[aquabelle]

I have a first appointment with a Pdoc this week with continued encouagement from my T. I have severe anxiety which interferes with my being able to verbally communicate with "authority figures" . With help from my T, I have some written information to share. But, I need some information about what to expect to help reduce my anxiety.

Take your notes with you. The p-doc will ask you about what's going on for you and will probably prescribe medication to help you.

[sunrise]

At the first meeting, they would typically do a psychiatric evaluation. They will ask you questions about your symptoms, about your family history, medical history, mental health history, and more. They will also ask you what medications you are currently taking (all kinds) and what psychiatric medications you have tried before. If you are unable to communicate readily, they may have to spread the evaluation out over two sessions to give them more time to get the information they need in order to formulate possible treatment options.

[aquabelle]

Sister Rags and Sunrise, I appreciate your responses.

I am trying to gather enough written documentation from my T and other MDs to have most of the answers for history in my files before our session. I really would like to be able to try a medication to reduce anxiety so that I can improve my therapy and in conjunction relieve my depression. My MD said that she is not comfortable prescribing anything but up to 20 mg Lexapro, and that is not working for me. I also know that I can't take beta blockers because I take Beta-agonists for my asthma. In your opinion, do you think a Pdoc will prescribe anything for the anxiety at the initial session?

[healingme4me]

Mine didn't, wasn't going to either.

On the same note, however, I wasn't on anything, going into those initial appointments. Neither my primary doctor nor neurologist prescribed anything for psyche meds.

(which, where primary is concerned, my ex and I have had same one for years, even when married, and gp did prescribe an AD to my then husband. So GPS prescribing meds, isn't far fetched for me, just wonder if your pdoc will take what you'd been given, into account.?)
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[Altered Moment]

Unfortunately the pdocs don't have much in their tool box for anxiety. Buspar, AD's, and benzo's, and they may not want to prescribe and benzo.

[Jolisse]

Originally Posted by aquabelle

Sister Rags and Sunrise, I appreciate your responses.

I am trying to gather enough written documentation from my T and other MDs to have most of the answers for history in my files before our session. I really would like to be able to try a medication to reduce anxiety so that I can improve my therapy and in conjunction relieve my depression. My MD said that she is not comfortable prescribing anything but up to 20 mg Lexapro, and that is not working for me. I also know that I can't take beta blockers because I take Beta-agonists for my asthma. In your opinion, do you think a Pdoc will prescribe anything for the anxiety at the initial session?

If your anxiety is disrupting your life, you need to make that clear to your pdoc.
He may want to put you on a benzo, to help you deal with your anxiety.
For me, I needed to address my anxiety, in order for my therapy to be beneficial.
I think it depends on the pdoc, mine has no problem prescribing a benzo.

[sunrise]

Originally Posted by aquabelle

My MD said that she is not comfortable prescribing anything but up to 20 mg Lexapro, and that is not working for me.

Why won't she try any other SSRI or an SNRI? Like Paxil, Zoloft, etc. Not being helped by 20 mg Lexapro means it is time to move to the next one on the list, or at least add a second medication. Yes, an MD may choose to prescribe a medication at the first appointment, especially if it is not a controlled substance (i.e. not a benzo). If you have tried several SSRIs or SNRIs with no luck, then they may try a medication in a different class, such as an atypical antipsychotic like risperidone or quetiapine.

[aquabelle]

Why won't she try any other SSRI or an SNRI? Like Paxil, Zoloft, etc. Not being helped by 20 mg Lexapro means it is time to move to the next one on the list, or at least add a second medication.

She said she only prescribes Lexapro because that is the "clean" one and she thinks an expert should take over if something else/more is needed. I do respect her statement that she doesn't feel comfortable with psyche meds. I would rather have a md who says they don't know and doesn't want to guess. Although from what I have read on here, it seems like all the Pdocs just guess and check till something works.

[Bigmike727]

If you're anxiety is disrupting your life, more than likely you may get put on a benzo like Rivotril or Xanax, possibly along with an anti-depressant like Prozac. For me Prozac has worked wonders on my anxiety in the long-term and Rivotril helps with the short term anxiety attacks. Then again, many pdocs are wary of prescribing benzos, as they are known to form dependencies.

[Altered Moment]

Originally Posted by aquabelle

Why won't she try any other SSRI or an SNRI? Like Paxil, Zoloft, etc. Not being helped by 20 mg Lexapro means it is time to move to the next one on the list, or at least add a second medication.

She said she only prescribes Lexapro because that is the "clean" one and she thinks an expert should take over if something else/more is needed. I do respect her statement that she doesn't feel comfortable with psyche meds. I would rather have a md who says they don't know and doesn't want to guess. Although from what I have read on here, it seems like all the Pdocs just guess and check till something works.

It is true but i would much rather have a pdoc prescribe. They do have a lot more knowledge and experience. Its not a total shot in the dark but largely it is.

If they give you a benzo for anxiety that is not shot in the dark. That will work for sure. But you need to be aware of the risks with them.

[sewerrats]

Lexapro may have been to high at 20mg , 10mg is less side effects s you would have felt better , she gave you the best SSRI if trialed it for 8 week and it did nothing, she wont risk you on a less superior med . she will had you over to a shrink, she is a illness doc not a P DOC.

Make it VERY CLEAR to your p-doc that you MUST have help with your anxiety NOW. Remember that your p-doc is working for you. This past year has been the worst for me in terms of my mental health. Anxiety/agitation was consuming me. FINALLY my p-doc prescribed BuSpar and...much to my surprise and delight...it's helping me.

Be assertive!

[Altered Moment]

Originally Posted by Sister Rags

Make it VERY CLEAR to your p-doc that you MUST have help with your anxiety NOW. Remember that your p-doc is working for you. This past year has been the worst for me in terms of my mental health. Anxiety/agitation was consuming me. FINALLY my p-doc prescribed BuSpar and...much to my surprise and delight...it's helping me.

Be assertive!

You know that will mean a benzo Sister Rags. I guess they will probably try Buspar first. I am glad to hear it is working for you. I haven't heard good results with it.

[aquabelle]

I really appreciate all the information. My anxiety manifests as an inability to express myself. Basically, I have lots of thoughts/answers to questions in my head, but I cannot speak. (Along with the typical increased heart rate, sweating, rapid breathing etc) I am pretty sure that I will not be able to "Make it VERY CLEAR to your p-doc that you MUST have help with your anxiety NOW." My plan at this point is to have a lot of written information to provide for my case. I am also uncomfortable with asking for a specific treatment as I don't know much about benzos or other options at this point. Thanks for the support!

[healingme4me]

Originally Posted by aquabelle

I really appreciate all the information. My anxiety manifests as an inability to express myself. Basically, I have lots of thoughts/answers to questions in my head, but I cannot speak. (Along with the typical increased heart rate, sweating, rapid breathing etc) I am pretty sure that I will not be able to "Make it VERY CLEAR to your p-doc that you MUST have help with your anxiety NOW." My plan at this point is to have a lot of written information to provide for my case. I am also uncomfortable with asking for a specific treatment as I don't know much about benzos or other options at this point. Thanks for the support!

Good idea, address your symptoms.
There's even a slight chance, celexa could be prescribed
Be the patient, let your dr. be the dr., know what I mean? Assert, that you aren't feeling well without demanding

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[Altered Moment]

Writing it all down is the best idea. For anxiety for me in the end I had to demand. I believe we have to self advocate.

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[aquabelle]

Writing it all down is the best idea. For anxiety for me in the end I had to demand. I believe we have to self advocate.

Thanks for that Zinco. I really wish I could advocate for myself, but past experiences show that I am not there. I won't even send food back at a restaurant when they mess up, and I have a food allergy! I just don't eat and end up paying for an inedible meal.

My T is the one pushing me to see the Pdoc for meds so our therapy can be more effective. Hopefully the material he shared with the Pdoc will have influence. And I have been working on writing concise information to share. I just hope the Pdoc is one that can work with me and my speech challenge.

[Altered Moment]

It is not uncommon. I can be that way sometimes with food in a restaurant or whatever. Don't want to complain or put other people out. It has taken a long time to be assertive. Even today I get very anxious before an appointment. I forget what I wanted to say. I can't remember how I was doing last week let alone last month. I tend to minimize how bad I am doing. That is why I started keeping a mood log everyday. I bring it in and he reads it and he gets an accurate picture of what is really going on with me. He likes it and I like it it works well.

Another example I run into is if I have been in a deep depression and haven't showered for two weeks. Then on appointment day I force myself to take a shower and shave because I can't go out in public like that. But it gives him a false impression because I clean up like a new penny. I am tempted to go in all grungy so he can see how bad it is. The mood log solves all that.

[healingme4me]

Aquabelle, maybe your T and PDoc can communicate, with your express permission? That's a form of advocacy, for yourself?

Are you working on speaking up for yourself, in therapy? It's not easy, to send something back, but sometimes you can get freebies, because the restaurant wants to please you, keep your business. Saw a woman, not turn back her coffee, today. Just quietly to herself said, this isn't what I wanted. So wanted to rush to her rescue, because she'd have gotten a coupon for a freebie.
Situation and distraction determined otherwise...



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[aquabelle]

Aquabelle, maybe your T and PDoc can communicate, with your express permission? That's a form of advocacy, for yourself?

Yes, I filled out all the paperwork so they could share information. It was mt T recommendation to go to this Pdoc, so I know they have worked together before.

And, yes I am working on "taking care of me" in therapy, but the anxiety seems to be the main issue right now, stopping all progress. I intellectually know what I should do, but my feelings about it are not aligned. Right now I am focused on making it through my appointment on Friday. I will let you all know how it turns out.

[aquabelle]

Just to let you all know how it went...
The computers were down so the Pdoc could not access all of the data that had been sent. They, of course, were running behind on appointments due to the computer issues. When I met with the Pdoc, she started asking rapid fire questions to get as much information as she could quickly. I then proceeded to have a panic attack. It was not the greatest first impression, but I did get prescribed Klonopin for my anxiety. I have to go back in 2 weeks. Hopefully, I will be able to communicate calmly by then?

[BlessedRhiannon]

Originally Posted by aquabelle

I then proceeded to have a panic attack. It was not the greatest first impression, but I did get prescribed Klonopin for my anxiety. I have to go back in 2 weeks. Hopefully, I will be able to communicate calmly by then?

Actually, it was probably the absolutely perfect first impression. The pdoc got to see just how severe your anxiety is first hand. They realized you need help with it and prescribed something that can help. I'd call that a good result.

If the Klonopin doesn't help or has side effects that you don't like, don't be afraid to tell the pdoc (or write it down and hand her your observations of how the med is/isn't helping). Sometimes, the first med tried isn't the right fit. My pdoc started me on klonopin, then switched to ativan, then switched me to xanax, which has been the ideal med for managing my anxiety.

[sewerrats]

Originally Posted by aquabelle

Just to let you all know how it went...
The computers were down so the Pdoc could not access all of the data that had been sent. They, of course, were running behind on appointments due to the computer issues. When I met with the Pdoc, she started asking rapid fire questions to get as much information as she could quickly. I then proceeded to have a panic attack. It was not the greatest first impression, but I did get prescribed Klonopin for my anxiety. I have to go back in 2 weeks. Hopefully, I will be able to communicate calmly by then?

THAT PANIC ATTACK may have been I good thing ,at least you got there attention, they can see you need help not guess

[aquabelle]

Rhi and Sewerrats - thanks for all of the advice. I suppose you are right, having a panic attack right there did cut out the need for further questions. Unfortunately I will have to wait till they open on Monday to start the meds (I was prescribed trazadone and klnopin to add to the Lexapro I already take) because she gave me detailed verbal instructions on how to start taking them. I do not remember anything of what She said, nor did I write it down. I thought about calling the after hours number, but I am sure with the computers down, there will not be access to the data.