Help me help myself please.
June 13, 2011 11:22 AM   Subscribe

I went to the doctor a couple of months ago after recognizing that my anxiety was getting out of control. I was prescribed Cymbalta and generic xanax to take as needed. My dr strongly suggested that I see a therapist and/or psychiatrist.

I'd been down this road before and was never ok with the psychologist/psychiatrists/medications. Nothing seems to work. This time around I was put on Cymbalta (30mg for a week and then 60mg) and once the initial exhaustion passed it seemed to make me incredibly hyper and happy. That was actually physically exhausting as well. I went back to my doc and she said that it was probably too much and lowered me back down to 30mg.

Today I finally made an appointment with a psychotherapist and I really don't know what to expect or ask for. The last 2 weeks I've been an emotional wreck. Crying for anything and everything. My work is suffering. My relationship is suffering. I have no energy, no appetite. For a while I thought I was successfully managing my issues by enjoying what I can and not stressing the small stuff. Everything seemed ok.

My boyfriend thinks I'm crazy and selfish and I am so on edge and sensitive to everything that I can not deny this. I don't know how to organize my thoughts never mind organizing what comes out of my mouth or anything else. I don't know what else to do. I am not on birth control and while the majority of my symptoms sound like pmdd the duration of them makes me rule it out.

In addition to seeing the psychotherapist on Wednesday should I go see my gynecologist? Back to my GP? Should I stay on the Cymbalta? I like my doctor and trust her but my decision making skills are failing me. Please share your suggestions, experiences, anything. Thank you.
posted by mokeydraws to Health & Fitness (7 answers total) 4 users marked this as a favorite
You do, as they say, have to help yourself, but you can let the therapist help you. Take the text above printed out on paper, and anything else you would like to write down about your thoughts and concerns. Let the therapist help you sort all that out - that's his job.

You can also discuss then what to do about your medical questions. You sound really keyed up right now and everything probably feels really urgent, but it can wait a couple of weeks. Your therapist may have a list of bloodwork she'd like you to get, or some advice about investigating that avenue of causality, so it'd be worth waiting a bit to find those things out.
posted by Lyn Never at 11:39 AM on June 13, 2011 [1 favorite]

If you like and trust your doctor, do what your doctor is telling you to do.

When you see your psychotherapist, you can tell them exactly what you've told us. I saw a therapist once for a specific situation, but I couldn't even articulate what that situation was. When I called to set up the appointment and she asked what I wanted to be seen for, I just burst into tears and cried "I don't know, I just want to feel better." She was able to calm me down and ask enough questions to find out what I needed. Which is all by way of saying: do not worry (ha!) about articulating yourself to your therapist. They will help you do that. Go to the appointment. Go to the next one. Give it a chance to work.

Sorry you're feeling this way... hope you feel better soon.
posted by dpx.mfx at 11:41 AM on June 13, 2011

Look. Plan on falling apart. Embrace it. What you are looking for is clarity, for personal acceptance and for a better understanding of yourself and how to deal with things. That means shit is going to fall apart in the short term.

On the positive, you have the opportunity to rebuild yourself. You have the ability to learn from your mistakes, to take a new critical look at your system of coping and build a solid structure for your future.

With a good psychotherapist, you will find that it is actually impossible to say something wrong at all. The only thing you do to mess things up is to either undershare stuff, or overshare stuff - and you won't be able to tell what and where the right level is for a long time. If you share too much, your therapist will be slightly overloaded, but they'll help you prioritize and you'll have a task list of things you start working on. Similarly, if you share too little, your filter may focus them on the wrong stuff in the short term, but in the long term they will help you tease all the right stuff out of you. In either case, by prioritizng your mental health and approaching this with an open mind, you're already making some good progress. Focus on that in the short term.

Go to your appointments. Share your feelings. Ask questions. Accept feedback. Make some corrections if they are obvious. If they aren't just keep doing it. Sooner or later, you'll see that you have some greater clarity in the changes you want to make and the way in which you need to make them. If not, talk to the therapist about that.

Good luck. We're pulling for you.
posted by Nanukthedog at 11:45 AM on June 13, 2011 [4 favorites]

First off, good for you for reaching out for help. It can be scary, but these are experts who can help sort this all out.

The psychotherapist will be well versed in guiding you through the initial steps of the therapy process. They'll ask you about what is bringing you in now, how long you've had similar issues, what you've done in the past that's worked and not worked, and will also ask you more generally about your background (e.g., family, health, etc.). Their job is to help you put this all together in a story that makes sense, and from that figure out the best way to tackle those problems. There is not really anything you need to prepare for that meeting, but you might think about what exactly you would like to accomplish in therapy (e.g., if this went away tomorrow, what would be better/different in your life?). If you have worries about the process, feel free to ask. Also you can learn a little more about the kind of therapy they do, how long people usually work with them, etc. if that will make you feel more comfortable.

The next thing I would recommend would be going to see a psychiatrist. Your primary care physician is an expert in diagnosis and generalist knowledge. His/her recommendation to see a psychiatrist suggests to me that they feel that it would be better for you to have someone with a more specialized knowledge of mental health conditions and their medical treatment. Just like if you had a broken bone they would refer you to an orthopedist who could provide more specialized care. The psychiatrist would be able to help sort through some of the medical concerns you have (e.g., PMDD), refine your diagnosis and refer on to other medical specialists if it seems like that's the best explanation of what's happening.

Basically, the best care you can give yourself is to put yourself in the hands of people who are experts at managing anxiety and depression. From there you can judge if it feels like you are able to build a relationship that feels right with your providers and can help decide if this is working for you. Keep the lines of communication open with your providers. If you have concerns or reservations tell them so you can work together to find a solution that will work for you.

I wish the best for you.
posted by goggie at 11:49 AM on June 13, 2011

You are not crazy or selfish for experiencing anxiety and being unable to cope with it on your own. You are not crazy or selfish for needing medication. You are not crazy or selfish for needing therapy. If your boyfriend told you that you are crazy and selfish, that was a wrong, ignorant, and cruel thing for him to say. You are not crazy and you are not selfish. You are experiencing a mental health issue that you need professional help to address. You are taking steps to get that help: you are brave and responsible.

Don't make any hasty decisions right now, instead get some expert help. Go to your therapist appointment and tell her how you are feeling, what you have tried in the past, what you are currently trying, and that you need help determining next steps regarding your meds and other medical care (such as seeing your GYN). If you don't click with that therapist, try a different one. If you feel like you don't know what to tell your therapist, say, "I don't know what to tell you." Write up a list of things you need to discuss with her and take it with you. If you need your therapist to take a greater role in asking questions rather than waiting for you to tell her things, say so or find a therapist who is more proactive.
posted by Meg_Murry at 11:53 AM on June 13, 2011 [8 favorites]

To be honest I would not take psych meds at all unless I had consulted with a psychiatrist, not a GP. It is important to monitor reactions such as what you seem to be having, for reasons I won't get into here. And it is important to have an expert in these meds, which your GP is NOT.
posted by St. Alia of the Bunnies at 12:07 PM on June 13, 2011 [2 favorites]

To be honest I would not take psych meds at all unless I had consulted with a psychiatrist, not a GP. It is important to monitor reactions such as what you seem to be having, for reasons I won't get into here. And it is important to have an expert in these meds, which your GP is NOT.

Agreed, but also don't just stop taking it until you've spoken to a psychiatrist, because going off them suddenly can make things worse. If your therapist cannot prescribe, get a referral to a psychiatrist for medication management.

Your doctor is probably not a dummy, but this isn't their specialty. Better to consult an expert.

Hang in there. I have been down this road before and it is scary, but just try to take it one day (one hour, one minute) at a time. You're on the right track and this will get sorted out.

Your boyfriend is probably confused and frightened by the change in your personality. Or he might be a jerk, but let's assume he's not. In the short term, tell him that you understand that he's frustrated, and you're taking steps, and you aren't going to discuss this any more until you speak to the therapist. If he continues to not be supportive, then maybe you've learned something important (and unfortunate) about him.

If you feel suicidal or feel like you want or need to harm yourself, please go to the nearest emergency room. It doesn't mean you're crazy or that you are going to get committed. But it can be a side effect of medication.
posted by thinkingwoman at 3:04 PM on June 13, 2011 [1 favorite]

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