to medicate or not to medicate

[aml0017]

So if you've read my recent posts, I've been having a hard time lately with prolonged anxiety and now depression, after 3 relatively anxiety free years. I have never really stuck with medication too much, nor therapy, in the 20 yrs I've been dealing with anxiety/depression. I always chose to try other methods, mostly relaxation, exercise, diet, etc. to manage it. That didn't cure it obviously but helped me get over the bad parts enough to delay considering meds.

The only meds I have ever tried were buspar (did not work, made me way more jittery than normal) and celexa, as prescribed by my gp. I was on celexa (don't remember dose but was low I think) for about a year after a long bad anxiety episode followed by depression, 4 years ago or so. I remember I wasn't really sure if it did anything or not. While I was on it I had low anxiety levels, but then again I've often had long periods with low anxiety when I was not on the meds. Also during that time I had gotten really good with diet/exercise and lost a lot of weight, I felt the best I had in a long time. I do think the lifestyle changes made more of a difference than the meds. But I wonder if the meds are what made me feel ok enough to go about those changes.

Now that I find myself in the same place I was before the last time I started with celexa, it has got me wondering again about meds. I find in my current mood, and just feeling so depressed and down it is hard for me to find the motivations to even get out of bed much less exercise or eat right. In my "normal" state of anxiety I find I can still do the things I need to do.\

How much has medication helped you? Also, what is the benefit of getting meds from a psychiatrist vs just a general practitioner?

[Kuma]

I think the benefit of getting psychiatric meds from a psychiatrist rather than a general practice or internal medicine doctor has to do with expertise, and with the intersection between therapy and medication.

I say expertise because it is nearly impossible for a general practice doctor to have much expertise in every area of medicine, to keep abreast of the most current studies and developments, etc. For one person to have expertise in neurology and urology and dermatology and rehabilitation medicine and oncology? It just isn't possible. A psychiatrist should have specific expertise regarding psychopharmacology.

Regarding the intersection between therapy and medication, I think a psychiatrist is better suited to make adjustment on medication depending on how things are progressing in therapy, to evaluate when a dosage needs to be increased, or decreased or a medication should be added or stopped, etc., depending on what the psychiatrist sees during the course of therapy -- assuming that the psychiatrist is also doing your therapy. That is why I am not a big fan of psychiatrists who only do psychopharmacology and who outsource therapy to psychologists or other therapists. I think it is better not to look at medication in isolation.

But -- having said all the foregoing -- I realize there are some people who will not be able to see a psychiatrist for either medication or for therapy -- usually for financial reasons. And so those people will need to do whatever they can do -- see a GP or whatever. But I don't think it is optimal.