Seeing a psychiatrist for anxiety. How does that work?

November 16, 2012 9:02 AM

Seeing a psychiatrist for anxiety and depression - How does that work? I went to a doctor about my anxiety issues and she gave me a referral to a psychiatrist to get some anti-anxiety meds as she did not feel comfortable prescribing them. (She didn't give me a name, I have to call my insurance to get a list or something I guess. Also, she gave me a no refill xanax prescription after I begged.) I am somewhat bewildered by this as I didn't expect to have to go to a psychiatrist so I have some questions.

I posted this a couple of weeks ago. This question started out as an comment in that thread, but I realized that I had some questions.

I understand that some psychiatrists treat patients with therapy but most just prescribe medicine.

How do you find out what type of psychiatrist (counseling vs medicine) they are? What if I end with one who actual counsels patients? Should I not go to them because I only need one who prescribes meds? Should I just go to one who prescribes and get a psychologist for actual counseling for anxiety? Is that the best way?

Do you just go to an appointment, talk to them, and they prescribe you something?

Should I tell the psychiatrist I am only looking for meds when I call? I don't want to look like a drug seeker. Medical shows have taught me that is a "thing".

Thanks. Anon email: [e-mail]. If it matters I'm in Chicago.

posted by anonymous to Health & Fitness (11 answers total)

You want to go to a psychiatrist to get psychiatric medicine. GPs are not trained to dispense it and monitor what it does to you. I mean, they go to medical school, obviously, but there's a reason they're, well, not psychiatrists.

A psychiatrist will prescribe you medication. It might not be at the first session, but a psychiatrist's job is to prescribe you medication. They are not a therapist. They might do some therapy, but that is not their primary function (unless you go to one who is both.) Their primary function, as an M.D., is to ascertain your state of mind and figure out what medication would be best and to monitor you and adjust your dosage. This is why it is highly recommended you have both a therapist and a psychiatrist. The psychiatrist knows you are looking for medication, you do not have to tell them. It is up to them, however, to figure out if medication is appropriate for you.
posted by griphus at 9:06 AM on November 16, 2012 [8 favorites]

Also, as someone who has both been through the ringer of all this stuff and has watched a bunch of medical dramas, don't assume medical dramas are any more relevant to what is happening to you any more than, say, CSI accurately reflects forensics.
posted by griphus at 9:08 AM on November 16, 2012 [1 favorite]

99% of psychiatrists just prescribe meds after diagnosing. That's what they do.

psychologists will want to talk to you about things, suggest therapeutic approaches and maybe also meds.

If you're looking for clue on how a psychiatrists will operate: Ask How long is the first appointment and generally how long are follow up appointments. If the breakdown is something like 1 hour, then 15-30 minutes once a month. Yeah they are just gonna give you meds.
posted by French Fry at 9:27 AM on November 16, 2012 [4 favorites]

When you get the name of a a psychiatrist from your insurance, you are pretty unlikely to be given the name of someone who offers psychotherapy. You're welcome, however, to say to them when you call that you are interested in a medication evaluation for depression and anxiety. If you couch what you want as an evaluation, you are much less likely to be seen as a possible seeker of the types of medications that psychiatrists prescribe that get people high. (Anti-anxiety medications are among those.) Basically, going to a psychiatrist is the same as going to any other doctor. You go to them for their expertise in diagnosis and treatment. They've done it hundreds of times, probably thousands.
posted by OmieWise at 9:28 AM on November 16, 2012 [1 favorite]

Please get that list from your insurance company today. If you can't make the calls, find someone who can help you do it. This has to be your first priority. MeMail me if you want some strategies and wacky ideas on how to find someone to help you.

As griphus indicates, your doctor is doing you a huge favor here. You do not want your regular physician giving you your psych meds. And you will basically just be getting meds from a psychiatrist because quite frankly, they are massively, massively understaffed and no one really does drugs and therapy anymore (going to school for 13 years means too much debt to be able to take the reimbursements for talk therapy, and insurance companies normally want the meds-coded appointments to last 10 to 20 minutes.)

In my area, it can take six to ten weeks to get into a psychiatric practice.

Also, try getting into a therapy practice (probably with an MSW) right away too. They can see you MUCH sooner and can probably give you advice as to WHOM on that list from your insurance company is a) good, b) actually taking new clients, c) and so on. You may be able to get some referrals from your regular doctor, but no one can say whether they'll be good referrals. My current doctor would be brilliant at that; my mother's doctor frankly says and does stuff he has no business saying or doing. Total crapshoot, basically.

And please hook up with NAMI. They have at least two big affiliates in Chicago - Greater Chicago and South Suburbs.

If you call them at (800) 950-NAMI (6264), or [phone], they will be able to provide you with immediate answers to all your questions and maybe give you leads on where to get started. You can also just show up to an office during regular hours.

Realistically,

1. You will have to call several different psychiatrists to find one who still takes your insurance, is actually taking patients, etc. This can be very very hard. I strongly, strongly, STRONGLY urge you to have a friend help you.
2. You just need to tell them "I have been experiencing anxiety and depression, and my regular doctor said to find a psychiatrist." Don't mention drugs, everyone knows you're calling a psychiatrist's office and that's almost always for medication management.
3. You may end up seeing a psychiatric nurse practitioner or similar. Don't freak out, for anxiety and depression they're usually really good (better at this stuff than normal doctors are at dealing with it.)
4. You may want to look at your options just over the state border if Illinois is a pain about PNPs prescribing. In my experience it is ALWAYS easier to get started with a psychiatric practice if the state allows PNPs to prescribe, etc.
5. If you have problems with your current psychiatrist, find a new one first and get set up with an appointment and be SURE that new stuff is all straightened out BEFORE you cancel your current appointment.
6. You will probably freak out at some point and worry that THIS IS NOT WORKING. Try not to run with that worry. It doesn't help and it's usually untrue. Be patient, ask people (reliable people) for advice, etc.

I suppose it happens, but I've never met someone who used depression as a way to get meds. I sort of suspect that it's just too hard to pretend to be depressed - crying for an entire hour is exhausting. Having said that, be prepared to say good-bye to the Xanax for a while. They will probably switch you to something less likely to cause dependence - my money's on Zoloft, but some doctors surprise you, so.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 9:33 AM on November 16, 2012 [6 favorites]

The key points have already been well outlined above, but I'd like to add that if a psychiatrist is hesitant about prescribing you benzodiazepines such as Xanax, try not to take it personally. (I have a problem with this myself, psychiatrists make me extremely nervous and defensive.) Drug-seeking aside, there are other perfectly valid medical reasons such as their reputation for aggravating or even causing depression.
posted by Lorin at 10:35 AM on November 16, 2012

Should I not go to them because I only need one who prescribes meds?

Given the levels of extreme anxiety and depression you describe in your questions, you may want to consider both meds and therapy.
posted by crankylex at 11:17 AM on November 16, 2012 [2 favorites]

Keep in mind that if you find one that has a larger practice, your very first appointment may be a 45 minute intake appointment with a counselor. Don't let that discourage you...it's common practice. The counselor (can be an LPC or LSCW) does the history and symptoms portion and then passes that on to the psychiatrist. You appointment with the psychiatrist might be a day or two later than the intake appointment depending on the schedules of everyone involved. But once you do the intake part, your med check appointments with the psychiatrist will be about 15 min each. You can also consider doing talk therapy with the counselor if the practice offers it...I've seen practices where you have a 45 min talk session with a therapist then see the psychiatrist immediately after. Best thing to do when you call is tell them your GP has referred you for an evaluation. Then ask them how the appointment works...they will tell you.
posted by MultiFaceted at 1:01 PM on November 16, 2012 [1 favorite]

I can only speak for my experience, but I would imagine it is similar. I had similar problems, and definitely had similar anxieties about going to a psychiatrist!! I'm not a crazy person!

But I learned the same things as the people above were saying. Think of a psychiatrist as a GP for mental health issues.

When my GP recommended going to a specialist, I asked her to recommend some in the area. She gave me a list of a couple. I looked them up, and picked the one that seemed right for me. (My criteria were: nearby, with a website, with multiple doctors*.) I called them up and told the person "my doctor recommended I talk to a psychiatrist, is anyone there accepting new patients?" The lady said yes, and which doctor I wanted. I said "I'm having trouble with X, Y and Z, I'll go with whatever doctor is good with that." Made an appointment.

When I arrived, the doctor introduced himself, led me to his office, and had me sit down. He then asked "what can I help you with?" I thought that was great- just a perfect intro into letting me tell my story. I tell him what my problems are, he asks questions, and offers solutions.

My return visits are 30 minutes, and the conversation wanders all over the place. If I am doing good, we talk about all kinds of things. If I'm not, we address the changes and maybe he asks some pointed questions for me to think about.

Long story short: if my experience is any indication, the hardest part is picking up the phone and starting the process. Maybe you have to try a doctor or two before you meet one that works for you. But they are there to help


(*) I generally like practices with multiple doctors, because that means if I want or need to switch doctors, I don't have to go to a whole new place and set up billing all over again and all that. It's also a vetting process- if my doctor was hired by other doctors, I can assume they aren't complete quacks. Sole practicioners are a bigger crapshoot. IMHO only.
posted by gjc at 2:37 PM on November 16, 2012 [1 favorite]

It's quite common to find practices that are a group of affiliated therapists with a variety of backgrounds (psychiatry, psychology, LCSW, etc.), where you can often see a psychologist or LCSW or whatever for regular therapy, and see a psychiatrist in the same practice for meds and med check-ups. It's convenient and allows for "one-stop shopping" at one practice, where your talk-therapy person and your meds person work together and can talk about your case together easily, and you can move among different treatment modalities (talk therapy, meds and talk, just meds) fairly easily as you work out what works for you.

Get the list from your insurance -- I'm sure your insurer has a list online and you can input "Chicago" and "psychology" and it'll pop out a list. You can probably see if several providers work at the same group, or at least if they're at the same address (if your insurer's website doesn't output group names, some don't). If calling is too overwhelming, get a friend to make calls for you.

The other thing about a practice group is it's often easier to get in quicker, since they'll schedule you for first available. That person will often help you find the "right fit" within the practice, once the initial crisis is getting under control.
posted by Eyebrows McGee at 6:21 PM on November 16, 2012 [1 favorite]

You sound like an assertive person, so perhaps this will not be a problem for you, but I want to tell you about my experience with a psychiatrist.

I believed the oft-repeated thing I read on AskMefi about psychiatrists being too busy to do therapy, being mostly concerned with medication, etc.

I got referred to a psychiatrist for post-partum depression by my OB. This psychiatrist totally wanted to do therapy. I was a mess and couldn't figure out what I needed, and saw him for eight sessions (at more than $200 each) before I got myself together enough to realize that I was not getting what I wanted out of the doctor-patient relationship. I expected him to evaluate me for meds and refer me to a therapist. Instead, we had these weird, expensive, chats that did not in any way help me develop coping skills for what I was going through. I was too worried about seeming drug-seeking to explicitly say, "So, doc, should we look into pills or what?"

So, my advice is: Ask for what you need and make sure you're clear about expectations.

(I realize that psychiatrists suggested by your insurance will be less likely to do this sort of thing, but it was totally contrary to my expectations, so I thought I'd throw it out there as a cautionary tale.)
posted by socks on both your houses at 6:50 PM on November 16, 2012