# Talk to me about panic disorder **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [January 23, 2022, 1:59pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266 "2022-01-23T13:59:55Z")\ **Posts on this page:** 17\ **Page:** 2
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [January 25, 2022, 6:37pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/21 "2022-01-25T18:37:33Z")
> [@teelabrown](#): > > The doc ran an ekg on me, which showed no heart issues that he could see. He didn’t know what was wrong and suggested a psychotherapist. I’m one of those folks who doesn’t like the idea of a head doctor. To me, this isn’t a stress/depression thing that I can just talk away, it’s a majorly physical phenomenon. Since my heart seems fine, I’ll just wait a few weeks and see if this doesn’t go away on its own. Then I’ll reconsider my options. > [@squeegee](#): > > Teela, I’m surprised your doctor had so little to offer you. I can see him being conservative about prescribing benzos (a huge addiction issue in the US), but not even discussing antidepressants or referral to someone expert in those is a bit strange. I don’t in any way want to underrate the value of psychotherapy, but I agree with @squeegee on this. There are amazing pharmaceuticals to deal with the underlying causes of panic attacks. SSRIs like Prozac, for instance, for some people can be a game-changer. The reason we (as a society) continue to develop effective pharmaceuticals is ultimately to improve the quality of life and reduce suffering. Panic attacks are needless suffering. ---
**Author:** ![SmartAleq](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/smartaleq/32/163_2.png) [@SmartAleq](https://boards.straightdope.com/u/SmartAleq)\ **Post date:** [January 25, 2022, 6:44pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/22 "2022-01-25T18:44:56Z")
A psychotherapist absolutely CAN make recommendations for your PCP or a psychiatrist in the same practice to prescribe meds. They don’t need to be a prescriber themselves to do this–and they CAN set a person with panic disorders on the CBT road to help get on top of them because it’s better to get at the root causes and learn how to manage on one’s own rather than only relying on pharma because that’s not necessarily sustainable in the long run. Psych doc can help to parse out if this is a mostly physical issue that’s better handled with meds or a trauma response that’s better handled with therapy. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [January 25, 2022, 7:07pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/23 "2022-01-25T19:07:26Z")
> [@SmartAleq](#): > > A psychotherapist absolutely CAN make recommendations for your PCP or a psychiatrist in the same practice to prescribe meds. They don’t need to be a prescriber themselves to do this–and they CAN set a person with panic disorders on the CBT road to help get on top of them because it’s better to get at the root causes and learn how to manage on one’s own rather than only relying on pharma because that’s not necessarily sustainable in the long run As someone treated for anxiety for close to 20 years, I’ve never encountered a psychotherapist working in concert with a psychiatrist in the same practice. I’m sure it happens, but it doesn’t negate what I said: psychotherapists cannot prescribe meds nor do they receive the training that a psychiatrist does in medication. I agree, cognitive therapy can be helpful and I’ve said so twice in this thread, but I don’t think using medications is “unsustainable” in any way, and that’s for Teela to decide in concert with her physician(s). ---
**Author:** ![BippityBoppityBoo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bippityboppityboo/32/5745_2.png) [@BippityBoppityBoo](https://boards.straightdope.com/u/BippityBoppityBoo)\ **Post date:** [January 25, 2022, 8:43pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/24 "2022-01-25T20:43:40Z")
> [@squeegee](#): > > A psychiatrist does not do therapy; there’s no couch you lay on and talk They do both medicating and talk therapy. The balance varies by the practitioner. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [January 25, 2022, 8:57pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/25 "2022-01-25T20:57:00Z")
> [@BippityBoppityBoo](#): > > They do both medicating and talk therapy. The balance varies by the practitioner. Interesting. I thought MDs doing talk therapy was outmoded these days. Thanks. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 25, 2022, 9:05pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/26 "2022-01-25T21:05:18Z")
> [@squeegee](#): > > I’d have thought this was a weird parody, but apparently you’re serious. 😕 Is this an equivalent to the poster above who said they get panic relief by applying cold on their face/head? My understanding is that submerging your face in cold water activates bodily changes to prepare us for swimming, which includes activation of the parasympathetic nervous system which suppresses anxiety. It’s a survival mechanism evolution built into us, it just also happens to help cope with emotions like anger or anxiety when they get too strong. ---
**Author:** ![Dinsdale](https://avatars.discourse-cdn.com/v4/letter/d/97f17d/32.png) [@Dinsdale](https://boards.straightdope.com/u/Dinsdale)\ **Post date:** [January 25, 2022, 9:13pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/27 "2022-01-25T21:13:40Z")
> [@squeegee](#): > > …there’s no couch you lay on… Man: Doctor, my wife thinks she’s a chicken! Doctor: I can cure that. Man: But we need the eggs! 😉 ---
**Author:** ![BippityBoppityBoo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bippityboppityboo/32/5745_2.png) [@BippityBoppityBoo](https://boards.straightdope.com/u/BippityBoppityBoo)\ **Post date:** [January 25, 2022, 9:39pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/28 "2022-01-25T21:39:19Z")
> [@squeegee](#): > > but I don’t think using medications is “unsustainable” in any way Benzodiazepines (Xanax, etc) can become ‘unsustainable’ in the long term as it is all too easy to become acclimated to them and need ever increasing or more frequent doses. They are riskier for older people or in some occupations. They can be very unpleasant to come off of after long term use. I know this from decades of using them. They are very helpful for short term use, like a month or two, while the person works with a skilled therapist to develop skills to deal with anxiety or panic, like CBT or DBT, meditation or mindfulness, etc. I also know _this_ from decades of working with skilled therapists. Knowing you have 5 Xanax a month to handle a panic attack or an anxiety attack is workable in the long term. I did that for quite a while. Finally realized I never quite got around to needing those last couple every month. Self talk and knowing I had them if I needed them was/is enough. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [January 25, 2022, 9:45pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/29 "2022-01-25T21:45:33Z")
> [@BippityBoppityBoo](#): > > Benzodiazepines (Xanax, etc) can become ‘unsustainable’ in the long term as it is all too easy to become acclimated to them and need ever increasing or more frequent doses. Oh, totally agree. Benzos are addictive and dangerous. But they’re not the sum of all ‘meds’ if you consider all the other antidepressants and so forth out there. I take an atypical antipsychotic for example (antidepressants don’t seem to work for me). There’s a huge smorgasboard of options that aren’t benzos. _And_ I have as-needed benzos (Lorazepam for anxiety, Temazepam for sleep) that I take as seldom as possible; I think I last refilled my benzos 1.5 years ago and I’m still on the same 1-month’s prescription amount on hand. Knowing they’re in the toolbox is damned helpful even when you resist the temptation. Anyway, making a blanket statement that meds are ‘unsustainable’ in general is my objection. Many many meds are fine over the long term, you just need to be aware of their limitations and hazards. I think we’re on the same page here, BBB. ---
**Author:** ![BippityBoppityBoo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bippityboppityboo/32/5745_2.png) [@BippityBoppityBoo](https://boards.straightdope.com/u/BippityBoppityBoo)\ **Post date:** [January 25, 2022, 10:35pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/30 "2022-01-25T22:35:07Z")
> [@squeegee](#): > > Interesting. I thought MDs doing talk therapy was outmoded these days. Thanks The devil is in the details, of course. Much easier to be reimbursed for a medication management visit than a psychotherapy visit. A doc can do 3 or 4 med visits in the hour they could do a therapy visit in. Insurance companies far more willingly pay for a $160.00 med management visit every 90 days than a $260.00 psychotherapy visit once a week. ---
**Author:** ![SmartAleq](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/smartaleq/32/163_2.png) [@SmartAleq](https://boards.straightdope.com/u/SmartAleq)\ **Post date:** [January 26, 2022, 12:27am UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/31 "2022-01-26T00:27:48Z")
Types of practices can vary from state to state, here in Portland OR I can assure you that there are multiple behavioral health practices that have psychotherapists and psychiatrists working in concert, and that some psychotherapists do have authorization to prescribe. I know this because I had occasion to pick up my son’s meds when he was being treated by one practice and the name on the scrip was the name of his therapist, who is not a psychiatrist. So there you go. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [January 26, 2022, 12:51am UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/32 "2022-01-26T00:51:53Z")
Interesting. I know that in California where I live and in most states pschologists/therapists are definitely _not_ allowed to prescribe meds and only physicians and nurse practitioners can do so. I went looking for the rules in Oregon and came up dry, except that in 2017 [the governor of Oregon vetoed a bill that would have permitted the practice](https://www.aacap.org/AACAP/Press/Press_Releases/2017/AACAP-Applauds-Oregon-Governors-Veto-of-Psychology-Prescribing-Bill.aspx), and in [this article from American Psychological Association](https://www.apaservices.org/practice/advocacy/authority/prescribing-psychologists), updated just 6 days ago, Oregon is not mentioned in a list of states that permit the practice. 🤷‍♂️ In any case, the OP is in California, so a psychotherapist would need to work in concert with a doctor or NP to prescribe her meds. ---
**Author:** ![teelabrown](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/teelabrown/32/8412_2.png) [@teelabrown](https://boards.straightdope.com/u/teelabrown)\ **Post date:** [January 26, 2022, 10:11pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/33 "2022-01-26T22:11:24Z")
Thanks for all your input, everyone. I haven’t had any issues for almost two days now, and the peculiar sensations in my chest have also vanished. Since the ekg didn’t indicate anything bad, I’ll just wait a bit to see if whatever this is hasn’t just gone away on its own. If it comes back, I’ll re-consult with the doc on what to do. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [January 26, 2022, 10:32pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/34 "2022-01-26T22:32:37Z")
Glad to hear you’re doing better. ---
**Author:** ![stretch](https://avatars.discourse-cdn.com/v4/letter/s/a6a055/32.png) [@stretch](https://boards.straightdope.com/u/stretch)\ **Post date:** [January 28, 2022, 1:02am UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/35 "2022-01-28T01:02:52Z")
My therapist was also an ARNP so could write prescriptions, but worked with my PCP to come up with a med plan. My ex saw a psychologist for therapy and a psychiatrist for meds, in the same place. I was being treated for depression, he was treated for bi-polar. Different approaches and caregiving team for different issues. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [January 28, 2022, 11:40am UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/36 "2022-01-28T11:40:51Z")
Every therapist or psychologist I’ve seen has either had a psychiatrist on staff or otherwise has some sort of special relationship with one. It’s a requirement for Arkansas Medicaid to pay for their services. My old psychologist didn’t have this back when I saw him (and so he had to give me a steep discount for me to afford seeing him), but he’s now on staff at the hospital that is only a block away. Even though I am on maintenance meds, I’m a big proponent of trying without them first. Medicines can stop working over time (including antidepressants) and trying to change them can be quite shitty. Plus there are restrictions with several meds that you might not like (e.g. no alcohol), and side effects. It just makes sense to me to try other avenues first, especially for a problem that is new that you might be able to get treated early before it becomes too much of a bad habit for your brain. ---
**Author:** ![teelabrown](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/teelabrown/32/8412_2.png) [@teelabrown](https://boards.straightdope.com/u/teelabrown)\ **Post date:** [February 19, 2022, 9:16pm UTC](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266/37 "2022-02-19T21:16:42Z")
The weird heart/chest sensations came back, and the panicky sensations are long gone, so I went to see a cardiologist. They asked a lot of questions, and I had a normal electrocardiogram. I’m now wearing one of those smaller devices that have taken the place of the bulky “Holter monitor”. It’s about the size of an Apple watch and sticks onto your chest with some seriously adhesive tabs. Every time I feel like there’s an irregularity with my heart, like it skips a beat or quivers, I press the center of the device and then note down what I was doing at the time in a little book. The device is really comfortable; I can’t imagine going around with one of those old-fashioned big versions. After two weeks, I mail the device and the little log book back in to the lab that makes them, and they report the findings to my cardiologist. I’ll see him again on 3/23, but before then, I have to have an echocardiogram. I guess I’ll have to switch to a “Mediterranean diet”, though I already eat a lot like that anyway. But out with the New York steaks, the gelato, and the buttered toast. Not to mention the Camembert. Hey, all of those things are of cow origin. [Previous page](https://boards.straightdope.com/t/talk-to-me-about-panic-disorder/958266.md?page=1)