Help me get help

February 8, 2013 7:25 AM

How do I start getting treatment for my mental health problems, specifically, in Austin, TX?

Hi -- this question has been asked in some variations in the past, but I'm a special snowflake.

I've struggled with ADHD and anxiety and probably depression for as long as I can remember. I was diagnosed with ADD is a kid, but was the outlier who was a high performer in school (but I had to devote so much time to get everything done with all of my distractions and hyperfocus).

After a conversation with my husband a few months ago, where he effectively told me he didn't want to be married to me anymore, I realized that I am not in control of these problems as much as I thought. I spent most of the second half of 2012 unemployed and depressed, which my husband took as lazy, and compounded the problems in our marriage. We are trying to work on things, but it isn't going so well, and I'm trying to preempt the fall out if the marriage ends, which would not be my choice (but that's probably a whole other question here)

After reading a lot on the green, and in other places, I want to try medication to see if that will help me as these are long term chronic issues for me. How do I get started?

I just went to the GYN for the first time since moving to Austin, and tried to bring up my anxiety and depression, and was told to start working out. I do not have a primary care physcian.

Do I just call up a psychiatrist? I found one who can take me on as a new patient and manage meds -- but he doesn't take insurance. Is this normal? I don't mind paying, but I don't know if that should be a red flag.

Do I just ask for medication? Do I start with a therapist, and get referred?


I appreciate any help anyone can offer, and any specific recommendations in Austin especially.

posted by hrj to health & fitness (8 answers total)

A lot of psychiatrists don't take insurance. Call one up and schedule an appointment. They're qualified to help you, but a GYN likely is not, at least with this problem. (Though exercise certainly is one way to deal with depression.)
posted by dfriedman at 7:31 AM on February 8

The insurance issue isn't a red flag to me. Running a private medical practice is basically like running a small business, and dealing with insurance could frequently not pass a cost/benefit analysis.

If you *do* want one that takes insurance, call the 800 number on your insurance card, or go to their website, they can help you find psychiatrists in your area that definitely take your insurance.

Also, I *strongly* suggest doing some kind of therapy (eg CBT) with a licensed therapists. Psychiatrists, 99% of the time, *only* do meds, and in my experience, the meds aren't actually that helpful without therapy.

Good luck.
posted by colin_l at 7:34 AM on February 8

I found this list (PDF) of mental health and counselling resources in Austin. Good luck to you.
posted by faraasha at 7:37 AM on February 8

Seconding finding a therapist first and asking for referrals. Yes, medication may help, but it would be much more effective to do both together. That you might want to go through your insurance for because it will add up quickly if your doing it out of pocket on a (probably) weekly basis. A psychiatrist is good, but they may strongly recommend therapy to your treatment plan.

Good luck!
posted by andariel at 7:52 AM on February 8

Not trying to threadsit -- but it seems that a lot of therapists in the area don't take insurance either. I don't think I could afford weekly individual therapy, especially as my husband and I are considering couples counseling as well.

I'm not "low-income" so I wouldn't qualify for things like that either. I've done therapy alone, and did not find it helpful.
posted by hrj at 8:01 AM on February 8

Do I just call up a psychiatrist? I found one who can take me on as a new patient and manage meds -- but he doesn't take insurance. Is this normal? I don't mind paying, but I don't know if that should be a red flag.

This is common, yeah, and not necessarily a red flag. Psychiatrists who are competent and take insurance often have long waiting lists for new patients anyway.

(FWIW, I have a competent insurance-taking psychiatrist in Austin who I'm very fond of. He probably has a long waiting list right now. He did when I started seeing him; I had to see someone out-of-group for a while, until I percolated up to the top of his list. But let me know if you're interested and I'll point you in his direction.)

Do I just ask for medication?

If you're seeing a psychiatrist, they'll just straight-up assume you want to try taking psych meds — or else why would you be there? Your line is, "I've got these symptoms and their ruining my marriage. I think I might have ADHD, anxiety, or depression. I'm wondering if medication might help." The doc will ask you a whole bunch of questions about your symptoms, and — if they think it's a good idea based on the answers — prescribe you some medication. After that, you'll probably spend a while futzing around with different meds and dosages until you find The Right Thing.

It's really common for people to feel like they've got something to prove to a new psychiatrist. Like, if a doc asks some question about the severity of your depression, you might feel like they're saying "I don't think you're really all that depressed. I think you're just bullshitting me." (After all, coming from other people in a non-medical context, that's totally what that sort of question would mean.) And so it's easy to fall into this trap of thinking you need to second-guess the doc and work out what the "right" answers are. Try not to do that. Just answer honestly. You are really seriously not going to get thrown out on your ear for describing the "wrong" symptoms. You might get a diagnosis that surprises you — but then, if it's accurate and the treatment ends up working, that's a good kind of surprise.

It's also really common to feel like "Well, I shouldn't ask for meds, because then I'll sound like some drug-seeking tweaker and they won't want to help me." Not true. Don't worry. Some docs are reluctant to prescribe Schedule II meds (like Ritalin or Adderall) to a brand-new patient. But they won't yell at you or kick you out or call the police or whatever. They'll just say "Let's try something less restricted first and see if that works."
posted by Now there are two. There are two _______. at 8:03 AM on February 8 [1 favorite]

hrj: "I've done therapy alone, and did not find it helpful."

When the psychiatrist I started with first prescribed meds for my depression, she insisted that I also do individual talk therapy in addition to taking the meds. She felt that was the best combination for me to manage my symptoms. I didn't necessarily have to see *her* for the talk therapy, just as long as I was seeing someone regularly.

I don't know if this is common, or if it was just my situation, but just putting it out there as a possibility.

Good luck to you!
posted by SuperSquirrel at 11:31 AM on February 8

Just a clarification -- I am completely open to doing therapy in addition to meds, with a separate doctor -- I just don't think therapy without meds is enough for me at this point.
posted by hrj at 2:16 PM on February 8