Jack is a hot mess.

​
His relationship is a very scary rollercoaster (his girlfriend sounds like she’s a real life Hall-o-scream!) and he doesn’t know what to do about his lease because the rent for his perfect, 2 blocks from the beach townhouse goes up $600 in August.

Jack gets lost in these thought spirals that just take him deeper into the chaos that is his anxiety.

Oh yeah, and his kidneys suck. Blame Covid.

And this is someone who was doing really well the first 6months of therapy! He’s got way more skills than before and his insight has impressed even you at times.

So what gives? What should you work on next?

Besides looking for apartments 11 blocks from the beach or updating his Tinder profile with his flailing relationship in excruciating detail. (Just kidding! I know that's not the kind of therapist you are, Reader. That's his homework.)

Hmm… How about you dig into the quality of his anxiety, what’s been changing and if he might consider medications?

“No way. I’m not going to rely on some stupid pill.”

“Why not? What if it’s something that just helps when things are really bad so you can stop the spiral?”

“My sister was on Zoloft and it made her crazier. She had to take it every day for years! No thank you.”

I saw Jack.

Eventually.

His therapist had talked with him about options and that meds could help. They only talked loosely about Xanax and Prozac but he was at least willing to see what I could offer for his anxiety.

​That’s what today’s video is about. The interplay of anxiety with the types of meds we can offer, and how they play into what a person really wants to do about their treatment.

I talk about physical vs emotional aspects of anxiety and how being able to explain the difference can lead to very different treatment options.

Plus the overall medication options including PRN or as needed medications, SSRIs, SNRIs which are taken daily, or Buspar (buspirone) which is just for anxiety (it also works in the serotonin system but isn’t an antidepressant) and taken 2x/day

Then there’s the tricky bit about trying to align what a person is willing to take, or risk in terms of side effects, for a potential benefit.

These are all really important points that will influence a prescriber’s choice of treatment and if they don’t hear the “right” details during that quick appointment, your client might not get what they really need!

Jack may walk out with the dreaded Zoloft prescription when there could be something better for him.

If you love medication details or hearing nuanced case discussions then get excited! Those videos are next!

Turns out Jack wasn’t completely against meds or feeling better, but he’d had a big medical scare recently and was very distrusting of his body and medicine in general!

After discussing the (hopefully) short time frame for his girlfriend situation and lease decision, we went with the PRN, propranolol.

Why propranolol?

Well I’ll get into it more in the next video but this medication is for the physical symptoms of anxiety.

Although Jack's anxiety was very emotional and would spiral out of control, the triggers were often physical. The more stressed he felt, the worse his physical symptoms became, leading to that cycle of out-of-control anxiety!

With as-needed dosing up to twice a day he was able to feel more in control of whether he wanted to take a pill or not. And after a detailed explanation of how physical anxiety can feed emotions, he was able to calm his body so his brain could take back over and use those sweet skills he’d learned from therapy with you!

Fabulous, right?

Anxiety can feel so terrible and chaotic. And a brief meeting with a rushed psychiatrist may not be the best answer. That can worsen anxiety all by itself!

Yeah, Jack was right: No thank you!

But with some prep work from you, your client will know what to say and how to choose a treatment path that feels aligned, even if their doc only has 15 minutes to spare!

Don't feel anxious about talking to clients who might need meds. This is solid guidance and is not outside of your scope.

And so very helpful! Look at you, Reader. Total rock star!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly online psychiatrist

P.S. After about 1 year of treatment Jack graduated from care with me! He had broken up with his girlfriend, found a roommate to help with the rent, and got a clean bill of health for his kidney issue that had given him such a scare. A great outcome and no SSRIs in sight! The medication was just the thing to help him get over his anxiety enough for things to work out.

P.P.S. This week's anxiety video link!​