How do you get medications for anxiety or depression?
August 2, 2016 2:04 PM   Subscribe

I've read a lot of questions and replies here about various medications for anxiety and depression, and I'd like to at least get evaluated and find out if they'd be helpful for me. Who do I go to for this?

I keep reading about people here (examples: 1, 2, 3) whose anxiety and depression have been helped by medication, and whose symptoms sound a lot like mine. I've seen therapists in the past, but am not seeing anyone now. My anxiety, depression and OCD are probably no worse than they ever were - I'm day-to-day very functional - but my coping tools and strategies are working a lot less well than they used to.

I'm at the point where I'd like to try medication, or at least talk with someone about whether meds would help me.

How do I go about this? I don't currently have a therapist. I don't think my PCP would prescribe anything - she's not a big fan of drugs, and I'm kind of leery of asking her and losing even the small amounts of xanax she prescribes for me. Do I just start looking for a psychiatrist? Are they all open to doing prescriptions now? Is there a specific kind of appointment I should ask for? I don't want to come off like "drug-seeking", though actually, I suppose that's just what I am doing.

Also, is it worth trying to find someone who does the psych genetic tests mentioned in this comment? And if so, is there a way to find them? The idea of speeding up the process of finding the right medication is pretty attractive.

Thanks for any info. I'm in Ann Arbor if anyone has a specific suggestion.
posted by anonymous to Health & Fitness (21 answers total) 3 users marked this as a favorite
I don't think my PCP would prescribe anything - she's not a big fan of drugs, and I'm kind of leery of asking her and losing even the small amounts of xanax she prescribes for me.

Uh. Get a new PCP, immediately. That's bananas. PRN xanax should be the easiest thing to obtain from a PCP; they should be tracking how often you're getting it.

But yes, they will probably refer you to a psychiatrist. You go to a psychiatrist because you need certain drugs. These people are trained to weed out folks that are drug seeking; don't worry about it.
posted by furnace.heart at 2:10 PM on August 2, 2016 [14 favorites]

At least in most places that I know about in the US, prescriptions are written by either your PCP or psychiatrist. Most therapists are masters level (LMFT, LCSW, LCPP) or a PhD (psychologists) and don't write prescriptions. All psychiatrists that I know are involved in medication management - usually the therapy part is minimal (once a month or less), although a few really like that part. So, if you don't want to talk to your PCP, start shopping for psychiatrist. Just be aware that there may be a long wait for the first available opening.
posted by metahawk at 2:13 PM on August 2, 2016

A psychiatrist's job is to evaluate your mental health and prescribe medication if think it is necessary. Unless you show up at the psychiatrist's office demanding Xanax by name and dosage, you're not going to get labeled "drug-seeking." Therapists who are only licensed in therapy (i.e. didn't go to medical school like a psychiatrist) cannot write you prescriptions as far as I am aware.

If you are doing this through insurance, you may need a referral from your PCP to see a psychiatrist. If you don't, you can just call up their office and schedule an appointment. You don't need to set up any special kind of appointment; they might ask why you're scheduling one but "I think I have anxiety/depression" is enough for them.
posted by griphus at 2:14 PM on August 2, 2016

ps. If your situation is at all complex, (as in depression, anxiety AND OCD) you probably want a psychiatrist anyway. PCPs only know the top couple of options for any situations. They don't know all the ins and outs of side effects and interactions for the psych meds that a psychiatrist would know.
posted by metahawk at 2:14 PM on August 2, 2016 [3 favorites]

Physicians are going to be concerned about "drug seeking" for medications that have a potential for addiction/abuse. Xanax does have that potential. BUT, most antidepressants and anxiolytic medications are not addictive like that and asking about those as treatment options shouldn't be something that raises red flags. Your physician should be talking to you about various options to treat the concerns you present with. One being short acting medications like Xanax that are best for time-limited episodes like panic attacks, vs. a long term medication like other classes of anxiolytics. Psychiatrists are experts with these medications, so consulting one would probably be helpful. Also? If your PCP isn't checking in on concerns you've presented in the past and is sending signals they won't talk to you about other options, I agree another PCP might be a better match. You might also consider therapy as an adjunct to the medication. The psychiatrist should be able to help with referrals there.
posted by goggie at 2:17 PM on August 2, 2016 [1 favorite]

Yeah you need a new PCP. When I first approached mine about my anxiety, she encouraged me to start Xanax as needed. I was a little reluctant and she was like, "Listen, we're getting you into therapy and we're going to try a daily dose of BuSpar. But you are having a really hard time right now and need to have an emergency release valve."
posted by schroedingersgirl at 2:19 PM on August 2, 2016 [4 favorites]

It is fine to seek drugs. It is fine to ask about drugs. It is fine to initiate conversation about drugs.

If you're not walking in instantly asking about a drug with high street value (I get my xanax generic for $5 at Target, it's literally worth pocket change on the street; nobody's down on the corner hissing "Zoloft Celexa Wellbutrin" at passerby) like Oxycontin or Adderall*, nobody's going to think you're scamming or a bad person. Outside of yearly physicals, nobody goes to the doctor because nothing's wrong - if you're there, there's a reason, and you can say so. And if your doctor isn't interested, find another doctor.

*If you feel you have AD(H)D, do ask for testing first, don't just go in asking for drugs. That one's tough right now.

You can get a standing order for antidepressants at urgent care, if that's the only easy place for you to get to. You can get them at Planned Parenthood regardless of your sex or gender.
posted by Lyn Never at 2:34 PM on August 2, 2016 [3 favorites]

Your doctor seems a little sketch for not already referring you to a mental health specialist, and if it's relatively simple you might benefit greatly from switching to another doctor, one who you communicate with better.

But it is great that you want to take control of this yourself and something that should be relatively simple. Ask your doctor to refer you to a psychiatrist for a diagnosis if you need to get a referral for insurance purposes. They shouldn't give you any difficulty about this - if they do, that is an absolute dealbreaker. If you don't need a referral, you can just call a psychiatrist's office directly and set up an appointment.

If you're unsure what to say, go with something like "My anxiety, depression and OCD are probably no worse than they ever were - I'm day-to-day very functional - but my coping tools and strategies are working a lot less well than they used to." They'll take it from there.

You'll probably see a psychiatrist for a longer session first to get your mental health history, and they'll suggest a treatment plan, which will likely involve some medication. You can definitely bring it up, too, and it won't be seen as drug seeking. It will be seen as you being an informed adult wanting to take charge of their own health. Seriously, don't worry about that.

I'm not sure if those genetic tests are currently worth it - my psychiatrist mentioned them last year when I first started on an SSRI but she said they were about ten years off from being effective. In cases of anxiety and depression it seems like side effects make themselves known fairly quickly, like, within a month or so, so it shouldn't take too long to find the one that works for you. If you have something else going on though then the meds question gets more difficult. That's where a complimentary treatment plan involving therapy, medication, and lifestyle adjustments come into play, so you have support while the meds issue gets ironed out.
posted by Mizu at 2:35 PM on August 2, 2016

Am I missing something? You said you're taking Xanax; you're already on anxiety medication. The question is not "how do I get anxiety medication?"; it's "how do I determine what's the best anxiety medication for me?".

If the Xanax is not enough, talk to your PCP about that. She might be leery of drugs, but she's willing to prescribe Xanax for you, so maybe she's willing to do other stuff as well. Have a conversation with her, be sure to go into detail about how your non-pharma coping skills aren't working as well as they used to, and mention that you might want to look into getting a referral for a psychiatrist.

The key to not coming across as drug-seeking is your tone. If you say "I want drugs, so you need to refer me to a psychiatrist who will prescribe something for me", you'll come across as a lot less legitimate than if you say "here's how I'm feeling; what do you think is best?"

And listen to what she says. Yeah, she might just be like "well, I don't like psychotropic drugs so you're SOL". More likely, she has a reason not to. They're powerful drugs that affect brain chemistry, and they have powerful side effects. Most people use psychopharmacology as kind of a last line of defense when nothing else works. They're also easily abused. But they're widely advertised as kind of a magic bullet, so doctors are accustomed to patients requesting them even when unnecessary. It's probably less the case that she is anti-drug than that she wants to make sure that's the best treatment for you. This is why you need to go into detail and explain that you didn't just call her up after seeing a full page ad in Golf Digest. This is something you've struggled with for a while, you've seen therapists before, that isn't working, etc.

Are you a student at UofM? Their counseling center is generally considered the best in the country. If your PCP really is unwilling to do anything other than Xanax, try talking to someone there. At the very least, they can steer you in the direction you need to go.
posted by kevinbelt at 2:36 PM on August 2, 2016

My experiences with getting anxiety/depression medication is to unintentionally wait until I'm suicidal and then go into my PCP's office and tell him that I am suicidal and boom, prescriptions appear. I do NOT recommend this approach in terms of waiting until you're in crisis mode, of course, but your PCP should be a good first line of defense if you aren't suffering from a complex mental health issue. The other nice thing about going through your PCP is that they will generally be much easier to get ahold of; every time I have tried switching to a psychiatrist I have faced a multiple-months-long wait for an appointment and that has just never been reasonable for me.

If your PCP is unwilling to prescribe something ask them for a referral to someone who will, and look for a new PCP. Anxiety and depression meds are so common these days that any halfway decent PCP should be comfortable working with them.
posted by joan_holloway at 2:40 PM on August 2, 2016 [2 favorites]

Oh, and yes, if you are a student at UMich, absolutely go to their counseling center. That is actually where I first was prescribed an SSRI! They have nurse practitioners who handle the prescriptions and then you need to also see one of their counselors for therapy on a regular basis to maintain the prescription. I found it really helpful as my first time dipping my toes into that world.
posted by joan_holloway at 2:42 PM on August 2, 2016

If you aren't a student, is your PCP in the U of M system? If so, try to get a referral to see a psychiatrist at the Depression Center . If your PCP won't give you a referral, change PCPs immediately.

Although your PCP can legally prescribe medication for depression and anxiety, a psychiatrist will know a lot more about the various medications and will follow you more closely.

If you MeMail me, I can recommend a psychiatrist at the Depression Center, but finding a personal fit matters, and I can't guarantee that he'll be a good fit for you. Plus there will probably be a long wait to see him.
posted by FencingGal at 2:47 PM on August 2, 2016

You want a psychiatrist. In my experience, PCPs will often prescribe psychiatric medication, but only if it's relatively simple. Once you start talking about titrating doses and trying various medications and combinations of medications, you are really in the jurisdiction of psychiatry. Ask your PCP for a referral. If they won't give you one, fire your PCP and get a new one.
posted by Anticipation Of A New Lover's Arrival, The at 3:49 PM on August 2, 2016 [1 favorite]

It would probably be good to find a therapist to help you work through this stuff. A therapist can diagnose you and refer you to a psychiatrist. As many therapists will tell you, meds work best together with therapy.
posted by the_blizz at 4:13 PM on August 2, 2016

Yep. Both times I got on anti-depressants (IANAD):

1. Made an appointment with my PCP to discuss my symptoms which I felt were related to depression. (Digestive problems, unmanageable fatigue, mood swings, appetite swings, difficulty controlling my weight in my case.)

2. During the appointment, ask directly if these symptoms could be related to depression.

3. Doctor asks me questions about my symptoms.

4. Doctor prescribes a low dose of anti-depressants and behavioral therapy, and asks me to make a follow-up appointment to monitor my response to the medication.

Source: right now I'm on a low dose of Zoloft and it has helped me a lot. I am also seeing a therapist and my co-pay is low because of my diagnosis.

If you feel your PCP is not listening or responding to you in a helpful way, get a second opinion and consider switching.
posted by Pearl928 at 4:18 PM on August 2, 2016

Echoing everyone above who says you should see a psychiatrist. Anxiety and depression can be huge hurdles to tackle without medication, especially if you have very bad anxiety. You want to secure a good psychiatrist who can follow you through that journey, and be talking to a therapist while it's happening if you can afford both, so that you get a sense of what is helping, how you can manage both conditions as the medication reduces your symptoms, and other changes you can make to make your life easier that don't involve medication.

You may need to try more than one medication before you find something that is effective for you, or that really improves your condition -- that's normal. Sometimes you have to try more than one kind of medication together. It's important to ask a lot of questions, be a bit skeptical and also believe in your doctor a bit too.

I had to try about 8 different drugs before I found a combination that worked for me. At different points in my journey, I had to use short-term medication (like benzodiazapines) to reduce my anxiety immediately and manage panic attacks, as well as try different long-term medications to help me get to a sustainable point. I couldn't have done that with a PCP, especially because there were many medications I didn't respond to. Everyone is different and you might need to be more persistent than others to find the right medication for you.

At another point, I had two bad psychiatrists who did not listen to me when I objected to taking a medication that he thought would improve my depression, because one of the side effects was appetite suppression (I have an eating disorder and did not need or want any more encouragement to avoid eating). I eventually realized that if they weren't going to listen to me, I should get a new psychiatrist. And you should do the same. There's a balance between knowing what you need and want, and trusting your doctor; therapy will help you figure out that balance, and a good psychiatrist will ask enough questions that you will feel comfortable with their judgment.
posted by mmmleaf at 4:32 PM on August 2, 2016

Just wanted to add that I find it difficult and time-consuming to find and make appointments with psychiatrists. Though that very well may be your best longer-term option, in the short term, explaining this to your PCP should result in trying standard low-dose anti-depressant. PCPs seem to like that you are looking or receiving other assistance though such as a therapist. You may find that a low-dose helps you to make the next steps (and steps and steps) to make an appointment with a psychiatrist and/or a therapist. Don't delay. Help yourself. Find another PCP today. (Yes, I sound like Dr. Suess, himself.)
posted by RoadScholar at 7:11 PM on August 2, 2016

Psychiatrist! Both times I was referred to a psychiatrist, it was by a therapist who said "hey, I think you'd benefit from medication too." But you don't need to be in therapy to see one. In my experience, it's common for people to see psychiatrists solely for medication management, so a psych is totally not going to get judgey if you make an appointment and say "hey, I want drugs" because that's what most of their patients are there for. They may suggest other forms of treatment as well, but they probably won't steer you away from medication.
posted by Metroid Baby at 7:41 PM on August 2, 2016

In my experience (and in a household of 4, at one point every single one of us had a prescription for Wellbutrin, among an assortment of other things, so it's not an inconsiderable amount of experience), a psychiatrist is a better bet to start off with figuring out what works best for you, as PCP's tend to be familiar with/comfortable with one or two common antidepressants and perhaps one or two benzos, but that's about it.

For all practical purposes, everyone going to see a psychiatrist these days is going to get medication. A good psychiatrist will encourage you to see a therapist as well if they think it would be helpful for your situation (and a small handful of psychiatrists do therapy themselves). But yes, everyone in the waiting room of a psychiatrist's office is drug seeking, in the sense that they're there for medication management. Call up the office, and ask for a new patient appointment.

I know there's a lot of shame and stigma wrapped up with mental health and level of functioning, and I totally get the fear you may have that you'll walk into the office and the doctor will say, "there's nothing wrong with you other than your being a lazy pathetic screw-up--thus you don't need drugs, you are just need to stop being such a screw up." But that is not going to happen, and media reports our "overmedicating" ourselves for the slightest mental hangup are greatly exaggerated. It's actually far more common for people to not seek treatment when they need it than to seek treatment when they don't. In other words, if you think your level of functioning is such that you could benefit from medication, a psychiatrist will very likely come to the same conclusion.
posted by drlith at 8:43 PM on August 2, 2016

If you're not walking in instantly asking about a drug with high street value (I get my xanax generic for $5 at Target, it's literally worth pocket change on the street; nobody's down on the corner hissing "Zoloft Celexa Wellbutrin" at passerby) like Oxycontin or Adderall, nobody's going to think you're scamming or a bad person.

No one should think that you're a bad person, obviously, but doctors do often worry about red flags with people who ask exclusively for benzos like Xanax to manage chronic anxiety, because there is a possibility for addictive behaviors with them and they can create major risks if combined with alcohol, which is often also used by people with addictive behaviors. So you may be getting pushback on Xanax due to physicians having fears about prescribing a short-acting medication with a high potential for problems for a long-term chronic condition (which is different from having a few Xanax on hand to help manage acute panic attacks, or to get someone through a week or two before a longer-acting medication becomes effective).

It sounds like you want something that is longer-acting, though. I think, generally, as long as you go into a psychiatrist's office with an open mind about what might work (obviously paying attention to anything that has or has not worked in the past, and to any side-effects that would be dealbreakers), rather than saying, "I'll only take X medication" (without really, really good reason), reasonable doctors should be willing to work with you.

And I agree that if you're hesitant to ask your PCP for help managing your health, she may not be the best PCP for you.
posted by lazuli at 5:37 AM on August 3, 2016

Not only are psychiatrists open do doing prescriptions, they almost exclusively do prescription, as insurance has increasingly drawn a bright line between psychologists and psychiatrists, paying one to do talk therapy and the other to prescribe medication. Your fastest route to the medication you're interested in trying is to just make an appointment with a psychiatrist. If your insurance does not require referrals for specialists, you should just do that. If your insurance does, be sure that there isn't an exemption for mental health - sometimes there is. If there isn't, the thing to do is first find a psychiatrist, because a lot of them don't take insurance (at least in NYC where I am) so all these hoops may be unnecessary.

If you find a psychiatrist who takes insurance but you need a referral, call your PCP's office and ask the receptionist for one. Most PCPs that I've run across recognize that our current health care system requires a lot of referrals, and that their practice would be unsustainable if they actually had to see each patient before issuing one - you can probably get a referral without even talking to your current doctor.
posted by Ragged Richard at 12:31 PM on August 16, 2016

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