How to talk to a doctor about anxiety?

February 28, 2021 6:50 PM

After years of putting it off, I made an appointment to see a doctor about my anxiety this week. What should I say to the doctor? What is it like to see a doctor for anxiety? More questions inside.

I had a bit of an aborted attempted to get my anxiety treated last winter. I had an initial appointment with this same doctor, got some blood work done, but due to my mother's health issues/moving to a new city/the pandemic/anxiety... I put it off.

After having some unbearable anxiety since Wednesday, I decided to make an appointment with the same doctor to continue where we left off.

What exactly do I tell a doctor about my anxiety? I've always had some sort of general/social anxiety. It's permeated every area of my life since I've been in my mid-teens. I've been getting more anxiety spirals lately about, honestly, stupid things.

For example, what set off this week's anxiety spiral is waiting for a reply from our accountant about doing my mothers' & my taxes this year. I sent him an email on Wednesday and he hasn't replied yet, so naturally my anxiety brain is working overtime thinking that my accountant is ghosting us! Then I get anxious about finding another accountant, or doing our taxes myself... like, LOGICALLY, I know that both of those options are pretty simple. LOGICALLY, I know that he'll probably reply! But I've been having awful anxiety about this, it's ridiculous. My body feels tense, I'm irritable, I've barely had an appetite, etc. (It's better than it was on Wednesday, but still.)

I'm in therapy and I feel like it's been very helpful, but I think that medication of some sort is necessary. I can only get "so far" without it.

But then it scares me to imagine being on medication FOREVER. Can I also ask for a referral to see a psychiatrist? It worries me to have psych meds managed by a GP, due to their training. A psychiatrist would surely know more about managing medications for depression/anxiety than a GP. I'm in Canada, so I have no idea how this works.

I feel dumb seeing a doctor about anxiety because, deep down, I worry that they wouldn't be able to understand the effects that this has been having on my life. Doctors have to be able to push through so much shit to become a doctor... how could they understand the ridiculous amount of anxiety I'm having about stupid shit like an accountant emailing me back?! I'm afraid that they'll be unsympathetic. What do I tell them? I feel so embarrassed.

posted by VirginiaPlain to Health & Fitness (12 answers total)

You don't need to be on medication forever - sometimes being on the meds can help get your thinking calmed down enough that your brain can then take advantage of therapy to learn how to work differently, at which point you can come off the meds and still function. (That said, some people brains seem to be wired to favor anxiety and they find it helpful to stay on meds to keep their brain functioning the way it should) Point is you won't know until you try and find out. And maybe even try for a while and then go off the meds and see what happens. But you definitely are NOT making a life long commitment just to try them.

When you do see the doctor, it is helpful to be able to talk about how the anxiety is impacting your life. For example, here is a common assessment for generalized anxiety. Please note that the scale is says "most days" or "nearly every day". It does not require that these symptoms happen all the time every day, but rather they are showing up. Moderate anxiety would be five out of seven showing up at all on more days than not or three or four occurring at least a little bit on most days. It actually seems pretty easy to get a high score without being THAT anxious but reality is that is all it takes for professionals to think that it is worth doing something to help.
posted by metahawk at 7:01 PM on February 28, 2021 [3 favorites]

I’m sorry you’re having such a rough time! I have a few thoughts that might help.

I’m not Canadian so I can’t speak to GP vs a psychiatrist. I have my medication managed by a psychiatrist because that’s all he does all day. I feel like a psychiatrist might feel more comfortable if I need an unusual combination of medication- and lo and behold I do...

According to my physician assistant friend who is in primary care they see this all the time. All the time. It is not just you!

I would not worry about having a “simple” problem that you feel you should had overcome. I’m an allied healthcare provider and I love it (love it!) when I’m actually able to help someone even if the solution is rather straight forward. So, think of it this way: you are presenting your doctor with the opportunity to “win” by having a problem they can help you with!

The doctor **might** give you a brief written questionnaire to assess your anxiety (this is common for depression at least). If you can give an example of how your anxiety has impacted your life all the better. Hey, you could just print out what you wrote above and hand it to your doctor.

Would you feel more comfortable if you wrote something out and brought it to your appointment? You could write out questions/concerns and/or medical history. That way you have something to fall back on or hand the doctor if you really don’t feel well during the appointment. I did that when I got really depressed, my doctor was out of town, and I had to see a stranger. He was perfectly kind and sympathetic by the way.

As to your concern of needing anti-anxiety medication for life, let this internet stranger reassure you that I took a benzodiazepine for a while but then I felt better and asked to stop. So, no, you would not necessarily need this for life.

Also: we are in a pandemic. Be so kind to yourself!
posted by ticketmaster10 at 7:11 PM on February 28, 2021

I went on meds for anxiety, and it was such a good decision. I was in therapy beforehand too, & not making any progress at all until the meds let me feel what it was like not to be anxious all the time, & also that my life wouldn’t fall apart entirely if I stopped worrying about everything. I stopped taking medication after about a year & it wasn’t very hard to stop at all, and I still feel so much better & really really glad I did it.
I told the doctor it was affecting my ability to work & they were sympathetic.
Good luck, getting help for things when you already feel bad is kind of the hardest part, but its really worth it
posted by velebita at 7:23 PM on February 28, 2021 [3 favorites]

If it helps, I just talked to my own family doctor and a friend who is a family doctor about this, and basically everyone is showing up with anxiety right now. This is a very anxiety-inducing time! Your accountant example is a great one to share with your doctor. The advice above is excellent - I just wanted to reassure you that this is a thing that is coming up lots for family doctors so hopefully yours won't bat an eye.
posted by bighappyhairydog at 7:24 PM on February 28, 2021 [1 favorite]

If it helps, I can tell you about my experience talking to my GP about anxiety in Canada.

I told him I was dealing with a lot of anxiety and I would like to try medication for it. He asked me some questions for about 5-10 minutes, similar to some of the questions mentioned by people above. Then he said I seemed like a good candidate for medication and he wrote me a 3-month prescription for escitalopram/cipralex (an SSRI), which he said is a good starter medication because it works well for many people without many side effects. He told me to try it for 3 months and then follow up, and if it was working for me he would write me a longer prescription.

In the end, it didn't work well for me so I never followed up. I've since figured out that my issue is more likely ADHD so I've pursued a different medication path. But that's how the conversation went for me!

Just want to add -- I hope your GP is wonderful and supportive, but try not to get discouraged if they're unhelpful or dismissive. Some doctors are unfortunately not good at dealing with mental health issues. If your GP isn't being helpful, push for a referral to a psychiatrist. That said, GP's are perfectly qualified to prescribe most psych meds, so there's no need to see a psychiatrist necessarily if your GP is being helpful and the meds are working for you.
posted by mekily at 7:26 PM on February 28, 2021 [1 favorite]

Also in Canada, and I just went through this myself a few months ago with my GP. Pretty sure my exact words to him when he asked what I was here today for were “Im pretty sure im struggling with anxiety”. Then he asked me to tell him about it, I kinda rambled on about my panic attacks and how it was going to affect my work soon if i didn't do anything. Then he said i could get a referral, or have him prescribe meds. The idea of talking to yet another person seemed like way more effort than i feel I’m capable of right now so i asked for meds — I’m already on other medications for the rest of my life (and have been since my teenage years) so one more is not a big deal to me.

I was lucky the first med prescribed worked really well to start. I thought it was a friggen miracle drug. Its gotten a little more difficult since then trying to keep the effectiveness up and side effects down but i still wish I had done this years ago instead of suffering in silence! My doc has been really great about tweaking dosages and validating the side effects as real things that happen and discussing options to deal with them.
posted by cgg at 7:47 PM on February 28, 2021 [3 favorites]

First, GOOD FOR YOU for making an appointment. Getting on medication can be hard, and stigmatized, and scary.

I went on medication after being told by my therapist that it was probably time, that therapy alone wasn't doing enough for me. I went to my GP, told him what medication my siblings had tried and worked for them, and we tried that. I've been on that medication, sometimes more and sometimes less, since 2008. Sometimes I have a psychiatrist to help me figure out additional medications when I'm having a harder time, and to taper off them when I'm having an easier time.

Do I wish I could be off my base medication? Sometimes. Do I really not care? Most of the time. I could *probably* handle tapering off, but I've been stable for so long that it feels comfortable (and my doctor agrees) to stay here.

All this to say: it's ok. You're not alone. You're doing a good thing for yourself. And medication doesn't have to be forever, but it's also ok to need help.
posted by Ms Vegetable at 5:47 AM on March 1, 2021

it scares me to imagine being on medication FOREVER

Here is something to try. I find that sometimes, finding a parallel with physical health can help with processing questions about mental health, because we as a society are still not quite there yet with how we prioritise it.

Say that, somewhere along the line, you hurt your back and couldn't walk properly anymore. You sort of put up with it for a while, but it makes you grumpy and hard to be around when it flares up, and it makes life more difficult. If you go to a doctor, they might say to you, you need to do regular exercise to help it recover, but I'm going to prescribe you a painkiller to help you get on and do that. You might have to take it for a while, but if you do regular physiotherapy (and you might need to try different exercises to find the ones that help) then you will probably be able to come off it at some point.

That doesn't sound so unreasonable, right? Try it again, but this time, you're being presribed drugs so that you can do normal life for a while to try and recover, and therapy instead of physiotherapy, trying different techniques instead of different exercises.

Also, if therapy isn't quite doing it, try a different therapist or for them to try a different approach with you. There are tons out there, and they all focus on different parts of you, so it's worth trying different ones!
posted by greenish at 5:48 AM on March 1, 2021 [1 favorite]

You've gotten a lot of good answers so far. My best advice, as someone who was diagnosed with anxiety at 12 and the diagnoses just piled up from there, is to write out all your questions and concerns now. Keep adding to that list and refining it till you bring it to the appointment. Sometimes you get in there to talk to the doctor, even when you're super comfortable with them, and you just can't think of all the stuff you wanted to ask.

Then when you're there, either take notes, record with permission, or ask for a printout summary of what y'all discussed. Anxiety in particular can make you not think or remember as clearly, because you're using up so much RAM on being anxious. Having something to refer to can really help when you're trying to process what happened and how to decide what to do next.

You've got this! Sometimes the hardest part is making the appointment. Oh, and if you haven't lived without anxiety, either for awhile or for ...ever, the feeling of NOT being anxious will just blow you away. I hope that you can get a piece of that.
posted by fiercecupcake at 9:42 AM on March 1, 2021

You could take your question as written above (or a version of it tweaked for this purpose), print it out and say to your GP: “I find it hard to describe what’s going on for me in the moment sometimes, so could I ask you to read this?”. You can include the background, how long it’s been going on, the ways it impacts your every day life right now, that you’re interested in medication but have concerns x,y,z about it and so on.

Well done for doing this, you’ll be so glad you did.
posted by penguin pie at 11:27 AM on March 1, 2021 [1 favorite]

I told my doctor I was experiencing a lot of anxiety and it was making it hard to function. I gave examples and they asked questions. You can read the questionnaire linked above to know what kinds of things to reference. You can even say, "I'm in therapy and it's not enough." Or "I've felt anxious and paralyzed about talking to you about this for x months."

My prescription is very light and non-addictive and the doctor advised trying to shift off it when I can. But for now it's very helpful. I'm sad that for so long I didn't think medication was an option.

Remember your anxiety would likely make this conversation hard, and that's a good reason to try. If the conversation doesn't go how you expect, you can make a plan b. But first try plan a.
posted by rockyraccoon at 12:36 PM on March 1, 2021 [1 favorite]

it scares me to imagine being on medication FOREVER

I hear you! One of the hallmarks of anxiety is being afraid of seeking anxiety-treatment, it's nefarious.

I was also a person who had a hard time talking to my doctor about anxiety despite having a lot of anxiety-related symptoms for a while. Finally I had the conversation and it went decently. Basic push was: I am not enjoying my life because my anxiety is interfering. And it's been a journey over time. At first I was just on some as-needed medication to address the primary issue I was having (sleep). Then after I started therapy, and was having some daytime stressors as well, I took some of the as-needed meds during the day sometimes, in line with what my therapist suggested. Then there was a road bump where the medication layout changed and I had to see a psychiatrist instead of my primary care doctor about medication. I tried regular medication (don't remember the name) and it made me too jangley and I stopped taking it (in consultation with my doctor at the time). Now I have a psychiatrist who prescribes a small dose of as-needed meds and I will probably start trying some other anti-anxiety meds once I've been vaccinated.

I assume you've talked this over with your therapist? I don't know specifically how all of the types of doctors interact in Canada (I am in the US) but I'd feel OK with your GP prescribing meds if you feel like you have good communication with them.
posted by jessamyn at 2:10 PM on March 1, 2021