Therapy for anxiety / panic disorder?

[kgizo]

I've always been a little anxious and it is getting worse as I get older so it is time for therapy. In looking at my insurance the search options are overwhelming for "mental health": PhD, MSW, PSYD, MD, LPC, and so many more. Does anyone have a recommendation for the type of credentials best suited for treatment of anxiety / panic disorder? Thanks.

 

[momhappy]

Both of my siblings have dealt with anxiety/panic attacks. I believe the two main forms of treatment are medication and cognitive behavioral therapy. Neither one of my siblings did anything with therapy - they both just went on meds. I would suggest going to your regular doctor and getting a referral.

 

[azstonie]

Don't go on the meds without getting the book by Jim Phelps, MD, first and I want to say DISREGARD THE TITLE ENTIRELY in case you don't think its "applicable" to you:
Why Aam I Still Depressed?

This book was recommended by the Psychiatry staff at Mayo to patients and that is where I heard of it and bought it. I bought in paperback, which is useful, and on my Kindle, which was a good read but not helpful as a reference book or book to take in to a counselor or doctor. This book has hands down the BEST and most current material on medications that I have ever seen. If you read this and understand it, you will be more up-to-date than most psychologists/psychiatrists and for sure your internist.

Basically, depression and anxiety are mood spectrum disorders. If you hop right on to antidepressants you may be kindling a bipolar I or bipolar II condition immediately or months/years down the road. Most people can manage depression/anxiety that is not making them suicidal, by exercise, supplements, spirituality and yes therapy. Medication should be your avenue of last resort and only if you are on the spectrum such that you cannot work or feel suicidal.

These books also helped me:
The 10 Best Ever Anxiety Management Techniques
The 10 Best Ever Depressnio Management Techniques
by Margaret Wehrenberg

They contained all the info I got at Mayo and then some. Highly recommend them.

Magnesium by Doctor's Best brand (that matters, BTW, most magnesium is the wrong type/formulation).
Fish oil.
Hard exercise.
Spiritual outlet.
Manage the people in your life or they will manage you.

Kgizo, I've got a soft spot in my heart for you (see my avatar and you will know why) and please check back in okay? I'll be watching for you.

 

[maccers]

Have you checked what mental health services are offered in your area? IMO, ideally you would be screened and assessed and then offered appropriate treatment, e.g. meds and/or individual therapy, group therapy, outpatient programming etc. Where I live, most of the hospitals and primary care networks have screening and assessment centres. Psychiatrists and psychologists work as teams. At the very least, I would recommend a psychologist over someone with a counselling diploma/degree.

ETA: I have an anxiety disorder...Medication was useful for me to get it under control so that I could get more from my therapy sessions...I've continued my therapy for MUCH longer than my meds (years and years). Ultimately, therapy was the most useful but meds did provide a more stable foundation initially. Therapy is a long-term commitment, if you're interested in really getting to the root of things.

 

[Begonia]

I too suffer from anxiety, and so read this post with interest.

In the early years I thought it was depression, but now know it to be anxiety. I'm menopausal now and the anxiety seems to be getting the better of me (less testosterone?). I find hard exercise and supplements, meditation and prayer essential. I've been working nonstop for two weeks, haven't had some serious cardio and am an anxious mess.

I'll look for those books as I'm always looking for more tools to help me (I really don't want to go the medication route). Thanks for sharing both of you...

 

[momhappy]

I'm sorry, but I do not agree that medication is only for those who can't work and/or feel suicidal. Both of my siblings could work and neither one of them was suicidal - the medication helped them tremendously in certain situations. I'm certainly not advocating that medication is the only way to go because I do believe that there are certain things that can be beneficial (like exercise for example), but I would encourage the OP to seek professional/medical advice.

I wish you the best OP.

 

[diamondseeker2006]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

 

[momhappy]

I too suffer from anxiety, and so read this post with interest.

In the early years I thought it was depression, but now know it to be anxiety. I'm menopausal now and the anxiety seems to be getting the better of me (less testosterone?). I find hard exercise and supplements, meditation and prayer essential. I've been working nonstop for two weeks, haven't had some serious cardio and am an anxious mess.

I'll look for those books as I'm always looking for more tools to help me (I really don't want to go the medication route). Thanks for sharing both of you...

I'm sorry to hear that you experience anxiety too, Begonia I hope that your work schedule eases up soon and allows you to engage in the activities that can hopefully offer you some relief!

 

[azstonie]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

Yes they can. Usually its bipolar II ("soft"). This is why meds are not the way to go UNLESS suicidal or becoming nonfunctional for work or family.

Also, you cannot take meds 'forever' and the long-term effects are completely unknown for many of the meds.

The book is excellent.

 

[azstonie]

I'm sorry, but I do not agree that medication is only for those who can't work and/or feel suicidal. Both of my siblings could work and neither one of them was suicidal - the medication helped them tremendously in certain situations. I'm certainly not advocating that medication is the only way to go because I do believe that there are certain things that can be beneficial (like exercise for example), but I would encourage the OP to seek professional/medical advice.

I wish you the best OP.

Right. Long-term/short-term risks versus immediate benefits. The problem is that people are not told the potential for kindling of bipolar when they take antidepressants or antianxiety medications. Everyone should make their own decisions based on complete information.

 

[momhappy]

^Agreed and by "complete information" that should include professional/medical advice

 

[diamondseeker2006]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

Yes they can. Usually its bipolar II ("soft"). This is why meds are not the way to go UNLESS suicidal or becoming nonfunctional for work or family.

Also, you cannot take meds 'forever' and the long-term effects are completely unknown for many of the meds.

The book is excellent.

The reason it is alarming is that the person was eventually diagnosed with bipolar, also. Severe. Cannot work. Meds do not work for long at all. Endless horrible cycle.

Will look into the book but it may not help since they are already years into meds.

 

[packrat]

I hope you can find something that works for you kgizo, whether that be a form of therapy or medication or whatever else you look into. I had panic attacks for a few years-but didn't know what it was until someone's mom said that's what one of her daughters had and what my symptoms sounded like. I thought I was having a nervous breakdown or something. I'd been to therapy when I was younger and it was...well let's just say I had no plans to return, and where I'd gone was the only place available in this area. So I went to my regular Dr. and she gave me a medicine that wasn't specifically *for* panic attacks/anxiety, but it did help. It wasn't until I started dating my now husband that the anxiety dissipated, and I've not taken the medication for several years now. I still have moments but never full blown I'm going to pass out panic attacks.

I notice some things just in general will exacerbate my feelings and I get more "worked up" than I would otherwise. Caffeine, not drinking a lot of water and being dehydrated and not enough sleep make me more susceptible to anxiety. Yoga helped me *immensely* and it's something I need to get back into doing on a daily basis. It was very cathartic, for me. Might be something to look into?

 

[maccers]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

Yes they can. Usually its bipolar II ("soft"). This is why meds are not the way to go UNLESS suicidal or becoming nonfunctional for work or family.

Also, you cannot take meds 'forever' and the long-term effects are completely unknown for many of the meds.

The book is excellent.

I can't comment on the bipolar link but it does tie in with what I said earlier about going somewhere to get properly screened and assessed by a psychologist/psychiatrist team.

 

[diamondseeker2006]

Not sure if the medical comment was made for my benefit, but the person I am speaking of has been to multiple doctors for 15 years. That's how he got on all those meds (and is not really doing well on them).

 

[NOYFB]

I've always been a little anxious and it is getting worse as I get older so it is time for therapy. In looking at my insurance the search options are overwhelming for "mental health": PhD, MSW, PSYD, MD, LPC, and so many more. Does anyone have a recommendation for the type of credentials best suited for treatment of anxiety / panic disorder? Thanks.

Hi kgizo, I'm sorry you are dealing with anxiety issues. I have them as well. I am an LCSW (Licensed Clinical Social Worker) and I can tell you that social workers are trained to be very client centered, and that we always "start where the patient is". Social workers understand that it's not a default in the individual causing the distress, but rather the systems/stressors in their life. Not to discredit any other professions, but it's been my experience that other disciplines (PsyD, LCPC, etc) tend to prescribe medication, or refer to a psychiatrist who can prescribe meds, rather than trying to understand what in the patient's environment (not the patient) is causing the issues.

To answer your original question, if you truly want client centered therapy without meds, I'd look for a good LCSW that specializes in anxiety and depression.

Good luck to you.

 

[azstonie]

^Agreed and by "complete information" that should include professional/medical advice

Like yours about your sibs, riiiiiight.

 

[Begonia]

Thanks momhappy

I'm on-call with shift work, which isn't ideal for someone with this disorder. I feel like I have to slay dragons every day - the dread can be enormous. Exercise provides an few hours of relief. Apparently anxiety messes up your ability to sleep (that explains a lot). Hard to slay dragons when you're tired.

Anyway, thanks for your kind thoughts.

 

[missy]

No advice to offer but just to second the advice by Azstonie, maccers and Lil misfit. And to offer (((hugs))) and good thoughts and wishes to both kgizo and Begonia.

Kgizo, it might pay to see a couple of different specialists at the same time to manage different needs. Social work/pyschologist and then see if you might benefit from a psychiatry eval if the social worker and/or psychologist feel you could be a candidate for med therapy as well.

Begonia, thinking of you and hoping you find restful sleep soon...we are very similar that way and I know what lack of good sleep can do. (((Hugs))).

 

[Loves Vintage]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

Yes they can. Usually its bipolar II ("soft"). This is why meds are not the way to go UNLESS suicidal or becoming nonfunctional for work or family.

Also, you cannot take meds 'forever' and the long-term effects are completely unknown for many of the meds.

The book is excellent.

The reason it is alarming is that the person was eventually diagnosed with bipolar, also. Severe. Cannot work. Meds do not work for long at all. Endless horrible cycle.

Will look into the book but it may not help since they are already years into meds.

DS - I hope you come back to this thread. I do not know if this will be helpful, but it was eye-opening for me. I also have a family member diagnosed with bi-polar, which began after a 5 day treatment of IV steroids for another medical condition. She was treated with lithium for years. She was never quite right (meaning that she still had a lot of symptoms, perhaps toned down, but a lot interpersonal issues, I guess you could say), and she always wanted to discontinue the drug, and sometimes did, with disastrous consequences (required hospitalizations.) During one of these hospitalizations, they switched the lithium to lamictal, and there has been a huge difference in symptoms. She tolerates the med much better. She also takes some other mood stablizers. And, then, a few months later, she developed another serious condition as a result of the years of lithium use. Her levels were not measured for many of the years that she was on the drug. It is not clear to me whether the psychiatrist did not order the blood work, or if she was non-compliant, but I think it was not being ordered. All of this is to say -- has your family member tried different combinations of these drugs? If he or she has always been on the same core drugs, maybe it is time to look into other combinations of drugs? ALSO, I am currently dosing out all of my family member's medications into weekly pill containers. I think a lot of her issues in the past with meds have been related to her accidentally skipping doses. I hope you find something useful in here.

 

[Tacori E-ring]

I am a LPC and work with all the disciplines you mentioned. I would suggest you find a counselor who specializes in CBT (Cognitive Behavior Therapy). I find those techniques work best with anxiety issues. Feel free to interview the therapist before you commit. You need to feel comfortable and it may take a few times to find a good fit. If meds are needed, and it bothers me when people make rash unqualified judgments on medication, you will need to see a psychiatrist. Out of the list I would stay away from your family doctor. I see a lot of patients with screwed up meds from good meaning but unqualified family doctors.

 

[House Cat]

Oh my gosh. Antidepressants can trigger bipolar??? That is alarming (not for me but for a family member).

Yes they can. Usually its bipolar II ("soft"). This is why meds are not the way to go UNLESS suicidal or becoming nonfunctional for work or family.

Also, you cannot take meds 'forever' and the long-term effects are completely unknown for many of the meds.

The book is excellent.

The reason it is alarming is that the person was eventually diagnosed with bipolar, also. Severe. Cannot work. Meds do not work for long at all. Endless horrible cycle.

Will look into the book but it may not help since they are already years into meds.

DS - I hope you come back to this thread. I do not know if this will be helpful, but it was eye-opening for me. I also have a family member diagnosed with bi-polar, which began after a 5 day treatment of IV steroids for another medical condition. She was treated with lithium for years. She was never quite right (meaning that she still had a lot of symptoms, perhaps toned down, but a lot interpersonal issues, I guess you could say), and she always wanted to discontinue the drug, and sometimes did, with disastrous consequences (required hospitalizations.) During one of these hospitalizations, they switched the lithium to lamictal, and there has been a huge difference in symptoms. She tolerates the med much better. She also takes some other mood stablizers. And, then, a few months later, she developed another serious condition as a result of the years of lithium use. Her levels were not measured for many of the years that she was on the drug. It is not clear to me whether the psychiatrist did not order the blood work, or if she was non-compliant, but I think it was not being ordered. All of this is to say -- has your family member tried different combinations of these drugs? If he or she has always been on the same core drugs, maybe it is time to look into other combinations of drugs? ALSO, I am currently dosing out all of my family member's medications into weekly pill containers. I think a lot of her issues in the past with meds have been related to her accidentally skipping doses. I hope you find something useful in here.

Finding a med combination can be a nightmare, especially if the person isn't stable. It takes most people YEARS to find the right meds. You have to be 100% compliant, no alcohol or drugs, eating right, sleeping right, exercise, and of course therapy. People with BP are extremely sensitive to everything...even sugar gives me tiny swings.

Therapy was the main component of my treatment plan that provided me with the most stability. I am on Lithium right now too with other meds, but I will be making the switch to Lamictal (slowly) tomorrow because my kidneys are starting to show some issues.

Supportive family is EVERYTHING. I don't know what I would do without mine. You guys are really a blessing to your family members.

I have been diagnosed for 21 years. It's been a long road.

My therapist is a marriage and family therapist. I have seen many different therapists with many different letters after their names. I have found that matters the least. What matters is how you click with the human being that is giving you therapy. I needed someone who was going to communicate with me on a soul level. My wounds ran deep, very young childhood stuff. I needed someone who was going to treat me with kid gloves and understand me. When I found that, I stayed. I pay out of pocket for therapy. it's worth every penny.

 

[momhappy]

^Agreed and by "complete information" that should include professional/medical advice

Like yours about your sibs, riiiiiight.

I'm not sure what you mean by this I don't necessarily disagree with your posts azstonie, but if someone is reaching out for help on an anonymous online forum, then my suggestion would always be to seek medical/professional advice, do their own research, and then make decisions that are right for them. My siblings made choices that worked for them, but I realize that there are any number of variables that can affect treatment and/or outcome.

 

[momhappy]

Thanks momhappy

I'm on-call with shift work, which isn't ideal for someone with this disorder. I feel like I have to slay dragons every day - the dread can be enormous. Exercise provides an few hours of relief. Apparently anxiety messes up your ability to sleep (that explains a lot). Hard to slay dragons when you're tired.

Anyway, thanks for your kind thoughts.

Everything is hard when you're tired!!! Hugs to you, Begonia & hang in there - keep fitting in your work outs whenever you can.

 

[lyra]

I see the value in seeing a doctor first. You must know for sure that you don't have an underlying physiological issue before you start a new regime. If the bloodwork and other testing comes up negative, then I'd look for a psychiatrist, because that is the medical specialist for most mental health issues. From there, I'd hope to be referred to a CBT program or therapist. I really believe CBT can be a wonderful resource for people with anxiety, panic, depression and other disorders. It's a solid program, I've done it, and what you learn stays with you a lifetime. It's okay to be choosy when picking your therapist.

 

[asscherisme]

I've always been a little anxious and it is getting worse as I get older so it is time for therapy. In looking at my insurance the search options are overwhelming for "mental health": PhD, MSW, PSYD, MD, LPC, and so many more. Does anyone have a recommendation for the type of credentials best suited for treatment of anxiety / panic disorder? Thanks.

Hi kgizo, I'm sorry you are dealing with anxiety issues. I have them as well. I am an LCSW (Licensed Clinical Social Worker) and I can tell you that social workers are trained to be very client centered, and that we always "start where the patient is". Social workers understand that it's not a default in the individual causing the distress, but rather the systems/stressors in their life. Not to discredit any other professions, but it's been my experience that other disciplines (PsyD, LCPC, etc) tend to prescribe medication, or refer to a psychiatrist who can prescribe meds, rather than trying to understand what in the patient's environment (not the patient) is causing the issues.

To answer your original question, if you truly want client centered therapy without meds, I'd look for a good LCSW that specializes in anxiety and depression.

Good luck to you.

I agree 100%. LCSW is the way to go. I haven't had anxiety but 2 of my kids have had it. I didn't want to go the meds route because its unknown what meds do to a developing brain. I will say that you might have to "shop around" to find a good fit. Its very common to not click with the first therapist you go to. They understand that and if you don't feel comfortable with the person you see, try someone else.

When you find the right fit with a LCSW you will know it and I have found that they center mostly on not only what's bothering you at the moment, but looking for solutions within your life, family, etc.

Edited to add: therapy isn't a one time "lets do this for 6 months and you are cured" situation. My 18 year old son has been in out and out of therapy since he was 5. It doesn't mean it doesn't work, it just means that at times in his life when things get a bit overwhelming for him, it helps him to copy and learn coping techniques. He has learned so much and has come so far. Therapy has been invaluable for him. My 11 year old daughter had gotten to where she couldn't function in school due to her anxiety and therapy helped her so much its amazing. I'm sure medication has a role for some people, but for my own kids, I feel that therapy was the way to go.

 

[Tacori E-ring]

Make sure you go to a provider in your insurance network. Most have searchable systems so you can look up behavioral health and see what pops up. Then most agencies have bio on each therapist. Might help you narrow down your choices a bit.

 

[kgizo]

Thank you all for your input and kind words. Y'all are wonderful! I greatly appreciate the personal stories, knowing of your successes gives me hope. The tips and info shared were helpful. A few reinforced what I thought I knew, but most were brand new to me and it's good to have multiple options.

Regarding the meds - no meds debate, I have meds for occasional use. They are extremely helpful as they prevent the anxiety from escalating into a panic attack, or if I don't take them it still helps just knowing they are available. Daily meds aren't something I am interested in at this time.

I think a lot of your suggestions (CBT, yoga, supplements, etc.) will help me better manage the anxiety. I had heard about limiting caffeine (easy enough) and sugar (next to impossible), but not about the supplements so I will order some and give it a go. My concern is that anecdotally I've heard it gets worse as menopause approaches and the hormones go ballistic so I'm trying to prevent my situation from worsening to the point where I would need meds on a daily basis.

I'm also going to look into the recommended books as I didn't realize there could be some connection with depression or bipolar. Being more knowledgeable will make me feel more comfortable heading into therapy. And, thanks for explaining the certification differences and what to look for in a therapist. I won't be dismayed if I have to try a few before finding someone I click with.

 

[Tacori E-ring]

Thank you all for your input and kind words. Y'all are wonderful! I greatly appreciate the personal stories, knowing of your successes gives me hope. The tips and info shared were helpful. A few reinforced what I thought I knew, but most were brand new to me and it's good to have multiple options.

Regarding the meds - no meds debate, I have meds for occasional use. They are extremely helpful as they prevent the anxiety from escalating into a panic attack, or if I don't take them it still helps just knowing they are available. Daily meds aren't something I am interested in at this time.

I think a lot of your suggestions (CBT, yoga, supplements, etc.) will help me better manage the anxiety. I had heard about limiting caffeine (easy enough) and sugar (next to impossible), but not about the supplements so I will order some and give it a go. My concern is that anecdotally I've heard it gets worse as menopause approaches and the hormones go ballistic so I'm trying to prevent my situation from worsening to the point where I would need meds on a daily basis.

I'm also going to look into the recommended books as I didn't realize there could be some connection with depression or bipolar. Being more knowledgeable will make me feel more comfortable heading into therapy. And, thanks for explaining the certification differences and what to look for in a therapist. I won't be dismayed if I have to try a few before finding someone I click with.

Glad you have some direction now. I did not read all the responses but PLEASE be careful with supplements. I have had many patients on so much stuff that contributed to their mental heath issues. Also I anxiety is not always connected with bipolar. That is a completely different illness (though all three are mood disorders). Yes, people with a bipolar DX can also have anxiety issues but you would have symptoms (which maybe you do?) Not sure how it got brought up in a thread about anxiety. Don't worry too much about the sugar. It is a mood altering substance but more linked with depression than anxiety. Caffeine is another story. Eliminate if you can. I know a few psychiatrists who specialize in hormonal changes. Maybe look for that if you are concerned.

 

[ame]

I wish you great luck. I hope you can find someone to help.

I saw someone for a while, actually I tried several different "someones", in addition to taking Wellbutrin which my GP prescribed. Therapy for me actually made it WORSE and compounded it with other things to panic about. I got very frustrated with the talking part, because the more we talked/I talked, the more engrained these issues became in me, it was as though that was the goal for the therapists I saw, perhaps for longer term billing. The more I saw them, the more obvious that "scammy feeling" became to me. I kept feeling like I was getting played, like they didn't want to help, they wanted to make money. None gave me any insight as to why, none gave me any ideas to help calm down. It was "here's a scrip, see you next time!"

Wellbutrin helped to a fault, in that it helped "quiet" my brain a little bit, esp at night. But it was not the answer and eventually I weened off of it.