So what's the deal with medication?
October 10, 2014 2:20 PM   Subscribe

I have been in therapy for a little while for anxiety/obsessive thoughts. This has gone very well so far, but I still feel awful, and I am wondering whether I should try meds. Snowflakes after the jump.

My therapist is really great, and between that, mindfulness, and regular exercise I feel like I'm making a lot of progress. However, I don't necessarily feel better. There's still a "veil" over everything most of the time, including when I am very busy/active. Also, my parents have told me that they cannot afford therapy more than once a month, which I don't think is enough (I'm finding it kind of difficult just to make it through the week).

So, I would like to try meds. My therapist mentioned benzodiazepines, but (as I told him) my anxiety is pretty much constant, so it would be better to have something I could take regularly rather than as-needed. He also told me that SSRIs would be a bad idea, since they could exacerbate the mood cycling that I've experienced.

So, what alternatives are available to me? (Thanks in advance.)
posted by myitkyina to Human Relations (17 answers total) 3 users marked this as a favorite
I agree that therapy would probably be better if you went weekly. Can you ask your therapist if they have a sliding scale or other payment plan?

Ask your therapist if they recommend a good psychiatrist or psychopharmacologist. Thats who can help you find a medication that would work for you. If you have insurance ask them to help you find one that's on your plan.
posted by radioamy at 2:26 PM on October 10, 2014

Are you in school? You might have counseling services available through a university or something. I'd probably be looking at talking to a psychiatrist about medication. In particular, that business about antidepressants and cycling mood? That happens for people with bipolar. If your counselor things you have bipolar disorder, then you ought to be getting that treated. If they don't, then--well, not all non-prescribing therapist are really well aware of how the different pharmaceutical options work, so you might not be getting good info. Especially if they're recommending 24/7 benzos, which should be a last resort and I probably wouldn't even take them that way then. Psychiatrists are usually a better resource for when you need medication and the circumstances are kind of tricky. I have been very happy with mine.
posted by Sequence at 2:34 PM on October 10, 2014 [1 favorite]

The mood cycling comment is a bit odd. Has he diagnosed you with Bipolar Disorder? If so, that might bring a whole different set of medications into play.

Regardless, unless your therapist is a psychiatrist, he is not going to have as much training in medications as a psychiatrist will. It would be best to talk to a psychiatrist about which medications might be suitable.
posted by jaguar at 2:34 PM on October 10, 2014 [1 favorite]

Note: I am not a doctor. Do your own research, particularly in controversial areas like this one. Don't take anyone's word for anything.

OP: "I am wondering whether I should try meds"

My advice is not to try them, as it's too risky. There is a good chance they'll do more harm than good. Unfortunately, psychiatric drugs have long-term effects that act to exacerbate the very conditions that the drugs were meant to treat. Explaining all the ins-and-outs of this idea is really beyond the scope of a short post on AskMeFi. My advice to you is to take a look at the work of investigative reporter Robert Whitaker. A few years ago, he wrote an excellent book called, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. The book won an award as the best investigative journalism book for 2010.

If you're interested in something shorter, try these other articles:

"Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria"

"Antidepressant Withdrawal Syndrome"
posted by alex1965 at 2:41 PM on October 10, 2014 [2 favorites]

Go to your GP for an assessment. I'd try Celexa which has worked wonders on my anxiety, and the generic is $7 per month without insurance. I'd think LONG and HARD before getting onto Benzos. Prozac was fun, right up until I broke out in hives from it.

The point is, meds are a very real aid in helping anxiety, but it's sort of a process to find a drug and dosage that work for you.

But Benzodiazapam...too addictive for my tastes.
posted by Ruthless Bunny at 2:42 PM on October 10, 2014 [1 favorite]

Please go to a psychiatrist and have yourself evaluated.

My advice is not to try them, as it's too risky.

Unless alex1965 is your doctor, I would take comments like this with a grain of salt. Millions and millions of people (myself included) have been helped by antidepressants. No one says you have to stay on them forever but your question was should you try antidepressants. If your therapy, exercise and mindfulness training are not working then yes, a prescription medication, given under the supervision of a medical professional, is certainly worth a try. It's medication. It's not a life sentence. Good luck.
posted by nubianinthedesert at 2:46 PM on October 10, 2014 [25 favorites]

Response by poster: Are you in school?

Yes, but high school.

The mood cycling comment is a bit odd. Has he diagnosed you with Bipolar Disorder?
that business about antidepressants and cycling mood?

I meant that throughout the day I have significant ups and downs in terms of dealing with the thoughts. Good days are about 50-50. I don't think I've ever experienced anything that could be considered a manic or hypomanic state. My therapist was the one who used the phrase "mood cycling", but said he believes what I'm experiencing is anxiety only.
posted by myitkyina at 3:06 PM on October 10, 2014

The mood cycling comment seems odd to me to since you don't have mania and I'd ask the therapist to expand on that.

Anyway - something to mention/suggest to whoever might end up prescribing meds for you is Buspar/Buspirone. It's considered to be good for anxiety (perhaps as good as benzos), it has a very low side effect profile, it's non-addictive, it's available as a generic, and it's not an SSRI. Some people find it useful, some don't. The downside is that you have to take it twice a day (and it's not instantaneous; it takes a few weeks before you can see its effects.) Anecdotally, I have found it quite helpful, and to be honest I think that making sure to take a moment to focus on some self-care (even just in the form of swallowing a pill) twice a day has been helpful to me in itself.
posted by needs more cowbell at 3:16 PM on October 10, 2014 [2 favorites]

I took a relatively mild dose of an old-school (as my doctor described it) antidepressant called Dosulepin for a few years. I gather it is not used in the US for some reason.

The main effect was that I slept really soundly and I didn't feel anxious any more. The side-effects were practically nil for me, so I suppose I was one of the lucky ones for whom taking the pills was a 'no-brainer'. I stopped taking them when my life had settled down a bit, and the anxiety hasn't really returned, although I'm probably a higher-than-average-anxiety sort of person generally (I cope with it now by spotting and correcting negative thoughts).

I don't think anyone can really answer your question. There are lots of medications around, and everybody seems to react differently to different ones. The time to bring up the subject of medication is probably when you're not seeing any more progress from therapy. There may come a point where a certain dose of a particular product will help. But that time may not be now. It may not be ever. Medication doesn't necessarily have instant results either, any more than therapy does. The wrong medication can make things much worse. You can certainly have a conversation with your GP about the options.
posted by pipeski at 3:29 PM on October 10, 2014


Investigative reporters, even ones that wrote excellent books, are not qualified to assess whether medications would benefit you personally.

The correct step for investigating whether medications would help is for your therapist to refer you to a psychiatrist, who is qualified to discuss the medication options with you and in consultation with you and your therapist help you determine whether medications would benefit you. You seem to be aware that they are not a panacea and won't fix everything overnight, but in some people an appropriate medication can provide some mental or emotional stability that can work in concert with the coping strategies that you seem to already be benefiting from.

When I went on meds for 18 months, my therapist referred me to a psychiatrist and as a team we determined what might be beneficial to me. The medication didn't fix everything and didn't wipe away the constant fog I was in, but they did provide some stability so I could continue my progress. I am fortunate and eventually progressed enough that I could go off the meds and feel sufficiently normal; others find them helpful to stay on.
posted by Tehhund at 4:55 PM on October 10, 2014 [2 favorites]

What alex1965 says.

Sorry to be laconic. Please see my other posts on related topics for my perspective -- won of long and dismal experience.

(Yours does not have to be! Just say no.)
posted by bertran at 4:58 PM on October 10, 2014

Best answer: Hi, myitkyina. We have a bit in common (anxiety, INTJ) so I'm just going to share some things that have been helpful for me. It's pretty hard for anyone on the internet to give you good advice here because mental health is a complex thing, but I can give you a couple jumping off points.

For learning about meds, I have found Crazy Meds to be super helpful. Now, I started using that site after I was already on Effexor, so I used it to help me understand what I was taking and what kinds of side effects I could expect. I also learned some strategies for getting off of it. I found it really effective, but I would probably not recommend starting with it simply because it's kind of a bitch getting off of it. Tehhund is right that medication doesn't fix everything, but it can be really helpful in getting you to a more stable place so you can actually work on fixing some things. It can turn the volume down.

Of course, the other thing that can turn the volume down is time. You're still in high school, which means that your brain is still growing and this is a really chaotic time for lots of us. It doesn't necessarily mean that it's always going to be like this — maybe just going through a growth spurt of some sort. It doesn't make it more comfortable, I know. It also changes the medication conversation in some ways, because a 40-year-old brain is different than a 16-year-old brain.

If you are going to try meds then you want a psychiatrist who you can see more than once a month, particularly at first.

That might seem discouraging, but medication is just one tool in the box and it doesn't work for everyone. Even for people it does work for, often the first 3 or 4 drugs are not good fits. But! There are tons of types of therapy and strategies out there. And lots of books.

You might find Cognitive Behavioural Therapy to be useful (Mind Over Mood, Feeling Good) and you might not. I found that I was pretty good at using CBT to be even more judgemental of myself after a bit of practice — as a fellow INTJ, you might find that too. I have found Acceptance and Commitment Therapy to be really amazing (Things Might Go Terribly Horribly Wrong). Lots of people find meditation to be helpful. I find super-engrossing hobbies that require all of my attention (modular origami, sewing, SketchUp) to work for me for similar reasons.

The important thing is to be gentle with yourself. If getting through my week means doing a bit less, or spending time on some things that seem weird, or (for me) eating ice cream instead of dinner because my appetite vanishes when I'm anxious... then I got through my week! Good! Give yourself room the same way you would be generous and understanding with a loved friend.

Feel free to memail me if you want to chat more. You can do this.
posted by heatherann at 5:15 PM on October 10, 2014 [2 favorites]

You can take benzos on a non-prn (as needed) basis. Clonazepam is the natural one for this use. It also has anti-manic properties.

Have a look at Brain Lock by J. Schwartz.

Needs more cowbell is literally the only person I've encountered who had success with buspirone for anxiety, and I've been doing Internet mental health forums for nearly 20 years. (But good news, needs more cowbell!)
posted by persona au gratin at 2:35 AM on October 11, 2014

Clonazepam (Klonopin) was a fucking miracle drug for my anxiety. I went from being unable to leave the house, answer the phone, or even open my mail to almost completely normal again in less than a week.

Previously I'd been prescribed Xanax to take "as needed" but the problem with waiting until you have a panic attack to take it means you've already had the damn panic attack. So my prescription was to take 1mg/night every night of the Klonopin as a proactive measure instead and that worked a zillion times better.
posted by Jacqueline at 3:34 AM on October 11, 2014 [1 favorite]

Best answer: Buspar has been pretty helpful for me. I find that I tend to ruminate a lot less (these cycles of over-thinking and worrying to the point of obsession often left me feeling exhausted and depressed--is that what you meant by mood cycling?) I also sleep better; I wouldn't say I feel sedated at all, but I tend to fall asleep faster and stay asleep. I've found that it had also reduced most of my stress/anxiety-induced behaviors (jaw-clenching, nail-biting). I just feel like it took my nervous energy down a notch or two, but otherwise I don't feel "altered" day to day. I'd give it a go--seems like the mildest thing out there, and a good place to start if you're unsure about long-term meds in general but feel compelled to try something.
posted by lovableiago at 8:34 AM on October 11, 2014

One thing that crossed my mind was to bring up the possible impact of trauma. I don't know if you have been through any trauma, but I am a textbook example of how trauma can really mess up a person's moods, cause bad anxiety, and wreak a ton of other havoc in the form of Post-Traumatic Stress Disorder (PTSD). If you feel like trauma is contributing to your current state, I would definitely bring that up to your therapist. With PTSD, you can help alleviate the symptoms with meds like clonazepam (which I take), but you can't expect to totally knock it out with meds, unfortunately. Just a lot of therapy.

As far as trying psych meds in general, it is your body and your quality of life. I have been on meds for a very long time. I don't love that, but I am so glad they are available. And I get very cranky when people try to talk me into ditching them, especially when it's people who have no real knowledge of psych meds. Just because the disease in invisible, people seem to think it's okay for them to try to make choices about treatment for other people, and that's just dumb.

I don't know how meds might change you or which meds you should try. But I know with certainty that living with terrible anxiety and depression will really hurt your quality of life. If it were me, I would want to at least try things that might help.

Thinking good thoughts for you.
posted by mermaidcafe at 9:24 AM on October 11, 2014 [1 favorite]

I have tried a variety of meds at various points without a lot of luck (and with a lot of side effects). Have you considered trying meditation? Doesn't have to be one or the other, but meditation is free and without side effects.
posted by getawaysticks at 11:04 AM on October 12, 2014

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