How do I handle seeing a doctor about depression or anxiety medication?
April 10, 2012 3:39 PM   Subscribe

How do I handle seeing a doctor about depression or anxiety medication?

I've suffered from depression and anxiety for a long time, and after talking to friends of mine who have been on various drugs for depression and/or anxiety, I finally got the nerve1 to make an appointment with someone who can prescribe medication. This is after several months of what has felt to me like ineffective talk therapy, and quite a few incidents in which my functioning in daily life has been impaired.

My appointment is with "my" primary care physician; I put "my" in quotes because this is the person I selected because my insurance asked me to but I've never seen him before. There are no other physicians I've seen before in my area, either.

So what now? What do I say and do when I have the appointment? I want to maximize my chances of, sometime in the near future, finally not feeling like crap. And what do you wish someone had told you at this point in your life?

Also, a couple related questions:
1. I am currently employed with health insurance, on a year-to-year contract which ends June 30. There is a high probability that I may not have insurance after that date. How should this effect what I do? I'm particularly worried about the possibility that in the future, this would be considered a "preexisting condition".

2. My psychotherapist does not seem supportive of this. In particular when I asked her if she could refer me to a psychiatrist she changed the subject to how there were things that she had suggested I do that I hadn't done. My sense is that she sees medication as a last resort. How should I deal with getting a new therapist?

(This is a sockpuppet of a longtime mefite. I will confirm my identity by memail if you want, especially if you're someone I know. I'm using a sockpuppet because my main metafilter account name is a username I use in some other places.)

If it matters, some demographic info: 28, male, currently living in Oakland, CA but I may be moving away soon.

1. Okay, so I called my mother and got her to do it. Whatever. It's kind of cruel that the universe is set up so that you have to get over your anxiety a little bit just to get treatment for it.
posted by omicron to Health & Fitness (25 answers total) 15 users marked this as a favorite
If you don't want this to appear on your insurance records, you're going to have to see a private-pay psychiatrist and pay out of pocket. Also for the meds. I used to do this because I wanted to keep my insurance "clean" of pre-existing conditions, but I stopped doing this after my chronic physical illnesses began. Most private-pay psychiatrists, at least in my area, charge $100 - $200 for an evaluation and $50 - $100 for followup visits to assess the efficacy of the medications.

If you decide that it is more important to get treatment ASAP from your primary caregiver, one possible script is "Hello, Dr. So-and-so. The primary reason I'm seeing you today is to discuss my depression and anxiety; I've been working with a psychotherapist, but I think that a medical intervention would also be helpful."

Listing three to five specific instances where your day-to-day functioning has been impaired will help the doctor assess the scope of the issue. "I missed an important work conference because I had a panic attack last August; earlier this year, I wasn't able to help a friend with driving him home from the hospital because of overwhelming anxiety; several days a week, I find myself crying in the shower and not knowing why" or whatever your equivalent experiences are.

Best of luck.
posted by Sidhedevil at 3:48 PM on April 10, 2012 [4 favorites]

If this doctor is like mine, you'll be filling out a form listing any medical issues you want to discuss. You'll check "anxiety/depression" on the form (or however it's listed) and then the doctor will ask you what's going on with that, or with whatever else you've checked.

Again, if he's like mine, he'll take the lead through the whole thing, and suggest we try the generic equivalent to Zoloft for a time to see how it goes.

I was not required to convince John of anything aside from describing my symptoms, if that's worrying you. Good luck to you, and I hope this appointment goes as painlessly for you as it did for me.
posted by chazlarson at 4:08 PM on April 10, 2012

Most doctors are willing to prescribe antidepressants if you're also seeing a therapist. At one point, I got my antidepressant through this method, though I now see a psychiatrist. My appointment to get meds basically went, "You're depressed and you want to start an antidepressant? You're seeing a therapist? Great, let's try this one."

Since you may not have insurance in the near future, it makes sense to start by trying one of the cheaper antidepressants - most of the SSRIs are available as generics that are on the various $4/month lists, but a few are more expensive. I've never heard of a good reason to start with the expensive ones. Tell your doctor you want to start with a generic that is available cheaply, it shouldn't be a problem at all.
posted by insectosaurus at 4:11 PM on April 10, 2012 [2 favorites]

I just reread your question and saw the bit about the new therapist. There are a couple things in there. If your therapist doesn't think you need medication yet, but is supportive of your decision, you might consider sticking with her. If she's not supportive of your decision or you're uncomfortable with her, it makes sense to me that you'd seek a new therapist.

Are you asking for advice on how to find a new therapist, or how to terminate the current relationship? Regarding finding a new therapist - you'd find one much the same way you found this one (asking friends, asking for referrals). Regarding terminating the relationship, it's just a frank conversation where you tell her that she's not meeting your needs.
posted by insectosaurus at 4:16 PM on April 10, 2012

I think sidhedevil's advice regarding your approach to the physician is outstanding--be clear, as concise as appropriate, a brief well organized history (2-3 minutes at most) is helpful and past/current efforts to manage this in other ways. Be honest if asked about drug/alcohol use/abuse ( be specific regarding frequency/amount). Do not be thrown if he/she suggests some tests to rule out other things (thyroid, etc)--this is good medicine. The first course of treatment is usually an SSRI/SNRI/etc. Drugs specific to only anxiety (benzodiazepines) are not a first course of treatment unless the anxiety is clearly situational, incapacitating, needed for only a brief period of time or for very specific indications . I really hope this goes well for you--if you have any spcific questions please feel free to email me. BTW, medical intervention is not a "last resort" any more than taking insulin is a last resort to dieting and exercise if you are diabetic.
posted by rmhsinc at 4:17 PM on April 10, 2012

Be dead honest. You won't surprise the physician with anything you say, especially not on this topic and in this time.

Get another therapist, if you don't like what she's saying. It's as easy as just not going back. She works for you, not the other way around. Some therapists really are better than others, some have some particular kind of therapy they champion and want to prove with every patient, and sometimes that's not the right choice for a given patient.

To dismiss medication outright seems pretty ridiculous to me. We're all different, but I don't think I could have begun to approach any therapeutic goals without getting a little firm footing from some chemicals first.

I wish I had been told how important it is to begin to learn to monitor my mood, emotions, and anxiety. I know when I was younger I went on and off meds and people around me saw changes, but I saw nothing because I wasn't looking for anything. So I didn't get any real benefit.

Pay attention to your thoughts. The lifesblood of anxiety and depression are your thoughts. Anxiety makes you scrutinize EVERYTHING. If you start to listen a little to your thoughts, you will start to hear how much mental energy you flush down the toilet with cycling, inane thoughts that may or may not be accompanied by mild-to-extreme tension in your body. Have you ever caught yourself after having been down a thought rabbit hole for significant periods of time, about something you're not even very interested in or that stresses you out? What was your body doing at that time? Probably not relaxing. When you are depressed, nothing seems like a good idea, and your thoughts illustrate that viewpoint. Don't take any shit from yourself. When I do poorly playing chess on the internet I viciously insult myself, without thinking about it, as a matter of habit.

I won't go on more, but suffice it to say: The more you begin to be aware of how exactly your anxiety and depression manifest themselves, the more you will be in a position to know if your meds are working. If you just down the pills every day and forget about it you could literally be doing better and not even realizing it.

Finally, read the instruction manual on your disease. Aaron T. Beck's books on anxiety and depression were extremely helpful to me in understanding the nature of my adversary, and I'm sure there are any number of books of comparable relevance and value.
posted by TheRedArmy at 4:18 PM on April 10, 2012 [6 favorites]

And what do you wish someone had told you at this point in your life?

I wish someone had told me that the medication would not make me happy. It's not just that my medication didn't work, in part due to misdiagnosis, but the fact was that my life sucked and no pill was going to fix that. So I went into medication and therapy with overly-inflated hopes of being a happy, shiny, healthy person and that didn't happen. So, just, be realistic.

I also wish that someone had told me/taught me how to be my own advocate regarding my care. I had some pretty horrible experiences that I understand now could have been prevented had I not internalised the idea that my doctors/therapists knew best/better than me about what was going on in my mind. Pay attention to your feelings, physical and emotional, and report them to your doctor/therapist. Listen to what they say, but if something feels wrong, speak up.
posted by sm1tten at 4:20 PM on April 10, 2012 [6 favorites]

Most of the the advice above is good.

Some other notes:

Since you are talking about anxiety and depression, you will likely be offered an antidepressant. Some prescribers are apt to hand you whatever antidepressant they have samples of. These samples were provided by a pharmaceutical representative, and if you start taking those samples you will be getting a newer, likely far more expensive drug than your physician would be apt to suggest otherwise. This will be problematic if you opt out of paying for the drug with your insurance or if you should find yourself without insurance in a few months.

Before you go, familiarize yourself with the generic options. The newer, more expensive antidepressants are generally no better in terms of efficacy or side effect profiles. The current medical consensus is that prescribing antidepressants is generally a game of trial and error, though there are some recognized differences between the drugs.

Prozac (fluoxetine), Celexa (citalopram) and Paxil (paroxetine) are available for $4 a month at Walmart (and for nearly as cheap at other pharmacies, I'm sure), so you might want to take a special look at those. (Wellbutrin and Zoloft are also available as cheap generics.) Prozac is thought to be "activating," which means it can exacerbate anxiety. Celexa is a good option for starting on -- it has a good side effect profile and because it has a moderate half-life it is less difficult to get off of. The largest study to date of first-line treatment of depression used Celexa as the initial drug for these reasons. Paroxetine may be harder to come off of, but is indicated for social anxiety as well as depression. Another very cheap generic option indicated specifically for anxiety is Buspar (buspirione). Check out crazy meds and the wikipedia entries for the drugs to get a little background.

I don't mean to tell you to walk in asking for a specific drug -- but to make you aware of your options when you are having that conversation with your doctor. It helps to be an educated consumer.

Other things to touch upon during your appointment: Have a conversation with your physician about your potential loss of insurance. Also, ask about how to come off the medication should you need to.

Read up on your options. It may help you feel more in command of yourself when you go in for your appointment and help you have an informed, frank discussion with your doctor.

And, yes, you can feel better. I believe you will feel better. But you may not hit on the right drug the first time around. Dealing with mental illness takes grit. You have to demand good care sometime. As much as you can, build a relationship with your treater. If your anxiety and depression becomes severe or doesn't resolve, don't continue to receive care from a primary care physician. Intractable mental illness calls for a psychiatrist. Get the care you deserve.
posted by reren at 4:30 PM on April 10, 2012 [3 favorites]

Do not bother worrying about the insurance thing. Preexisting conditions are what matter for that - and it doesn't matter if you go through insurance or not; if you get new insurance they make you promise you didn't get medical advice on Y condition for X period of time, and lying on that question means they can deny future claims. Just get the help you need.

To start the conversation, bring in some printouts of filled-in anxiety and depression screening tools. There are LOTS AND LOTS to choose from. When I was brought into the partial program they had me take the Beck tests, which are copyrighted to high heaven, so MeMail me if you want suggestions beyond the two I linked, which have the primary virtue of being easy for me to remember where they're located.

I wish, back in the 1990s when it was starting to become obvious that Something Needed To Be Done, that someone would have told me that:
  • It does no good not to ask for help,
  • This stuff doesn't resolve itself on its own,
  • It takes real work to get better,
  • Just because things get worse for a while doesn't mean you're on the wrong path
  • You're probably going to have to try a couple of different things (maybe including multiple kinds of therapy and meds) before you find something that it works,
  • It is SO WORTH IT to get treatment even though yes, it is a massive pain in the neck sometimes,
  • This doesn't mean you're weak, stupid, worthless, etc., and actually being honest and taking care of it is a huge sign of bravery and self-discipline and maturity and taking responsibility for your own welfare,
  • You might not have what you think you have, or even what the first doctor you talk to thinks you have, and that doesn't make you incredibly weird or them incredibly incompetent (brains are hard,)
  • You should only start with your primary care physician (and get a referral to a psychiatrist - but be patient, because it could take weeks to get in to see them,) because they kind of suck at knowing the details and being able to really help you out,
  • Different kinds of medicine have RADICALLY different side effects and efficacy, so don't judge them all based on initial experience,
  • Learning more about your illness, writing out your experiences, coming to accept weird ideas like "don't believe everything that you think," and reading the "hard" books about what really works and doesn't work is actually empowering and helpful (at least for me, YMMV)
  • People are judgy jerks sometimes, but they are wrong, even if they're related to you and seem otherwise intelligent and wise,
  • Having a mental illness doesn't say anything in particular about you as a human being - lots of people get sick, and actually lots of people are deeply screwed up in many ways,
  • You can get reduced-price meds and there are sliding-scale clinics and just because you're poor or lack insurance does NOT mean you can't get help,
  • There are a lot of us out there - a LOT more than you think there are, I guarantee you - and we try to support one another as much as we can,
  • And NAMI, DBSA, and a whole host of other avenues of support and assistance and comfort exist and are very helpful.
Bring a complete medical and psychological history to that first meeting with your PCP, along with a list of all the drugs you've ever been on, weird reactions you've had, etc. Also bring a family history - I went back four generations and out three (including, thus, second cousins) because there is significant psychiatric history all over the place in my family - but you should at least have your parents, your grandparents, and your siblings, even just noting stuff like "had diabetes, but no mental illness that I can think of" or "had a problem drinking in college but gave it up when he flunked out of Calculus and has been sober forty years."

I'm on the way out the door, so the book will end somewhat sooner than it sometimes does (seriously, read some of my other questions/answers.) MeMail me if you want to talk, need resources, whatever. I may be crazy but I try to be helpful, too. :)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:38 PM on April 10, 2012 [7 favorites]

Oh, and this treatment page from NAMI can be really helpful. It talks about the antidepressants, but a lot of them are good for anxiety too. I have so many more links, but not enough time right now. :)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:39 PM on April 10, 2012

As long as you're not trying to get them to cover inpatient sort of stuff, I have never had an insurance provider give a hoot about my going to doctors to get more psychiatric medication on the grounds that it was a preexisting condition. Most of this stuff is pretty cheap and a *lot* of people are on it. I currently pay for everything I'm on out of pocket because it costs me less than insurance would. (I'm also on some other stuff that would be markedly more expensive, but I'm getting those patient assistance plan things for those at present for the most part.) I have gotten the impression from my PCP that she's a bit surprised I even bother seeing a psychiatrist, but because I'm on multiple things, I'm more comfortable having him manage my meds. Said psychiatrist is $60/visit and I only have to go every couple months. So, doing so sans insurance, not the end of the world.

I'm not really sure about graceful ways to find a new therapist. When I don't like one, I just stop going and try somewhere else. I've only really had one that I liked for very long, and she was a Master's student who graduated and moved. In a way, I feel like that's given me better results; rather than becoming one person's project, I try to just work with more immediate stuff. Less general talk, more using the person as a sounding board for constructive personal self-improvement projects. This works better when I'm on meds.
posted by gracedissolved at 4:41 PM on April 10, 2012

I am a longtime consumer of medication for depression (as well as for epilepsy and for ADHD), and I highly recommend the website crazymeds and its forums to get a) consumer-oriented information on neuropsychiatric meds (antidepressants, anti-anxiety drugs, etc.), and b) other people's stories about their experiences with depression, anxiety, panic attacks, etc., and with the meds, the side effects, the health care system, the docs, and the insurance industry.

(FYI: In my experience, the site doesn't push meds as the be-all and end-all. It deplores the Big Pharma-influenced prescribing of neuropsychiatric meds to people who just want to tweak their lives a little bit.)

Regarding your therapist's attitude toward medication – "My sense is that she sees medication as a last resort" – well, to dismiss psychiatric drugs as an option out of hand is to overlook the fact that depression/anxiety, etc., are pretty horrible experiences, too.

As crazymeds' Jerod Poore says:
1.  Keep it Simple

One of the core philosophies of Crazy Meds is a very simple calculus you’re faced with when it comes to side effects (and many other things in life):

Which sucks less?

Take all the symptoms of your condition(s) and all of the side effects you’re most afraid of, annoyed with, sick of, etc. Write them down, type them up, imagine them in your hands. Extrapolate into the future, keeping in mind that your condition(s) will keep getting worse if left untreated, while almost all of the side effects will go away, or diminish, or you’ll acclimate to them, or you’ll find a way to mitigate them. Then ask yourself, “Which situation sucks less?”
posted by virago at 6:02 PM on April 10, 2012 [2 favorites]

I wish someone had told me that the medication would not make me happy.

I think this is a really good point. Medication can help you build the physical and emotional energy you need to deal with the issues in your life, but it can't fix any of the other issues aside from the depression itself.

virago's recommendation of is super.

I have never had an insurance provider give a hoot about my going to doctors to get more psychiatric medication on the grounds that it was a preexisting condition

In California, where the OP lives, insurers can (and in my friends' experience, do) charge higher premiums to subscribers who have a record of being treated for depression. This is not the case in all US states, but it is the case there.
posted by Sidhedevil at 6:11 PM on April 10, 2012 [1 favorite]

Here's how I handled it; maybe not the optimal approach but it got the job done. Called the doctor's office (I didn't have a primary care doc then either, so I picked a clinic based on convenient location and asked for a doctor that was accepting new patients). When they asked for the purpose of my appointment, said "I'd like to speak to someone regarding depression." Showed up to the appointment. The doc knew I was there regarding depression, and started by giving me the PHQ-9. I tried to relax and answer honestly. The result indicated moderate depression. He asked if I was doing any therapy, and I said I was looking into it. He said medication would be a reasonable thing to try, and asked a few more questions, trying to determine which med would be best. He picked one that has been around for awhile and was available as an inexpensive generic. The whole thing was stressful for me, but normal routine for the clinic. There were a couple follow up appointments where we did the questionnaire again and increased my dose. No big deal.

It's been three years now and I'm so glad I made the leap. Medication hasn't made me a happy person, exactly, but I haven't spent a day laying in bed and crying in years. It's given me some breathing room to accomplish some things without feeling so crushed. Increased my confidence and ability to take care of what needs to be done, which was missing there for awhile. Like this comment describes.

Don't expect a miracle, but don't give up before trying either. You're worth the effort. Good luck!
posted by beandip at 6:30 PM on April 10, 2012 [1 favorite]

Here's how it worked for me:
Me, looking at shoes: "My friends say I should tell you I'm depressed."

General practitioner, probably reading off form/questionnaire: "Tell me about your housekeeping."

Me: "Oh my gosh it's a mess and I don't have energy to do anything and I don't want to be around people and I keep making excuses and I've been trying to pull myself up by my bootstraps but it's not working and it seems like all the color has gone out of the world and SOB!" (Once started, it was just such a relief to tell a doctor and know that help was on its way.)

General practitioner: "Hey now, it's gonna be ok! This runs in my family, and I've seen the medicine help lots of people. Let's try you out on this medicine, and then check back in, in 3 months, to see if it's working. You should start feeling better in a week or two. I've got some free samples to get you started, and I can write the prescription for a generic if that's ok with you?"

I didn't need a psychiatrist, just the general family doctor. I'd never seen that doctor before. I had insurance but didn't use it -- he gave me a cash discount for the visit so I think it was about $100, and the medicine itself was on the WalMart $4/30-day / $10/90-day prescription list, which is listed on this pdf.
posted by Houstonian at 6:39 PM on April 10, 2012 [1 favorite]

P.S. (Sorry for the double post.)

Crazy Meds has a lot of layers. Here are a few good places to start:

Everything You Need to Know About Psychiatric/Neurological Medications ("You don't want to end up crazier than you were to start with")

Crazy Meds’ Pages about Antidepressants

Crazy Meds' Pages About Anxiolytics/Anti-Anxiety Medications

There is also a Crazy Meds blog as well as a Facebook group. (And Jerod Poore is working to facilitate mobile access to the main section of the site -- meaning, the site without the forums.)

Finally, I have been taking neuropsychiatric drugs aka "crazymeds" for a while.

Some of the side effects do indeed, as Crazy Meds puts it, "suck donkey dong" (e.g.: Alcohol does not play well with my meds, so a big, rocking night for me is one during which I drink one [1] glass of white wine) .

Like sm1tten, Sidhedevil and beandip, I have not been transformed into Mary Sunshine by taking meds.

But my life has improved a hell of a lot since the days when I was so depressed that I was hiding under the covers every hour of the day except when I was at work. I wish the same for you, and you will be in my thoughts. Feel free to shoot me a memail.
posted by virago at 6:55 PM on April 10, 2012 [2 favorites]

"Hey Doctor, I've been struggling with what I think is anxiety and depression. I've tried therapy and it just isn't working well enough for me. This problem is having a significant effect on my life. I'd like to try some anti-depression medication."
posted by TooFewShoes at 8:32 PM on April 10, 2012

Response by poster: Alright, the first wave of answers seems to have died down, so I'm reading and commenting.

sidhedevil: my question is not so much how to make this not appear on my insurance records as whether I'd want to.

chazlarson: I was worried about having to convince my doctor of things, so thanks for telling me you didn't have to. (I've recently heard stories from friends of mine who have had trouble getting psychiatric medication, but now that I think about it that was Adderall. People don't do antidepressants for fun.)

insectosaurus Are you asking for advice on how to find a new therapist, or how to terminate the current relationship?

Both. To be honest I'm sometimes not sure that therapy is helping, but that may just be that I have the wrong therapist. Starting over in therapy scares me, though...

rhmsinc: BTW, medical intervention is not a "last resort" any more than taking insulin is a last resort to dieting and exercise if you are diabetic.

This is what so many people have told me, and I'm trying to work on reframing this. If I'm sick, I go to the doctor. I'm sick. So I should go to the doctor.

Fee Phi Faux Phumb: thanks for the tests. Although the anxiety one makes me anxious and the depression one makes me depressed...

gracedissolved: thanks for pointing out that the cost is relatively low. When I think about mental health care and being without insurance I think about how expensive weekly therapy would get, not how expensive seeing a psychiatrist every couple months would get.

virago, re: side effects: yeah, basically the side effects that worry me come down to lower tolerance for alcohol and lower sex drive. Drinking less is awesome -- I spend too much on booze as it is! And I'm okay with the sexual side effects as well. (I'm aware these aren't the only side effects but these are the ones that jump out at me.)

beandip: if I could handle this the optimal way I'd already be healed! This is why I have to handle in it the slightly non-optimal way of going to a general physician; I just don't have it in me right now to find a psychiatrist.

Houstonian: General practitioner, probably reading off form/questionnaire: "Tell me about your housekeeping."... oh my god. My girlfriend showed me an episode of Hoarders and she didn't tell me she was trying to tell me something but I knew.

Thanks for all your help! I'll keep monitoring this thread. (This is why I went sockpuppet, not anonymous.)
posted by omicron at 8:39 PM on April 10, 2012

Anxiety sucks. A lot.
I went to therapy for it but it kind of helped and kind of didn't. I went back and forth about it and overanalyzed and then had anxiety about the anxiety.
I was at an appointment to update my birth control pills and just sort of blurted out that I need help managing anxiety. The doc was super nice and didn't need convincing of anything. Living with anxiety sucks. She told me to watch funny movies and to give buspar a try. The generic is cheap and I can't describe how much better I feel. Seriously. The side effects have been minimal-no loss of sex drive just some dizziness immediately after taking the buspar.
posted by itwasyou at 1:23 AM on April 11, 2012

This is what so many people have told me, and I'm trying to work on reframing this.

If your car's radiator blew out and left you stranded on the side of a road in the middle of nowhere, and a man stopped and introduced himself as a mechanic with tools and water and coolant, you'd ask him for his help, right? You wouldn't be ashamed, or tell yourself that you should try harder to fix it with a paperclip and stick of gum, right? You've been working on that radiator without tools, and you can still learn all the ins-and-outs of the car's mechanics, but first let's get you back on the road. Once you point that mechanic to the general direction of your radiator, he knows what to do and he can help.

The medicine is life-saving. It doesn't make you happy, it makes you normal. You will have good days, and you will have bad days with the medicine -- it's just that not all days will be like they are for you now. Your mind, which is not getting the chemicals it needs, is telling you that maybe you don't need the medicine. Take the medicine for a month and then see. I suspect the reframing will happen naturally after that month, when you can see for yourself the difference it makes to have the proper chemicals at work.

People talk about depression more now than they used to, but still you have no idea how many people have gone to a doctor about depression and are now taking a pill to help them. People who are well-adjusted, happy, successful. Lots and lots and lots of people. It's just that we still see it as something you keep a secret, and that plus the chemical-starved mind is telling you that you shouldn't need the medicine. There's no shame in taking any medicine you need, and no shame in telling a doctor you need it.

That initial visit is hard, but you're doing the smart thing. You will feel better. Keep that doctor's appointment and just tell him, even if you have to write it down on an index card and hand it to him. All those people who take antidepressants have been before a doctor, and so the doctors have seen how uncomfortable it is for the patient to just tell them. They want to help you, and they can. You just have to let them know.
posted by Houstonian at 3:23 AM on April 11, 2012 [2 favorites]

as for the insurance issue, if your doc tries to prescribe you the newest coolest brand only drug, don't take it. the cost will be astronomical if you lose your insurance in a couple months. ask for a drug that has a generic, so you will be able to reasonably continue taking it if your insurance goes away. (for instance paxil and prozac and wellbutrin sr [NOT xr] are relatively cheap as generics now, though i am not saying you should ask for those specifically)
posted by misanthropicsarah at 9:05 AM on April 11, 2012

Make an appointment just to talk with your doctor for 15 minutes or even less. Before asking your physician for a prescription, you might look on line for quizzes/evaluation forms for depression and general anxiety disorder. You can print one or more, check off those that apply, and show them to the doc -- or just write down the relevant ones. The doctor will probably ask some questions, maybe ask about suicidal thoughts. All your anxiety and neuroses will naturally accompany you into the doctor's office, and you're not expected to be clear, to be confident, or to seem like you know what's you're doing.

You don't have to explain anything to the old therapist if that's daunting. You can just stop making new appointments. You don't have to pay for a session just to go in and say you're moving on, though you can do that if it seems better to you. You absolutely do not need to justify your reasons or try to persuade the therapist, and I'd advise you not to try. If you call and leave a message, you don't even need to take their return call.

You can ask your physician to recommend one or more therapists. If you have a preference between male and female, say so. If you call someone who can't add anyone new to their schedule, ask that person for another name -- then you can say, "I got your name from Busy McBooked-Up," which might feel less awkward. In my experience, when a therapist calls they have several minutes to ask you about yourself, and to say things about themselves. I found that these little chats help a lot, either to make me feel more comfortable or to notice if something about them turns me off.

For me, using an antidepressant has made it possible for me to benefit from therapy; before medication, I was too low and anxious to make any progress. The drug didn't make me feel happy, but rather as if a big weight had been taken away. I felt more like "myself." I traded up, such that I could tolerate enough anxiety to do some things I'd been unable to do before. And success leads to success, I've found. My anxiety doesn't go away... I just continue to increase the range of tolerablity.

Feel free to MeMail me. I really wish you well.
posted by wryly at 11:26 AM on April 11, 2012 [1 favorite]

Until recently, I didn't have a PCP either due to lack of health insurance. I had to go into my first appointment asking for antidepressants, so I know where you're coming from. I'd really recommend writing down on paper whatever you're having troubles with, and then handing that paper to the doctor. I had a few things going on (your problem was one of them), so that's what I did. I just said something along the lines of "I have really bad anxiety so I wrote it down" and gave it to her. It ended up working really well.

If there's anything else you feel needs noted in regards to your health, writing it down will give you an opportunity not to leave it out, or feel too intimidated and afraid to actively bring it up when you're there in person with your anxiety barreling down on you full force. I mean--you don't have to write everything, they will ask you questions on the new patient form and such. But with this method you can maybe put a line in about not having had a PCP for a while...I never had one in my adult life before, so noting it on my paper allowed me to make sure I talked with my doctor about it in my first session. There is some doctor-patient etiquette that is generally followed in certain situations that was completely unknown to me, so if she or he is aware that you're not familiar with it, that can also help you with ensuring your new relationship with them progresses favorably.

If you have any more questions, please feel free to memail me as well. On a closing note, for what it's worth, I wasn't expecting medicine to actually help with my anxiety or depression. But half a year later, it's actually done a LOT. Just keep in mind that it may take some fiddling--my doctor and I tried three different dosage levels before I was at one high enough to have a(n emotionally) tangible effect.
posted by Estraven at 11:01 PM on April 11, 2012

Response by poster: So I went to the doctor this morning. I freaked out and I talked really fast about all the things that were wrong with me and I ended up with a prescription for citalopram.

Then I went to the pharmacy and now I have a bottle of pills. And it just feels better knowing I have them. (I figure the best time to take them, in terms of keeping a routine, is the morning, so I'm starting tomorrow morning.)

Citalopram, by the way, is $4 at Target. My doctor actually had the Target list sitting on the desk. (We don't have Walmart here.)

Also, in talking this over with my therapist (I went to my regularly scheduled appointment yesterday) I realized that she wasn't as against them as I thought.
posted by omicron at 4:19 PM on April 12, 2012 [1 favorite]

omicron, you've taken the right steps, and I'm glad things are moving forward for you.

I assume your doctor has already told you this stuff, so sorry if it's repetitious:

* It can take at least six weeks for a medication to fully kick in. Signs that it's starting to work (this is my experience; your mileage may vary):
The low periods don't last as long and don't go as deep.
You have more energy.
You get more pleasure out of being around other people.
Little things don't bother you as much.
You wake up feeling more well rested.
You have more self-confidence.
In general, you experience relief from anhedonia ("the inability to experience any positive feeling whatsoever ... no pleasure, no satisfaction, no fulfillment, no sense of accomplishment, no sense of worth, no sense of meaningfulness").
Other people (friends, relatives, co-workers, your girlfriend) notice any of the above changes. (They may notice this stuff before you do ...)

* Tell the doc about any other drugs you take (prescription or over-the-counter, e.g. aspirin), as well as any dietary/nutritional supplements.

(Good Old Crazy Meds points out that many supplements can, at best, give you nothing but expensive urine. And Just Say No to ginkgo biloba and anything else on this list.)

* Make the most of your appointments with your doctor. I can't really say it better than the Mayo Clinic does:
* Write down any side effects (typical side effects for Celexa aka citalopram).
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, vitamins or supplements that you're taking.
* Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
* Write down questions to ask your health provider.
* Read LobsterMitten's excellent summary of AskMe depression advice. Apply as needed. Especially important is the last line: "If these aren't helping, try again, let someone know."

Keep on keeping on ... and know that lots of us are rooting for you.
posted by virago at 9:31 PM on April 12, 2012 [3 favorites]

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