When is it time to see a physician for anxiety?
September 22, 2017 8:13 PM   Subscribe

Difficulty Level: Canadian with no family doctor. For my entire life, I guess, I've really struggled with anxiety (probably depression), excessive worry, low-self esteem, and so on and so forth. I have had a rough year and my situation right now is really not... ideal. I am seeing a therapist, but I am having soo much anxiety. Is it honestly time to see a doctor for some sort of medication? How do I proceed without a family doctor?

Even the idea of finding a family doctor, which I've heard is notoriously difficult in my province (Alberta), gives me anxiety. I do have access to a large university clinic, can I just see a doctor there? How does this process work in Canada, where you just can't go see a specialist? What do I even say to a doctor? Will they think I'm just there for... drugs?

I really struggle with excessive worry and and anxiety. I actually don't have panic attacks, but when I get into an anxiety spiral it lasts for hours. I can feel my heart palpitate, I feel tingly, I want to throw up, I sweat, etc. Deep calming breathing as recommended through therapy does not work at calming me down. Therapy has helped me see the bigger picture, but the day-to-day anxiety is still there. I'm starting to think I need help beyond therapy. How do I know when I should even see a physician for something like this?
posted by modesty.blaise to Health & Fitness (11 answers total) 2 users marked this as a favorite
What you're describing sounds just like a panic attack. If you're spending hours feeling like this, it's definitely time to see a doctor and examine options for further treatment. As far as what to say, your last paragraph is perfect- print it out and take it with you. I don't know about doctor finding in Canada, but I will say that most GPs are not going to see you as drug seeking as you have a history with your therapist. Perhaps your therapist can help you find a GP?
posted by PorcineWithMe at 8:22 PM on September 22, 2017 [1 favorite]

Response by poster: I think I always thought a panic attack was something different. Like an urge to leave the room or hyperventilating? I just sit there feeling anxious for hours with a sick feeling in my stomach, okay... maybe I've always underplayed my symptoms and never understood what a panic/anxiety attack was.
posted by modesty.blaise at 8:28 PM on September 22, 2017

I think your instinct to see a physician is a good one, and you have a couple of options.

Firstly, to find a family physician, you can try search The College of Physicians and Surgeons of Alberta's website, where there's an option to find info on physicians who are accepting new patients:

Alternatively, you can go to any walk-in clinic in your city. This is absolutely something a walk-in clinic doctor should be able to deal with themselves or make you a referral for.

To find out about walk-in clinics in your city or about other local resources - or just to get answers about the process - you can call 811 at any time of the day or night to talk to a registered nurse about the most appropriate health care option for you.

Alternatively, you can also try Access Mental Health Alberta at mental.health@albertahealthservices.ca or 1-844-943-1500 to talk to a clinician who can discuss your options and help refer you appropriately.
posted by haruspicina at 8:39 PM on September 22, 2017 [3 favorites]

If Albertan University Health Clinics are at all like the ones in Ontario you should be able to just call and make a doctors appointment, and they will probably have an on-staff Psychiatrist. You may be able to make an appointment directly with the Psychiatrist or you may need to see one of the regular doctors first to get a referral. I would expect your University's health clinic would have a web site with information about the health services they offer, including mental health services, and how to book an appointment. Your school's Disability/Accessibility Services might also be a source for information on supports available to you.

The University Clinic may tell you that there is a waiting list to see the psychiatrist, so if your situation is urgent tell them that so they can expedite your appointment if they are able.

Examples of the type of web pages you should look for (from my local university): Queen's University Health Services and Accessibility Services.

Most psychiatric drugs aren't "fun", so unless you walk in asking specifically for benzodiazepines (or something similar) I think they're unlikely to think you're a "drug seeker".
posted by Secret Sparrow at 9:13 PM on September 22, 2017

IANAD. I have a generalized anxiety disorder Dx. What you are describing is what I experience when I'm unmedicated and having an anxiety attack, if not even more intense. I have found medication (bupropion+gabapentin+klonopin) to be extremely useful in terms of allowing my level of functioning to stay more level with minimal negative side effects. Other people have different experiences - no one can offer any guarantees, and sometimes it hurts more before it hurts less.

But I'm pretty sure it can be made to not to hurt so much as you're describing. I don't know about accessing psych care in Canada, listen to others there. I just want to tell you I've been able to obtain relief from the pains you list through the medical system.
posted by PMdixon at 11:05 PM on September 22, 2017 [2 favorites]

Chiming in to agree that it's time to see a doctor. Also remember that most meds used for depression and/or anxiety can take months to really work. So you might feel better in a week, but more likely you'll have to give it at least 6 weeks, sometimes longer, to really see an effect. It might also be a bit of trial and error, at least at first, to find something that works for you without intolerable side effects.

Ideally you have a longterm daily med to lessen the baseline anxiety, then if the anxiety attacks are still there, add a short acting rescue med. (Some docs reverse this process by starting with the as-needed med, but if you have everyday low level anxiety that sometimes bubbles over, it's probably worth starting by turning down the heat.)

Best of luck!
posted by basalganglia at 5:04 AM on September 23, 2017

I think that seeing a doctor is a great idea. I would just be cautious about medication and make sure that you are being your own advocate. Sadly, the only thing that most doctors know how to do is write out prescriptions. I would be VERY VERY VERY careful in regards to daily benzo use. I learned this the hard way. I don't mean to make you more anxious, but I just don't want to see you do worse than you are doing now.

I would also make sure that you are addressing all of the other things: diet, exercise, sleep etc. Meditation is also good. A good therapist would also be high on that list.

Please feel free to message me if you need to .

Good Luck!!!!!
posted by kbbbo at 6:12 AM on September 23, 2017

If it's any comfort re. your fears they'll think you're "just there for drugs" - based on your question, I would say the right time to see your doctor was several years ago, if this has been going on your entire life! But of course it's never too late. Go do it now.

If you think they're going to give you the side-eye as a "drug seeker", you may be vastly underestimating the number of people with mental health problems like this doctors see in the course of a day. It feels extreme and awkward for you to ask for medication because you've never done it before, but they prescribe mental health medication all the time.

(On preview: There are plenty of other anti-anxiety med options other than daily benzos. YMMV but UK GPs in my experience will only prescribe benzos for short-term or occasional use because of their addictive properties, but there are plenty of other things that can help).
posted by penguin pie at 7:07 AM on September 23, 2017

Even the idea of finding a family doctor, which I've heard is notoriously difficult in my province (Alberta), gives me anxiety.

Awww I am so sorry you are going through this. It may be helpful to know that one of the side effects of living with anxiety is that it can be hard to seek treatment because of... anxiety! Sucks. I finally jumped through all the hoops (I am in the US) and was very happy I did. Congrats on you for seeing a therapist and thinking about taking the next step. I can't offer Canada-specific advice but I'll tell you what worked for me medswise.

1. The key when you talk to a doctor is telling them that you are already seeing a therapist and that the anxiety is negatively affecting your life. Just what you said here. Make sure you're doing all the other stress relievers somewhat (cutting down on caffeine, decent exercise and sleep, etc) and explain that isn't working.
2. Many meds take a while to work but one of the reasons people like benzos is that they work very quickly. So don't convince yourself that anything is going to take months. It may not.
3 Regarding benzo, they can be habit forming. That said, not everyone has this reaction to them. I have benzos for when my anxiety gets very bad and am able to take one (or a half of one, maybe for a few days) and then stop. Make sure you are being mindful about whatever meds you take, but do not stay 100% away from benzos because you are afraid. There is a good chance that whatever they give you, you will be afraid to take it at first. This is, weirdly, normal.

In the meantime, between now and then, you may want to look into some mindfulness/meditation things to help you ride out a panic attack. Just learning how to see your feelings and reactions without being alarmed by them. It's only one tool in your toolkit but it may make the next few days/weeks more palatable. I am sorry you are going through this.
posted by jessamyn at 7:33 AM on September 23, 2017 [1 favorite]

Discuss the issue of getting a doctor with your therapist. He or she might have referrals or tips on best local treatment options, and definitely can support you through treatment.
posted by crazycanuck at 9:28 AM on September 23, 2017 [1 favorite]

I'm also a Canadian with no family doctor (BC, though I used to live in AB). All clinic GPs I've ever seen (both a university clinic and normal walk-in) have been totally willing to manage mental health problems, including medication. Because so many people, especially young people, don't have enough a family doctor, they do this all the time. I tend to like young doctors better for mental health, and lots of them work in clinics. The most likely thing is that they will prescribe you an SSRI for your ongoing lower level anxiety, but they should also be willing to prescribe a rescue medication for when your anxiety is overwhelming or when you have panic attacks. They may not do the latter until the clinic has seen you more than that first time. Often, when SSRIs are prescribed they will do 2-4 week follow-up. If they don't do this, you should do it (aka go in again) and discuss whether medications are working.

Like was said above, you should definitely emphasize all of your other strategies (lifestyle and therapy) and how long you've tried them (years rather than weeks or months). Bring a list in case you get flustered, and keep notes when you are there.

The downside of clinics is having to do more advocating for yourself and knowing what your goals are. Because you may not see the same doctor every time, you may have to recount to them in some detail what your history is (though they'll have it in your file). At the university clinic I used to go to, you could request doctors, so I stayed with the same one so long as I thought they were doing a good job.

Obviously, having a psychiatrist manage medications would be great, but my experience in BC is that waiting lists are really long (like, many, many months) even in the university clinics, and even for people who are in far, far worse shape than you are. Still worth a shot, but most people I know with anxiety like yours have it managed by an experienced GP.
posted by lookoutbelow at 6:44 PM on September 23, 2017

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