Is My Psychiatrist an Idiot?

[Guest Guest_Brishen_*]

I've never heard this before, and I wondered if anyone else had. Moreover, I don't think that my psychiatrist actually knows who I am, anyway, and as I have had just an outright crap time of it with the public mental health system, I am wondering if I should look for a new psychiatrist.

Every time I see him, which is not often, he seems to think I have a different problem. Although I like his manner and upon my initial visit, liked him very much, I don't know that he is really listening to me. I'd once thought that the diagnosis of bipolar was a foregone conclusion and that he would prescribe some sort of mood stabilizer. He'd mentioned lithium as the next step. When I saw him last week for the prescription, he decided to prescribe me Manerix (moclobemide), an MAO-A I believe, and said something like, "Why should we stabilize your mood as it is now?" He said that he now thought I had dysthimia and why should we stabilize my mood at a dysthimic level. I kind of thought he was on crack. I've never heard of mood stabilizers having that property. I thought the goal was to put a ceiling on both depression and mania. Is he pulling my leg or something? I mean, I was hospitalized while rapid-cycling between mania, hypomania, and depression last year (at least, that's what I thought was happening, and so did the attending psychiatrist).

So is it true that mood stabilizers would stabilize me at some sort of unhappy, unmotivated state, or what? I am definitely willing to explore the diagnosis issue and would be willing to accept that I don't have a mental illness at all, even if it means that I might just be some neurotic, weak-willed, nervous chit, but.... I am not even getting that out of this psychiatrist. What would you do? Is he the crazy one?

[Velvet Elvis]

I've never heard this before, and I wondered if anyone else had. Moreover, I don't think that my psychiatrist actually knows who I am, anyway, and as I have had just an outright crap time of it with the public mental health system, I am wondering if I should look for a new psychiatrist.

Every time I see him, which is not often, he seems to think I have a different problem. Although I like his manner and upon my initial visit, liked him very much, I don't know that he is really listening to me. I'd once thought that the diagnosis of bipolar was a foregone conclusion and that he would prescribe some sort of mood stabilizer. He'd mentioned lithium as the next step. When I saw him last week for the prescription, he decided to prescribe me Manerix (moclobemide), an MAO-A I believe, and said something like, "Why should we stabilize your mood as it is now?" He said that he now thought I had dysthimia and why should we stabilize my mood at a dysthimic level. I kind of thought he was on crack. I've never heard of mood stabilizers having that property. I thought the goal was to put a ceiling on both depression and mania. Is he pulling my leg or something? I mean, I was hospitalized while rapid-cycling between mania, hypomania, and depression last year (at least, that's what I thought was happening, and so did the attending psychiatrist).

So is it true that mood stabilizers would stabilize me at some sort of unhappy, unmotivated state, or what? I am definitely willing to explore the diagnosis issue and would be willing to accept that I don't have a mental illness at all, even if it means that I might just be some neurotic, weak-willed, nervous chit, but.... I am not even getting that out of this psychiatrist. What would you do? Is he the crazy one?

As I understand it mood stabilizers are can both treat mania and stop stop cycling. It could be that your psychiatrist meant that is no point in treating you for mania when you are depressed, which is a good point. A mood stabilizer could help prevent future depressive episodes, but an AD might be the best tool to get you out of the suck you're in right now. Ultimately, you'll probably need both.

[myrkkyhammas]

get a new shrink.

[LunaRufina]

I kind of thought he was on crack.

My thoughts exactly.

Ideally- Moodstabilizer then AD. Otherwise both together for bipolar.

Otherwise, starting an AD as a bipolar with no moodstabilization you are just asking for trouble by way of courting a manic episode. While it obviously doesn't happen all of the time that an antidepressant would induce cycling- it happens often and it's not a good idea to test it out.

Either he is completely off or isn't being entirely honest with you.

Which would lead to the conclusion that myrkkyhammas came to without all of this.

~navy~

[AirMarshall]

What the...?

I've read your post 5 times trying to figure out what this doc is thinking... Doesn't make sense.

If you have had mania and hypo mania sufficient to to be hospitalized, it should be clear that you've 'probably' bipolar (assuming not schizo or drug abuse induced).

At best, I could chalk this up to some total breakdown of communications.. but even that is a stretch. Stabilizing you 'low' doesn't make sense. Even if you are cyclothymic, the goal would be to stabilize the cycling and get you back to normal....non-depressed. A mood stabilizer would be appropriate and once stabilizing begins, an AD MIGHT be added if appropriate.

MAOI's have been used for bipolar but they are so far down the list to be a drug of last resort. There are several dozen other drugs that have proven effectiveness superior to MAOI's. BTW, with Manerix Tricyclic Antidepressants and SSRI's are contraindicated, and Antipsychotics only with caution. This part agrees with his comments.

If you want to give this guy one more chance, I would ask him to justify why he is dismissing your hospitalization and previous symptoms as not being bipolar. And why he is not following treatment for affective mood disorders (which include both bipolar & cyclothymic) by treating you with a standard mood stabilizer, (like lithium, which he has mentioned).

I hate to say it, but you would probably be better off with a good GP who will trust your documented history and follow standard drug protocols, if you cannot get to another Pdoc immediately.

Good luck,

a.m.

[ncc1701]

Heya Brishen,

What AM said.

That's weird.

Manerix is a fantastic (IMHO) drug for unipolar depression.

For bipolar it's not what you'd call first-line.

Now, I'm biased towards family docs.

But at least we/they can follow a guideline.

And, get referred to a different psychiatrist.

It's just.weird.

--ncc--