View Full Version : Therapy and/or meds???? What is going on?
I am posting this to spark debate I guess about why so many on here are on meds.
I am saddened and shocked that the first line of treatment in anxiety for so many is to walk out of the gps with benzos, anti depressants and beta blockers.
If you have clinical depression for example (a good mate of mine is bi polar) then anti depressants are a life saver. For many people then psychiatric drug treatment is a necessity. I get that.
But for pure anxiety... What is the drug doing to treat the cognitive and behavioural problems that are causing the anxiety?
So many on here complain the drugs are making them feel worse. If the drugs are the answer for us all, why are people on here posting saying they are having panic and anxiety all the time and in the next breath they list all the meds they are on. The sceptic in me thinks.... Clearly these are not working so well?
Benzos slow the nervous system down, so I can see how that would provide relief. But then they are really addictive and can affect you making you feel out of it. Long term they are depressive.
Anti depressants have the happy co incidence to improve anxiety in some, however, they can also make it loads worse.
That seems to be the major flaw in psychiatric drugs. They all affect different people in different ways and you don't know what they are going to do for you until you have been on them several weeks. People think it is a well understood science yet even psychiatrists will admit they can never be sure.
Those several weeks could have been spent on CBT which is now recognised as truly the most effective method of producing lasting relief and cure from panic and anxiety.
20 years I have suffered, lost my job, had house bound times, countless trips to doctors, health anxiety, felt suicidal at times, missed out on many many things, been too scared to live for far too long. Far too scared to take meds even though they were offered hundreds of times. Have driven many gps mad probably wanting to shut me in a room and throw away the key so I wouldn't bother them again!
CBT is doing it for me now. But it has taken a while or me to find the right programme.
Saw several psychologists in my quest, all helped slightly but perhaps didn't quite hit the mark.
Cbt4panic, endorsed by nomorepanic has been the solution for me.
I would love more people to try it and break out of the daily cycles of anxiety they are trapped in.
It is a hard fought road for me so far and I am by no means totally cured as have only been working on this programme for 3weeks but the feelings of hope and understanding I have now are immeasurable.
Even if this post persuades just one person who is taking meds to think about combining it with the therapy also then I feel it is worth posting this.
I don't mean to offend anyone currently taking meds, as I say I was always too scared to take them.
But perhaps drugs aren't the only way? ...
ladymillion
29-01-13, 19:50
What is CBT4 panic? I have been attending CBT for about 6 months and i have just been started on antidepressants, although i did not want to have to turn to medication. I would do anything to overcome anxiety/ panic/ agoraphobia
I think most people agree that a combo is better than meds alone. I can't speak for others though.
But I agree with you. I am on lexapro right now and also doing therapy. I tried without meds for a couple years and just did different types of therapy, CBT, EMDR, etc etc. I went to two different therapists and the second one was the right fit for me.
It wasn't until the depression really hit hard that my therapist brought up anti-depressants. Before depression, I just had anxiety and because I still could work, function, etc I did not do meds. The addition of depression changed things. I have been on a roller coaster with them, but do think overall that the medication and my therapy together are helping. Before I was on lexapro I considered stopping therapy because I was so depressed and could not understand what help it was doing and what the use was of anything anymore. I had never been in such a dark place. No energy, no motivation.
Since being on lexapro, it has given me the motivation and energy to keep going to therapy and doing some really difficult emotional work that I could not have had the clarity to do before.
So I guess my thought is ... everybody is different. Everybody's experience is different. Therefore, everybody's treatment will be different. I am in school to be a therapist so obviously I am biased and believe that therapy should be first-line treatment before meds and even if meds are used, should be in conjunction with therapy.
But not everybody may agree with me.
Good discussion though!
---------- Post added at 14:52 ---------- Previous post was at 14:51 ----------
Although in re-reading your post, it seems you were wondering more along the lines of meds for anxiety. There are some anti-depressants that have been approved for anxiety disorders as well, although the science of it is beyond my brain's understanding.
Ladymillion Cbt4panic is a programme online, endorsed by this website in fact it was on these forums that I discovered it.
Google it and see for yourself.
It is free for 30 days then once payment has been taken you even have another 30 days to ask for your money back. I don't even think they ask for any of the material back should you do that.
It is the most bona fide treatment course I have discovered.
The man who put the programme together was an anxiety sufferer himself for years, he then trained as a therapist and developed a CBT programme.
The workbooks are easy to read, full of humorous cartoons which really get the message across, plus each section has accompanying videos which you watch once logged in or you can download them
It cost me £58 (actually hasnt cost me that yet as i am still on my months free trial) which was cheaper than one trip to a psychologist for me. I think there are also payment plans to spread the cost.
There really is no catch.
Sparkle1984
29-01-13, 21:09
In combination with CBT and lifestyle changes, meds have worked very well for me, to the point that I'm now in recovery and tapering off the meds.
My main problem last summer was anxiety, but this had also triggered depression. If I wasn't offered meds while I was waiting for CBT, I don't know how I would've coped, and I don't think I would have been able to absorb the concepts. I dread to think what might have happened to me if I hadn't got help when I did. I think I might have ended up losing my job as I was getting to the point where I couldn't concentrate or function properly. I couldn't sleep properly, I'd lost my appetite, I lost enjoyment in my hobbies and social activities, my heartbeat was constantly pounding I was being tormented by negative thoughts during virtually every minute of my waking life. The thoughts were very intrusive and morbid. I was terrified of death and dying and of my relatives/friends dying. I was worried that I'd never be the same again and I was getting to the point where I was dreading waking up each morning, knowing that I'd be spending yet another day feeling awful. That is when I knew I had to go to the doctor's. I scored "severe" on the GAD scale and "moderate" on the depression scale. I never reached the point of harming myself but I dread to think what could have happened if my condition had been allowed to fester.
So I don't think anyone can tell me that I didn't need meds as a first line treatment.
I think it's great that you are able to function without medication, but unfortunately this isn't the case for all of us on this forum. If you felt as bad as I did last August, you would probably need medication too.
Having said that, I do believe very strongly in a holistic approach, which is why I've made lots of lifestyle changes and learnt cognitive behavioural techniques. I've also been learning relaxation and mindfulness techniques. It's all listed in the link in my forum signature below. I also believe that the NHS should provide much faster access to counselling and CBT - it's disgraceful that many people on this forum have said they've had to wait for months for therapy. It seems like this condition is treated as a lower priority than physical illnesses.
I'm sorry if this post sounds like a rant and rave, but I do believe the meds saved my life and livelihood and I'll be forever grateful for that. So if I sound defensive, that is why. I will always be defensive of anything and anyone that has saved me. It always concerns me whenever I hear anyone suggest that access to meds should be restricted - it could cause incalculable harm. I believe they should be made available to anyone who feels they need them, as long as their doctor agrees of course.
nomorepanic
29-01-13, 21:16
You can read about CBT4PANIC here:
http://www.nomorepanic.co.uk/showthread.php?t=91696
Sparkle1984 you misunderstand me. Don't think I said meds should be restricted, just that it shocked and saddened me that they were a first line defence and then no follow up support was felt necessary therapy wise.
People walk away on meds and that is that. They are left unless they then go and ask for CBT for which there seems an interminable wait.
Your story and symptoms sound scarily identical to mine. I also registered severe on the GAD over the years on several occasions, and depression has featured, unable to function, get out of bed, however was lucky enough to have practical support from my mother in raising my eldest 2 kids who at the time were very young. I don't know how I managed, I was so bad I had visual hallucinations and heard things at times, perhaps at those times meds would have helped, I will never know, as I said, I was so paranoid at those times I couldn't have swallowed a pill.
I am sorry you felt I was having a dig at you. I do not mean to cause offence and that was never the intention of this thread so please accept my apologies if that is ow it comes across.
If the meds help then all good. But there are people put there who post on these forums and they seem no better or even worse on them and yet no mention of cognitive or behavioural advice seems forthcoming from their doctors. Infact some people don't even seem to have heard of it!
Sparkle1984
29-01-13, 21:51
It's OK, I know you were not having a dig at me personally. I feel more on edge tonight because of my PMS and this thread triggered a reminder of what a friend's friend said to me on New Year's Eve about me taking meds. (I started a thread about that here (http://www.nomorepanic.co.uk/showthread.php?t=127256) if you want to know the backstory). But that is not your fault of course. I do not mind lively debates about things.
I think my opinion is actually not a million miles away from yours, in that I think that people should always be offered therapy as well as meds. However, I still think that meds should be the first line treatment for people with symptoms of depression or people with severe anxiety, because they may not be able to focus on the therapy otherwise. Furthermore, if people can't be offered therapy within, say a day of being diagnosed with anxiety/depression, at least they will be able to take the meds to start getting better while they're waiting. It is especially important to offer urgent tangible help if someone could be at risk of harming themselves.
If it was up to me, the NHS would be required to provide access to therapy within a week of a diagnosis. When I walked out of the doctor's surgery I felt more positive as I knew I could start the meds that evening and that I would be on the road to recovery. It took about a month before I started CBT classes, but I still considered myself lucky knowing that many people in other parts of the country have to wait several months. In my area, CBT is taught in big classes of about 50 people, which does mean it's rather impersonal but on the plus side it does help to keep the waiting lists down. In any case, people can still request 1:1 help if they feel they need it.
I realise meds aren't appropriate for all cases, and I know that some people cannot tolerate them at all. But I think that when they do work, they can help to get people in the right frame of mind to start CBT or counselling.
my own thoughts are that generally most folk with anxiety go to there GP for help, and most probably think that medication is a solution to the problem, and almost all GP's are only qualified in diagnosing and prescribing medication, of which some are encouraged to be prescribed for anxiety disorders........ hence, medics prescribe medication because that's what they do, and people take them because the doctor tells them too, etc.
So, people with anxiety problems 'usually' want a quick 'solution', docs give them the quickest (and sometimes only) solution they can, medication.
Which sounds a bit defeatist in a way, but lets be honest, if people went to their GP and they were at the end of their tether with anxiety, and the GP said 'i think in the long-term you would be better facing your fears and working through your anxiety than taking any medication, therefore i am going to refer you for therapy which may take months, good-bye', then there would be even more complaints on here!!
You also hear a lot of folk saying things like 'i need to see a psychiatrist!!', not thinking that these doctors can only prescribe medication too, very few are actually qualified in a recognised therapy, hence years of chopping and changing meds to find a 'cure' (and usually never do) when also expecting the 'come in, lie on the couch, and tell me of your childhood' routine.
Gosh this is long for me!!
In thetube82's 'ideal world' there would be true patient choice, with a good informed choice to the choices (if that makes sense!!).
So, no answer here then!! except, speak to the GP and get him/her to discuss all the options fully and make the decision yourself.
thetube82
I have to say I completely agree Pinktel.
A panic attack, for example, is the body's flight or flight response reacting abnormally sensitively to a situation which is perceived as a threat but isn't - the response itself would be perfectly normal (and necessary) if you were being chased by a lion!
If it is so bad that you can't function then it's maybe OK as a "crutch" to use while you have therapy or try to get to the bottom of what's causing your anxiety but it should never be for the long term.
I'm starting to read stories now where people are basically being given medication to get over bereavement - that's shocking! Grief is real and normal and necessary, it isn't something that should be medicated away.
I also think that many people seem happy to remain in ignorance of what's causing their condition, hoping it will somehow just "go away". Everybody owes it to themselves
to find out as much as they can about their anxiety - knowledge is, most definitely power.
Sparkle1984
30-01-13, 13:28
But where is the evidence that meds should never be used for the long term? Some people have a chemical imbalance so they have to stay on meds for life, and that's not their fault. No one would ever say to a diabetic, "why do you need long term insulin?", so why do people with depression always have to justify why they need long term medication?
I'm hoping I won't need to stay on meds for life (I'm currently weaning off them to see how I go) but if it does turn out that I need them long term then people will just have to accept that I'm ill. No point on living a life of misery or pain if medical science can help.
True, Sparkle. I think that everybody's situation and need are different.
Yes, let's be clear, this post is about people with pure neuroses needing therapy above meds.
Depression, clinical depression which can occur separately or in conjunction with anxiety, needs meds and plenty of rest for the brain. Unfortunately at the moment that is the best the psychiatric profession can offer us. It will be a fabulous day when some new answer arrives and I know many who will be better off as a result.
But really, with a pure anxiety, isn't it a bit defeatist to say we are ill?
In this scenario it is purely ourselves, making repeated mistakes about the symptoms we are feeling, and giving them focus and importance that they shouldn't be given. We know people with pure anxiety are not ill because many can and do recover with the correct therapy and behavioural tools. It's not an illness per se in that our bodies are actually functioning normally, responding as they should to our own requests for adrenaline. As soon as we learn to stop making that request, our limbic system stops ordering up the adrenaline.
It boils down in this scenario to lack of belief and faith that holds us back. We can't believe that there isn't something wrong. Yet when people truly do believe they are fine, that the panic is not a thing to be feared, that is when they improve. So we can't say people are ill just because they have a lack of faith in themselves.
So it's a real tricky and emotive subject. And the meds are helping certain people, and so is the CBT, but the meds also seem to be causing a lot of bother for a lot of people, and for those people icannot for the life of me think why they aren't fighting tooth and nail for CBT. And if they can't get it, get onto the CBT4PANIC website and start taking control back.
Many many years ago as a young mother with husband children and older family to care for - I had a doctor who (when I was having panic / anxiety attacks) told me to "pull myself together I had responsibilities - go home and read your Bible it will do you more good than any medication".
Another Dr put me on Ativan and I just could not function they made me sooooo tired. with so many people depending on me I had to stop meds and cope with panic as best i could. I developed a fear of meds and now in later years I have a Dr who will listen when I am in a panic - hopfully starting CBT next week.
Was referred for this last July:ohmy:
June
Sparkle: depression is a clinical condition that is due to a chemical imbalance (among other factors) just as diabetes is a clinical condition. That's why it CAN require long-term medication.
Panic and anxiety ARE NOT. Therefore prescribing antidepressants for anxiety disorders alone, is entirely inappropriate to begin with, let alone in the long term.
Hi Pinktel
Personally (from experience) sometimes medication is necessary. I only needed it short term. It put me in a position to make lifestyle changes as well as make progress in counciling. I am now going off the medication I was on and going through withdrawal (all physical - dizziness, headaches, nausea and new addition today ... itching). But it was worth it.
I am also borderline depressed. Physically, my body does not produce enough seratonin (a fact of my life), so if I don't live a healthy lifestyle (physically and socially) I am prone to depression. If my situation was any worse I would definitly accept the need to remain on medication. I am grateful that I only needed medication for a time, but do not blame anyone for needing it all the time.
It does frustrate me that depression or any form of mental disability is not taken seriously. If someone has a broken leg or arm amputation ... no one suggests that should just shake it off and manage through it or that alternative ways means of healing should be found. We make allowances for them, plaster the leg so it can heal straight or find way to work around the disabilty and encourage them to do the same ... encourage acceptance of their disabilty or injury so that they can heal or learn to manage their life without it. I think the same courtesy should be extended to those with mental injury or disability.
The solution remains a combination of medication and therapy. Medication if needed and therapy is a given.
Bel8
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