witch doctor. Yours, anxious in NYC.

November 10, 2008 5:02 AM

I need a good psychiatrist / neurologist in NYC. Oxford Health Plan.

All my life, I've suffered from anxiety. It's low grade. I don't have panic attacks. I function as I'm supposed to and perform well at my job. I come from a family of Woody-Allen-esque Jews, so I figured that anxiety was simply my birthright. Most of my relatives are worry warts.

At 43, I've had an epiphany: I don't have to -- or at least I shouldn't have to -- live that way for the rest of my life. It's not fun or romantic or funny. I'm tired of walking around with a slightly queasy stomach all the time. I'm tired of constant what-if thoughts and sleepless nights. I want to be able to truly relax.

I've done the talking cure before, and I think it can be effective for some things, but that's not the route I'd like to go now. (Though if an MD suggests it as part of a treatment regime, I'm open to it.) I've also tried meditation. So far I've failed with that, but I'll keep trying. I'd love to try biofeedback some time, but that's another story.

What I've never tried is meds. I suspect that my life would be better if I was on some sort of anxiety medication. I want to explore this option (and other options) with an expert. Who should I see?

posted by grumblebee to health & fitness (9 comments total)

You don't necessarily need an expert for anxiety medications. Have you tried speaking with your doctor about this, or getting a referral? I know many primary care doctors who prescribe anxiolytics.

(And it would most certainly be a psychiatrist, not a neurologist.)
posted by gramcracker at 7:15 AM on November 10, 2008

I once got a prescription for Xanax from my general practitioner. That helped some, but what I'm really looking for is an mental-health expert with whom I can discuss all of my options. I know I can ask my doc for a referral (though on my health plan, I don't need a referral to see a specialist), but though my doctor seems fine, I don't know him all that well. I'm blessed with generally good health, and so I rarely see him. I think I've spent all of 45 minutes with him in the last five years. So I'd prefer to hear recommendations from other people.
posted by grumblebee at 7:26 AM on November 10, 2008

In a MeMail, someone suggested I see a Psycho-pharmacologists, claiming they are "much better trained than straight-up psychiatrists, they take an extra two years (I think) of training after their psychiatric residency." (Presumably, he meant better trained in terms of prescribing meds -- not in general.)

Thoughts?
posted by grumblebee at 8:05 AM on November 10, 2008

Anxiety is a common disorder. You don't need to start with a sub-sub-specialist. Get a garden-variety adult psychiatrist. My father is one, has no psycho-pharmacologist training, and knows the ins and outs of every anxiety med, because he's practiced for so many years.
posted by gramcracker at 8:36 AM on November 10, 2008

You don't necessarily need an expert for anxiety medications.

A good psycho-pharmacologist will give you tests and interview you to assess your particular type of anxiety. Anticipatory? Free Floating? Correlated with time of day, sleep patterns?

A garden-variety adult psychiatrist will suggest one of the top several medications -- an expert will keep going, helping you through the time-consuming assessment of each medication in turn (weeks or months of careful self-observation and dosage adjustment.)

If you are not typical, (and you have proven that here many times!) you may respond to one of the less-prescribed options that works especially for you, but your doctor has to have the patience and knowledge to explore those.
posted by StickyCarpet at 9:43 AM on November 10, 2008

If you aren't taking a B vitamin complex, using an appropriate time-management system, getting perfectly regular sleep and routine workouts, please start there. That's about all I do to manage my anxiety anymore, and I consider it managed. Sorry I can't recommend a doc, but seriously, try these practices if you aren't doing them.

If you're having free-floating anxieties, try to pin down any loose ends you can. Don't allow worry over the things you can control, like your achy tooth or your messy house, fix them. For me, that entails better daily routines, lists, etc. If the worry is about things you can't control, like disasters or illness or scary drivers, I'd lean toward CBT. You need to write over that tape. The what-ifs remain something that can be approached as a bad habit, though you said it, you're 43, maybe too old a dog?

I did try biofeedback with my therapist a couple times, and I really found it no different than a sort of meditation or breathing exercise. Maybe I didn't get it.

Also, you're a theater person. For me, acting was where I got many of the skills I need to control these worry impulses. Maybe this sounds nuts, but I attempt, and often succeed, in directing myself to other choices, keeping my own written "character" aright, which I'm going to patent as the "fake it till you make it" anxiety management school. I think positive self-talk, meditation and acting are all kind of related. Different levels of enacted self-actualization, perhaps. I'm trying to say, that maybe you have tools you can use on this problem that you didn't know were suited to it.

Good luck with meds, I suggest starting with whatever is recommended as having the least likelihood of side effects. Losing myself to weird side effects left me anxious ABOUT meds for a long time. I hope I've been a little help, even though I'm not speaking to your specific question.
posted by Ambrosia Voyeur at 9:56 AM on November 10, 2008

I have Oxford. I have a shrink who I don't really like, but she gives me the Rx I need and she's covered.

I talked to my GP to see if she knew anyone good, and she said, "This is NYC. There are a ton of psychiatrists here, but in my experience, there are great psychiatrists, and there are psychiatrists who take insurance. So if you found one who's OK and covered, you're not going to do much better than that."

Memail me if you want her name and more info. She's kinda weird but she knows a lot about meds.
posted by chelseagirl at 10:00 AM on November 10, 2008

I came in to post something similiar to chelseagirl. Be VERY careful with Oxford, though. A year ago, when I was considering short-term meds, I asked my non-network shrink to please help me find a network psychiatrist because of the cost. I printed out a list. She called me later, horrified, saying that without exception, everyone on that list was found to be objectionable by her colleagues, with accompanying horror stories.

I would accept chelseagirl's offer if she has one that's okay. Keeping in mind that just because she can deal doesn't mean you will be able to.

You might consider finding a shrink covered by Oxford and then seeing who they work with.
posted by micawber at 10:16 AM on November 10, 2008

Thank you all for your help. If anything happens -- if I find a good shrink or come up with a good way to relax -- I'll post about it here.
posted by grumblebee at 7:11 AM on November 11, 2008