Anxiety--do I see a GP or a psychologist?

[Anonymous]

Hi all. I've decided that I need to go see someone about my increasing anxiety. I am 33 and healthy, so I don't even have a regular doctor. Should I start by making an appt with a GP so try can test my blood pressure and stuff before giving me meds? Or should I just go to a therapist? Also, does the therapist need to be a psychiatrist to prescribe meds?

I am not med seeking, I just have not seen any results from many different ways I have tried to relieve the anxiety (diet, exercise, breathing, meditation, downtime, etc). Their is an appeal to taking a pill and just having a few hours without this feeling.

[Anonymous]

Sorry for the spelling issues, my phone hates me today.

[Anonymous]

A therapist needs to be a psychiatrist to give you meds. There are medical causes of anxiety (eg hyperthyroidism) so it's probably a good idea to get checked out by a GP. Some GPs will give anxiety meds, but I think often in a metro area like DC they outsource this kind of thing to psychiatrists. Psychiatrists in theory should do rule outs of medical causes of psych problems through blood tests etc, but in my experience this is almost never done.

[Anonymous]

I would try to find a GP in general for at least a basic physical, a psychiatrist for meds b/c they will be the most up-to-date, and a therapist who's under your insurance coverage. FYI, most psychiatrists don't accept insurance these days, but if you can find one in network, all the better.

[Anonymous]

Thanks. A GP can do meds, though, right? I was just thinking they would prescribe Xanax/Ativan, nothing extreme. A therapist is a good idea anyway, in theory at least. It gives me more anxiety even thinking about going to a therapist, but I guess I should just try it.

[Anonymous]

Anonymous wrote:Thanks. A GP can do meds, though, right? I was just thinking they would prescribe Xanax/Ativan, nothing extreme. A therapist is a good idea anyway, in theory at least. It gives me more anxiety even thinking about going to a therapist, but I guess I should just try it.

Xanax and Ativan are addictive benzodiazepams. I'd be surprised if a GP would prescribe. They are more likely to first try (if they know what they are doing) hydroxizine (Vistaril) or a beta blocker if not contraindicated (eg, if you don't have asthma). A GP might prescribe SSRIs as well, though I believe this is more common outside metro areas where there are shortages of psychiatrists.

A psychiatrist is likely to go straight for the SSRIs and perhaps script a benzodizeapam like Xanax or Ativan to take as needed to deal with acute panic attacks, or Klonipin (also a benzodiazepam but longer acting) on a daily basis to initially deal with general anxiety as you are eased into therapy. Cognitive behavior therapy tends to be the most effective form of therapy.

In the long run you want to be both anxiety and med free and CBT can help you get there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Thanks. A GP can do meds, though, right? I was just thinking they would prescribe Xanax/Ativan, nothing extreme. A therapist is a good idea anyway, in theory at least. It gives me more anxiety even thinking about going to a therapist, but I guess I should just try it.

Xanax and Ativan are addictive benzodiazepams. I'd be surprised if a GP would prescribe. They are more likely to first try (if they know what they are doing) hydroxizine (Vistaril) or a beta blocker if not contraindicated (eg, if you don't have asthma). A GP might prescribe SSRIs as well, though I believe this is more common outside metro areas where there are shortages of psychiatrists.

A psychiatrist is likely to go straight for the SSRIs and perhaps script a benzodizeapam like Xanax or Ativan to take as needed to deal with acute panic attacks, or Klonipin (also a benzodiazepam but longer acting) on a daily basis to initially deal with general anxiety as you are eased into therapy. Cognitive behavior therapy tends to be the most effective form of therapy.

In the long run you want to be both anxiety and med free and CBT can help you get there.

? My GP has prescribed Xanax and other anti-anxiety medicine. I was also depressed due to a fortunately temporary situation and my GP prescribed antidepressants on top of the other. You do not need to go to see a psychiatrist!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thanks. A GP can do meds, though, right? I was just thinking they would prescribe Xanax/Ativan, nothing extreme. A therapist is a good idea anyway, in theory at least. It gives me more anxiety even thinking about going to a therapist, but I guess I should just try it.

Xanax and Ativan are addictive benzodiazepams. I'd be surprised if a GP would prescribe. They are more likely to first try (if they know what they are doing) hydroxizine (Vistaril) or a beta blocker if not contraindicated (eg, if you don't have asthma). A GP might prescribe SSRIs as well, though I believe this is more common outside metro areas where there are shortages of psychiatrists.

A psychiatrist is likely to go straight for the SSRIs and perhaps script a benzodizeapam like Xanax or Ativan to take as needed to deal with acute panic attacks, or Klonipin (also a benzodiazepam but longer acting) on a daily basis to initially deal with general anxiety as you are eased into therapy. Cognitive behavior therapy tends to be the most effective form of therapy.

In the long run you want to be both anxiety and med free and CBT can help you get there.

? My GP has prescribed Xanax and other anti-anxiety medicine. I was also depressed due to a fortunately temporary situation and my GP prescribed antidepressants on top of the other. You do not need to go to see a psychiatrist!

Mine has too.

[Anonymous]

I have a family member with anxiety and the GP wouldn't touch prescribing for it--outsourced all to a psychiatrist. A bit of one stop shopping with the GP would have been so much more convenient

[Anonymous]

I recommend cognitive behavioral therapy. I had anxiety and this is the best long term fix- you may also need meds but I would try those second, not first. I would also probably prefer to get them via a psychiatrist.

[Anonymous]

My GP has RXd Xanax before, but I find it easier to see the psychiatrist. GPs are a little more cautious because benzodiazepines are widely abused. I've been taking it on and off for years and don't abuse it. The 20 questions, attitude and occasional refusal to RX by GPs annoys me. The psychiatrist requires less explaining and is willing to tinker with meds to get the right mix.

Therapy is a good place to start! The therapist might be able to recommend a psychiatrist. Your GP might give you Xanax in the interim and/or a referral to a psychiatrist.

[Anonymous]

For immediate help- a GP is great. Yes, the drugs are regulated and watched for abuse as it should be but it doesn't mean that you will be denied a refill- just that you need to call in again to request it. It's good to have a regular GP regardless. As for what is needed long term- I found that it takes a while to find a psychologist or psychiatrist that either has availability or "works well" with you so don't put all your eggs in the waiting for that basket.

[Anonymous]

Anonymous wrote:My GP has RXd Xanax before, but I find it easier to see the psychiatrist. GPs are a little more cautious because benzodiazepines are widely abused. I've been taking it on and off for years and don't abuse it. The 20 questions, attitude and occasional refusal to RX by GPs annoys me. The psychiatrist requires less explaining and is willing to tinker with meds to get the right mix.

Therapy is a good place to start! The therapist might be able to recommend a psychiatrist. Your GP might give you Xanax in the interim and/or a referral to a psychiatrist.

Thanks everyone. I made an appt with a GP, in the hopes of doing a general checkup and maybe what is in bold above. The anxiety is relatively new. It started when I had my twins about 2 years ago. I thought it was situational and I'd get over it, but it is still here and sometimes quite intense, even though my life has stabilized a lot. There is no real reason for the anxiety now, but it is still there and driving me a bit crazy. It might even be hormonal since that pregnancy messed with my body in a lot of ways that I'm still slowly recovering from. Not sure if there is a way to test for that though.

[Anonymous]

Also, does anyone see just a regular therapist/ counselor while getting meds from their GP? I've looked around my area and there are (not surprisingly) a lot more options in people and approaches when looking outside of psychiatrists.

[Anonymous]

Any decent therapist will recommend a physical if you've not had one recently. So, going to a therapist and GP are not mutually exclusive.

I definitely wouldn't get meds from a GP, though. Psychotropic drugs are very tricky, and most GPs just don't know enough about them to prescribe thoughtfully. A therapist can make referrals for psychiatrists, if you're so inclined after the physical and beginning therapy.

FWIW, I'm a psychologist, so have a bit of experience with these things. Also, CBT can be useful, but it's not considered a particularly long-term fix. It really depends on what's going on. Oh, and a therapist does need to be a psychiatrist to prescribe, but most psychiatrists aren't trained in psychotherapy any more. Good luck!