It's kind of like a sore throat, but mentally.
October 27, 2010 12:01 AM   Subscribe

Can my family doctor treat depression?

I've known for a while that things aren't quite right with me, but it's really starting to affect my life to the point where I might actually lose my job. I don't know what's wrong with me lately...I feel so lazy. I can't sleep when I'm supposed to sleep. I drink too much. Just all sorts of fun stuff.

I've been meaning to see a psychiatrist for a while, now, for anxiety. The tricky thing about that is that I've been too anxious to make an appointment. I think I might be able to see my doctor about it, even though just making a phone call to someone I don't know gives me chills, but I'm just so embarrassed right now that all of this is even an issue.

If I go to my family doctor, is it appropriate to bring this stuff up? What sort of things should I mention, if I do? Once again, I'm terribly embarrassed, and it's almost terrifying for me to open up to some doctor, especially if he can't really help me, or will think I'm obnoxious for bothering him when he has real patients to worry about. It's just gotten to the point where I don't think I can wait a week to get some kind of help.

Thank you so much for your help, and I'm sorry if this is a dumb question. I've just never really dealt with any of this before, and it's a little overwhelming.
posted by jnaps to Health & Fitness (15 answers total) 3 users marked this as a favorite
Some will try it, but they're not generally very good at it. Drug treatment of mental disorders is as much art as science. A particular drug (or class of drugs) can be a life-changing miracle for one patient and completely useless for another. A GP may give you a prescription for some drug or other, but he won't see you often enough to determine if the drug is doing you any good, or if it's causing you unacceptable side effects.

Much better to see a psychiatrist about this.

However, depending on your health plan, you may need a referral from your GP in order to see a psychiatrist.
posted by Chocolate Pickle at 12:04 AM on October 27, 2010 [1 favorite]

It's just gotten to the point where I don't think I can wait a week to get some kind of help.

I think this is the key here. You recognize that you need some kind of help and you need it soon. Your GP may not be the person who ultimately takes the lead in helping you get through this, but your GP is definitely a good starting place and seeing your GP is whole lot better than doing nothing. It's absolutely appropriate to discuss this with your GP. Why not start by telling him/her exactly what you told us: you're anxious, depressed, how it's causing difficulties in your life and job, and really just everything you've just said in this post. You don't need to be overdramatic, but this is not the time to try to minimize what's going on; be honest and clear that you feel you need help in the very near future.

Your doctor absolutely shouldn't think you're obnoxious for bothering him, and you're just as much a "real patient" as someone coming in with a sore throat. It sounds like it's going to be easier for you to pick up the phone and make an appointment with your GP as a good first step. Once you're there, you can ask for a referral to a psychiatrist and/or a therapist to further develop a plan to tackle this, but those are next steps.

The most important thing is that you recognize that you have to do something, it's getting worse, and you want to do something about it soon. You've done all that, so pick up the phone and call your GP. You've done that before and it was easy enough then, so why should it be any different now?
posted by zachlipton at 12:20 AM on October 27, 2010 [10 favorites]

I will add to zachlipton's excellent advice that your GP is a great first port of call because s/he can help you, immediately, with a short term prescription that can reduce the anxiety enough to help you pull it together to go through the process of finding a psychiatrist for longer term care. Basically, while it may not be the ideal long term solution, it can be a great short term solution to improving your quality of life and reducing the hurdles to longer term care.
posted by DarlingBri at 12:39 AM on October 27, 2010 [2 favorites]

Before you see a shrink, try anything - anything at all you think would help. It's the first - and hardest step, but it gets the ball rollin'. For me, I'm a lazy f*ck, but if I get up onto a bike (exercise), I feel about 100 times better, 6 hours into that ride (I go a little overboard). Drinking? Stop. Lazy? Don't be. Can't sleep? Well, boozing it up is linked to crap sleep - so is not exercising. Even those three things will help you feel better - is it that much of a mystery? Do you see the snowball effect? Congrats, you're like the rest of us, we openly accept you for being imperfect and I think there's no one that wants you to feel like crap.

And I think that's exactly what your doctor, if he/she is worth their salt, would say.

posted by alex_skazat at 12:55 AM on October 27, 2010 [1 favorite]

My family doctor listened to me describe my depression, found a medication that he felt would work well with the other medications I was on and suggested I find someone to discuss my mental health and depression with more fully.

Your doctor is not going to try to cure your depression, but he will help you with short term solutions that will make it easier to get what you need. Most likely, he'll be able to suggest someone who can help (and who takes your insurance!).

Your family doctor is trained to assist you in all facets of your health, mental included. He's no substitute for a specialist, but he will not find your request obnoxious in the least.
posted by aristan at 12:57 AM on October 27, 2010

That's a very good point DarlingBri. jnaps: if your GP doesn't happen to offer such an option offhand, don't be afraid to ask. It's perfectly appropriate to say something like "I feel too anxious right now to even deal with this and the thought of picking up the phone and calling a psychiatrist gives me chills. Is there something I can take in the short term to help me hold it together so I can get more help and not lose my job?"
posted by zachlipton at 12:59 AM on October 27, 2010 [1 favorite]

Response by poster: alex_skazat : Lazy was perhaps a poor choice of words. It's not so much that I've been inactive -- I tried to go for a walk in the park a couple days ago, just to try and get some endorphins running, and I've been doing P90x for a few weeks now. Sometimes I'm filled with all sorts of energy. The apartment is cleaner than it's been in a while, because I get these spurts where I just need to do *something* immediately.

It's that I haven't really been able to leave the apartment for almost a week now, and it's not really a conscious choice, but more of a deal where if I don't have someone with me at the grocery store of all places, I start to feel panicky. When I went for my walk it just felt like everyone was looking at me, and I know that's not true, but it got to the point where I walked back home and didn't leave for the rest of the day. And then I just get into this funk where I feel empty and numb and just weird.

I don't know why it's different at the bar -- maybe because once I've had a couple of drinks I feel like I can finally relax and enjoy being with my friends. I'm typically a very social, confident person. This whole thing is just really, really weird for me. So far I haven't done anything stupid while drunk, in fact, it's the only thing keeping me sane at this point, because I can finally sleep when I get home. I'm just leery of becoming dependent on alcohol, especially since addiction runs in my family.
posted by jnaps at 1:13 AM on October 27, 2010

in fact, it's the only thing keeping me sane at this point,
I've heard lots of problem drinkers say "Hey, I didn't have a drinking problem -- I had a drinking solution. Over time, my drinking solution became my drinking problem." For the right -- wrong? -- person, alcohol cures what ails. I mean, "I'm feelin' no pain!" isn't just some phrase picked out of the air, it's apt.

I'm just leery of becoming dependent on alcohol, especially since addiction runs in my family.
Yah, addiction sometimes runs in families because the underlying causes of the addictions -- both physiological and psychological -- tend to run in families. Your family members suffering addiction may have started out suffering what your suffering now but not had the presence of mind to see that it could lead down a dark, dark road; you've got a chance to cut this thing before it even gets started.

You could get extraordinarily lucky with your doc, could be that he pulls the rabbit out of the hat first time, sets you up with the exact correct mix of drugs which totally and elegantly addresses all aspects of your medical condition. I'd say your chances of that happening are about the same as my chances getting asked to join one of the world series teams as a pitcher and I throw a no-hitter, plus hit three home runs. Not gonna happen. Could, but... So use advise from upthread, use your GP as a stopgap measure, get some anti-panic drugs for you or at the very least some anti-anxiety stuff going on. If you're not sleeping, maybe he'll write you for ambien, which turns the lights out for many, sometimes does for me but mostly I need other stuff thrown into the mix too.

It took me years to get it all sorted out but I do feel pretty sorted out now. Frustrating work and a lot of it, often quite dispiriting. Got to keep on moving toward the goal, peace, ease, not buried by side effects. Feel out your GP, see if he's willing and/or able to do any of the work you're going to be entering into, otherwise thank him/her for the help they've given and for the referral they also gave. Read everything you can get your hands on -- the internet is absolutely your friend, you'll have to utilize your skills of sorting it all down, cutting through the droves of information and finding what is a fit for you.

Last. Even if you've now gotten into the door of a competent and qualified shrink, you are still at least as much responsible for your recovery as your shrink is. He doesn't see it that way but who cares, this is your life; you absolutely need his help but it is you who is going to live in the body you've got, while he's at home drinking fine wine around his fireplace with his trophy wife bringing a rack of lamb. So you need his help but it's important that you be in the decision process, that you've read enough to pose intelligent questions
posted by dancestoblue at 2:09 AM on October 27, 2010

Our family Dr was very, very helpful treating my husband for anxiety & depression. And since we were both already very comfortable with her & the office staff, it worked out very well. No need to meet & 'try out' a new health professional, & all the anxiety that goes with that. Call for an appointment & say you're feeling serious anxiety. Then, the first step is taken & you're on you way to improved mental health. Give it a try, and good luck.
posted by jsslz at 2:21 AM on October 27, 2010

Drinking in circumstances like yours is common -- there's even a name for it: self-medication. Beware of alcoholism, it can make you the walking dead, and I speak from personal experience.

Also from personal experience -- talk to your doctor immediately. My internist picked up on my symptoms the second I started to describe them and knew exactly what to do. My condition was fairly easy to treat with Lexapro -- God bless Lexapro! It made me a normal person for the first time in years.

The thing to get over is the idea that your depression is somehow a failure of willpower, or a weakness of character. IT'S CHEMICAL, and might be successfully treated chemically. Drugs are not necessarily the complete answer, of course. But as others have said, your primary care physician is the place to start. Go now!
posted by Srudolph at 4:37 AM on October 27, 2010

Please quit drinking. Not for good, just for now until you have worked things out. It may feel better temporarily, but it doesn't help anything in the long run. Have you seen a psychologist? There are psychologists that work on sliding scales, so call around and check. I would go see a psychologist first and foremost to get a baseline objective opinion (it may take a couple of sessions before that can be determined).

If you are having anxiety, you could always go and talk to your GP about getting a short term benzodiazipine like clonopin or valium or xanax or ativan. They will help with the anxiety, but are not meant to be used for long periods of time. They are addictive and coming off of them after being addicted is a bitch- I know this from experience.

Good luck.
posted by TheBones at 6:23 AM on October 27, 2010

If I go to my family doctor, is it appropriate to bring this stuff up? What sort of things should I mention, if I do? Once again, I'm terribly embarrassed, and it's almost terrifying for me to open up to some doctor, especially if he can't really help me, or will think I'm obnoxious for bothering him when he has real patients to worry about. It's just gotten to the point where I don't think I can wait a week to get some kind of help.

Call. Your. Doctor. It's ABSOLUTELY appropriate to bring this stuff up with your family doctor. Ask for a referral to a psychiatric practice. You can even ask if their office can help you make the appointment -- not only is that less phone calling for you, but often a doctor can get you on another doctor's schedule faster -- but I find this varies regionally. (Where I live now, most offices actually have a scheduling person who schedules your appointments with specialists for you; other places I've lived it was more ad-hoc.)

You are a REAL patient. You have a REAL medical need.

Your doctor may be completely comfortable treating your anxiety/depression, or may send you for a referral. Either is fine (but if you don't feel like your depression is improving, or your doctor isn't seeing you pretty damn often while you adjust to the meds, you probably need to see a specialist to at least get established). It's also pretty common to see a psychiatrist to get established on meds, do a couple rounds of talk therapy (with the psych or with a therapist in the same practice or recommended by the psych), and then have your GP do the maintenance and maintain your med prescriptions and check you up, and only go back to the psych if there's a problem or a change.
posted by Eyebrows McGee at 6:50 AM on October 27, 2010

The drinks work because you're self-medicating. I have been there myself. More precisely targeted and dosed medication will work even better.

I would ask for a referral to a psychiatrist and a psychologist/therapist/counselor, because studies have shown that medication plus talk therapy work better in combination than either in isolation.

Best of luck to you. It will get better.
posted by Sidhedevil at 8:36 AM on October 27, 2010

Just because no one else has mentioned it: Do NOT drink and take benzodiazepines, if you get prescribed them. It will knock you on your ass.
posted by saveyoursanity at 9:36 AM on October 27, 2010

Best answer: Most psychiatrists and physicians that I know about start out the same way, prescribing an ssri for a depressed and/or anxious patient. If that ssri doesn't work or if it has bad side effects, they will then switch you to a different ssri. Even though the various ssri's are in the same category of drugs, they vary in how they affect people, and even someone in your own family can have hugely different experiences with a given ssri.

So there's no harm in talking with your regular doctor first. If you have no luck with the first couple of tries, you might want to see a psychiatrist. Some people benefit from combining two drugs, or from adding what's called a mood stabilizer. For these and other more advanced options, your physician will probably bow out.

You can ask your physician to suggest a psychiatrist -- that's a good place to start. Some shrinks do talk therapy, but most don't. Therapy can help a lot to give you perspective and encourage new habits once your meds start working. By the way, when a drug works for you, you'll know it. If you can't tell, then it's not working.

Your questions are absolutely not stupid, and the uncertainty you feel is totally normal. Depression and anxiety come into play when it comes to getting help, just like they do in all other parts of your life.
posted by wryly at 10:21 AM on October 27, 2010

« Older Things to do in Guilin, China.   |   I don't have anyone to escort me from the hospital... Newer »
This thread is closed to new comments.