Overall Treatment Of Anxiety Disorders In Primary Care
Of the total 539 primary care patients with an anxiety disorder, 52.7% were receiving treatment for psychiatric problems. One hundred-thirty-two patients were receiving both psychopharmacological treatment and psychotherapy, 113 were receiving only medication, and just 39 were receiving only psychotherapy.
Reasons given by participants for not receiving pharmacotherapy are shown in and for not receiving psychotherapy are in . Among the top two most frequently endorsed reasons for not getting both types of treatment was that the patient didn’t believe in treatment for emotional problems. The most commonly endorsed reason for not receiving pharmacotherapy was that the primary care provider didn’t recommend this treatment . This was also endorsed by 17% of those not getting psychotherapy. Additionally, not realizing that he or she had a treatable, emotional problem was the third most common reason for not receiving pharmacotherapy and the second most common reason for not getting psychotherapy . Barriers related to treatment access, such as cost, convenience, and knowing how to obtain care were commonly endorsed as reasons for not receiving psychotherapy, but rarely given as barriers to pharmacotherapy.
Reasons given for not receiving psychotherapy
Managing An Anxiety Disorder
Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. Anxiety disorders are more than normal feelings of nervousness or anxiousness they involve excessive fear or anxiety. However, there are several effective treatments available that can help most people lead normal productive lives.
Anxiety disorders can cause people to avoid situations that trigger or make their symptoms worse. In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must be out of proportion to the situation, last longer than six months, and hinder the ability to function normally. For more information about Anxiety Disorders, see the NC Health Info page on Anxiety, Bipolar Disorder and Depression.
Anxiety disorders can be treated by a wide range of mental health professionals, including psychologists, psychiatrists, clinical social workers, psychiatric nurses, and licensed professional counselors. You may need to visit with several different providers before you find the right match. A good relationship with your mental health provider will help you get the most out of your treatment.
You can use your health insurance plans directory to find a mental health provider in your network. If you have Medicare, you can use the Physician Compare directory from Medicare.gov to find a provider that accepts it. Other directories for specific types of providers are listed below.
Is It Good Enough To Go To Your Doctor Or Do You Need To See A Psychiatrist Our Decision
If you’re taking or want to take medication for your mental health, it can be hard to know where to go. Maybe you’ve been taking the same medication for years and aren’t sure if it’s working as well as it should. Maybe you’ve been on the fence about whether to try medication. But you know you need help. And you need to trust that the person you go to for help is the right person. Is your primary care physician the right person for the job, or do you need to see a psychiatrist?
As with so many things in mental health, the answer to that question is “It depends.” It depends on whether you’ve taken medication before, on which symptoms you want to treat, and on your personal preferences. The simplest answer is to trust your gutif you feel good starting with your primary care physician , that’s probably where you should start, and if you prefer starting with a psychiatrist, that is probably the right choice for you.
But if you’re still not sure, you can use this article as your decision-making guide. Answering the following seven questions will give you the information you need to make a decision. Read on to learn when a primary care doctor is the best choice and when a psychiatrist is the better option.
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Drug Interactions And Overdose
While benzodiazepines are relatively safe when taken only occasionally and in small doses, they can be dangerous and even deadly when combined with other central nervous system depressants. Always talk to your doctor or pharmacist before combining medications.
Dont drink on benzodiazepines. When mixed with alcohol, benzodiazepines can lead to fatal overdose.
Dont mix with painkillers or sleeping pills. Taking benzodiazepines with prescription pain or sleeping pills can also lead to fatal overdose.
Antihistamines amplify their effects. Antihistaminesfound in many over-the-counter sleep, cold, and allergy medicinesare sedating on their own. Be cautious when mixing with benzodiazepines to avoid over-sedation.
Be cautious when combining with antidepressants. SSRIs such as Prozac and Zoloft can heighten benzodiazepine toxicity. You may need to adjust your dose accordingly.
Paradoxical effects of benzodiazepines
The benzodiazepines work because they slow down the nervous system. But sometimes, for reasons that arent well understood, they have the opposite effect. Paradoxical reactions are most common in children, the elderly, and people with developmental disabilities. They include:
- Increased anxiety, irritability, agitation, aggression, and rage
- Mania, impulsive behavior, and hallucinations
Get Your Antidepressant Prescription Online
PlushCare provides you with access to a network of board certified doctors who are qualified to assess your physical and mental health remotely.
If they find that you may benefit from an antidepressant prescription they will electronically send your prescription to the pharmacy of your choice.
To book an online appointment, click here.
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How To See A Psychiatrist
While a PCP should be able to refer you to a psychiatrist, many dont require referrals anymore. You may not need to see a PCP first if youd rather go straight to a psychiatrist.
Its worth noting that many psychiatrists dont accept insurance. You can talk to the provider and/or your insurance company to figure out your payment options. For example, if you have out-of-network coverage, your insurance plan might reimburse you for part of the cost of treatment.
If you cant get an appointment with a psychiatrist right away and feel like youre struggling, your PCP should do their best to make sure you have the care you need. If outpatient psychiatric care isnt an immediate option for a patient, Kakish says, hell consult with a psychiatrist on what to prescribe and how to manage their condition until an opening arises. If you need acute care for issues like self-harm or suicidal ideation, a PCP would recommend in-patient treatment to stabilize your symptoms and keep you safe. Your PCP might also recommend psychotherapy and connect you with community resources and social support.
Iv What Do You Need To Know About Online Doctors For Anxiety Treatment And Prescriptions
Why should I choose an online doctor for anxiety?
Consulting an online doctor is one of the easiest ways to seek care for anxiety and mental health disorders while saving time and money. Most providers offer on-demand appointments, and theres no need to leave your home.
What types of services and areas of expertise do online anxiety doctors offer?
Mental and behavioral health care are among the many services offered by online anxiety doctors and psychiatrists. Telehealth providers order labs, write prescriptions, and provide related services, including preventive medicine, urgent care, and follow-up visits.
How much do online anxiety doctors cost?
Telemedicine providers that offer mental health services may charge per consultation or per month of care. Typically, rates are relatively affordable even if youre uninsured or your insurance company wont cover these services.
Do online anxiety doctors accept insurance?
Many online doctors accept Medicare and private health insurance. Consult your insurance company or the provider to confirm.
Can online anxiety doctors prescribe medication?
It depends. Online doctors can prescribe most medications, including antidepressants and beta-blockers, that can reduce anxiety symptoms. However, regulations typically prohibit them from prescribing controlled substances, such as benzodiazepines.
What if I need a lab test?
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Trial And Error May Be Reduced When Prescribing
Anxiety disorders are one of the most common psychiatric disorders in the nation. According to the Anxiety and Depression Association of America, approximately 40 million adults in the United States have some form of anxiety disorder1. While many different psychiatric medications have been developed to help patients with anxiety, it can be challenging to find an effective medication regimen that minimizes adverse effects and maximizes therapeutic benefits. Finding an optimal treatment plan often requires a lot of trial and error with various medication formulations and dosages, adding to patient frustration and distrust of medications.
One way that providers can reduce the amount of trial and error when prescribing medications and improve medication compliance is by utilizing pharmacogenetic testing. PGx testing is the practice of examining a particular patients DNA to determine how they would respond to certain medication. While there is growing evidence that PGx testing can predict medication efficacy2, new research also shows that PGx testing can help clinicians determine proper medication dosages by eliminating medications that could lead to unpleasant side effects based on an individuals genetic makeup3.
Special Benzodiazepine Risk Factors
Anyone who takes benzodiazepines can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:
People over 65. Older adults are more sensitive to the sedating effects of benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents. Long-term benzodiazepine use also increases the risk of Alzheimers disease and dementia.
People with a history of substance abuse. Because theyre physically addicting and on their own and dangerous when combined with alcohol and other drugs, anyone with a current or former substance abuse problem should use benzodiazepines only with extreme caution.
Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth. Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose.
The connection between benzodiazepines and accidents
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After You Have Been Approved
After your doctor fills out your recommendation, and the state approves your submission, you will receive a medical marijuana card in states that require them.
When you find a dispensary, you will need to bring either your certified doctor’s recommendation or your medical marijuana card, or both depending on the state, and a current driver’s license or another form of picture ID.
Each state that has approved medical marijuana has its own system for treatment. Its important to check your local laws to make sure you stay within the margins of state law.
Is It Even A Prescription
No. The biggest reason is that marijuana is still an illegal substance on the federal level and isn’t technically even allowed for use in medical studies. Its classified by the DEA as a Schedule I drug.
The DEA maintains that “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.”
Instead of a prescription like other types of medicine, for medical marijuana, doctors write recommendations to the state asserting that a patient will benefit from cannabis.
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Treating Anxiety With Psychotherapy
Certain types of therapy are effective at treating anxiety disorders. In therapy, you talk with someone who has special training in mental health. You might meet with a , , , , or psychiatric nurse. Sessions focus on how to cope with symptoms and what causes your anxiety.
There are many types of psychotherapy used to treat anxiety disorders, but here are two common approaches:
. CBT focuses on changing anxiety-related thoughts and behaviors. Youll work to change the thoughts that cause your fears. You will also learn new ways to react to situations that make you anxious. Your therapist may also teach you ways to relieve anxiety, such as deep breathing. Most people see benefits from CBT in about 3 to 4 months.
Exposure-based behavioral therapy. Exposure-based behavioral therapy is a type of CBT. Its useful for and specific phobias, like a fear of flying. In exposure-based therapy, you gradually face the thing or situation that causes you anxiety. Your therapist will help you along the way. By the end of treatment, the object or situation wont bother you as much.
Speaking With A Doctor About Mental Health Concerns
Its important to speak with your doctor if you have any concerns about your mental health. Many people dont realize just how treatable depression is. While medication is not always a part of treatment, it is an effective option.
Its important to remember that antidepressants are not a cure for depression but rather one component of a comprehensive treatment plan.
A barrier for many when seeking help is the belief they need to see an expensive psychiatrist or therapist for treatment.These are valuable resources, but many times they have longer waiting lists, and may too expensive.
A good starting point is an appointment with a primary care physician. In most cases they are fully qualified to access your mental health and recommend treatment, including antidepressant prescriptions, or they can refer you to a specialist.
If you are suffering, know that depression is treatable, and the sooner you speak with your doctor about your concerns, the better.
Another important thing to note is that if you have any symptoms of depression or anxiety, your doctor will also want to rule out any other potential underlying causes that may mimic depression.
The American Psychiatric Association states that certain medical conditions like thyroid health conditions and vitamin deficiencies should be ruled out when there are symptoms of depression.
A primary care physician can run tests to make sure that there isnt an underlying issue.
Anxiety In The Primary Care Setting
Anxiety is an emotional and physical health problem. It is marked by feelings of fear, unease, and worry that can sometimes be so severe as to make us feel physically unwell. The source of these feelings is not always known. Sometimes it involves past trauma or injury sometimes it involves fear about something uncertain in the future.
A patient might say to me, I need something for my anxiety. They might have had prescriptions in the past for quick-acting medicines such as Xanax, Ativan, Valium, or Klonopin. Those are benzodiazepines, medicines that should only be prescribed with great caution and awareness of the risk for tolerance and dependence. In some cases these medications are good solutions but they have limitations. As a primary care nurse practitioner I want to move beyond what seems like a quick-and-easy fix but doesnt heal over time. The use of these quick-acting medications is an example of seeking an external locus of control over ones emotional state. Making a lasting and effective change in the dynamic of anxiety is neither easy nor quick, like taking a pill might be.
When we develop the ability to recognize harmful self-talk, we can practice changing the way we speak to ourselves each of us can exert powerful restorative effects on our emotional and physical well-being.
John Todd, APRN, FNP is a family nurse practitioner at Putney Family Healthcare, a department of Brattleboro Memorial Hospital.