Should I take medication for anxiety?
December 27, 2014 12:59 PM   Subscribe

It's extremely unpleasant and has not gotten better after two years of "working through it", but it's technically "mild". Is it bad enough to try meds?

I have posted a lot of questions here over the past year or so trying to figure all of this out. I started seeing a therapist in the fall and he diagnosed me with anxiety and depression. I think it's going well, and it helps just to talk about it, but the anxiety itself hasn't actually improved (if anything it's worsened).

The past two years have been absolutely miserable. I spend about 75% of any free time I have completely paralyzed by intense guilt, self-hatred, and fear. Most school breaks (especially summer) are spent in a depressed fog. And then I feel better just long enough to think I could actually do something interesting or fun. I spent a long time working through some of the legitimate issues that were linked to it (identity crisis, etc.) but I don't think there's anything left to do on that front. I just don't have any control over when I feel confident/happy and when I don't -- it's literally a coin toss. (It's kind of like this person, though I've never had suicidal thoughts or sleep problems nor have I self-harmed.)

However, I don't have any issues functioning. My parents were very surprised when I was diagnosed, and my grades are fine. And I have never experienced any physical symptoms, actual panic attacks, or probably any major depressive episodes. My therapist has classified this as mild anxiety/depression. He says he thinks meds would be a good idea, in large part because I do dissociate sometimes. However, this only happens when it's really bad -- in the summer and towards the beginning of the school year, mostly -- so it worries me that he's basing his decision on that.

So I'm not sure what to do. I have a prescription for 25mg of Zoloft (which would be increased, obviously) and I'm probably going to fill it this week. I'm not at all uncomfortable with meds, I'm just worried that maybe my anxiety "isn't bad enough". Maybe I'm just looking for reassurance? I don't know. Has anyone been in this position before? Whenever I read any posts about anxiety and/or meds it seems like the poster has it way worse than I do.

Thanks in advance.
posted by myitkyina to Human Relations (26 answers total) 14 users marked this as a favorite
Response by poster: Sorry, correction. I felt suicidal once, over the (last) summer naturally, but it's not a regular thing, and I still worry that what I'm experiencing is not "real" depression.
posted by myitkyina at 1:03 PM on December 27, 2014

Besides therapy, have you tried anything else? Exercise (especially outside in parks/natural spaces) might really help. I think for anxiety it's best to do fairly strenuous exercise, e.g. raised heart rate for 35-40 minutes minimum, several times a week. Check out this book.
posted by three_red_balloons at 1:07 PM on December 27, 2014 [2 favorites]

The past two years have been absolutely miserable. I spend about 75% of any free time I have completely paralyzed by intense guilt, self-hatred, and fear.

If this isn't bad enough, what is? Take the meds. If they don't help, try another one. You don't need to be at some hypothetical level of constant terribleness in order to justify medication. Your life can be a lot better than this and medication very well may be the answer. It is certainly worth a shot.
posted by something something at 1:10 PM on December 27, 2014 [23 favorites]

It is going to be tough for strangers on the internet to tell you if you should/shouldn't be on meds, or if your anxiety/depression is "bad enough" to justify using meds.

I would suggest that, in addition to your therapist, you consult with a psychiatrist who can prescribe and monitor any meds and adjust them as necessary. You'll know after a short period of time if they are helping, you can continue or quit based on that experience.

Also, take a close look at your course of therapy, it should be goal oriented, you should understand the modality he/she is using and, if you're not seeing any progress other than "it helps to talk about it", you might want to consider another therapist.

And, if you ever "feel suicidal" again, please get yourself to the E.R.
posted by HuronBob at 1:10 PM on December 27, 2014

Best answer: I had undiagnosed anxiety for years. I only wish I had started taking meds sooner. You have to experiment around with them, to find the med and dosage that works best for you. I've been on 10mg of Celexa for about a decade now, and it really helps.

I don't miss being all wrapped around the axle at work, or freaking out when driving on bridges, through tunnels, under overpasses, on winding roads, etc. I don't miss laying in bed, with the thoughts whirling around in my head, unable to calm them so that I can sleep.

I have always been a happy and optimistic person, and now I feel better.

I know a lot more people on some sort of anti-depressant or anti-anxiety drugs, in fact, I know more people on them than off of them.

Give it a try, see if you feel better. You don't have to white-knuckle it through life, you don't have to wait for it to get terrible. You can feel better now. There's no shame in it.
posted by Ruthless Bunny at 1:10 PM on December 27, 2014 [7 favorites]

Best answer: I wasn't as anxious as you, but I have dysthymia, which I used to think was "not 'real' depression." I'm now on low doses of Wellbutrin and Cymbalta, and I realize I couldn't have been more wrong. My only regret about taking meds is that I waited so long.

It took months of trial and error to arrive at my optimal dose (the Wellbutrin is there just to offset some of the side effects of Cymbalta). Work with a good psychopharmacologist, i.e., a psychiatrist, and be patient. Best of luck.
posted by Johnny Wallflower at 1:15 PM on December 27, 2014 [3 favorites]

Best answer:
I spend about 75% of any free time I have completely paralyzed by intense guilt, self-hatred, and fear.
This is "bad enough" for medication. Who wants to spend the vast majority of their free time paralyzed by guilt, self-hatred, and fear? I think that spending your free time enjoying your life and engaging in hobbies and social interactions would be vastly preferable to being in a depressed fog. I would in fact argue that spending unstructured time in this state is not actually a functional way to live at all, regardless of your grades or employment compensation indicating that you're technically functional.

Also, if you're just doing talk therapy, you should consider switching to CBT. I was able to eventually get off my anti-anxiety meds entirely after doing CBT, but I wouldn't hesitate to start them again if I started having problems, even if I knew that they were caused by a lapse in practicing my CBT skills.
posted by xyzzy at 1:21 PM on December 27, 2014 [3 favorites]

Best answer: I have a prescription for 25mg of Zoloft (which would be increased, obviously) and I'm probably going to fill it this week. I'm not at all uncomfortable with meds, I'm just worried that maybe my anxiety "isn't bad enough". Maybe I'm just looking for reassurance?

The thing people don't tell you about anti-anxiety meds is that part of the process is that you will be afraid to take them for various reasons that seem like good reasons. Most people who have taken anti-anxiety meds for anything other than constant debilitating panic attacks have been at this point. I have been there.

I spend about 75% of any free time I have completely paralyzed by intense guilt, self-hatred, and fear.

How much worse does it have to get? How would you feel if you could reduce this by 50%? There are things people suggest for anxiety (lowering caffeine, getting exercise, getting enough sleep). I found that a few things were true for me

- like many people I was kicking myself for waiting. I have mild anxiety and I basically take meds (lorazepam) as a sort of "reboot" button when it's gotten so bad I can't sleep and sort of spiral into annoying thoughts about everything and everyone.
- just having the option in my house makes me able to have a conversation with myself about my feelings (mindfulness, etc) which is useful in its own right. I have a few "If you find yourself doing this, it's time for medicine" rules that I don't let myself think myself out of. It helps. A lot.
- this has really improved my relationships with other people both because I'm not constantly bouncing my anxious thoughts off of them (family and close friends) and also because I'm more comfortable interacting in a number of situations which means I do more, my life is fuller and I don't just sit home and worry.

So yes, this is a good idea. You should do this. If it does not work, you can stop. Be aware that this one medicine may not be the perfect one and that there is a process. It won't start until you do. It's good to be conscious of downsides and be thinking about it, but yeah I'd get started and see how you feel.
posted by jessamyn at 1:23 PM on December 27, 2014 [13 favorites]

I'm not at all uncomfortable with meds, I'm just worried that maybe my anxiety "isn't bad enough".

This kind of tells me you should probably give it a go: You are basically saying "my only objection to doing this is rooted in the crippling condition it would treat." ie "I have anxiety about whether or not my anxiety is bad enough to justify anxiety meds." ie "My anxiety is so crippling, it interferes with my most basic decision-making abilities."

If you want to talk about non-med options, you can memail me if you want. I will be happy to talk, but I am not suggesting you go that route instead of meds. I am suggesting that if you don't want to become permanently dependent upon meds, there may be other things you can do that will help get and keep this under control. But those approaches tend to be time consuming and don't get immediate slam-dunk results the way meds do. If they work, meds would stabilize you fairly promptly so you are no longer being crippled by anxiety and can function better. (If you think you are functional without treatment, I will suggest that you might be surprised at how much more you can get done if your condition is properly treated.)
posted by Michele in California at 1:28 PM on December 27, 2014 [4 favorites]

Best answer: 25 mg of Zoloft isn't very much. It's the dose that my 11 year old daughter is on. I think you should listen to your doctor and try it. Years of being depressed and anxious can become a habit. Medication can break that habit in a way that therapy, diet, and/or exercise can't. Commit to 3 months of medication and see what happens. Since your issues are mild, 3 months could be all it will take to get you where you want to be.
posted by myselfasme at 1:29 PM on December 27, 2014 [2 favorites]

I wear glasses because of poor vision and I take anti-anxiety medication because my shrink suggested it. It never occurred to me that I was anxious but I was in misery. For years. I'm lucky, the first thing I was given worked for me.

I'm not sure why so many of us think not taking medication and suffering is more virtuous than taking meds (or doing CBT or exercising or meditating or all of the above) and feeling better.

Reducing suffering, including our own suffering, is better for everyone. Life's an experiment anyway. Take some meds out for a spin, under your doc's guidance. See how it goes. Don't be disappointed if it takes a while to find something that works. Hang in there!
posted by Bella Donna at 1:32 PM on December 27, 2014 [8 favorites]

Best answer: "Not bad enough" is bullshit, and it's the voice of your anxiety talking. What would happen if you took a little Zoloft even if your anxiety wasn't "bad enough"? Jail? Firing squad? Announcement in Times Square? Tattoo on your forehead? Having your medical degree revoked?

No. The worst thing that will happen is a moderate copay. Which is the same amount you will pay if it helps. So...go ahead and try it, and then stop if you don't like it.

Doctors don't suggest this stuff for fun. It's fine to try their advice.
posted by Lyn Never at 2:03 PM on December 27, 2014 [4 favorites]

Best answer: Trying medication doesn't mean committing to take it forever. Maybe think of it this way: your anxiety is mild enough that you are able to function without medication, but your symptoms are interfering with your enjoyment of life. Medication is one tool you can try to see if it will help you to be able to enjoy your life more, as has worked for many people (myself included). And, at the same time, if you try it and hate it, going off your medication won't mean losing your ability to function. Does that make sense? Rather than wondering if your anxiety is severe enough to warrant medication, think of the opportunity you have to try it out and if it helps, awesome. And if it doesn't help or you don't like it, ok. That's good to learn, too.
posted by Meg_Murry at 2:07 PM on December 27, 2014 [2 favorites]

I put off trying meds for years becuase the anxiety was feeding me all kind of plausible reasons not to do it. I finally tried it and it is a HUGE and welcome benefit. I'm still me in all the ways I want to be, but the volume on the constant self loathing and guilt and clenchedness is turned down. You can always stop if you hate it. Keep telling yourself it isn't permanent, you're just giving it a chance. And, see if it helps.
posted by Cocodrillo at 2:09 PM on December 27, 2014 [1 favorite]

I was on meds for anxiety for a while. Like you, I was and am functional -- I was just tired of the constant parade of worst-case scenarios running through my head at all times. Medication didn't solve my anxiety, it just made me sleepy -- but knowing how I reacted to it was a valuable data point as I made choices about how to treat my anxiety (as I do now, with lifestyle changes). There's no harm in trying.
posted by rogerrogerwhatsyourrvectorvicto at 2:35 PM on December 27, 2014 [1 favorite]

Medication made all the difference in the world for me.
posted by The Underpants Monster at 3:05 PM on December 27, 2014

You've been fighting with yourself long enough. Talk to a doctor and ask them to discuss low-dose treatment with you.
posted by Hermione Granger at 3:22 PM on December 27, 2014

Best answer: Most school breaks (especially summer) are spent in a depressed fog.

This is no way to live and will actively interfere with your ability to find a good job or graduate program because you weren't able to use your time out of class productively.

So much of my anxiety was papered over with, "my problems only happen soemtimes" or my pride in being able to push through my episodes in order to get things done. But the episodes are the problem. You have just organized your life in such a way to ensure that they don't interfere with your priorities now. If you don't address it now, then later on you will be in a situation where you're in a depressive, anxious fog when you can't afford to be, and it could interfere with your professional and personal life.

The pernicious nature of anxiety is that it gives you perfectly reasonable-seeming reasons for you NOT to treat it. But that is the anxiety speaking.
posted by bright colored sock puppet at 3:28 PM on December 27, 2014

I'm not a doctor, but I take meds for anxiety.

First off: yes, definitely look into meds. You've been trying to work it out without drugs for 2 years, and it's not working. It's time to try them.

I'll note that Zoloft is an SSRI anti-depressant; I guess it has some anti-anxiety properties, too, but be forewarned that a) this is 'long term strategy' kind of drug that will take several weeks to kick in, and b) some people have issues with SSRI side effects (such as anorgasmia).

Having dealt with this for many years, and after several bad experiences with SSRIs, my doctor put me on Wellbutrin (aka Bupropion), which was extremely effective for my anxiety and depression and is not an SSRI (and thus has none of the side-effects).

In parallel, my doctor also gave me a Rx for Lorazepam, which is a fast-acting anti-anxiety med.

Over a period of several years, I found I needed Wellbutrin less and less (and today I don't take it at all). I still take the occasional Lorazepam, but honestly, sometimes just having the bottle in my pocket, knowing it's there if I need it, is the real benefit.

Again, I'm not a doctor, and I'm most certainly not you - what works for you will likely be unique to you. But I'd again say yes, look into meds. And - you're not necessarily signing up for a life-long program of drug-based treatment with this.

I wish you all the best with this!
posted by doctor tough love at 3:38 PM on December 27, 2014 [1 favorite]

Best answer: IANYD but I take a very tiny dosage of anti-anxiety meds for 'mild' anxiety, and it's changed my life for the better. I no longer spend hours obsessively worrying about things or feelings a low-level of panic even when nothing's going wrong. I've heard from other people I know who take meds that haven't had the same effects I have, but I'm really happy that I found the courage to ask for help from my doctor and to make this change.
posted by toerinishuman at 4:27 PM on December 27, 2014

To answer what is probably an unconscious doubt in your mind: yes, it probably will be a little difficult to fill all that time you're wasting at the moment feeling anxious or distracting yourself from anxiety, but whatever you do fill that time with will be so much better.
posted by ambrosen at 4:55 PM on December 27, 2014 [1 favorite]

Leaving the question of how to address this to one side, symptom severity and functional impairment usually go together, but they're thought of as distinct (though is confusing). Though, arguably, if you're not able to have fun at all, you're showing impairments in the domain of leisure (and maybe social?) functioning.

Another question is, how long can you go with moderate or severe symptoms without it affecting your functioning? You have to deal with your issues one way or another, either through meds or a different approach to therapy.

Disclosure: my overall experience with an SSRI was not good, and if I'd known that I would experience the effects I did, I wouldn't have taken that drug. It may have helped with some things, I can't say for sure. I suspect it helped quiet the constant sort of 'buzzing' sense of heightened awareness I had since I can remember. But for me, the tradeoff was emotional flattening in all the ways described here, alongside the persistence of most of the rest of my anxious symptoms, plus weight gain.

The thing is, hindsight is 20/20, and it's impossible to tell who's going to experience what in advance. Some people obviously have benefited from SSRIs. It's a total crapshoot, and it takes trial and error and time to work it out. (One other thing with SSRIs - they can exacerbate undiagnosed mania, if that's at all in play.)

(You haven't been offered a benzodiazepine, but just so you know - they do work for somatic symptoms, but by themselves, they don't address the cognitive styles and symptoms typical of anxiety, and they do carry potential for addiction. [Saying that, personally, I'd rather use them - sparingly, in emergency situations - than risk the side effects I experienced with an SSRI. As per my doctor, odds are, if you one drug gives you side effects, others in the same class may do the same thing, to a greater or lesser degree.])

All that said - you can try this prescription and see what happens. It's all about measuring and monitoring potential and actual risks and benefits. If you do wish to try the prescription, and are concerned about side effects, you could try using a mood tracker like this one and check in with your doctor regularly. (Hopefully, you have a good relationship with them.)
posted by cotton dress sock at 5:22 PM on December 27, 2014

Best answer: From a physician's perspective, anyone who meets the diagnostic criteria for depression or anxiety has depression or anxiety that is worth treating. There is no 'bad enough for meds' - the fact that you have been diagnosed means that it is a problem. It's normal to get sad sometimes, or worried sometimes, that's part of the human condition. By the time you meet criteria for depression or anxiety, that means it's become a condition that is interfering with your life - and that includes your well being and quality of life, not just whether you have the ability to still drag yourself out of bed in the morning or whether you can still get decent grades/hold down a job.

(and I say all that quite aside from the fact that you've characterized your own situation as 'miserable', which I think to any objective outsider is quite sufficient to suggest that your mental health isn't treated well enough currently)

You have very little to lose and a lot potentially to gain… I'm glad you're considering trying the Zoloft.
posted by treehorn+bunny at 5:43 PM on December 27, 2014 [3 favorites]

Try the meds--that's the only way you'll know. I remember meeting a 70-year-old man who was at the doctor (I'm in med school) for a follow-up on his new anxiety meds. He felt loads better, and was kind of in disbelief. I asked him why he hadn't tried meds before, and he told me he'd assumed that his anxiety was just kind of how he'd always feel. I was happy that he'd found some relief, but bummed that he didn't find that relief until 70.

Meds aren't magic, but they help a lot of people. And they aren't permanent either. Just another tool in the toolbox for right now.
posted by namemeansgazelle at 6:01 PM on December 27, 2014

I spend about 75% of any free time I have completely paralyzed by intense guilt, self-hatred, and fear.

Yes, it's bad enough to take medication for.

1mg/night clonazepam (Klonopin) was life-changing for me. And once my anxiety was under control, I was able to get the rest of my life under better control and then taper off the medication. I get by just fine without it now.
posted by Jacqueline at 7:50 PM on December 27, 2014 [1 favorite]

Best answer: Get on the meds, stat. Don't assume your first med will be the med for you. You may well have to experiment.

In my experience, the meds take the edge off the awful. You can still get anxious or lose a few hours to sullen depression, but it's rarer. You feel more like "yourself," the you that you expect to feel like on an average day, instead of the you who just feels like a big crapsack. I've known people who said it blunted their emotions too much, but that sure hasn't been the case for me. If anything, some more blunting would be appreciated!

Anyway, you really sound like you need to try the meds. You are struggling, and the meds could help a lot.
posted by Ursula Hitler at 1:21 AM on December 28, 2014

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