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how is depression and anxiety medically treated?

Hi, I was recently prescribed apo propranolol for anxiety. I also suffer from depression which has never been addressed. I am worried about going on anti-depressants but other treatments such as diet and exercise haven't worked. My doctor wants to take it one step at a time, but I don't want to have to go on different medications.
6 Responses
480448 tn?1426952138
Hello and welcome!

The one good thing about having both depression and anxiety is that so many meds really treat both, as they are classed as antidepressants.  Many people get confused and think, "but it's an antiDEPRESSANT, so it won't help my anxiety".  No one is quite sure of the exact mechanism behind WHY they work for anxiety, but they do, in many cases.

If you haven't tried anything yet besides the Inderal, then you have lots of options.  The most commonly Rx'ed antidepressants for both anxiety and depression are the SSRI antidepressants, like Zoloft, Prozac, Lexapro, Celexa, etc.  Inderal is a beta blocker which can be effective in treating anxiety, but it can actually exacerbate depression.  Plus, you've got both conditions that need addressed.

My recommendations if someone is going to try an AD for either depression or an anxiety disorder, would be to try Zoloft or Lexapro first.  Part of my reasoning for that recommendation is that I've had great experiences with both meds treating my panic disorder.  It's really going to have to be something you discuss with your doctor, and honestly, approaching these disorders from a med standpoint is really mostly trial and error, as it's impossible to determine how someone is going to do on each med.  The two meds I mentioned have fairly good track records, both for effectiveness, and ease of tolerating the med.

Keep in mind that while meds can be very helpful in reducing the symptoms of these disorders (sometimes dramatically), they aren't a "cure".  They should only be PART of a treatment program.  The more "work" you do, the better you'll be.  That "work" comes in the form of therapy, and also work on your own.  You can ask your therapist for various resources, there are so many self-help books out there about these topics.  The "therapy" doesn't stop once the session is over.  That's where a lot of people go wrong.  They think popping a pill and going to therapy once a month is enough.  Usually it isn't.  You need to communicate with your therapist that you want "homework" basically...real exercises you can do at home and in between sessions, to help reinforce what you're learning in therapy.

Also, lifestyle changes are important.  Some people keep it minimal and may decide to cut out the coffee, cut down on smoking, and try to eat more healthy.  Others put more effort into this, revamping their diet, looking into different supplements (vitamins), starting (or intensifying) an exercise regime, working to improve sleep, etc.  You can always start slow and work your way up to bigger changes.  You can't argue with the fact that living a more health lifestyle will improve your state of mind, and your overall physical health.  Exercise is one of the biggies.  Get the "a-ok" from your doc if you're just starting, and start somewhere, even with a daily brisk walk.  Exercise makes the natural "feel good" chemicals endorphins.  (Actually, sex does the same thing, lol....it's not something always mentioned, but a healthy sex life can help a lot too!)

You can do all kinds of things, like journaling, meditation, yoga, support groups, taking up a new hobby (something maybe you've always wanted to learn), etc.  Anything basically that is going to improve the quality of your life will help you address your anxiety and depression.

Which disorder is primary?  Many times, a person with an anxiety disorder will develop a secondary depression (*raises hand), and other times, the depression came first.  That can make a difference in what you're going to focus on more.  

If the anxiety is your primary issue, your therapy and "self" therapy will involve more working on coping mechanisms, ways to help control the anxiety, ways to change that anxious cycle of thinking.  If depression is the main concern, your focus will be a little different.  It would involve pushing yourself to get more engaged in life, working towards minimizing any isolating behavior, improving your social support, those kinds of things.

So, in MY unofficial opinion, I'd say that it would be good to discuss your medications options with your doc.  If possible, a psychiatrist would be the best person to manage your meds, especially because you've got the concurrent diagnoses.  You will of course ask for a therapy referral also, if you haven't already.  If you're IN therapy already, you may want to ask about increasing the frequency of the sessions for a while, until you can see how you will do on the meds.

If you end up trying an AD, you MUST try to be patient (as hard as that is).  It can take up to 4-6 weeks before you may notice more obvious improvements.  Sometimes, it takes even longer, as sometimes dosage increases are needed to find a therapeutic level.  So, just go into it planning to spend some time playing the waiting game. In the grand scheme of things, it's not a long time to wait.  Just know you aren't going to feel better overnight.  And sometimes (not always), you have to even feel a little bit worse before you feel better, while you adjust.  

Try not to get too psyched out about possible side effects, or other people's bad experiences.  Everyone has a slightly different experience, you have to allow yourself to have your OWN unique experience.  Don't put to much stock into ANYONE'S experiences, good OR bad.  

There CAN be some initial adjustment side effects (hence my comment above about feeling worse before better above) when it comes to these kinds of meds (ie Zoloft, or other SSRI).  Most people report that they tolerated the med fairly well, if not perfectly (with no reported side effects).

When side effects occur during the adjustment period, they would typically be an increase in anxiety and feeling very jittery (like after drinking loads of coffee), GI disturbances (lack of appetite, possible nausea, diarrhea...rarely vomiting), sleep disturbances (too much or not enough), headaches.  Those are the more common ones.  If you have side effects, don't stop taking your medication...communicate with your doctor.  

There are lots of different approaches to managing those start-up side effects.  The best one is giving it time.  The good news is, the side effects (IF you have any) usually will start to improve significantly around week 2.  You can help to minimize the severity of any possible side effects also by asking your doc to start you out on a low dose, working your way up if needed.  If you end up having side effects that are bothersome, there are still options, one being a short term temporary course of something like Ativan or Xanax.  Just outlining common solutions.  None of this may ever be an issue for you (hopefully).

Lastly, just my opinion again, but I would recommend trying one of the SSRIs first.  I would stay away from the SNRIs (like Effexor), as they are more activating, and may exacerbate your anxiety.  The SSRIs really are a better choice to start with, if anxiety is your primary problem.  I also wouldn't personally recommend Paxil (an SSRI), only because it's one of the meds that is well known for being a toughie to come off.  Just more reported problems with that specific med, over its SSRI cousins.  Lots of people have done well with Paxil, but out of them all, it's one of the more difficult ones to taper off.

Please keep us in the loop, let us know how you're doing and what you've decided to try.  It's great if you can kind of "journal" your experience with your med.  I cannot stress how useful something like that is for people who come along and want to read how people did.  People are always seeking out others' experiences. Remember, a comprehensive program, addressing it from many different angles.

Take care!  Glad you found us!
Avatar universal
Wow, I can't thank you enough for your thorough thoughts. You gave me a lot to think about, and questions I can raise with my doctor. Thanks so much for being so detailed, as I found it difficult getting enough information from my doctor. To.o many questions and not enough time. So thanks again
Avatar universal
Have you tried therapy?  That's usually the first place we're sent, before trying any medication, and you didn't mention that one as something you've tried.  As for medication, if you go that route, psychiatrists are better at this than regular docs, usually.
Avatar universal
Does anyone know if blue cross covers therapy?
480448 tn?1426952138
Yes it most certainly would.  You would need to contact your insurance company, see what kind of coverage you have, and if you're on a plan where you have to choose a practitioner out of a network, ask them to help you find one, and ask if you need a referral from your doc (most likely you do).

Therapy is vital for sure either way, whether you go the meds route or not.  Most definitely give therapy a shot!

Which of your issues is primary?
Avatar universal
While Blue Cross does cover therapy, the selection is likely to be pretty limited, and might not include anyone who specializes in what's ailing you.  For anxiety sufferers, it's usually recommended to see a certified CBT specialist, for example, and insurance companies usually don't have any of these on their networks.  The sad fact is, the best and most versatile therapists and psychiatrists stop taking insurance as soon as they can get clients on their own if you live in a major metropolitan area.  Still, it's worth a look see -- there are exceptions of some practitioners who are very good but still take insurance because they're committed to serving even those who don't make a ton of money.
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