What to do when to depressed and anxious to get therapy for depression and anxiety?
October 22, 2012 7:01 AM   Subscribe

What to do when too anxious and depressed to get therapy for one's anxiety and depression?

So the question above the fold pretty much covers it, but for more details:

About me – black, female, mid-30’s, currently employed w/ health insurance but expect to be laid off early next year, live in Chicago.

I have had severe social anxiety all of my life from very early childhood until today. I didn’t realize what was wrong with me until I was an adult and saw a Paxil commercial several years ago. Since then I have bought around a dozen self-help books about social anxiety, including Feeling Good (which made me realize I am also depressed), but I always get too anxious to do the exercises.

I want to get therapy but am too anxious or apathetic (it varies) to actually start the process of getting therapy.

I’ve seen There is Help. I know about Psychology Today. I have an EAP at work. And I found the Panic/Anxiety/Recovery Center in Chicago (via goggling but it seems legit). So, I know how to find a therapist, I just don’t want to go to one. Scratch that, I need to go to one, but every thing about the whole process makes me anxious and/or resistant and/or apathetic so that I end up not wanting to go to one.

Psychology Today will just give me list, just like my insurance website and I suspect my EAP will also just give me a list of people to call. And really, I just can’t call some random person I don’t know about something that's as emotionally fraught for me as this. Novel situations and social situations with people I have no pre-existing connection with trigger the hell out my anxiety. Plus there’s that whole thing about how you will have to keep going to different ones until you find one that clicks. The whole idea of that puts me on the express train to Anxietyviille captial of Anxietystan.

The thing is I have no coping skills. If I actually got my shit together enough to 1) call, 2) make an appointment, and 3) actually go, I know if I didn’t work out, I’d be all depressed and "eff all this". I was incorrect before, I do have one coping skill. It’s avoidance, which doesn't help at all.

Lastly, because of my anxiety I don’t have any friends and I haven’t been to a doctor in a very long time so I have no one to ask for help. I do have family but they are completely useless and we don’t talk anyway.

Anyway, I figure I can’t be the only person in this situation so if anyone has any advice on what I can do, I would be grateful.

Anon responses can go to allbymyself001@gmail.com
posted by anonymous to Health & Fitness (25 answers total) 14 users marked this as a favorite
I found my former therapist through Psychology Today (I live in Chicago and will e-mail you her info). The nice thing about the therapists listed there is that you can do a 10-minute phone call with them to talk about your issue. So once you can make that leap to make the call, you won't be stuck with someone you don't feel comfortable with. That said, it's not terribly likely that you will have to therapist-hop until you find someone that you like. My therapist was the first and only one that I went to, and I was with her for five years.

What exactly about seeking help makes you anxious? Is it the fact that you would be sharing your feelings with someone you do not know? Is it imagining working through your issues? Being without the anxiety and depression that are somehow a security blanket? Or are you unsure as to why your anxiety is triggered by the idea of getting help?

I'll e-mail you and I'm happy to chat that way, as well. I struggled with anxiety and depression for many years before seeking help. After five years of therapy and medication, I feel about a 1000% better.
posted by anotheraccount at 7:15 AM on October 22, 2012

I'm like this, too. I avoid and avoid and it gets worse and worse and then it's impossible.

One thing that helped is that my once and future therapist's website says something like "I know that making the call is the hardest part, and that after that we can work together to make things better." I think most good mental-health workers will understand that. Asking for help is hard, and you (and I) have a condition that actively makes it harder.

Honestly, the only way I've been able to do it is when my life is just no longer livable. I realize I need outside help and that calling is the only way I can do it. Can you bribe yourself with a special treat if you make the call?
posted by fiercecupcake at 7:19 AM on October 22, 2012

An MD can and will give you medicine for anxiety. I'd suggest turning this into a few smaller steps. This is what worked for me.

1. make an appointment for a doctor for a checkup since your health insurance might be wrapping up (in fact you can break this down: locate doctor, locate doctor's phone number, call to make an appointment, go to appointment)
2. explain to your doctor that you have anxiety that is affecting your ability to sleep, function normally, deal with your impending layoff and that you're paralyzed by the idea of locating and getting to a therapist (this is not a necessary part of the whole thing but the doctor may have advice or someone in the office that treats people)
3. explain what else you have tried (exercise, eating better, whatever else you think might help. If you haven't tried these, try them)
4. your doctor will most likely suggest some sort of prescription just to try and not give you very much of it. You will maybe be afraid to take it, that will be your next hurdle but one that will be somewhat easier to deal with.

I have been there and it is terrible. This path may be helpful for you and I wish you luck. It's weird how much, in retrospect, it feels like one giant hump I had to get over and not just one of a million awful little things I was going to have to manage for the rest of my life. It really can get better and I wish you well.
posted by jessamyn at 7:22 AM on October 22, 2012 [6 favorites]

Have you considered trying to strike up an email-based solution with a more tech-savvy therapist (i.e., those with the good websites)? They will eventually want to see you, I'm sure, but maybe they can ease you into regular, in-person sessions by way of email and phone calls? Maybe there could even be some Skyping?

It sounds like you're struggling with something that's pretty deep if self-help exercises are overwhelming you. I think it would help to start by seeing a general practitioner who can get you on some medication to help you arrive at a point to begin work in therapy. Is that possible? There's absolutely nothing wrong with doing this, no reason to feel ashamed or worried. People have to do this all the time.

Regarding medication, too, if you are laid off next year, many generic forms of antidepressants exist now, so I would bring this up to your GP at the start if you want to try medication to help you along initially, just so you don't have to switch forms down the road.

If you ever want to talk to a stranger (who is not a therapist), feel free to send me a message. My father struggled with depression (amongst other things), and though I can guarantee I don't always know what to say, I try to be a good listener.
posted by iamfantastikate at 7:24 AM on October 22, 2012

And really, I just can’t call some random person I don’t know about something that's as emotionally fraught for me as this. Novel situations and social situations with people I have no pre-existing connection with trigger the hell out my anxiety. Plus there’s that whole thing about how you will have to keep going to different ones until you find one that clicks. The whole idea of that puts me on the express train to Anxietyviille captial of Anxietystan.

Therapists are used to random people calling for help with anxiety and depression. Please know that your therapist will not be a stranger for long and you are not alone. Also, it is not necessarily true that you will have to shop around until you find a therapist you click with. I have had three different therapists. Two several years ago and one that I am seeing now. They all have their strengths and weaknesses and they all helped me. When you're "ready" for help and receptive, you will get the most benefit. I found my current therapist through Psychology Today. She had a few blog entries on her office's blog. I like what she wrote. I liked her credentials (don't put too much into credentials, though) and she works on a sliding scale.

Self-help is mostly ineffective in my personal opinion. It's a multi-billion dollar business and we keep buying it, hoping to have some cure or turnaround. I have bought and read my fair share. It can help to enlighten us but in my humble opinion it cannot heal us. There is no replacement for a live, qualified therapist.

Good luck.
posted by Fairchild at 7:34 AM on October 22, 2012

I've been there. I actually got kicked out of my university's mental health services program because I skipped so many appointments (due to anxiety!).

A big part of what worked for me was, yeah, just hitting rock bottom. But also, breaking it into little, manageable pieces. Doing a lot of correspondence through e-mail was a big part of that. Making tiny checklists was another. Telling someone about my appointments so I felt weirder about skipping them. Having someone drive me to my appointments for awhile, because I couldn't make myself do it.

And yeah, anxiety will probably affect your ability to try medication right away. I filled 3-6 prescriptions before I actually took one consistently. My very first prescription, I filled, threw away, and lied to my therapist and psychiatrist about taking it for two months.

Just letting you know that other people have been there, too-- but honestly, it gets so much better when you get in there, do it, and stick to a plan. Medication + therapy (+ healthy life choices) is the best way to do it. Good luck.
posted by stoneandstar at 7:36 AM on October 22, 2012 [1 favorite]

I was like you. What did it for me was seeing an article about how depression literally changes your brain structure if left untreated. That scared me into doing something, because god knew I did not want to be stuck with an even more depressed brain. Also, I would think about other depressed folk in my family who had never dealt with their depression and were miserable and miserable to be around, and I didn't want to end up that way.

I like jessamyn's suggestion. Even a small dose of antidepressant can turn the volume down on your anxiety/depression enough to allow you to make decisions without shutting down, and then you can have more choices.
posted by emjaybee at 7:38 AM on October 22, 2012 [2 favorites]

Meds. Yes, you still need to call a doctor and make an appointment and go, but maybe a bit less stressful because you don't need to do the soul-baring and the trying to find a good fit.

Medication, as I see it, is the float that you can hang on to and keep your head above water long enough for you to learn how to swim. Maybe you can teach yourself to swim, maybe you need a coach, maybe you'll always need the float to help, but without that float to get you started it's all panicky splashing and semi-drowning.
posted by corvine at 7:50 AM on October 22, 2012

Sometimes (and I do mean SOMETIMES, as we all know how filled with ennui things can be at the best of times) I tell myself, "Self, anxiety and depression are the very things that make you not want to seek help for your anxiety and depression. Even though you could find a million reasons not to do this thing, do it anyway. Do it BECAUSE you're scared."
posted by Madamina at 8:07 AM on October 22, 2012

I said screw it all for so long. It took my wife to make the calls for me and force me to go. Not the best way to do it, but that's what happened for me.

Small steps. Make one phone call if you can, and forgive yourself if you can't. I've been coming out of a extended depressive episode, and to get out, I've had to forgive myself for a ton.
posted by SNWidget at 8:19 AM on October 22, 2012

I'm unclear how calling a GP is easier than calling a therapist for the OP. They both require "Hello, are you taking new patients? I'd like to make an appointment to discuss my anxiety." Bother are really fucking tough when you're in that place.

Psychology Today will just give me list, just like my insurance website.

I would go through the list and email, rather than ring, to set an appointment with whomever gets back to you with the soonest appointment.
posted by DarlingBri at 8:20 AM on October 22, 2012

I'm unclear how calling a GP is easier than calling a therapist for the OP. They both require "Hello, are you taking new patients? I'd like to make an appointment to discuss my anxiety." Bother are really fucking tough when you're in that place.

My thinking was this

- Even if you haven't been to the doc in a long time you may already HAVE a doc someplace who has your files and you don't have to make a big deal about you being new, which is helpful.
- When you call you don't have to mention your anxiety at all, you just say "I want a checkup" which is likely covered by your medical insurance and an all around good idea for health anyhow. When at your checkup you can ask about anxiety issues.

For me it was literally a bunch of steps

- looking up a doc
- writing down the number and leaving it on my desk
- waiting until I was in a decent place to make the phone call
- working on not talking myself out of the appointment

etc. etc.
posted by jessamyn at 8:26 AM on October 22, 2012

What if you found a therapist whose website/Psychology Today profile allows you to email them? They may ultimately want to speak with you by phone before setting up an initial appointment, but you could at least type up something like: "I've been experiencing what I understand to be social anxiety as well as depression since early childhood. I need and want to get help for it, but my anxiety ramps up at the thought of calling a therapist who is a total stranger. Can you please email me some information about how you typically work with clients, and what I could expect from a first session with you?"
posted by Meg_Murry at 8:36 AM on October 22, 2012 [1 favorite]

I kept delaying getting help as I slowly got worse and worse until I found myself sobbing uncontrollably in a fast food restaurant in the middle of the day as people awkwardly stared at me.. It made getting better so. much. harder. because I let it go so long that I went from moderately depressed to suicidal.

My best advice is to enlist the help of somebody to help you get the ball rolling. I'd be happy to make the appointment for you. Perhaps a local mefite can help you get to the first couple of meetings, so all you have to do is show up.
posted by zug at 8:38 AM on October 22, 2012

The thing I found in getting on meds was that suddenly, all those "tools" I'd been reading about & hearing about? Suddenly I could pick them up & use them. The reason self-help wasn't working was not because I didn't know, didn't have, didn't understand, it was because I was an armless person trying to pick up a tool with no hands until I went on meds. Once I'd re-learned how to use my arms, I was able to use the tools & go off meds. Maybe that thought isn't much practical help, but keep it in mind as incentive.
posted by Ys at 10:07 AM on October 22, 2012 [1 favorite]

I'm here to nth getting a regular doc to get you some anti-anxiety meds for the crisis point you're in now. Many good analogies here, so here's a terrible one: you can see the lightbulb is burnt out, but you can't get to it; meds = ladder.

Also nthing breaking it down into bite-sized steps. This really works.

Three more books for you to try, in recommended reading order:
Feel the Fear and Do it Anyway
Get it Done When You're Depressed
Cognitive Behavioral Therapy Workbook for Anxiety (some folks respond better to Dialectical Behavior Therapy, which also has a workbook for anxiety)

SuperBetter, to give yourself tiny goals (feel free to get my email from my user profile to add me as an Ally...I'll be more active at the end of this week).

If it helps to have someone cheer you on, consider me on your side as you work through this and feel free to contact me via memail or email.
posted by batmonkey at 11:37 AM on October 22, 2012

You might find email therapy less daunting. MeMail me if you'd like to discuss this a bit more.
posted by paduasoy at 12:23 PM on October 22, 2012

I agree with jessamym! If even those steps feel overwhelming, just remember to breathe okay? Sometimes you just need to take the first step and it gets easier! If you follow these steps you will feel so much better in just a few weeks. Be brave, and go google a nearby doctor right now, no excuses, don't let your inner demons win!!!
posted by dinosaurprincess at 4:14 PM on October 22, 2012

So, I am about to provide a walk-through of how this process went for me, but first I want to point out something I learned about my thinking from the therapist I met eventually. So there's a task, and metaphorically, it's akin to a mountain. I tend to do what you're doing here, which is get the lay of the land, think "geez, that sure is a tall mountain, no way I could climb that", and go back to bed or whatever instead of dealing. Mountains aren't scaled in one giant leap, though. They're done one step at a time, and you can camp partway up, etc. So you need to focus on getting to base camp and ignore the peak for now. Base camp is this: just the first phone call, or email. You basically did it here so I know you can do it again!

I used my EAP. They're surely of variable quality but in my experience they helped a lot with most of the things you list as concerns here. I looked up the number/email, spent 6 months rehearsing the 2-minute call in my head and not calling, and then one day I finally got fed up and called. I had to dial (oh, the ringing is so hard!), say hello to the receptionist, briefly describe my problem and what I needed (referrals and some guidance), pick an appointment time, wait a little while to get in, and then show up to the first appointment.

After that, I wasn't alone anymore. I told my EAP counselor about all these same barriers you list here. Here's what she did for me:
1) We talked about my problems so that she could figure out what help I needed, but it also worked as some temporary counseling and kindness for the 3-4 weekly meetings it took to get me through.
2) I used her as a coach to check in to see if I had gotten things done between meetings, like call therapists or get up by x time each day.
3) She walked me down to the office of one of the professionals I needed (they were in the same building), talked to the receptionist with me, and sat while I filled out paperwork, because I told her if I was left to my own devices, I didn't think I would get it done even though I knew I really needed to.
4) She went over types of therapy and therapists with me, and helped me cull the list of providers on my insurance's website down to a short list with a little info about each person, just stuff like the therapy type and "I know him, he's very easygoing, nice guy" or "we send a lot of people to her and I hear good things." This made the calling a LOT easier.

I have gotten into counseling twice, and both times I just went with the first person I got because the calling around was overwhelming. I'm sure it doesn't always work out fine, but for me it worked out fine twice. Don't accept gross incompetence or creepiness or what have you, but you can always seek an optimal match after you've improved some with the first therapist, if you need.
posted by zizania at 4:22 PM on October 22, 2012 [1 favorite]

depression literally changes your brain structure if left untreated.

technically, since it would be unethical to induce depression on a random sample, no one really knows if depression causes changes in the brain or if changes in the brain cause depression.

regardless, try to make decisions you think your future-self will be glad you made.
posted by cupcake1337 at 10:43 PM on October 22, 2012

If your company's EAP works the way mine did when I used it, you only need to do two things:

1. Make the call to the EAP. They will ask you some questions, and they will set up your first therapist appointment.
2. Go to the appointment.

I have SO been where you are; where everything seems completely overwhelming. Hopefully knowing that you're just two steps away from talking to someone will help you take that first step. It is not hopeless, and you can do it!
posted by MsMolly at 10:12 AM on October 23, 2012

OP here. created this account to update.

First off, I wanted to thank everybody for their answers. Intellectually knowing that you can't be the only one as messed up as you are is one thing, but hearing other people talk about it and how they got better is completely different. Thank you.

Honestly, the only way I've been able to do it is when my life is just no longer livable.
This is just so me. I never do anything unless the anxiety from doing it is less than anxiety of not doing it. I am so tired of this and really want to stop this and take control of my life.

Some folks respond better to Dialectical Behavior Therapy, which also has a workbook for anxiety)
I totally have that. I read it and liked some of the ideas in it, but I put down and never picked it up again. I'm really not sure why.
I really liked the idea of the dialectic - being torn between two things. Sometimes the CBT workbooks rub me the wrong way, they seem blamey with the "it's only your thoughts causing the anxiety. So, it's totally and completely your fault. You suck." The last two sentences may be more in my head than in any actual book. Still wiling to try CBT, or ACT or whatever in real life though.

I made an appointment with a doctor for Nov 12th. I got the name of my mom's doctor and very fortunately the doc's hospital website lets you make appointments over the internet. (Fuck yeah internet!!!!!). FYI, when I said that I had not been to the doctor in a very long time, I meant that the last doctor I saw was a pediatrician. Right now I'm trying to write up something about my anxiety to take to the doctor with me because I get all quiet and passive when I'm anxious.

Zizania and miss molly thanks for your experiences with EAPs. I now have a bit confidence that mine might be helpful. I looked into my EAP plan and it is with Cigna. They have an eight hundred number you can call to talk to someone, and they have this other thing where you can put in a request to have someone call you but only between the hours of like 8 and 5 pm (which is weird because that's when most people are work) and i think they are two different groups of people? Whateve. Anyway, after I go to the doctor, I think I'll call the 800 number. I still fill anxious about calling them, but a couple of people emailed my recommendations for therapists (thank you very much) so if it doesn't work out I have other options. It no longer feels like my last resort like it felt before, so anxiety is lessened.

Thank you all again.
posted by this is totally not a sock puppet at 12:19 PM on October 26, 2012 [3 favorites]

Good job. Now j<ust keep that ball rolling.
posted by Ys at 9:34 PM on October 28, 2012

So, I went to the doctor and told her about my anxiety issues and she didn't want to give me any anti-anxiety meds because she didn't feel comfortable starting me on psycho (not sure of the technical term) meds.

She did give me a referral to a psychiatrist, but because of the way my insurance works she couldn't actually give me a name. *rolls eyes*. I have to call the insurance company to get one. I did convince her to give me a no refill prescription (of xanax) which seems to have helped but it's only been a day so....

Now I'm not sure if I should go see a psychiatrist for more meds, or go find a psychologist. *sigh*
posted by this is totally not a sock puppet at 5:09 PM on November 13, 2012

Move 'em move 'em move 'em, keep those doggies movin'
Beaurocracy stinks. It stinks even more when it's unexpected. It stinks to high heavens when you were in a strength-sapping state of mind & thought it was supposed to be simple.

Do go to the psychiatrist. Let them have their little hoop game. If the net result is that you feel better, it will be worth it.*

*NOTE: As you have probably noticed in other posts about meds and depression, it can take some fiddling with amounts & types to get a med that works as advertised. You may get lucky (I did) & hit gold the first time out, but give it time. It is WORTH it if you can find some combination of meds & therapy that get you to a better state of you.
posted by Ys at 5:37 AM on November 14, 2012

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