Dear Dr. Archer,
I have dealt with both depression and anxiety for about ten years. Depression is not fun, but I deal with it and accept it, and have adapted to it without medication. My anxiety, however, seems to only get worse. I have panic attacks at work and become useless, or I'll have them at night and won't be able to sleep at all. The next day I show up for work without having slept the night before.
I went to my family doctor for the anxiety after I decided I could no longer deal with it. During the appointment, it was discussed that I was also dealing with depression. After taking the self evaluation test, my doctor decided to focus on the depression rather than the anxiety. He let me know that the drug he prescribed, Zoloft, could be used to treat both depression and anxiety.
For the next two months, the anxiety was one hundred percent worse. Even to this day, it has never been the same. I was given a prescription for Xanax. My doctor informed me that for the first couple of weeks the anxiety might act up, and in fact I ended up needing about 1mg for lunch every day. Then I would curl up in a ball and not function at all.
I had to tell my doctor we would have to try something else. He told me I'd have to see a psychiatrist, that he had done all he could. He told me to taper off the Zoloft, and he could no longer prescribe Xanax, as I could not take one without the other.
My question is, while I did not mind being on the anti depressant, I didn't enjoy the side effects and felt like I was trying to fix something that didn't need fixing, while making the thing I wanted fixed worse.
When I go to the psychiatrist, is this the way it's going to be? Is the depression going to be the main focal point rather than the anxiety? I don't want the nightmares, but I don't want to hide the depression from the next doctor I see. I don't want the depression to take the priority.
This is a great question with several important points
First, depression and anxiety often go hand in hand and many meds that treat one treat the other. In fact, the class of drugs broadly called ‘antidepressants’ are the mainstay for anxiety treatment. Also many doctors prefer to use these drugs as opposed to Xanax due to the abuse potential of this med. But the good news is that these disorders can be treated either together or separately.
I like to think of these disorders as lying along a continuum with mild anxiety (which can actually be healthy) at one hand progressing to more severe anxiety, depression and panic attacks at the other.
But that doesn’t mean that the antidepressant is always the right choice and certainly it’s sometimes the case where xanax is indeed needed with or without an antidepressant. Also in cases like yours that include panic attacks I will at times start an anti-anxiety med like Xanax first and then add other meds next. It all depends on the art of psychiatry and individual assessment and treatment.
A good psychiatrist will understand all of this so there is no need to hide any symptoms. Rather inform him of your family doctor's prescriptions and the results you experienced. Voice all of your concerns about how bad the anxiety is and then work together to find a good med or combo.
Remember to keep focused and stay patient with yourself as well as your psychiatrist. Often several medications need to be tried in order to hit on the right one that works for you.
If for any reason you don’t feel comfortable with your doctor, let him know right away. I feel we are entering a new paradigm in doctor-patient relationships that is more than ever a partnership as I discuss in this blog
. If your needs are not being met feel free to find another psychiatrist or get a second opinion. Take care.