Brief Answer:
Some thoughts and suggestions:

Detailed Answer:
Hello and welcome,

This is a tricky situation. And yes, doctors are trained that it is a red flag if a patient comes in to the office requesting a specific controlled substance.

I think the type of doctor who would be most comfortable prescribing a benzodiazepine (the class that Xanax is in) would be a psychiatrist. Next would be the family doc, and last would be the pain management specialist who would probably have you make a contract with them and limit the amount.

If you know that your family doctor would likely be hesitant to prescribe the Xanax, then skip that step and go to a psychiatrist.

One way to try to by pass the "red flag" is to explain everything you explained here, and that the Xanax worked remarkably for you. Then the doctor may be more likely to say, let's give you the medicine that worked for you without feeling like you are trying to manipulate him/her. Given what you wrote above, I do not think you are drug seeking.

All of that said, it may be possible that a different antidepressant would be a good idea (but I'd still give you Xanax until we'd see what worked!). Wellbutrin can cause some agitation and it sounds like you are always feeling keyed up (which may be why a benzodiazepine worked especially well as it has muscle relaxing effects). Have you tried Lexapro? Or a tricyclic antidepressant such as amitriptyline - which is used in fibromyalgia? Amitriptyline has more side effects (sedation, dry mouth) than a newer med like Lexapro, particularly in the beginning, but is used for headaches, myofascial problems, etc. It is an older class of antidepressant.

One concern about benzodiazepines (aside from it's street value and therefore abuse) is that some studies have shown a correlation between benzodiazepines and future development of dementia. This is something you can discuss and get the interpretation of from the psychiatrist.

I hope this information helps and that you are soon feeling well.

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Brief Answer:
Psychiatrist may be more focused on medical management.

Detailed Answer:
Because insurance reimbursement has changed, at least where I am in Wisconsin, psychiatrists are more focused on the medical management now. They aren't reimbursed for counseling, or at least not as much as in the past, so they focus on the meds. And although the initial appointment may be long (an hour), usually subsequent appointments are shorter, such as 20 minutes, and not every week. Probably he/she will have you come back in a couple weeks and a month to see if the meds are working, and then more likely won't see you for several months.

When looking for a psychiatrist in your area, it is reasonable to call around to ask the nurse or coordinator if they have a psychiatrist experienced with treating myofascial pain in association with anxiety.

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