Questions for Your Psychiatrist: A Checklist
A close friend of mine recently needed medication to treat her depression and anxiety symptoms. She asked me how to find a psychiatrist, and how to make sure that person was good. I told her that finding a good psychiatrist is like finding an excellent bagel outside of New York–it is possible, but the hunt will not be easy.
Abs and I have a lot to say about medication, psychiatrists, and, well, just about everything else. We will blog plenty about the whole meds issue (yes we use them, yes we find them helpful, no we are not supported by the drug companies) but, for now, we want to share a few insights we’ve gleaned from our personal experiences:
First of all, most anxiety prescriptions come from internists. This makes sense since the first person you go to when you don’t feel well is your primary doc. While this may be the cheapest way to do things (and sometimes that is all we can do), it may not be the most helpful. Internists typically have little knowledge about the intricacies of anxiety drugs, and even less knowledge about anxiety. Often they will hand you samples dropped off by the pharmaceutical rep that brought pizza to the office the week before, which may or may not be the best med for your particular set of anxiety symptoms.
We recommend that you find an expert in managing anxiety with medication–a psychiatrist, psychopharmacologist, or even a mental-health nurse practitioner. The best way to find someone is to get a referral from either a doc that you trust or an anxiety sister or brother. You may not have to see the psychiatrist more than a few times—just to get the meds right—before you can get refills from your internist. So even if this person is expensive (and he/she will be), you may need to go only once in a while.
Most of the time when we end up in the psychiatrist’s office we are feeling pretty desperate. It is often hard to think straight because we just want relief. But it is really important to remember that this doctor needs to do a real examination (even though it may be verbal rather than physical), so you should expect that this first session will be at least 45 minutes. Moreover, if/when you are prescribed medication, bring questions and take notes.
Based on our interviews with lots of anxiety sisters and brothers, we have put together a few essential questions:
- Why are you prescribing this particular medication? In other words, why Prozac vs. Paxil etc.? There are subtle differences between these drugs, and your practitioner should have a reason for choosing a particular drug(s) for your specific anxiety symptoms.
- What is the therapeutic dosage of this medication? When you first take an anxiety med (SSRI or SNRI), you are given a starter dose, which is lower than the therapeutic dose you need to effectively manage your symptoms. The starter dose allows you to get used to the medication with minimal side effects. We interviewed a sister whose internist put her on a starter dose for a medication and never raised it—alas the medication never became fully effective. So stay on top of the dosage stuff, in case your doc doesn’t.
- What are my instructions for taking this medicine? Most practitioners forget to tell us exactly when to take the meds (morning or night), how (with or without food), and what to do if you miss a dose. You also need to know if you can drink alcohol, take other meds, (including over-the-counter cold medications, vitamins, and herbs) and if it will make you sleepy, thirsty, etc. Ask and ask again…it matters.
- When should this start to work and what can I do in the meantime? Don’t forget this one. Anxiety meds can take a while to get into your system. Ask your doc how you can get some relief immediately.
- What are the side effects and is there anyway to counteract them? Until you begin taking a med, you can’t really know what your particular side effects, if any, will be. They are different for everyone in kind and intensity. If you are a “Suggestible Sister” (the suggestion of a side effect may be enough to bring one on), you may want to skip this question until you actually experience a side effect. If not, you definitely should ask your doc what side effects have been most commonly reported for your particular drug.
We suggest that you not only pose these questions to your doctor, but that you ask your pharmacist as well. An excellent pharmacist will often catch things that a doctor may not.
One more note:
We are wary about docs that sell stuff. An anxiety sister just told us that she spent $200.00 on vitamins at her new psychiatrist’s office, and that made our armhairs stand up. While we are not doubting that those vitamins may be helpful (or even needed), we do know that it is very easy to sell a vulnerable anxiety sister who is desperate for relief just about anything. (Ask Abs about those putrid green shakes she drank for six months…) Remember that it is perfectly okay to do a little research first or shop elsewhere for the supplements. Ask your doc to write down what she/he recommends and take a week to think it over.
Feel free to comment on anything we’ve mentioned. It’s always great to hear other sisters’ and brothers’ perspectives and experiences. If you have any questions you don’t wish to share with the community, please email us and we will respond right away.
I had recently found anxiety sisters after desperately seeking some support for my anxiety. I have found both so helpful and so thankful to have heard back so soon. I have been on effexor for 18 years I’ve been on it for both my pregnancies because although it was helpful it was literally impossible to come off of. Recently my twin girls have left for college and I have been suffering with severe anxiety n panic attacks again, my Dr increased my effexor saying that it prob wasn’t working anymore and needed to be increased Im praying it will help I also am taking .5 of ativan in the morning to help me with panic attacks Im terrified of I take this ativan every day it will not help anymore then what?? This anxiety has started making me feel like i’m unraveling 😢
Don’t worry about the Ativan. I had to do it as well. It will only be for a while before you feel like you don’t need to take it anymore.
Abs definitely understands how difficult the transition is to an empty nest. Sometimes, SSRI’s stop working after long periods of time and we don’t know exactly why. Many people have success with switching to another similar drug. Ativan and other benzos do not seem to lose their effectiveness in the same way….some people say they build up a resistance and need more but many anxiety sisters we know have taken the same dose of Ativan for years without a problem. You are on a very low dose of Ativan. We are not doctors and cannot give medication advice. However, we have talked to a lot of anxiety sisters and sometimes when they are going through really difficult times, they take small doses several times a day to always keep ativan in their systems — keep the system calm. Of course, talk to your doctor. Let us know what happens and how you are.
I started on .25mg of xanax along with Effexor in 2008. Effexor has recently been upped. My comment is that now I take two .5 xanax a day and extras if something stressful is going on. Should I look at taking Ativan instead? I like the idea of not upping dosage with that. I feel like My anxiety is getting the best of me every time I have to take extra. I have not sought out a counselor yet.
Xanax and Ativan are in the same class (both Benzos) so the difference between the is really which one makes you feel better. If Xanax helps, I would not switch to Ativan. If you need to up a dosage during stressful times etc., you should not feel bad about taking care of yourself. Counseling can be really helpful as well. We also have a lot of different ideas to manage anxiety on our website, so feel free to look around. Mags and Abs
Oh… good questions! I have been frustrated with my meds and don’t like the one my doctor is trying to get me to switch too. Thank you for the insight
You always have the right to ask questions and get 2nd, 3rd opinions. Good luck!