Wednesday, December 10, 2008

Anxiety medication dilemma take two

I'm still agonizing over the decision to go on medication. One, I'm incredibly impatient when it comes to medications working. Two, I'm worried about the side effects--yes weight gain which is always a fear. Three, I'm worried about the cost. Four, I'm worried it won't work and that my time will be wasted.

On the up side, a medication could work. I could perhaps think more clearly and process things better. I may not be as overwhelmed when faced with difficult decisions. It could possibly help with my continual vacillation between some denial and actual problem with exercising. :-/

So I bit the bullet and spent most of my morning making calls to psychiatrists' offices. I had a few names from my previous therapist. The two through the university who I wanted to see are booked until February and not taking new patients. I wouldn't even get to see them unless I saw their
LCSW first and then had her refer me to one of their pdocs.

I called a few others that were on my insurance list. On one call, this guy was super nice and answered my questions and knew of one who worked with ED patients extensively. The funny thing was that I asked him if he knew of this other psychiatrist whom I'd called. His answer was that "she had been around forever, and given my age and problem, he highly suggested I went to see the ED
pdoc." Hmmm, that kind of left me confused since she is the one I'm waiting to hear back from.

Another psychiatrist, I was able to speak with personally. She seemed very nice and worked with patients who were referred to her by my former therapist. The rest I called don't take my insurance with the exception of two
psychiatric nurse practitioners.

As my analytical brain likes to do, I've made a list of the possible
psychiatrists. This is the rundown, * indicates they accept my insurance.

Pdoc C. is an anxiety specialist who founded the Anxiety Foundation. He does both psychotherapy and pharmacotherapy and also uses animal assisted therapy. He has some experience working with eating disorder clientele. His fee, however, is a bit outrageous. Either he's really good, or he jacks his rates sky high.

Pdoc W. works with ED clients extensively and apparently worked under a well known ED researcher at the university. According to the guy I talked to who gave me his name, this pdoc, in his opinion, was the best ED one in town.

Pdoc L. was a a name given by my former therapist K. His specialty is addictions and is supposed to be a really nice guy. I think he also won some award a few years ago, voted as the best psychiatrist in town.

Pdoc G-R. is the one I spoke with. She's also worked with Ed clientele, though it is not her specialty. My former therapist, K. has referred several clients to her. She seemed very nice and even suggested if I had other names I wanted to run by her, to give her a call.

Pdoc F. has also worked with ED clients. She is the one that the guy who I spoke to said had been around forever. I don't know if that is a good thing or a bad thing. I'm waiting to speak to her personally, as that is something she just does with all new possible clients.

Pdoc Mc. or P. are nurse practitioners. My current therapist, C., has referred a few clients to them. She says that one is apparently blunt and gruff, but was able to find alternative meds that did not have weight gain as a side effect. The other she has not heard anything negative about.

Yes, I know this seems ridiculous. "It's just a psychiatrist" as one of my friends said. I called my mother to get feedback since she has been on what seems like every single medication known to mankind for depression. She tried
really, but she wasn't very helpful.

See, this is the thing. I'm placed with a number of options in front of me, and then I have a hard time choosing. One part of me says I should just go through insurance as it would be cheaper. Another part of me thinks I should go for the specialty. Then, another part of me says I should bite the bullet for the high initial cost of the first
appt. if the arrow points to them helping me more. Maybe I should just play spin the bottle?

Why am I making this so difficult? I think part of it is that I really want to be able to have an actual relationship with whatever
pdoc I see. I don't want it to just be med management which unfortunately is how it mostly is since insurance companies have "ruined" the field of psychiatry. This is according to my mother's current pdoc.

The other thing is I think that the follow-up
appts. would be a waste unless there were serious side effects going on. And I guess I'm just having trouble thinking about paying that much money for a mere 10-20 minutes at the max when you could just call and say how you were. I know most see pdocs much less frequently than a therapist but still.

Then, the really bad thing with all this (and why I'm really hating insurance at the moment) which I just found out is that any
pdoc session would count toward my mental health coverage. Currently, I only have a ten session limit/year, so it cuts my therapy by at least two or more sessions. I can continue of course, it's just everything would be out of pocket, and I would not be able to go as frequently.

This is where everything stands right now, and I'm having a terrible time in deciding what to do. It's essentially the story of my life. :sigh: Does anyone have any special wisdom? Or want to commiserate with me?

Part one of anxiety medication dilemma can be read

By the way, my day ended up strangely. I went to the store to pick up a few items. When I got home to put the items away, I realized there was a pack of cigarettes in the bag! I have not a clue how they got in there. Hmm, maybe this is some sign? Just kidding, I seriously doubt someone is trying to tell me to just kill the anxiety with a few smokes.


Sarah said...

I put off medication for as long as possible, then when I hit my rock bottom I knew it was something I had to do to help me in recovery.

I was recommended to my psychiatrist by my therapist, and I lucked out because she is an amazing psychiatrist.

Starting meds can be overwhelming, just the idea of if its going to work, side effects, etc. I believe it's really in the psychiatrist to find the drug that will work best for your symptoms. I deal with OCD, anxiety, and depression. I'm on two pills currently.

I'd also make sure that whoever you choose doesn't throw you on a high dose quickly. I started with one pill at only 5mg, and worked my way up, with follow ups, and discussions on my mood, etc. Be sure to be vocal about all your concerns even if you don't think they are going to affect how you are treated. I am really against taking meds, so my psychiatrist knew to start me low. She knew I did not want to gain weight, so she made sure the med did not have that side effect, and so on. It's very personalized, and you have more decision over your treatment than you think.

Sorry it's so long! You can get in touch with me if you want to talk more=)

Kim said...

I completely understand your dilemma, as I am right there with you. I have to applaud you for making all the calls (I know how torturous that can be). The truth is there are some terrible psychiatrists out there, but there are some great ones. I would think an ED specialist would be perfect. Let me know how it goes. You may just inspire me to stop white-knuckling it through this anxiety of mine!

Lola Snow said...

I'm possibly not the best person to ask about this, because I do tend to get a bit funny on medication. That said, when you do find the right one for you, it is so unbelievably helpful. Unfortunately sometimes it takes a couple of attempts to get there.

I can't offer advice with the Pdoc either, mine have all been allocated via the National Health, so i never got to choose. I guess there will be no wrong choice, just a bit of a gamble. It's not a binding contract, and I know there is the expense issue, but this is your future and your happiness, you should be choosey, and change if you are not happy.

I hope this works for you Tiptoe, so many people swear by meds for anxiety.

Lola xxx

Kara said...

Even though going on medication is complicated and scary, I'm a BIG advocate for it. I have ED and depression and I would be in a horrible position without meds. Sometimes people just need a little biological help. There are some meds that cause weight gain, but there are a lot that don't - so make sure to tell your doc that you don't want any possibility of weight gain.

Most psychiatrists want you to see them once a month, so I wouldn't go to a psychiatrist that you don't think you can afford. Although it is important to find one that you connect with.

Good luck!

Lisa said...

I was reluctant to take meds, too, but I'm glad I finally did. For me, it took care of the "buzz" of anxiety and depression that was keeping me from functioning. I've been lucky with my doctor, too, and she knew which medication was less likely to cause weight gain as a side effect.

I didn't have trouble with side effects when I started the first time, but I experienced some nausea when I started up again this fall. It lasted for about two weeks, but I was able to stick with it.

Tiptoe said...

Everyone, thanks for all the input. I guess I'd consider myself the procrastinator at this point, and I'm not feeling rock bottom or anything. I know that you don't need to be for meds, there is just more incentive for me to go on them when I am like that.

I'm giving myself the weekend to think through this more, though I don't know, that may be a bad idea too.

gutsinarut said...

I think you're wise to make a list of potential psychiatrists and to *want* a relationship with them. To many people I know just go to get their pills and be on their merry way. It's important to have background information. I just hate that it's such a struggle to get decent insurance coverage for these kinds of things. They don't realize that by not covering some of the most-qualified prospects, it's like playing with someone's life. It burns me up!

Oh, and the cigarette thing? Is really strange!

Tiptoe said...

Gutsinarut, thanks for the validation in actually wanting something more than pill dispensing with a psychiatrist. And yes, insurance indeed sucks sometimes!

Still haven't figured out the cigarette thing. It'll just remain a mystery.

Reagan said...

Oh wow, I can commiserate. I ended up choosing a psy. who doesn't take any insurance, because she was recommended by my therapist. She is absolutely wonderful, though the out of pocket cost does stress me. It's all what you think is important and what you can handle.

Also, as for the trouble making decisions, that really got better for me once I was on the meds!!

And don't let anyont tell you differently: This IS an important life choice.

Good luck!

Tiptoe said...

Reagan, thanks for commiserating with me. ;-) It's good to hear that meds helped you better with making decisions. That's a really difficult thing for me right now and gives more incentive to going on a med.

MelissaS said...

i have eating disorders and a drug addiction, so it's funny that i resisted prescription meds for years. so, i stayed in bed for a year and was too anxious to even dial my best friend. here's MY experience since. no recommendations, just my experience. i've seen five psychiatrists. the two not on my health plan were great. one, my current one, is my hero. my friends find the same thing. if you can afford it.... i take lexapro, which changed my life. i was wildly nauseous getting used to it,but then my mood lifted remarkably. i used to cry all the time. now i cry at, like, funerals. it's the item i'd take to a desert island. i take neurontin for anxiety, and it really helps. it's not a controlled substance (because of my drug addiction, i can't get those)but i'm much less stressed. klonopin is great for anxiety, but it's a benzo, and it is debilitating to get off. and i take trazedone for sleep. also not a controlled substance, so it's not weird like ambien and lunesta (all of which i took in quantity once!) good luck. i hope i didn't say too much

Tiptoe said...

MelissaS, thanks for sharing your experiences. I've been on lexapro which didn't do that much for me. I was on neurontin a few years ago for parasthesia after a dog bite to my leg. All the other meds I've ever been described have been for depression.

I'm really glad to hear that you have found a psychiatrist you like and the meds are helping you. Much luck for continued success. :-)

MelissaS said...

a good psychiatrist can work with you until you find the right mix for you. i'm limited in what i can take because of my drug issues. good luck to you!!!!!!

sarang said...
This comment has been removed by a blog administrator.
mtpkrth said...
This comment has been removed by a blog administrator.
Donlety said...
This comment has been removed by a blog administrator.