Am I doing this right?
May 10, 2014 2:56 PM   Subscribe

Was prescribed Lexapro by a nurse practitioner but am too anxious to take it. Seeing a CBT specialist on Monday for $$$. So now I'm anxious about the money. Spiral of doom inside!

I've been dealing (read: not dealing) with anxiety disorder for a long time, and reluctant to do anything about it due to finances, being shamed by an abusive parent, a stint with poorly managed SSRIs that left me feeling permanently sexually disabled, and just general logistical confusion (how does one go to weekly therapy appointments while holding down a full-time job? how does one justify the financial/time outlay when unemployed?) Then the bottom dropped out of my life when a longtime SO broke up with me abruptly, though I had been picking up on the signs on some level (and writing them off as anxiety!) We lived together and though temporarily housed, I'm now dealing with trying to find a new place in the super-competitive Bay Area, and moving the rest of my stuff. I don't feel merely stressed, I feel like someone fucking died, that I'm going to die, etc. I've been sitting on a Lexapro prescription for two weeks but the list of possible side effects has me terrified and I canceled the follow-up appointment intended to see how I was doing on the medication. I'm relying on valerian, kava, and similar bullshit to get through the day, and conveniently kava is contraindicated for use with Lexapro.

So I've scheduled an initial consultation with a CBT therapist who isn't covered by insurance, mostly because it was easy to get an appointment and he has evening availability. I have an FSA card that can cover 10-15 sessions of this, though the money was earmarked for another essential medical problem that I've been putting off forever. I'm hoping the therapist can reassure me enough to start the medication. Or something.

So, am I doing this all wrong? I have two kinds of health insurance, should I be finding someone covered by them? (One insurance is covered by previously mentioned abusive parent and I was afraid they'd get some sort of notification about this, though I've since changed to electronic notices.) Sliding scale therapy (in spite of the two kinds of insurance, I am probably low-income)? Find a talk therapist instead? Find a psychiatrist? Stop worrying and learn to love the pills? Chuck it all and work through a CBT workbook? How do I navigate this?

Final note: I had a physical and blood tests recently, everything is apparently normal.
posted by ziggly to Health & Fitness (7 answers total) 4 users marked this as a favorite
Go to the CBT therapist on Monday. Ask all of these questions. Ask the therapist to help you figure out what to do next. Seeing that therapist on Monday doesn't necessarily mean that you're committing to a long-term course of therapy with that person. But it seems as though you've been reluctant to take any first step for fear that it's the wrong first step. Any first step toward treatment is better than doing nothing. So take this first step, and ask this therapist to help you figure out what will be a good second step.
posted by decathecting at 3:04 PM on May 10, 2014 [6 favorites]

Agreed with decathecting: go see the CBT therapist, and ask about sliding scale payments. Any decent therapist will be flexible on that front. Explain the financial situation and I'm willing to bet the therapist will be able to at least give you a start on a treatment plan.

And consider that while the possible side effects of the Lexapro have you terrified, you're already terrified without it. At least if you take it things have the potential to get better.
posted by asterix at 3:10 PM on May 10, 2014

SSRIs take time to kick in. Lexapro might be a great thing for you, it might not, but it's not going to kick in fast enough for you to feel amazing in the next week or two, anyway. CBT will help present some more immediate coping mechanisms, which are really important at times when your life feels like it's crashing. Oxygen mask first, that sort of thing. Ideally, if you couldn't get a benzo--I hate how doctors withhold them from people in crisis but it's a thing that happens--you could conceivably ask about a tricyclic, which are sedating but not addicting.

That said, the therapist cannot really reassure you. What CBT is more about is teaching you how to reassure yourself properly. You already have all the information at your fingertips about the pros and cons of the medication. I suspect you already know that, rationally, being able to function is probably important enough to be worth trying it, and that the vast majority of side effects will go away if you stop, if not immediately then shortly thereafter. Knowing that rationally is not the same as accepting it and being able to act as though that is the truth, because you're fighting against the "but what if" that the anxiety part of your brain is producing.

You are not doing this all wrong. You're probably not doing this perfectly but nobody ever does anything really perfectly. You're going to be okay.

In the meantime, go drop the $5 or whatever on a Kindle copy of Feeling Good, because that will help you get more out of the CBT and at least start on reforming how you're thinking starting ASAP. That'll help you get through long enough to get to the therapist, the therapist will help you keep going long enough to get medication figured out, and the medication will help you get your life back on track. You're going to be okay!
posted by Sequence at 3:23 PM on May 10, 2014 [1 favorite]

Look, it's okay to take the Lexapro, it will most likely help. If you do experience any side effects, they will either go away after a few weeks or you will stop taking it, leaving you no worse than you are now. I've took many years ago for a short period and it does help. I cannot take much of anything, btw. Tylenol makes me ill. Continue looking for therapy, it will help.

I do have some great news for you. Right now, your life is just plain awful. Everything that could go wrong, has gone wrong. You no longer have to be afraid of anything anymore because you are surviving the worse. You are stronger than you thought you were. You are now free to make the big changes that everyone is afraid of. You can now live the remarkable life that you have been waiting for because, at this point, you know that you can try anything because you are strong enough to handle anything. Embrace that.
posted by myselfasme at 4:55 PM on May 10, 2014 [2 favorites]

Go back to the nurse practitioner (or even better, see a psychiatrist) and talk about your concerns. Some of your fears may be unfounded, others may be about things that are easily remedied, some may persist but just not feel like that big a deal once the accompanying anxiety is gone. You are entitled to ask as many questions as you need to feel comfortable about actually taking the med you have been offered. I know that spending money on your mental health can seem overwhelming, but it's one of the best investments you can make. Seriously, even if you have to spend a few hundred dollars to see a psychiatrist and/or therapist, imagine the potential payoff - you get on the right med for you, find yourself suddenly able to function without crippling anxiety, use your newfound vitality to start chipping away at the practical things that need solving in your life, and end up getting a great job because you finally have both the confidence and the mental energy to put together a great application and interview well. And suddenly you're earning more than you were before - or at least more than you would have if you had ended up long-term unemployed. Financially speaking, paying for mental health care is a surer bet than anything the stock market can offer - you are literally investing in the thing that you use to pursue every important goal in your life - your mind. And that's leaving aside the most important reason for getting help, which is that you are a goddamn human being and you deserve to have your suffering reduced so that you can live a life that's meaningful to you.

Also, please tell both your treatment provider(s) and your pharmacist about every complimentary medicine you are taking or have taken recently - some of them may require a washout period befor you start lexapro. I don't mean to give you something else to be anxious about, but some herbal medicines can cause really severe interactions with meds even many days after you have stopped taking them, so it's important they you are upfront about everything you use, including tinctures or teas. A good psychiatrist may even be able to use details about how you self-medicate with herbal products to inform her decision about what pharmaceuticals might work best for you.

Hang in there! You're doing a whole heap of things RIGHT :)
posted by embrangled at 5:37 PM on May 10, 2014 [1 favorite]

Yeah, you're doing everything right. You're going to be okay.

I think you've got two things going on:
1. you have a chronic anxiety disorder, and you're having an acute episode, which is
2. distorting your cognition and making it very hard for you to solve problems, including the immediate one of how to initiate treatment for your anxiety disorder.

Hang in there, a good CBT can help talk you down out of the acute episode, and help you use any handy immediate problem as an example of how to self-manage problem-solving during an acute episode and more generally how to self-manage so that regular everyday stuff doesn't turn into an acute episode.

And for right now: it really, really doesn't matter if you start Lexapro today, tomorrow, or the next day, because, as everyone has said, it takes a couple of weeks to have a therapeutic effect. I know that seems like bad news, because it's not going to help right away, but the CBT really will, and you're not actually any worse off than you were before you went to get help. It might seem that way, because oh no another problem! but it's not - you are just in a distorted frame of mind where everything is kind of scary. Like, happy kittens chasing butterflies in a field of rainbows might seem like a crisis to someone in an acute anxiety episode. You are awesome because you are going through a lot of shit and you still found the resources you needed to get help, and you're going to be fine.

Good luck, and please check back in with us when/if you feel like you can. (**No pressure**!)
posted by gingerest at 9:20 PM on May 10, 2014 [1 favorite]

I want to respond to the concern that your parent might get notification about your using their insurance. If you're concerned, call the company and ask if there's any way at all the parent might find out.

I manage my company's benefits program. Our employee's have two types of insurance:
-Employee Assistant Program (EAP) - includes 5-7 counselling sessions, free of charge. You call an intake number and they set up an in-person counselling appointment and then you coordinate directly with the counselor.
-Reimbursement - usually a pocket of money which is reimbursed to the account holder upon submissions of receipts.

I can't speak to how the reimbursement would work in terms of confidentiality - consider calling the insurer to ask if you utilize this service, is there any way your parent could find out?

As for EAP, there is no way the parents or company will know who uses this service. Please feel free to call to confirm. As an employer, the most information I have access to is the number of people who used the service in the past year; there's absolutely no way I can figure out who used it. Personally, I used my parent's EAP insurance as a teenager for multiple counselling stints and was assured it would be entirely confidential.

A final note - while insisting to a friend of mine "I can't do this", she replied "you are doing it". It's not what you asked, but has been some source of comfort to me since.
posted by offrecord at 8:49 AM on May 12, 2014

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