My shrink wont listen

[StrawPipes]

Ok, before I begin I want to state that I am "NOT DIAGNOSING MYSELF." I believe this is in the right place. If I'm wrong my apologies and feel free to move.

I get terrible anxiety/stress and occasional panic attacks. I'm currently seeing a Mental Health Nurse Practitioner. I tell her all my symptoms and what not and how it's just anxiety. I don't feel depressed; I don't seem to lack that much motivation. I've been depressed before and I know how shitty that was and I don't ever want to feel like that again. Those 4 months were living hell (My cousin killed himself and my girlfriend broke my heart) The reason I'm saying this is because my shrink (and many others from what I've read) have a tendency to believe that their is an underlying disorder that causes anxiety. Examples of these are Bipolar, Depression, PTSD, etc. I am a medical major as well and understand the reasons behind these beliefs. I am not bias and I have been doing exactly what she told me and tried many medications.

Well I tried the anti-depressants Mirtazapine, Flexapro, Paxil , and the anti-psychotics Abilify and Seroquel, and all these medications did was make me very petulant and acquire worse anxiety then previously reported to her. I'm starting to think I have Generalized Anxiety Disorder (again my opinion, not a diagnosis). Benzos are the only thing that seem to combat the anxiety and make me be able to function with daily activities. I believe i can help myself through this because I have never have anxiety this bad before. I believe all I need is someone to talk to, someone intelligent who can relate and share experiences; hell, someone to argue with and have intelligent debates.

The problem is my shrink is so reluctant to believe that it's Generalized Anxiety Disorder. She won't give me any Benzos unless putting me on other medications that have done nothing to help me, and in fact, made me feel worse and more anxious. What can I tell her that she will actually listen? I understand Benzos being addictive and I understand the reticence shrinks have to prescribe said medications for help. But to be honest, they are the only medication that works. I believe I can limit myself from them to bypass addiction and help my overall anxiety issues, but she just wont have it. She want's to try Trazadone next I believe and i'm done taking all these medications that do nothing but fuck my mind up and make me feel worse.

Should I get a new shrink? Should I keep on trying to explain to her nothing's working and I really believe I can combat my anxiety with valid social communication and limited Benzos on the side for when I'm not with her? I've tried numerous times and it hasn't seemed to work. Maybe I should cut and paste this and give her a copy? Maybe I should say fuck it all and just suffer anxiety? Maybe just bitch and moan some more?

Any opinions?

 

[The Chemist]

I would look for a new Doctor, only because i firmly believe that not every single Dr is the same.

Plus, if you don't like the level of care or the results, change the type of Dr you're seeing...perhaps a Psychotherapist might suit you better, or since you seem pretty set on obtaining Medicine (for legitimate use), i would look around for a Psychiatrist.

A simple call to your Insurance Company will help you sort the details out, and they will give you the names and addresses of any Dr that meets criteria you lay out to them.

Hope this Helps, Good luck!

 

[StrawPipes]

I wouldn't say I'm pretty set on getting medication. I was willing to try medication and Benzos are what worked best. I firmly believe I need someone to talk to and in the meantime like when I'm at home, have something to help me incase I start getting a panic attack or the anxiety gets worse. So I guess you could say I'm set on obtaining a Benzo, but I will try without it...

 

[AfterGlow]

Have you tried a clinical psychologist?

Trust me, benzos are no solution for GAD. They can temporarily alleviate symptoms, but you'd better use the time to figure out what's making you so anxious. You would most likely develop a tolerance to benzos over time and require larger and larger doses to get the same relief. And the anxiety you're feeling now is nothing compared to the anxiety from benzo withdrawal.

I'm diagnosed with GAD so I know what I'm talking about. My psychiatrist wants me to take Xanax XR daily, but I will only use IR sparingly because I've gone through withdrawal already and it's hell.

I wouldn't say I'm pretty set on getting medication. I was willing to try medication and Benzos are what worked best. I firmly believe I need someone to talk to and in the meantime like when I'm at home, have something to help me incase I start getting a panic attack or the anxiety gets worse. So I guess you could say I'm set on obtaining a Benzo, but I will try without it...

 

[James.]

To expand upon Afterglow's sentiments, benzodiazepine usage is increasingly risky for individuals who have experienced depressive episodes. Your situation sounds somewhat familiar, through my own experiences with what may have been social anxiety disorder. The occasional bedtime use of a benzo opened such a comforting window of perceived "normalcy". I spent years pleading with health professionals to find any solution that mimicked the mood/behavioral benefits experienced after taking a sleeper.

It just the same took years to realize how seriously a small dosage would compromise my attitude and performance for days afterwards. Addiction potential put aside, benzodiazepines are particularly powerful drugs for a significant percentage of the population. And although you know your own personal reactions to drug X better than any Doctor, please remember that you might not be recognizing the range & potential of its negative side-effects. Benzos are so often seen as a relatively low-risk prescription. On a positive note, it seems that your health practitioner is displaying a high degree of caution (and therefore regard) for bringing you to good health.

Whether or not she has the diagnosis right is undoubtedly your right to question. Yet I would stress that you approach any continued relationship with your health practitioner with genuine open-mindedness. As a med student, you're probably well aware of how grey a science mental health can be. Comorbidity of disorders is such a complex issue, yet the suggestion that your anxiety is linked to (an even inactive) depression is not an unpopular diagnosis. How long have you been seeing this individual for?

 

[James.]

I believe all I need is someone to talk to, someone intelligent who can relate and share experiences; hell, someone to argue with and have intelligent debates.

That is an extremely helpful addition to what should be a multi-faceted approach to recovery. Hopefully you have a friend or two who have experienced similar problems. Beyond that, your best friends should be the ones who have the time to be with or talk to you whenever you are experiencing a panic attack.

The main thing I would suggest is seeing an additional therapist, while making a continued run at making the practitioner's treatments work. A psychiatrist, perhaps in addition to a psychologist, cognitive behavioral therapy in a group setting (for example); whatever you have the time and resources to invest in. Research what institutions are highly regarded in your area. You can demand the best, but remember that assertive self diagnosis and "debate" can hinder your relationship with any professional.

I really believe I can combat my anxiety with valid social communication

Then do it; engage in therapeutic conversation with strong people who genuinely want to help. Yet one so often has to diversify to solve anxiety issues. I am skeptical that communication alone is going alleviate your symptoms fully.

Should I keep on trying to explain to her nothing's working

It sounds like you may be at risk of getting into a cyclical, head-butting relationship with her. As a patient or a practitioner, it's easy to be at fault for this. I would seriously step back and look at the professional strengths she has displayed so far. If this is a situation where you disagree with her ideas through debate rather than discussion, be the first to renew the relationship through humility. Honestly listen to every point she has to make.

I know that this can be difficult when you're influenced by any number of chemicals. Sedation, aggression, confusion and frustration happen in the process of finding an appropriate medication. Yet the most important thing is that you continue to recognize the positives & negatives of new treatments, and to curb your educated opinions while under professional care. Debates so often misconstrue as arguments, and even a world renowned physician may subconsciously reject valid opinions if they're put forth in a heated or argumentative way.

 

[PureLife]

SSRI's and anti-psychotics DO help certain people with their anxiety to a level that they can cope with. Just because you have anxiety doesn't mean you should jump right into benzos, which is what your getting at? They aren't a magic cure. They ran my life for 5 years until i got off them and sought alternative treatment. Then again, sometimes benzos are the only option for varying people.

 

[StrawPipes]

PureLife - I appreciate the input but if you read my first post you will see that I state that I have tried everything she threw at me, usually for a month. However, there was no benefit from taking them and they just made me more petulant. I don't enjoy getting high on Benzos so that is not the reason why I want them. I want them cause so far -- after numerous attempts at different medications -- they were the only thing that works.

 

[footscrazy]

In the past I have also experienced extreme anxiety to the point I was suicidal and I also often encountered the view that 'you don't get suicidal off anxiety, it must be depression, or this, etc etc'. I know that my main problem was anxiety, I am not depressed and have never been prone to depression. I think a lot of people underestimate anxiety as being just as severe a disorder in its worst cases as any other mental illness.

In my experience, psychiatrists were absolutely hopeless at dealing with anxiety. I had terrible experiences with them. What helped me was seeing a psychologist, who I worked through cbt with - and this helped enormously to the point where I cured myself of my GAD and panic disorder (through a lot of work, and a fair amount of time too). However what was also absolutely essential at this point was an ativan prescription to take during panic attacks only. I truly believe this saved my life as I was terribly close to the edge at some points. I received a prescription of 50 which lasted me a year and should be all you need if you take them only when absolutely needed. They are a last resort when nothing else works, not any means of cure.

 

[StrawPipes]

In the past I have also experienced extreme anxiety to the point I was suicidal and I also often encountered the view that 'you don't get suicidal off anxiety, it must be depression, or this, etc etc'. I know that my main problem was anxiety, I am not depressed and have never been prone to depression. I think a lot of people underestimate anxiety as being just as severe a disorder in its worst cases as any other mental illness.

In my experience, psychiatrists were absolutely hopeless at dealing with anxiety. I had terrible experiences with them. What helped me was seeing a psychologist, who I worked through cbt with - and this helped enormously to the point where I cured myself of my GAD and panic disorder (through a lot of work, and a fair amount of time too). However what was also absolutely essential at this point was an ativan prescription to take during panic attacks only. I truly believe this saved my life as I was terribly close to the edge at some points. I received a prescription of 50 which lasted me a year and should be all you need if you take them only when absolutely needed. They are a last resort when nothing else works, not any means of cure.

Yes, this reply is exactly what I want to do. I have even told my shrink that I want to do this but she said it's not happening. I believe I can defeat this anxiety -- seeing how i was never anxious before in my life, nor not really depressed either -- but I would need something on the side so when I get close to panic attacks or the anxiety gets to unbearable and there's nobody there to help talk me down. I.e my shrink or counselor or whoever. However when I said this she gave me that 'I believe you are just trying to score drugs off me' kind of look and told me she already gave me 14 .5mg Klonopin 2 months ago and won't give me anymore. She basically stated that if I want her help were going to do it her way and only her way with straight up anti-psychotics and Flexapro.

I believe my mom said it best. This day and age if somebody walks in to a psychiatrists office asking for help from anxiety they are right away assumed to be depressed or bipolar, and I am not bipolar. I do have a short fuse but that's just cause of all the stress I've been under and people seem to know how to light it.. However, I don't stay in that petulant state of mind for weeks which are symptoms of bipolar. I missed my psychological evaluation today which was sad because I really wanted to go get it done and figure some stuff out. If only my insomnia wasn't getting worse and worse and I somehow lost my ambien pills. So no refill till the 23

 

[Z Y G G Y]

Get a new practitioner, preferably not a Nurse Practitioner. I personally have had very bad luck with the NPs. I have gotten benzos from GPs and psychiatrists several times for anxiety related to school. I also usually get pain killers and sleep meds, which with my conditions and even if the doctors know I'm dependent have not usually been a problem, but with the NPs it always is. I have seen several and not gotten one med that I needed and had to then see a regular doctor or a psychiatrists to get the meds which I did, but pain in the ass so I avoid NPs now as I don't want to see two practitioners when most my meds are scheduled so I'm pretty sure now any NP will block a prescription of a scheduled med. When in rehab my insurance would only cover the medical practitioner to be a NP and she blocked my prescription of pain meds, when during my previous stay the medical doctor approved them, then after tons of bitching I got to see an MD for a second opinion and got the pain meds w/o which I have a hard time sleeping or eating or anything for that matter. So, my experience might be biased against NPs, but thats what I can tell u.

And as mentioned before CBT is also great. I did over a year of it and my anxiety/depression went from always existent to now rarely happening.

 

[James.]

Yes, this reply is exactly what I want to do. I have even told my shrink that I want to do this but she said it's not happening.

Ugh.. Sorry if I seemed to lack empathy in earlier posts

Good luck with a new practitioner, your current one sounds unprofessional from that statement alone.

 

[asecin]

james just discuss ur issues here man. we will listen. i promise

 

[Heuristic]

I'm sorry to read about your situation OP, and I think you've gotten a lot of great advice in this thread.

My .02:

I view problems like panic attacks and generalized anxiety disorder as multi-faceted. It's unlikely that there is a single cause, or a single solution, to them. You want to take a multi-faceted approach. So:

(1) Pharmacological. Benzos can help, particularly with respect to panic attacks. However used regularly they decline quickly in efficacy, and they tend to have unwanted side-effects on cognition and memory. Really they are a very short-term remedy, or one used sparingly. SSRIs have few, if any, side-effects on memory and cognition, and their therapeutic effect can last indefinitely. The Other Drugs forum here has some great information, and very knowledgeable people, on those subjects.

But, it's very unlikely that medication by itself will resolve your symptoms.

(2) Cognitive-Behavioral Therapy This is where you'll get the most bang for your buck. You'll learn how to recognize thoughts that are causing panic attacks, or feeding anxiety, and how to stop those thoughts. You'll also learn better ways of managing your behavior. The success rate for panic attacks here is extremely high.

You mentioned that you're under a lot of stress. Part of cognitive and behavioral therapy involves an emphasis on solving problems, and it sounds like you might benefit from this emphasis as well.

Finally, while I'm pretty skeptical of religion, Eastern or Western, meditation has been shown to be effective in reducing levels of general anxiety, and practice at it will give you more control over your emotions. This is incorporated into CBT by many practitioners.

Some of this stuff you'll need to explore with an actual practitioner, however you can begin immediately on your own. Set aside about 30 minutes a day to meditate. That means you find a quiet room, you turn off the TV or radio, and you sit somewhere comfortable in a good, erect posture. Then you're going to close your eyes, and you're going to focus on breathing. In and out, in long slow breaths. Just focus on the breathing, nothing else. Pretend that you're nothing but breath. As you do this, you'll feel various thoughts and worries arise; just focus back on the breathing. Nothing but breathing. You'll start to feel yourself relax. Just keep at it. After 30 minutes of this, you should feel much more relaxed--and that's the goal.

Each day you practice this, you'll get better. Within a short period of time, you'll be able to do it anywhere, and will be able to get yourself to sleep without using ambien.

As you go through your day generally, try to be aware of your thoughts. Whenever your mood shifts, or you start feeling anxious, you'll have had a shift in thought. Maybe you've started worrying about something; maybe a task you've been putting off is pulling at you; maybe you're envisioning something terrible happening. By noticing the thoughts causing that mood shift or worry, you'll be in a position to do something about them. If they're irrational worries, address them as such; if they're legitimate worries about something you've been putting off, then go do whatever you've been putting off.

Remember that some anxiety is normal, and is just your mind telling you that you'd like to take care of something--and once you do, that feeling of anxiety will disappear.

 

[dankstersauce]

^^^yeah, I'll second meditation. It's been the single most helpful thing for my anxiety. Well either working out or meditation. Ideally both worked the best.

I don't want to put works in the OP's mouth but I know when I was having my worst bout with anxiety my attitude towards help was really shitty. I had it stuck in my head that benzos were the only thing that would help me. And I kept focusing all my energy on how bad my anxiety was...trying to convince doctors that I needed benzos. The more I focused on my anxiety, the worse it got. And I'd constantly replay the anxiety in my head...like I was trying to build up proof of how awful my anxiety was.

Just try to keep an open mind, I know that I didn't have an open mind and it didn't help me any. Actually it made things a lot worse. And every time I've been on benzos I've ended up worse than I was before.

 

[StrawPipes]

^^^yeah, I'll second meditation. It's been the single most helpful thing for my anxiety. Well either working out or meditation. Ideally both worked the best.

I don't want to put works in the OP's mouth but I know when I was having my worst bout with anxiety my attitude towards help was really shitty. I had it stuck in my head that benzos were the only thing that would help me. And I kept focusing all my energy on how bad my anxiety was...trying to convince doctors that I needed benzos. The more I focused on my anxiety, the worse it got. And I'd constantly replay the anxiety in my head...like I was trying to build up proof of how awful my anxiety was.

Just try to keep an open mind, I know that I didn't have an open mind and it didn't help me any. Actually it made things a lot worse. And every time I've been on benzos I've ended up worse than I was before.

No that makes a lot of sense to me. I even told my ex-girlfriend a few weeks ago that maybe this is all in my head and maybe I just am fooling myself in thinking I have extreme anxiety; coincidentally, producing more anxiety and altering it much worse. I totally understand this concept and I even tried to do the opposite; tried tricking myself into thinking this is all because of my attitude. It seemed to help a little bit a few days but then it seemed to return.

I will take all these advices into consideration. Like I said, I don't want to take any medication unless I really have too. Yes I abuse opiates and such but I definately don't abuse Benzos and never have. I thought maybe the anxiety came from my opiate withdrawls but I've been on Methadone for that and I still get anxious.

Heuristic - That sounds like great advice and I will definately give it a try.

James - It's ok, I wasn't angry or upset with your lack of empathy; your post made a lot of sense too. I thought I clarified certain information in my initial post but maybe I left some stuff out.

Thanks everyone for the input

 

[Captain.Heroin]

I'm really sorry to hear about your predicament man. I've had doctors who are *completely* against benzos. For whatever reason. But they'll sure as hell push SSRI's or TCA's on you like they're candy...

Anyways, look for a few different doctors. It shouldn't be too hard to find a doctor who will give you some benzos.

 

[bronson]

Have you ever tried Buspar. It's not a benzo, but it's a drug specifically Rx-ed for anxiety disorders. It's taken several times daily and isn't scheduled so it's much easier to get a scrip for. At first I didn't think it was very effective in dealing with my anxiety and it had some odd side effect, however once I worked the dosing out properly with my Psych it seems to be very effective.

It may be something to consider if you haven't already.