should I find a new psychiatrist for my anxiety?

[Delphinia]

hi all... I have had severe anxiety and daily panic attacks for years. I feel like I have the panic relatively under control, but my generalized anxiety has been bubbling up out of control. I recently started CBT therapy, but am still having a hard time so yesterday I saw a psychiatrist for the first time in hopes of getting a benzodiazepine to get me through the rough patches. I told her about my drug history... I tried xanax briefly years ago and used ativan for about 7 months last year, given to me by my PCP. I've tried various SSRIs, buspar, hydroxyzine, etc. I gathered up all my dregs of courage (I was terrified of being judged by her) and told her I thought a benzo would help me for maybe a month or two. She immediately launched into her spiel about how dangerous benzos are... which I guess is to be expected. She prescribed me an SNRI. I told her about how when I started on my SSRIs, I had horrible cant-sit-still anxiety, so she reluctantly wrote me a script for 2 weeks worth of klonopin, just to get me adjusted to the SNRI. I was nearly in tears. I felt like no one would listen to me... I don't have a drug history, I don't abuse my medication (not that it doesnt sound fun, I just don't want my tolerance to go up!), and I really feel like benzos in a low dose make me feel normal... though I realize its not a long term solution.

She told me to take the klonopin twice daily. I asked If I could skip it on days when I work with my CBT doctor to really deal with my anxiety without help.

"Absolutely not!" she said. "I don't want you to learn that you can take a pill and make it all go away."

I felt like a scolded child. I am so frustrated... I'm an informed adult and I should have a say in how I treat my anxiety. When my PCP gave me ativan for months he didn't seem too concerned how I took it. I fucking hate that I am at the mercy of medical professionals.

So I guess my question is, is this normal or acceptable behavior from a psychiatrist? I ask because this was my first psychiatrist visit.

Thank you everyone!

 

[RobotRipping]

normal yeah, acceptable no, not in my opinion at least. I'd honestly just find a new doctor, that doctor sounds inconsiderate and cold, no need for that. Yeah benzos are risky and not be taken lightly but the doctor didn't have to talk down to you. I guess if it was the first appointment there's likely no chance you were getting a benzo prescription. I had to wait months and months and plenty of appointments as well as blood tests before i got my prescription and i only get 8 valium per month. Although my gf gets 30 ativan a month and hasn't had to jump through any hoops at all, it's very inconsistent where i live at least.

maybe a low dose of a benzo would work for a while but the dose always goes up and once you're at a high dose you are stuck there and no easy way to get out of it, so think really hard before going this route.

I also feel like i should have a say in my treatment, i think that's a really big deal so sometimes i just end up medicating myself but ultimately working with a doctor will probably lead to better results.

 

[NightOwl]

I have had this priblem with my psych as well. Been with him for yrs and tried various ssri's. Stopped seeing him and then returned after a two yr break. On that break i had been assaulted nearly beaten to death and even after our prior history several visits, he will still only out me on an snri (pristiq) and 20 measley .5 alprazolam every month. I understand i am a younger man but i have been on my own since i was 17(25 now). I feel the same way when i first asked for xanax, and my doc reacted the same way, benzos are dangerous, easily abused blah blah blah. And he refuses to up the dose afte i tell him that .5 does not cover it. I really want to look into a new doc as well, but i feel like if i go to a new doc and explain the situation they will think i am drug seeking or something, any suggestions?

 

[Alex000]

Doctors vary a lot. Is it acceptable? No, I detest the thought of anyone being subject to the kind of treatment the OP has described from this psychiatrist. NightOwl, you seem to have a very similar problem. There are reasons, though, why doctors will rant against benzos, and some of the reasons are valid, BUT the ranting and scolding and that is not warranted. A lot of doctors develop a god-complex - they just do. It is unfortunate, but true, and many think they know better than any of their patients and probably better than any other doctors. Some doctors are not so benzo-phobic WHEN there is clearly existent anxiety and/or nervousness which makes the patient not as functional as he or she would be otherwise (e.g. not eating, not sleeping, not going to work due to the anxiety). Some doctors ARE benzo-phobic, however, and will almost ALWAYS try to sneak in another drug in place of a benzo, where a benzo would do a better job. Psychiatrists, particularly, will often go through several anti-depressants including various SSRI's, SNRI's, and others like Wellbutrin (XL), Remeron, and Deseryl. Some may EVEN resort to anti-psychotics for simple anxiety control over a benzo, through some bent and skewed rationale and logic. So, some psychiatrists will whip the pad out and write for this benzo or that (does not mean they are a good doc, even if a benzo is a good option) on the first visit for anxiety and/or nervousness interfering with functioning, and some psychiatrists will never prescribe a benzo. Some are even weird in their little habits (never prescribing Xanax, but prescribing Klonopin) or some similar habit. Every doctor is different - just keep that in mind. There are trends with certain doctors, as I said the god-complex is not a joke, it is real. I am not saying above that certain other psych meds are necessarily BAD for anxiety, simply saying some docs won't script a benzo when that would be the best. Good advice is not to tell a doctor what to write for, but rather explain the symptoms allowing him or her to draw the conclusion a certain drug is needed VIA self-report on the patient's part. Sometimes, when you have had a doctor for a while and he or she becomes quite familiar with you, more direct approaches CAN result in the patient's allowance of some self-prescription, if you will. Also, remember age of doctors is a factor which often makes them either benzo-friendly or benzo-phobic, younger doctors tending to shy away from them more. Benzos do carry serious risks - cannot deny that, but they can really help in some circumstances, and the pros outweigh the cons. This post of mine feels a bit scattered to me, so I am sorry if it seems so to anyone else. I just want to make sure it doesn't seem like benzos are the answer for everything, and other psych meds can help, but it all DEPENDS so much on the individual patient. So, the doctors vary, and the patients vary. Medicine is really not as cut and dry as they would like you to think it is - it really is more of an artform than it might seem. Try this, try that. Almost like cooking for individual palates - weird, but sort of true. I hope this helps somehow. Again, I am sorry if it appears scattered.

 

[Swimmingdancer]

I wouldn't say that's normal. That doesn't even make sense to me. Why would she tell you you're not allowed to skip it when you don't need it or in order to learn how to deal with your anxiety without it? If she doesn't want you to "learn that you can take a pill to make it all go away", then why would she even prescribe it to you? And in my experience (and from what I've heard from many others) it's best to take benzos only when you absolutely need them instead of on a set time schedule every day. If you take them 2x a day every day you will quickly become dependent and your tolerance will go up so they may lose effectiveness and you will feel terrible if you ever decide to stop taking them. I would definitely get a new psychiatrist. It can take some work to find a good one, but they are out there.

 

[Delphinia]

thank you all for your perspectives!

Nightowl, I'm so sorry that happened to you. I feel the same way, like if I try to go to a new doc they will think I'm drug seeking. I try to tell myself that we have a right to seek out the care we deserve

Alex, thanks for sharing your experience. I agree, I don't want to suggest anything to sound pushy, but then its hard to get them on the subject of benzos. Is it really true that new doctors never proscribe benzos on the first visit! Thats horrible... that means (if indeed benzos could help) you will have to keep coming back for the mere chance of getting medicine. Sneaky bastards.

Swimmingdancer, yes, this was my exact thought. My pcp gave me ativan to take as needed for months. It was great for me, and I weened off ahead of shedule. I suppose I could go back to him, but it's a last resort... he is a good doctor and I would rather use him for medical stuff and not pester him about my mental issues.

Just so frustrating. I got horrible... HORRIBLE anxiety when I started taking SSRIs, and I feel the SNRI will be the same. The dose she gave me to deal with it was a paltry .25 klonopin 2x daily, which hardly puts a dent in my general anxiety, and I'm quite sure won't touch the side effects of SNRI. I havn't taken the SNRI yet, and don't think I'm going to. Will keep taking the klonopin AS NEEDED for anxiety along with CBT therapy until I can muster the will to do this whole clusterfuck all over again. Thanks again to everyone!

 

[Alex000]

If the Ativan really worked for you, I might suggest going back to your PCP and telling him about your still present anxiety, and you could not get relief save for the Ativan PRN. I don't know the ins and outs of the reasons you don't want to go back to your PCP for that reason, but it sounds like a benzo is a good option for you as needed w/ therapy, too. I would still try to find a psychiatrist, though, that is not so benzo-phobic. It seems you have a good understanding of how benzos effect you and your own anxiety's nature. If all you need, drug-wise, is a benzo here and there, I would suggest that if the PCP option is not feasible or does not cut it. I will say, though, 0.25 mg clonazepam 2 x daily is more than it might seem. Not saying that it is a lot, or even enough, but it is a bit more than it might seem/sound. Nevertheless, it is still a small amount compared to many, many benzo scripts.