Anxiety and Depression

April 2, 2011 2:08 PM

What should I do about my anxiety/depression?

I've been seeing a therapist and she said I have anxiety and depression. I'm going through a relationship loss but also with the anxiety, I told her I've had intrusive thoughts the past several years on and off. Since I told her, it's been worse, and she suggested short term medication, or as long as needed to keep my anxiety/depression at bay. I was told years ago that I have an anxiety disorder and was given a prescription, but never followed through because a family member told me about a bad reaction they had to those medications.
I don't go through my insurance to see my therapist, due to hardships getting insurance in the first place. I don't want to go through insurance to see a psychiatrist, who would be able to prescribe meds in conjunction with care from my therapist.
I'm thinking of just asking for medication from my primary care doctor due to anxious thoughts. Maybe this could really help me.
My anxiety causes the intrusive, scarey thoughts, and they are so scarey that it depresses me. Just because these thoughts pop into my mind doesn't mean I want it to happen on any level, does it? That scares me. It is thoughts of harm to my loved ones. For God sakes, I work in the social services business and take care of people, always been fond/wanting to help those in need. She keeps asking if I have a plan for these thoughts. NO I do NOT, but again it scares me because does just thinking about it mean I want it to happen?? :(

posted by dt2010 to health & fitness (13 answers total)

"I'm thinking of just asking for medication from my primary care doctor due to anxious thoughts. Maybe this could really help me." I think so, stop "thinking" about it and do it. Follow through, work through the common initial side effects (7-14 days) and then give it six weeks. If you do not feel significantly better try another med. . Many of the SSRI's which you might need for long term management are generic--cost should not be a problem. If you do not/have not abuse(d) alcohol or other drugs you might ask the physician for a benzodiazepine to help with the short term anxiety management while more appropriate medications kick in. Perhaps clonazepam as it has a longer 1/2 life. Stop listening to stories and get some help. Most of the psych medications do have some initial side effects They may be a minor annoyance or a significant problem--get through it. Remember you are trying to change the level of selected neurotransmitters--this takes a bit of time and patience. Good Luck
posted by rmhsinc at 2:29 PM on April 2, 2011

It sounds like you are going through a lot. These are questions to talk about with your therapist (or another therapist, if you feel like this one isn't working out for some reason). It's also her job to assess your safety and ask you if your thoughts have a plan associated with them, so she is trying to help you and trying to make sure that you are safe. Having intrusive thoughts (of harming yourself or other things) does not mean you are going to do it, but it can feel very, very scary. Your therapist is the best person to help you deal with those feelings. No one on the internet is equipped to tell you whether you need medication, but you should talk to your doctor about it if you feel it might help.
posted by so_gracefully at 2:30 PM on April 2, 2011

Just thinking these thoughts DO NOT mean you want them to happen. A lot of people with OCD have these kinds of intrusive thoughts. They can be about contamination, or about harming other people, or about horrible things happening, or sexual images that you find disgusting. Basically thoughts that are out of line with how you really see yourself, and hence the thoughts cause you great distress.
In fact, about 80% of the population report having intrusive thoughts! I have thoughts sometimes that seem so out of line with anything I'd ever believe/want to happen, that just pop into my head. The thoughts can become obsessive/very distressing when you believe that just thinking the thought is almost as bad as carrying out the action, or that thinking the thought means it is more likely to happen. A lot of people try to suppress the distressing thoughts, which makes them worse.
So, thinking these thoughts does NOT mean you are a bad person or that you really wish harm upon your loved ones. It sounds like you could greatly benefit from CBT first and foremost, and maybe some SSRIs if need be. Try to find a therapist who's trained in treating OCD and anxiety disorders and who uses CBT as a main approach. Good luck.
posted by whalebreath at 2:55 PM on April 2, 2011

sorry, DOES NOT
posted by whalebreath at 2:56 PM on April 2, 2011

Ya therapist is best, but SSRI's and whatnot can take a long time because you usually need to be on them for almost two months to get the full effect, and you could go through a lot of them before you find one that clicks with your own chemistry.

So what you can try immediately, which act's sort of like an SSRI (In that it increases serotonin and doesn't just keep what you have), is 5-htp. 100mg before bed with a b complex vitamin. See how that goes and if need be, add another 50mg in the morning by itself.

It usually works extremely quickly for people. As in hours or a day. Although you do have to quit them for a week every quarter or so so your body doesn't develop the means to stop the uptake up all that serotonin.

For general calmness, Rhodiola works wonders for me. Ironically, there is a point where you can either take too little or too much and it acts to alert you and increase stamina a lot. In both amounts, I felt great.

Plus, you don't get the brain zaps weening off of 5-htp and you don't get the loss of libido. In fact, Rhodiola is said to increase it a lot. Of course there is very little double blind research about Rhodiola. There is research on 5-htp that points to helping depression but it's kind of common sense, that increasing serotonin would help.

But if your thoughts are disturbing in other ways, maybe you won't be put on SSRI's. And always talk to a doc about mixing any mood altering medication with the above. Especially 5-htp.
posted by penguinkeys at 3:04 PM on April 2, 2011

penguinkeys, are you a doctor who has diagnosed the poster and knows what other medications he or she might be on? Wikipedia lists these possible risks and side effects of 5 HTP. I do not think it's prudent to tell someone you don't know to take drugs and at what dosage.

dt2010, your GP might be able to prescribe something. There are also psychiatrists who will work with people outside of insurance companies, and may have a sliding scale. Your therapist should be able to help you find one. I am on a couple of medications for anxiety, and they have been life savers. Just because your family member did not react well to one doesn't mean you won't benefit from it. For example, one medication I'm on, Lamictal, can cause a life-threatening rash in a very small percentage of people. I was cautioned by my doctor to watch out for that, but I am not susceptible to it, and it has proved to be of great benefit to me.

You do not need to live like this, trust me. You deserve better.
posted by desjardins at 4:26 PM on April 2, 2011

From personal experience, I can only say this: it's worth it. It's like getting a CPAP if you have sleep apnea - you don't even remember what decent sleep IS until the thing interfering with it is gone.

The "ramp up" time can be frustrating, at least it was for me. I went through three different medications, then a series of dosage adjustments before it really settled in and did it's job. Just trust me, it's very much worth it.
posted by OneMonkeysUncle at 4:27 PM on April 2, 2011

I went to a therapist for a time when I suffered from depression. My primary care physician prescribed the medication based on my therapists recommendation. It was very helpful to me and eventually went off the therapy and medication altogether. If you are worried about side effects, discuss them with your doctor. But ultimately, for me, taking the step of getting medication to help deal with my mental and emotional issues was the turning point for me. I started living a much healthier lifestyle in many ways. Hang in there and you will feel better.
posted by Roger Dodger at 5:59 PM on April 2, 2011

Just because these thoughts pop into my mind doesn't mean I want it to happen on any level, does it?

Nope.

I'm sure there's a good reason that therapists ask about plans and make people do things like sign contracts that they're not going to hurt themselves or others, but it always felt to me like on this one issue, they weren't listening: "Stop worrying about seeing me on the front page of tomorrow's paper, covered in blood and screaming, and start telling me that these thoughts are just pictures my mind has chosen to scare the crap out of me with."

The stuff that goes on in your head is not an expression of your wishes. Those images are not your plans, goals, or fondest desires. Who knows why they're there. It's like your brain is poking you--hey, we haven't felt panicky in minutes, LOOK AT THIS! Or maybe it's more metaphorical than that--"Here, self, let me find a glaringly horrible way to express the sense of helplessness I'm going through." Or, hell, maybe your mind is just trying to find the cause of all this anxiety--it must be caused by someone else, so let's imagine some big vengeance for it. It doesn't matter why the images are there...the fact is, they're there, they're causing you distress, you need to deal with them.

Yes to asking your GP for meds. Talk through the relative having had a bad reaction, exactly what that reaction was. Ask what symptoms you can expect, so that when you have them, they don't add to your worries. Ask what the backup plan is. Ask what you can do outside of just talking, to help yourself. Ask about breathing exercises, relaxation, ways to redirect your thoughts. Read about anxiety. (I just found one of my favorite anxiety books--one I'd given to a friend years ago, after it helped me an awful lot--at a thrift store the other day, and bought it to keep around in case I ever needed it again, "Don't Panic," by Reid Wilson--it's more about panic attacks, but there are lots of strategies around relaxation and refocusing that might be useful, so I'll recommend that, too.)

It's an illness, it's treatable, it does *not* have to define your life, and it gets better. I promise.
posted by mittens at 6:28 PM on April 2, 2011

"penguinkeys, are you a doctor who has diagnosed the poster and knows what other medications he or she might be on? Wikipedia lists these possible risks and side effects of 5 HTP. I do not think it's prudent to tell someone you don't know to take drugs and at what dosage"

I thought I was being prudent in telling dt2010 to talk to their doctor before taking these things with medication. I also stressed 5-htp should be talked over. This person was already advised by a professional to take an SSRI but of course, if they have low levels of serotonin in the first place, this won't exactly help. The doses are just what I found in the trials I read about.

And I assume we're all adults here and it's a given that caution is to be placed on the advice of an internet stranger. If this person was diagnosed with something more serious than anxiety and depression, I'm sure they would have been advised to keep stick tabs on what supplements they take.

If you want a link with many studies done on 5-htp, here you go.
posted by penguinkeys at 8:39 PM on April 2, 2011

I have had disabling anxiety and depression for many years. I've been on meds and in therapy for years. The best thing I've ever done for my condition was recently get into an Intensive Outpatient Program specifically for anxiety. They use "Acceptance and Commitment Therapy" which basically means accepting that you have anxiety and learning that just because you have a thought doesn't mean that your emotions have to react to it or you have to do what it is telling you to do. It's just a thought. Once you realize this, then being willing to be uncomfortable and anxious, but do whatever your anxiety has kept you from doing is the key. There's a great workbook that we're using -- Get Out of Your Mind and Into Your Life -- which you could use. There are several people in the program who are having very disturbing intrusive thoughts like the ones you describe, and this is really helping them.

You could look for someone who uses this kind of therapy or cognitive behavioral therapy. I was in insight-oriented therapy for years, learning "why" I felt the way I do, but I was still paralyzed in many ways to get on with my life.

Just remember: anxiety is thought-based; thoughts are just thoughts. Just because you are thinking something does NOT mean that you will do what you're thinking.

Best wishes.
posted by la petite marie at 9:10 PM on April 2, 2011 [1 favorite]

IMNAD - but, anti-anxiety meds tend to be pretty fast acting (a few hours) and are often prescribed as a complement to the anti-depressants. And while antidepressants can take weeks to come up to full power, some people (not all) notice the difference much sooner. What I am really trying to say, is talk to your therapist about she thinks might help, then talk to your GP as soon as you can. You may find things get noticeably better very quickly. (Can't promise but the benefits make it well worth a try as soon as you can.)
posted by metahawk at 9:56 PM on April 2, 2011

Your therapist and your regular doctor should make a pretty good team to help you through the process of selecting and adjusting to medication. As long as you're still seeing both, there shouldn't be too much of a problem or a need to see a psychiatrist. Also, there are now a lot of generic antidepressants that are relatively inexpensive. Of course it's best to find the medication that works best for you, but cost is often a factor.
posted by easy_being_green at 11:49 PM on April 3, 2011