Preparing for a doctor's appointment re: anxiety.
May 15, 2017 10:38 AM   Subscribe

The medication I've been taking for my Generalized Anxiety Disorder (GAD) is no longer working. My PCP and I are working through our options, but I'd like to get the hive's advice to help me prepare for our next appointment (which is tomorrow morning). My PCP is wonderful and she brings her own ideas to the table, but she also encourages me to take an active role in my health. Yes, I am in therapy; this question is really just about the medication side of things.

Some background:

* I was on 20mg of fluoxetine (Prozac) for about 15 months. For the first year it made my anxiety manageable and was truly life-changing, but it no longer works. We tried a higher (30mg) dose of Prozac, but that had no effect.

* I tapered off of the Prozac and am now on 50mg of sertraline (Zoloft). I've been taking it for about 10 days and feel no different at all, maybe even worse at times. (I know SSRIs take time to work.)

* I take a little dose (0.25mg) of alprazolam (Xanax) as needed. I have been taking it more often than usual over the last couple of months, but my PCP metes it out in 10-pill prescriptions and I feel confident that I'm using it safely and responsibly.

* Before starting the Prozac, I was on buspirone (BuSpar) for about six months. It had a very small positive effect and I discontinued it once I started the Prozac.

* I also take amitriptyline (Elavil) for migraine prophylaxis. I had been on 10mg for a couple of years, and my PCP upped this to 20mg last month. It helps me sleep which does help my anxiety a bit.

* My TSH and CBC were checked in late March; both normal.

The anxiety:

* For the past two months or so, I've been extra fidgety. I almost always feel like my heart is pounding / about to explode.

* For the first time in my life I've been having panic attacks, mostly characterized by hyperventilation that lasts for 10 minutes or less.

* The only new stressor in my life is a new relationship (we've been dating for about 3 months). I really like him and that scares me.

So, my question: Should I keep trying the Zoloft? If so, how much and for how long? Is it time to try an SNRI? Are there other things I should be asking about?
posted by schroedingersgirl to Health & Fitness (13 answers total) 1 user marked this as a favorite
Best answer: Print out your post and questions and take two copies to your appointment. It will help you stay on track.
posted by Carol Anne at 10:49 AM on May 15, 2017 [7 favorites]

PCP's aren't always the best folks to be exploring mental health medications with, just because it's not their specialization. I would ask for a referral to a psychiatrist. The more things you try, and the more specific you get with things not working (or working really well), the more you need a specialist.

However, the wait to find a (good) Psychiatrist can be really, arduously, superfucking long, so keeping in touch with you PCP until you have a Psychiatrist lined up is a smart move.
posted by furnace.heart at 11:02 AM on May 15, 2017 [5 favorites]

Yep, I was also going to suggest a referral to a psychiatrist as well, preferably one who specializes in anxiety disorders. Your history sounds like it's getting complicated and your anxiety worse (now having panic attacks).

As furnace.heart mentions, hold on to your PCP as a prescriber until you have a psychiatrist lined up, I'd go even further though and suggest that the fact that you've consulted with the psychiatrist doesn't mean you have to take their advice. After your first meeting, if you're not happy you can go back to your PCP and/or on to another psychiatrist. Sometimes you click, sometimes you don't.
posted by Jahaza at 11:07 AM on May 15, 2017 [1 favorite]

I agree you should see a psychiatrist or psychopharmacologist in the near future. For now, just write down your history and your questions. Make sure that when you take notes at the appointment, read back your notes to the doctor to confirm they match what they said. (This is good practice for all doctors appointments!)
posted by radioamy at 11:19 AM on May 15, 2017

Best answer: IANAD, but a patient with similar issues.

In my experience, 10 days is not enough time to judge Sertraline's effectiveness. That said, IIRC, that is also the rock-bottom dose, and there is much room for elevating.

Also, I have used Ativan rather than Xanax as a supplement and found it works well. Perhaps worth considering.

EDIT: As others have said, get with a psychiatrist ASAP.
posted by DrAstroZoom at 11:20 AM on May 15, 2017 [2 favorites]

Best answer: * For the past two months or so, I've been extra fidgety. I almost always feel like my heart is pounding / about to explode.

* For the first time in my life I've been having panic attacks, mostly characterized by hyperventilation that lasts for 10 minutes or less.

Beta blockers help me a lot when I have these sorts of attacks that are characterized more by physical symptoms than actual thoughts. They aren't good enough alone to fix anything completely, but they help for those times when it feels like my nervous system is just turned up to 11 and needs to be cranked back to a 7 for other stuff to work.
posted by Sequence at 11:23 AM on May 15, 2017 [1 favorite]

Best answer: The only new stressor in my life is a new relationship

Not really joking: do you live in the US or the UK? You may have an additional new stressor in your life.
posted by Lyn Never at 11:57 AM on May 15, 2017 [7 favorites]

Best answer: Do you talk to your therapist about your medication? If you see them regularly, they should have decent insight into your situation, and whether the stressors you're experiencing are in line with the anxiety you're feeling.

My psychiatrist is also my therapist. It took me a while to figure out how to balance "fix it with therapy" and "fix it with medicine" in our discussions. But the general idea is that medication should keep me stable enough that I can articulate my emotions and needs in therapy. If I'm having physical symptoms, but no emotional symptoms, I'm over medicated. If I'm flooded by emotional symptoms to the extent we're going in circles, I'm under medicated.

Obviously there's a bit more nuance. Some medications exacerbate certain symptoms more than others, so a psychiatrist will have more experience in how to retool your regimen.
posted by politikitty at 12:50 PM on May 15, 2017 [1 favorite]

Best answer: While waiting for psychiatrist appointment, Ask doctor about increasing the Zoloft; it can be increased by 50mg every week up to 200mg.
posted by SyraCarol at 7:01 PM on May 15, 2017 [1 favorite]

Best answer: SSRIs make it worse before they make it better. It can take a few weeks to even out. You need to give it more time.
posted by Amy93 at 7:52 PM on May 15, 2017 [1 favorite]

Response by poster: Thanks, you guys. Some really useful ideas here!

We've decided to try the Zoloft for another two weeks, at an increased dose of 75mg/day. Fingers crossed!

Re: a psychiatrist, my PCP volunteered today to refer me to one if the Zoloft isn't the ticket. She has been practicing for over 20 years and has been de facto specializing in mental health, specifically anxiety and depression, for most of that time. I'm hoping to continue working with her directly but will absolutely take her advice (and yours!) to see a psychiatrist if it comes to that.
posted by schroedingersgirl at 6:35 AM on May 16, 2017

Please go see a psychiatrist. You need a true specialist in psych meds, not a GP/PCP. Playing mix and match with SSRIs and tricyclics is dangerous. Seratonin syndrome is miserable and can be life threatening.

You need and deserve more help.
posted by monopas at 3:59 PM on May 16, 2017

Best answer: Hi, it sounds as if you have found the right therapist/doctor, and I will share my story in case it sheds any other light on your life also!
I have been taking Wellbutrin,( or the generic BuPROPion XL 300 mg. TER), for years now and it has been the best move I ever made,. I had never taken anything in all of my 45 years, for mood, pain, depression, besides aspirin and general OTC Ibuprofin. We had just before this period of time, moved out of state to a beautiful house we re-did, but in a town that was not accepting of outsiders, (I am serious). This situation became more than I could handle, and usually I am very insightful as well as stable/balanced mentally. It caused crying- literally hard crying daily for 6 months. My new M. D. automatically recommended I start on an anti-depressant right away- no one should suffer that long as much as I did. Depression, it has been researched and found, left un-checked for as long as months to a year even may be a possible threat to you as it will not be easily changed - the brain becomes different in some ways I cannot describe, but your doctor will understand this.

It was not the Wellbutrin I was on at first , but like you, I tried several different ones before I asked my psychiatrist for it by name. The others were not working even after trying them for a few months each. I knew a lot about it, and she was agreeable. It does not begin w/ the full dose; it gradually is increased, and cannot be skipped or forgotten even one day, thus it is not recommended for someone who is not reliably keeping track of the medications they take, or for example an alcoholic. It is now used as well for raising one's libido, and assists smokers as they are working on stopping- it actually helps the person quit.

Does everyone not understand that a psychiatrist normally will not spend in-depth time on a regular basis?? They may do an hour long in-take and follow up with your other doctors, scheduling you for weekly sessions, but they only actually prescribe drugs; a good, experienced M. S. W. or a therapist w/ a Masters or PHD in psychology at the very least makes a great therapist as they are more about taking their time with you for purely talking and listening; it doesn't take a rocket scientist to see your problem if you it is definite what your present diagnosis is now, so take it and change up medications,(realizing of course that you DO have to give them each about a month trial of taking one to be sure an anti-depressant is helping! ), if you like, but please do find a good therapist you can talk to, alongside whoever is prescribing as part of your "treatment team".

I have worked alongside psychiatrists during my years working in mental health , and found them to be honest, no one I would want to be counselled by; then, having been a patient with 2 different ones I tried for awhile, really were both very negative, off-course w/ diagnosis, non-helpful, quick to criticize and judge me, which was outright weird and probably should have reported them. Most that I have met are the same way. 90% of the ones I worked with in helping w/ therapeutic group therapies, one-on-one session feedback that I was reading as I was an assistant on the team, and seriously found that basically truth is many of these guys have some mental illness themselves, and got into the field perhaps for their own self-analysis. I know that these people are perturbed with me by saying this. I am not saying they are all this way, but really do consider yourself very blessed if you are with someone that is truly in it for you!

I have found one now, finally, who is a great listener, helper, compassionate, and works w/ many successful medications; I believe this is because his primary work has been with addiction. He has worked with hundreds of patients even more- he is over 60 years old, and has no goal of stopping because he loves his work. This is rare! We consider ourselves to be in our prime, with experience and knowledge that younger people cannot have yet. I am very active, love life, and needed someone to help sort out medication for myself. I was lucky as a friend of mine told me about him. If you are not pleased, talk to friends and get real answers about who to go to!

People do not like to prescribe this, but the only drug I have had success with for my own anxiety disorder is Clonazepam. If you can at least get someone to prescribe 2, or 3, 1 mg. tablets per day (they won't do it if it interacts with a Benzo you are taking),or even ask for half that amount, taking it in the a.m., mid-day, and at bedtime you will possibly find success. I did. I have no side effects, nor do I become drowsy or sleepy! I have had to drive my children, do housework, volunteer work, and study so I wanted to continue to move forward in life. I would not touch many drugs out there, including Valium or other calming medications, and remember- it is true that if one truly is in pain, or suffering a real problem you are not an addict. For centuries now we have been fortunate to have discovered many life-saving, and life improvement medications. It will be up to you to seek out the proper way to handle this w/ help from your team, and not abuse a medication. It means the end of it!

Unfortunately the F. D. A. has cracked down on doctors and who can prescribe, how many people they may prescribe for, etc., due to the high level of addiction in the U. S. today. Sadly this is not good news for ones like myself who lives with daily pain. My doctors know me now; I worked w/ one M.S.W. as a recommended by a friend,again!, who saved my life when I was going through a rough patch, and continued on with her as a therapist and an energy worker; she is also a Light Energy Worker, licensed, and a powerful one , as I knew she was a true healer as soon as she touched my ankles, working without massage and usually I put an eye pillow on, covered w/ a blanket--or more than a light touch on my next the knees, to my stomach, throat and neck, forehead where our Chakra is, known in yoga and recognized by many ancient ones and passed on now, as our Third Eye, ending at the Crown of my head, or last Chakra which is our connection to all others and to God. It incredibly changed my life. I was still doing yoga daily, seeing my doctor, and it all came together.

It seems if I must change doctors, due to moving or when my chronic situation with my spine acting up, the whole circle of why and what I have been taking happens. That is when YOU must be pro-active, they will think you are defensive if you have taken a drug successfully and that helped you like the Clonazepam, so be ready, do your homework, talk to other patients and how they live their lives beautifully with the help of a medication that frees them and allows you to be a more balanced, happier, healthier person.

Best of luck to you! It does no harm to go on to this person and mention the 2 medications I have here; Wellbutrin is a wonderful medicine, developed 2 decades or so ago by Burroughs Welcome Company, (a 100 year old British home based company, bought out by Glaxo awhile back), as a very successful treatment in most cases appropriate for depression, and had great clinical trials,approval by the F. D. A. and it has gone on as I mentioned to be successful helping others with their situations.
posted by Journal for Journeys at 7:47 AM on May 19, 2017 [1 favorite]

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