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On meds for depression but afraid to see a pdoc


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I'm getting meds from my internist right now.  This is the first time I've ever been on an antidepressant.  I know I should probably see a psychiatrist because my depression is very long standing, plus I have other complicating factors like probably a full blown anxiety disorder (social phobia). There are many reasons why I'm reluctant to see a psychiatrist:

1.I'm afraid that when I tell her my mom has bipolar disorder, she will immediately try to put me in that box as well.  I REALLY don't want to be diagnosed as bipolar and I seriously don't think that I am.  A few instances I've felt something which may be hypomania for minutes or hours at a time (NOT days, weeks, or months) but it is something I seem to be able to turn off at will, unlike my depression. 

2.I'm afraid she'll immediately try to put me on a cocktail and/or keep jacking up the dose without giving it adequate time to kick in. It took me FOREVER just to get myself to take ONE antidepressant because I was so terrified of them, and I'm weaning myself up very slowly at that.  My internist is perfectly willing to let me do that, but I'm skeptical that a pdoc would.  I can't afford multilple meds anyway.  One at full retail is bad enough.

3. I'm afraid she will tell me I need to be on meds forever, and I'll be labeled as non compliant if I say that I want to try to go off them after a couple years (that is, if I'm diagnosed with MDD and not bipolar.  I know that if you're diagnosed with bp you can't weasel your way out of meds.)

4.I'm already noticing a difference in my depression after 2 weeks on only 2.5mg of Lexapro and 1 week on 5.  And despite my previous post about being skeptical of SSRIs for social phobia, I think maybe it is making a difference.  I wouldn't have had the balls to make these kinds of posts pre-Lexapro.

5. Perhaps the most importnant reason of all:  I can't fucking afford it because of the whole no insurance thing.  Unless she's willing to give me a pretty serious discount.  I am at her mercy pretty much--she's the only private practice pdoc in our area.  I have to pay for a tdoc out of pocket too and unless I can get my meds for free, and discounted tdoc and pdoc, I don't see how this could possibly be remotely affordable. 

Can someone tell me it won't be the end of the world if I see a pdoc?

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hollywood,

The money problem is definitely significant, but in your area there are probably psychiatrists who work on a sliding scale or are willing to work around your financial situation in other ways.  It may take some sleuthing, but they are probably there to be found.  There are also ways to get discounts or free meds.  A psychiatrist would have access to a LOT of samples.  Mine pushes them on me months worth at a time.

As for the rest of it...

Your psychiatrist cannot MAKE you do anything.  If you see one and they don't seem to jibe with you for whatever reason, you do not have to go back.  You are paying them. 

My psychiatrist is very open to my feelings and suggestions.  Often we discuss things for awhile, and then he makes a few suggestions.  He answers any questions I have about the suggestions and I pick which one seems like the best fit for me.  I never feel pressured into doing something that I don't want to do.

I hope lexapro continues to work for you.  It may be all that you need!  If it is working, I can't imagine a psychiatrist who would switch things around.  If it ain't broke, don't fix it and all.

Basically... going to see a psychiatrist won't be the end of the world. ;)

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Hollywood,

It won't be the end of the world if you see a pdoc.  ;)

Seriously... with the exception of your last concern (the cost), I wouldn't worry about the rest. No one... not even a pdoc, can force you to take medication you don't want or can't afford (unless you get comitted, but it doesn't sound like things are that bad).

The best thing you can do is provide her with all of this information. Let her know your concerns - that you are anxious about medication, and especially that you don't have insurance and can't afford a lot of medication. Being honest will be the best thing you can do. If you agree to take medication that you have no intention of taking, you'd only be hurting yourself. If you have no intention of taking it (for whatever reason), tell her that. But try to be as open as you can to trusting her expertise - to the degree that you can afford it, anyway.

If she's a halfway decent doc, she won't automatically diagnose you with anything based solely on your family history.

As far as the costs go, there are some good threads around here somewhere about patient assistant programs and places you can get free meds. Also, a pdoc is more likely that your gp to have a decent supply of samples (or could very easily get some). It's okay to ask for samples - at least enough to get you through the "trial" period (so you don't pay for an entire script that you don't end up using).

~Sunshine

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Hollywoodfreaks,

Nope. Won't be the end of the world.

I went to my family doc for depression for four years before I finally gave up and made an appointment with a pdoc. When the third antidepressant in four years pooped out and I could feel another bad bout coming on, I made the jump.

The ONLY bad thing has been the additional cost.

The good things are:

- They understand what you're talking about.

- They're not going to go all funny and quiet when you say how bad you really feel. Whatever it is, you know they've heard worse.

- They'll generally give you samples for free until you've settled on something that works.

- If you don't get along or don't like the treatment, you don't have to go back.

- They treat mental illness, not everything under the sun plus MI

And besides, you can always go back to your internist. It was months before I told my family doc that I had decided to see a pdoc. There was no weirdness with my doc, he was happy for me that I was feeling better.

Another thought. The diagnosis isn't to define you. It's to give them a framework for treatment, a better chance to find the medicines that are going to work for you.

Greeny

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I'm constantly fighting off the BP dx just because my MDD/anxiety-whatever  is so hard to treat that my docs think it must be something else. I've gotten used to just telling them my symptoms and calmly clarifying myself if they misinterpret me. They have no specific interest to push a dx on you and all you need to do is tell them what you're like and not let them get onto the wrong track. Of course with social phobia this can take some work. It really helps me to get outside support from my family or my tdoc to overcome my phobia so that I can go in and get my meds.

It's great that you're feeling some positive Lexapro effect and that you're acclimating yourself to the AD scene at your own pace. Why not stay with your Md until you're 100% on Lex and then just do a consultation with the pdoc to see how it feels? It's all about whether you feel strong enough to get their help, because I guarantee you that they won't push anything on you.

I'm always thinking that my pdoc is in control of my life, but it turns out that she's just a petite woman I hire to write me prescriptions. The trick is being able to remember all that when I'm talking to her.

Good luck out there,

KK

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I just want to agree with everything that's been said, and to add that, as a BP mom, I've read that my kids are more likely to end up with unipolar depression than BP.  So it wouldn't necessarily even make sense to stick you with the BP dx.

Glad the Lex is helping,

sg

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hollywood freaks,what state are you in?

Knowing this can help a lot.

If you have a Comprehensive Care Center in your area,they go by your income.

If there is,it may be a very low price for you to pay.

You see a Psychologist for a certain amount of time and then I think you see a Psychiatrist later.

These two will work together in deciding your treatment.

Also,you may be able to get reduced rates at a teaching hospital.If there is such in your area,contact them and ask if they do such.

The following two sites are to help people get medications at a reduced or free rate.

http://www.merckhelps.com/

http://www.pparx.org/

This next site may be able to help you find therapy.

http://www.nami.org/Template.cfm?Section=Y...liateFinder.cfm

If you would like,PM me and let me know what state you are in,like I said,this can help a lot.

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You didn't say much about the tdoc you paying out of pocket for.  Are you currently seeing one?  Just because you see a pdoc doesn't mean you HAVE to see a tdoc.  In 5 years I have never seen a tdoc. 

Don't allow yourself to become caught up in the stigma of being dx'd bipolar.  Before my dx my gp had tried paxil, prozac, zoloft, and lexapro in an effort to quell the never ending depression.

Finally the one friend I trusted with everything personal gave me the name of a pdoc.  I went to see her, filled with images of lying on a couch telling her everything that happened from the time I came out of the womb to present and analyzing it all to death, and STILL being depressed.  To my amazement, she didn't care a whit about family history, but was concerned about how I felt and why.  She suggested at the end of the first session that she thought I was bipolar.  I wasn't yet aware of the stigma..I was like really?  THAT is why I feel this way?

She also suggested every med I have ever tried, but it was up to me whether or not I wanted to try it.  Being dx'd bipolar was a relief to me because now I could begin to study why I felt like I did and what to do.  Even today, if I chose to not take drugs there is no one who would force me to.  And, like others, everytime she prescribed something she usually gave me way more samples than I needed.  Seeing her was the best move I made in years.  I would hate to imagine where I'd be today had I not seen her.  I am informed about what is wrong with me and research on the net all the time.

Don't be afraid.  There is always a way somehow to get around even the money thing.  But first, what is important is to get YOU feeling right.  You can always change anything.  YOU are in charge, not anyone else.

BTW..my gp was delighted when I finally told him.  He said well that explains why all thoses SSRI's didn't work.  Great move!

I hope you decide to try her..I am positive you won't regret it.

Dan~

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Dan, the reason I'm afraid of being dx'd bipolar is not the stigma, but the fact I will have to take meds forever.  At least with depression you can pretend that you'll be able to go off drugs one day. 

;) Also, my SSRI IS working and is not making me manic either, both of which I think are signs that I'm unipolar.  I still think I should be under the guidance of a psychiatrist though because it's not like this was just a one time episode.  I've had several and this last one decided that it just wasn't going to end until I pulled out the big guns.

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If a dx means you have to take meds forever, you had to take them already, but didn't know it, and have been paying the consequences of skipping the stuff.

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i see no stigma in a bp dx.  but, somewhat like kingkong, i'd (past now, altho it has come up one time since for same reasons as kk's) been fighting off the bp dx for years.  in my case, i did not win the fight & i was actually MISdxed bp I, rapid cyclying, first, then *just* bp I or bp NOS for close to a decade.  i would lay big odds the only reason bp II never came up is because i never drank.  no family history of bp whatsoever.  this ("backwards") misdxing can & does happen.  it was 6 shrinks in 2 states; once it got on my record, asumptions were MADE.  so much for long intake questionaires, you name it.  thus,  followed a decade of meds i never needed in the first place, and a plethora of additional nasty side-effects.  there is now no doubt in my mind, that this was one big reason that then led to me getting back into cocaine to self-med, as i was feeling so doped up and physically ill - clean.  i felt so out of it on (always just) ultra low doses of any stabilizer tried.  one would *think* this would have given the pdocs SOME clue!

let me make very clear that i've always been told i'm the most compliant client re meds any doc has ever seen.  (perhaps TOO compliant - how "ironic.") i finally found one pdoc that was good (out of 7 more since) and she agreed to try me with no mood stabilizer.  she then moved away.  at least bp was finally off my record.  in the six yrs since, not one sign of even a hypomania.  i have mdd w/ some anxiety; also ptsd & ocd.  i stick with my tdoc + gp (an allergies guy), who happens to also volunteer at the transitional living for mi in my commmunity.  i realize i have lucked into a very unusual combo with these 2.  i am quite fortunate nowadays.  my misdx occured 16 yrs ago; the huge price i paid should have never happened in the first place.

so, this is my story and i wish it to serve you as a warning - not a mandate.  you seem to be doing well just the way you are doing it.  for mdd, i firmly believe what is oft said:  meds + tdoc bring the best possible outcome/s.

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Glad to hear of some improvement with the meds. Stay with it.

I can echo the thoughts of the others. See the pdoc and be honest with them and with YOURSELF. Tell them your fears and express your feelings. They are there to help and can only do so with the information YOU give them. So be honest.

I have MDD all my life. At times I believed no one could ever understand how I feel or help me. I was in couples therapy for 2 years before the tdoc slapped his forehead and said he didn't know why he didn't see it sooner and sent me off to a pdoc.

Yeah, I'll be on something for the rest of my life. But I have a LIFE to live, now.

Give them a chance to help.

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Dear Hollywood:

In an ideal world, you could eat your broccoli and walk 3 miles a day and never have to take any medication.  I would love that.  I lived 52 very healthy years with nothing more than that headache--requiring an aspirin.  I am married to a man who takes one med for his tummy.  Grrrr

The rest of us take multiple meds.  What difference does it make if you're on them the rest of your life?  Aren't there people with diabetes and glaucoma and hypertension and epilepsy and high cholesterol---and they're all taking pills a couple of times a day.  Would you rather have the depression?  I am so happy to be out of the black pit that I would eat kidney stew or liver every day if the doctor told me it would keep the depression away.  Depression is the most common illness now in America--you've joined the great Depressed Majority!  Grab a flag and join the march!  You're one of us!

Oops....maybe you don't WANT to be one of us.  Sorry.  Well, I love my AD and it changed my life, so I ain't giving it up.  And there's no reason why I should.  If it works, why are you in a hurry to get off it?

Just curious!

olga

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Olga,

Why the hostility? I guess I don't consider being on an antidepressant for at least 2 YEARS before trying to go off them as being "in a hurry to get off them."  I don't like the automatic assumption that I will always be depressed so I shouldn't even try to ever live without meds. Seems like a self fullfilling prophecy to me.  However, I know that the odds are against me and I should be prepared to go back on them should I become seriously depressed again.  And I don't understand why you discount exercise and proper nutrition either.  At one time I found an intense exercise regimen to help me considerably.

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In my experience, it is better to be on meds than to risk getting even more fucked up without taking them (sorry if this scares you...but depression can 'spawn' into greater things, at least it has for me).  Yeah, you're relying on a little pill to get you through the day, but at the end of that day, you'll most likely be glad you took it.  They make things A LOT easier.

I know it might seem weird and scary to be on medication for a long period of time, but it's worth a try.  If you don't like it after a month or so (usually you can tell if it's working or not by this time), you can go off it and try another med, or a different therapy. You said exercise helped you once, ever thought about trying it again?  Doing something to take my mind off of things helps me a lot.  Experiment.  Do creative things, or go running if that's more your thing.

I would save up some money and go see a psych if I were you.  He/she can evaluate your problem and help figure out what's best for you.  Like other people have said, you don't have to do anything he/she says if you don't want.  The important thing is to get someone with experience to help you figure out how best to help your problem.

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Hollywood:

Sorry--I didn't mean to sound hostile.  I just don't understand the resistance to meds if they're helping.  ADs have given me back my old life after 2 years in a black pit of weeping and inertia.  If I have to take this the rest of my life, so be it.

I didn't mean to be sarcastic about diet and nutrition.  I've eaten healthy food all my life, I'm an expert cook and organic gardener, I've been physically active and take care of a 7-acre property, I used to ski and swim and mow an acre of lawn with a push mower.....and here I sit taking 6 medications a day when 3 years ago I was taking nothing.

Sorry about my depressing attitude:  you're absolutely right.  It's just discouraging to have a healthy lifestyle for 50 years and still end up with ailments over which you have NO control.

So I take my antidepressant, because at least that aspect of my health CAN be controlled.

Again, I apologize and I hope you find the answers for your health that keep you active and happy.

My best regards,

olga

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Olga, I think it's totally fine if someone decides to stay on meds forever for depression.  I can certainly understand why and that is something that I know that I have a good chance of facing myself.  But I'm only 25 years old and facing the idea of taking a powerful drug with unknown long term side effects forever when I could be alive for 50 more years is a scary thing.  If I find that I can live without the meds at some point, great.  If I can't then I guess I'll have to adjust to that reality.

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Okay everyone, you've convinced me!  I now have my first pdoc appointment set for mid-July.  The person who scheduled the appointment said she is willing to reduce her rates for some people but I would have to talk to her about it myself.  I guess I'm going to have to put off getting a tdoc until I figure out how much the pdoc will cost and how many samples she is willing to give me.  My internist did give me a bunch of Lexapro samples yesterday so that's good.

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