Should I start with a therapist or a psychiatrist for my anxiety?
September 15, 2014 6:06 PM   Subscribe

I've had anxiety issues for years that are variable, but getting worse, and I'm having trouble coping. Should I make an appointment with a psychiatrist and try meds first, or start with therapy and add meds if necessary?

For years I've struggled with anxiety, which lately has focused on trends in the world that I have no control over. This has also led to some OCD symptoms when it comes to things like reading the news (since I don't want to encounter something that's a trigger, but I can't ignore everything either). I can hide it pretty well, but there's no question it substantially affects my daily life. And when it's bad it also affects my productivity at work, since I'm not relaxed enough to concentrate. When there's some extra stressor added to that baseline (like my recent move) it can get so bad I get shakes or brief sobbing fits trying to let it out. There may be depression in there too, but I'm not sure how big a factor that is.

Severity varies but the long term trend is getting worse, and I'm worried about my ability to cope and to keep my job. I went to a psychologist a few years ago and got diagnosed with general anxiety disorder, but after a couple months stopped therapy because it didn't seem helpful. I'm open to trying with another therapist, but at this stage I'm hoping for something that can temper the symptoms in a matter of weeks rather than months.

Is it normal and acceptable to go directly to a psychiatrist first, and then later start therapy? I won't have a primary care physician until November, so I can't get a referral (though my insurance doesn't require one). Am I right in thinking that medication could have some stabilizing effect in the short-to-medium term? I know that's the idea with depression, but I know less about anxiety. Is there a risk/stigma of being seen as drug seeking? I guess the other option is to see a therapist and they can refer me for medication if necessary. But I'm worried that finding the right therapist could take some time, and that something like CBT, if effective at all, will be more stressful than I can deal with in my current state.
posted by anonymous to Health & Fitness (15 answers total) 9 users marked this as a favorite
Sometimes when I am stuck in anxiety, the anxiety makes decisions extra hard. Either going to a therapist or a psychiatrist to get started is a good choice. There is no right answer--the most important thing, based on your symptoms and how they are affecting you, is to start getting treatment.

Another option may be your general physician. Many family physicians will prescribe medication for depression and/or anxiety. I think starting with a doctor to get blood tests for some culprits that can cause or contribute to anxiety, such as thyroid issues or vitamin deficiencies, can be a great place to start if you want to go the medication route first. You can even print out this question and bring it to a doctor.

If you feel more comfortable seeing a psychiatrist to prescribe medication, you can also print this out for them as well, and/or for a therapist, too. I think the most important thing is to get started with treatment soon, no matter which route you take.

I do want to add, if you do attend therapy again, you are now armed with information about what you didn't like about your first therapist, and why their method didn't work for you. A good therapist will be able to be flexible and have many different ways to work with you. You can explain what worked and didn't work from your previous therapist, which can be helpful in guiding therapy to be more effective more quickly.

I'm sorry that you are struggling. Speaking as someone who has had treatment for anxiety and depression, my only regret is that I didn't seek treatment sooner.
posted by shortyJBot at 6:20 PM on September 15, 2014 [1 favorite]

In my case, with the same diagnosis, medication made such a dramatic difference in my quality of life that I was upset with myself for putting it off for so long. I didn't truly appreciate how much effort hiding it took until I had nothing to hide. You should see both, because medication can buy you enough mental breathing room for the CBT techniques to flourish, but you definitely shouldn't be ashamed or worried about going for medications first if you need immediate help. It's a bitter irony that it is so anxiety-inducing to seek treatment for anxiety in the first place, but you should know that a sincere desire to feel better isn't going to raise any red flags.
posted by feloniousmonk at 6:21 PM on September 15, 2014 [5 favorites]

Am I right in thinking that medication could have some stabilizing effect in the short-to-medium term?

Yes, that was my experience.

I've actually had luck in the past just going to my PCP and saying "Hey my anxiety is ramping up a little and I can't sleep" and getting a short term (literally like 15 pills) prescription for lorazepam that would basically bring me back down to normal-ish so that I could function and do the rest of what I needed to do including make appointments with doctors, get out the door to do whatever I needed to do etc. Like feloniousmonk, after I got it taken care of, I was annoyed that I had taken this long because the change was very quick and very helpful for me. I literally sat there anxious and not sleeping worried about my anti-anxiety medication for a few days before I decided to take them. And I was worried about being seen as a drug seeker, but that was a non-issue in my case.

All of this is just to say that I am sorry you are feeling bad. Some of that can probably be dealt with sooner and then that will often help give you the tools that you need to take care of the stuff that may take longer to work out. So in your situation if you don't have a PCP, then I'd suggest making an appointment with a psychiatrist and then figuring out next steps when you have the immediate-dread problems a little more under control.
posted by jessamyn at 6:30 PM on September 15, 2014 [3 favorites]

I started with therapy and got a recommendation from the therapist for a psychiatrist she trusted and worked closely with.
posted by cecic at 7:00 PM on September 15, 2014 [2 favorites]

In my particular experience, I was dealing with both depression and anxiety (though at a lower severity, it sounds like) and eventually broached the subject with my GP, who prescribed Lexapro and it made a huge difference after a couple of weeks. I'd tried multiple times to seek help via the therapy route, and just couldn't manage to make myself do it. So for me, the GP route was far better than the nothing I was accomplishing with the therapy route.
posted by stormyteal at 7:11 PM on September 15, 2014 [2 favorites]

My anxiety really got in my way when it came to finding help -- my worrying and fear delayed my calling anyone for quite some time. So I'd say you should do whichever feels more manageable or less scary. You definitely can see a GP for your first medication, and another if the first doesn't work. The first choices are usually SSRI, which all have different effects on different people; there's no way you or a doctor can predict what will work for you. (Sorry, it really is kind of a crapshoot.) A psychiatrist is going to start out the same way.

Another aspect of my experience: Before I took medication, therapy helped me feel less alone and helpless -- but beyond that, I didn't get a lot of benefit. Once I had a drug that lessened the depression/anxiety, therapy really allowed me to move forward. You probably already know that medication isn't going to "fix you"; instead, it relieves some of the mental and emotional pain so you can make changes.

I really wish you well.
posted by wryly at 7:48 PM on September 15, 2014 [2 favorites]

As a person on medication and who goes to therapy for anxiety, I feel very strongly that medication be a last effort if physical manifestations of controlling it fail. If you can't manage to wrap your head around making efforts to alter your lifestyle or perception of reality - which is often necessary for people with anxiety, then medication might be right. But I want to warn, anxiety medications aren't like other medications. an antidepresssant might physically alter your brain chemistry to prevent the degradation of serotonin but something like a benzo only masks SYMPTOMS for the duration of the drug. I am prescribed klonopin and can easily put away 3-4 rockstar energy drinks and feel no jitters (not that I would) - the point is, all those chemicals and caffeine are still active, still in your body, but you are numb to the sensation of anxiety - which in this case would be a good thing - telling you to lay off the caffeine. Its a mixed bag. If you really need some medication I can highly recommend klonopin (clonazepam) because is long acting, you get a big effect from a single dose and its non-addictive, hovever be aware that sometimes a litttle anxiety is good - take the caffeine example, you don't want to totally numb yourself out to things that could really hurt you. Be well and I hope things get better!
posted by tahu363 at 8:00 PM on September 15, 2014

Like feloniousmonk, after I got it taken care of, I was annoyed that I had taken this long because the change was very quick and very helpful for me. I literally sat there anxious and not sleeping worried about my anti-anxiety medication for a few days before I decided to take them. And I was worried about being seen as a drug seeker, but that was a non-issue in my case.

All of this. I am finally taking medication for my anxiety and I am shaking my head at myself for taking so long to do it. Even waited on the pills for three or four days before starting it, too.

I have been in therapy for two years and the medication for a week. Both are good, I don't think the order matters. Do whatever you think is best for you.

Take care.
posted by sockermom at 8:02 PM on September 15, 2014 [2 favorites]

- NP w/counseling cred
- meds + talk therapy (i like cbt-ish approaches)
posted by j_curiouser at 9:01 PM on September 15, 2014

I have found that short term meds for acute moments of calm the hell down (diazepam) can be very helpful and I keep a few pills around for acute relief, should they be needed. It is not advisable to take this kind of medication regularly.

Having said that, I have had only horrendous experiences when I have tried longer-term, baseline, medication. The idea of having those experiences without ready access to a PCP or really easy access to the psychiatrist is kind of horrifying. Certainly, for me, therapy needed to be right up front with medication only as a safety net underneath. Getting things the other way around was counter-productive.

I can't tell you what to do, hopefully my experience is helpful. Note that I likely have additional issues to anxiety, YMMV, etc.
posted by deadwax at 11:07 PM on September 15, 2014

My experience: medication prescribed to you when young for anxiety can lead to crippling ethical and psychological problems and ruin your life.

A good therapist is always helpful, but, alas, hard to find.

Good luck.
posted by bertran at 11:20 PM on September 15, 2014

(For elaboration, please see my other posts on this and related themes.)
posted by bertran at 11:22 PM on September 15, 2014

I have found Celexa to be incredibly helpful for my worsening anxiety.

I always had anxiety issues, but I was able to power through them. My anxiety manifested in fear of water, bridges, freeway fly-overs, tunnels, and heights. I lived in San Francisco and Pittsburgh, so...yeah, I'd white knuckle it when I had to drive on things I was afraid of. It got worse after the Loma Prieta earthquake, when those structures collapsed and confirmed every single one of my fears.

One of my worst episodes was having to drive over that suspension bridge in St. Petersburg, FL in a downpour. I was nearly in tears! Horrible.

Then I started getting anxiety attacks at night and that's when I talked to my doctor. The medication helps SO MUCH!

Now I don't stress about the small stuff anymore. I don't mind driving over structures (although I'm not 100% convinced that they're all up to code!) I live my life with very little anxiety.

Now, when I got laid off, it was pretty bad there, but adding a sleep aid to my meds helped a TON!

If your anxiety is caused by problems with brain chemistry, then medication is an appropriate way to deal with it.

Go to a Doc-in-the-Box for a consultation with a PA, the meds are very inexpensive, and try them to see if they help.
posted by Ruthless Bunny at 10:09 AM on September 16, 2014 [1 favorite]

I went the meds then therapy direction. But I was dealing with a lot more than anxiety. I needed to get stuff under control before I could even think about therapy. Then it took me a while to do what I needed to do to even get into therapy.

IMO, if you're coping okay in general (ie not curled up in the fetal position on the couch), it's okay to start therapy and see how it goes. But everyone is different.

Know that it can take a few tries to find the right meds and the right therapist. This time around, I lucked out and the ones I picked worked for me out of the box. But don't be afraid to say that things aren't working/ changing therapists or doctors/ changing meds.

You can also look into support groups in your area. NAMI has always been my go to place for peer support.
posted by kathrynm at 3:45 PM on September 16, 2014

medication only helps somewhat. Try cognitive behavior therapy or dialectical therapy and therapist that are well versed in those schools of skill building and ways of dealing with/accepting your anxiety. Meds are only a crutch to get you to allow you to do the exposure work for your ocd work or to work on untangling your thoughts. it is the behavious, thoughts and feelings that you need to retrain and you can only do that through group therapy or one-on-one psychotherapy. as a person with GAD, depression, and ptsd ,nothing i take in pill form with help me. be sure to balance your eating. stay away from refined sugar. eats plenty of fresh veggies, take a multivitamin, high quality fish oil, probiotic, and other supplements to increase your overall wellness. You may have some deficiencies that need to be addresses through vitamins and supplementation. Yes, it soudsn like hocus locus, but it does help to some degree. get exercise too. that helps me the most. just work out till you are exhausted works every time. support groups help too. Look o the NAMI website and other mental health association websites to see if there are anxiety support groups in your area. I find a lot of comfort in knowing that i am not the only dealing with the anxiety and other mental issues i struggle with.
posted by Jewel98 at 8:44 PM on September 16, 2014

« Older Bad candy, bad!   |   Abolition of Slavery and Attitudes Towards... Newer »
This thread is closed to new comments.