Seeing a psychiatrist soon, what to expect and how to prepare? really anxious

[crazyguy]

Well I've been moaning on this forum about my depression, social anxiety and OCD for ages now.  No meds working, failed with CBT, etc.    I've been referred to "secondary care"  and after triage they have decided I need to see a psychiatrist.  Because of the NHS system I have no idea who I will see or when either, but I should know within a couple of weeks. 

 

What should I expect from the initial appointment and what details would help them to give me the best treatment?    I would really like some help from a psychologist and I hope a pdoc will be able to refer me for such treatment rather than just drug me up. No drugs have helped so far and I've tried plenty. 

 

My GP, who is very knowledgeable about MH,  feels we have exhausted the medication options anyway and that really I need therapy or longer term support, particularly to work on self-esteem.   

 

I should feel good that I may get some additional support but I don't........... I feel really down like this is just going to be another dead end let down. 

 

 

UPDATED PAGE 2. 

I would be really grateful for any further thoughts or replies. 

 

 

Edited December 18, 2014 by crazyguy

[olga]

I would immediately start making lists.  You can't trust that the system will have an accurate list of all the meds you've been on, and how long you took them.  It would be very helpful to the psychiatrist if you had a complete list.  If it is only the 6 meds you  listed in your signature, try to work out a chronology of when you took each one and in what combination.

 

If your memory is a little faulty, write the list anyway.  Go back and read any blogs or journals you may have kept to supplement the information.  If you can remember how you felt while on a particular drug, make note of that on the list.

 

Your GP may be knowledgeable about MI issues, but he still is not a psychiatrist.  The pdoc is a specialist and may have insights and expertise that could be very helpful to you.  If you had a fractured leg, you would go to an orthopedic specialist.  If you had cancer, you would go to an oncologist.  Try to think on the positive side that this pdoc will know things that could help you to have a better life.  There could be a combination of meds and therapy that might give you a fresh start.

 

Go there with as much information about past treatment as you can, so that the pdoc can help you to make informed decisions about future treatment.

 

olga

[jt07]

Olga has great suggestions. The only thing I would add is to write down exactly what's going on with you and what you need help with. It might turn out to be an essay, but that's ok. That way when you get to the psychiatrist you will have something to give the doctor in case your mind gets scattered. The list of meds and their effects that Olga suggested is vital.

 

Just be open and honest with your psychiatrist. Also, be open to med or other suggestions from the psychiatrist. Other than what has been suggested, try not to worry about it too much. Psychiatrists are not miracle workers, but they are much better than GPs.

 

I'm glad you are taking this step, and I wish you a lot of luck!

[crazyguy]

I guess I am just feeling quiet negative about everything given past experiences.   I would really like to explore the talking therapies more and I hope the doctor will be able to refer for that, rather than drugs alone.  I struggle to see how drugs could help me.... although I would consider some options but not others.  I hope to be given a doctor who is open to discussion, rather than one who follows a "these are my orders, do as you are told" mentality. 

 

creating some lists is a good idea.   I already have a list of all the meds I've tried since about 1998 but I need try and remember how long I was on everything and at what dose.   To be honest I suspect the doctor would only be interested in the more recent stuff anyway, but from my perspective I'm not prepared to repeat the same loop of drugs again before moving on to something new. 

[Savannah]

Don't worry about saying anything wrong to the pdoc. he has heard it all and understands what you are going through.

I was told by no less than 5mdocs there was nothing wrong with me, before a pdoc diagnosed me.

[iaawal]

When I saw my current pdoc for the first time I typed up a very detailed history. I added all current meds and past meds and the reasons I stopped them/if they worked. Then I divided my history into categories (psychosis, mood, anxiety, etc) and then had a misc. category and wrote a detailed description/history of that. I also added a section of symptoms I was currently experiencing and added a section for my hospitalization and a detailed account of that. 

 

Good luck!

[Equivilency]

I'm sure there is a lot of great GP's out there but I have a feeling you will be much better off with a pdoc. I agree with the others get a detailed list together so you and your pdoc can collaborate on an action plan.

[CeremonyNewOrder]

Just be as honest as you can and tell them everything.

[jt07]

I guess I am just feeling quiet negative about everything given past experiences.   I would really like to explore the talking therapies more and I hope the doctor will be able to refer for that, rather than drugs alone.  I struggle to see how drugs could help me.... although I would consider some options but not others.  I hope to be given a doctor who is open to discussion, rather than one who follows a "these are my orders, do as you are told" mentality. 

 

creating some lists is a good idea.   I already have a list of all the meds I've tried since about 1998 but I need try and remember how long I was on everything and at what dose.   To be honest I suspect the doctor would only be interested in the more recent stuff anyway, but from my perspective I'm not prepared to repeat the same loop of drugs again before moving on to something new. 

 

That's too bad if you've already closed off some options by yourself. Generally, the gold standard for psychiatric treatment is both meds and therapy together. And you need to be open to all meds. I would be nowhere if I didn't consider Abilify or Tegretol, both of which have changed my life.

[crazyguy]

Well the appointment has come through, not until the end of December.  

Feeling pretty shitty today, not sure how to get through my studies until then, everything is a struggle. 

[Flash]

Sorry you have to wait so long.

[jt07]

That's pretty crap having to wait so long. It's the same way here where I live - 3 month wait. Just be good to yourself in the meantime and don't be too hard on yourself about the studies.

[Cetkat]

As I don't see a direct response to the therapist part here.... I would make sure to tell the psychiatrist about any interpersonal/life/motivation issues & how you feel you need to be able to talk to someone about them because you feel unsure and occasionally unsafe in your own head.

 

The biggest thing to get across there is that you would never hurt yourself and haven't, but need an outlet to talk about such things and get a support structure to come up with ways of coping, and feel like you're not alone.

 

Don't lie.  So if any of that isn't accurate - substitute it for something that is (I picked a very generic example)... but I'd think it would be a convo like that would get you permission to see a psychologist/therapist.

 

Just get across that you need therapeutic help but are not a danger to yourself.

 

(I'm from the US, so I'm winging it, but the referral requirements should be rather similar I'd think)

[crazyguy]

As I don't see a direct response to the therapist part here.... I would make sure to tell the psychiatrist about any interpersonal/life/motivation issues & how you feel you need to be able to talk to someone about them because you feel unsure and occasionally unsafe in your own head.

 

The biggest thing to get across there is that you would never hurt yourself and haven't, but need an outlet to talk about such things and get a support structure to come up with ways of coping, and feel like you're not alone.

 

Don't lie.  So if any of that isn't accurate - substitute it for something that is (I picked a very generic example)... but I'd think it would be a convo like that would get you permission to see a psychologist/therapist.

 

Just get across that you need therapeutic help but are not a danger to yourself.

 

(I'm from the US, so I'm winging it, but the referral requirements should be rather similar I'd think)

It is tricky, I never know how to answer the self-harm questions because the only time I have self-harmed is as a teenager and I was on Paroxetine (paxil?) at the time which I think caused the problem.  Plus the self harm was really quite minor compared to what some people do.    Having said that I do have recurring suicidal thoughts, almost of an obsessional nature. But it is only when I'm really low that I start thinking about how they could be carried out.   

 

I feel my biggest issue is social anxiety but interestingly other people tell me it is the OCD that is most obvious - obsessive repetitive thoughts and ruminations, I don't have many obvious compulsions anymore.   They think that is what needs addressing and I guess to some extent I agree as my brain is just in a loop all day, it can be exhausting.

 

Having a therapist to talk to would be really helpful but I feel it needs to be over a long enough time frame to get to know someone and discuss lots of issues.   What I have had in the past is just like 10 sessions of CBT, which is OK for managing symptoms and setting some practical goals but totally useless for dealing with the low self-worth stemming from a crappy childhood.

 

Medication wise I'm still highly sceptical of AP / AAPs, I think the side effect profile sounds worse than the problem.  Might consider mood stabilisers depending on what one.    I would consider MAOIs.   Mainly I do not want to go back through all the SSRI/SNRI that I've already tried.  

[Cetkat]

You can pretty much answer them honestly.  As long as there isn't immediate intent, and therefore a safety issue, it seems practitioners prefer to keep patients out of the ER.  You just have to say you're not a danger to yourself but have issues that need addressed to keep it that way.

 

The self-harm isn't as major as suicidal intent.  Especially past self-harm.  That's usually seen as over and done with.

 

I can't advice on the OCD stuff.. that has too many nuances for me to really understand in this context.

 

I would go for regular therapy instead of structured.  Something like CBT can have time limits because there are programs built for it.  General therapy ideally lasts as long as insurance covers it and the therapist thinks it's beneficial.  Some AAPs have minor side effects.  APs as a whole are more sedative (IMO) and not good for depression type issues.  Lithium and Lamictal and good first-line mood stabilizers.  The others also work more as anti-convulsants/seizure meds and have additional elements to consider.  I wouldn't try an MAOI until you'd given AAPs, Lithium, and Lamictal a fair trial.  For one, most docs won't rx them due to the possibility of death if you combine them with the wrong food or OTC med... but they really are a last line defense.  

 

I'm on one now, but only after trying virtually everything else.  And I had to find a super experienced pdoc who felt comfortable enough to try it.

[crazyguy]

 

I would go for regular therapy instead of structured.  Something like CBT can have time limits because there are programs built for it.  General therapy ideally lasts as long as insurance covers it and the therapist thinks it's beneficial.  Some AAPs have minor side effects.  APs as a whole are more sedative (IMO) and not good for depression type issues.  Lithium and Lamictal and good first-line mood stabilizers.  The others also work more as anti-convulsants/seizure meds and have additional elements to consider.  I wouldn't try an MAOI until you'd given AAPs, Lithium, and Lamictal a fair trial.  For one, most docs won't rx them due to the possibility of death if you combine them with the wrong food or OTC med... but they really are a last line defense.  

 

I'm on one now, but only after trying virtually everything else.  And I had to find a super experienced pdoc who felt comfortable enough to try it.

Medication wise with the AP/AAPs many people on this forum have told me my opinions are too negative on those.... but I worry about weight gain, sedation and small risk of rare side effects like TD.  I've had weight issues all my life, I'm already fat and tired due to the depression and I've not got on well with sedating antidepressants like Mirtazapine or Amitriptyline before now.   I just don't need more sedation.        

 

I would definitely consider Lithium or Lamitcal, although the risks scare me.... Lithium with the kidney and thyroid issues and of course the infamous Lamictal rash. Although I don't know if my mood needs stabilizing though... it is consistently low. 

 

The only reason I mention MAOI is because I'm on Moclobemide now, which is a weaker "reversible" MAOI, meaning it has no food interactions and only some very limited drug interactions that may cause hypertension.   I've been on it a year and it has had some minor benefits, which is more than can be said for anything else I've tried. Therefore I wonder if the stronger irreversible MAOIs would be the logical next step.  I did some research which suggests the food interactions + death link is a bit over-hyped and quite easy to avoid with sensible diet, but as you suggest doctors don't prescribe them much so trying to convince them of that might be difficult. 

 

I think the only thing I am completely unwilling to consider is starting off the SSRI/SNRI merry-go-round again.  Been there done that and got the t-shirt.  They don't work for me period, infact all of them apart from Zoloft made me feel worse and even Zoloft was ineffective + intolerable side effects.

 

I'm sorry for going on and on.  I'm just venting my thoughts in public here.  Today has been another difficult day.  Failed to speak to someone I needed to speak to due to anxiety, failed to get any study done, I smell bad but can't be bothered to shower,  ugh. 

[Wooster]

 

 

I would go for regular therapy instead of structured.  Something like CBT can have time limits because there are programs built for it.  General therapy ideally lasts as long as insurance covers it and the therapist thinks it's beneficial. 

 

 

I believe the OP is in the UK. NHS doesn't let you decide what kind of therapy you get, though one can advocate for oneself.

[jt07]

I can understand not wanting to be sedated. I hate sedation, and it is one of the reasons that I don't do well on tricyclic antidepressants. The only sedating med that I currently take is mirtazapine which helps offset the insomnia due to Abilify.

 

Not all AAPs are sedating. For me, Abilify is the complete opposite of a sedating med. I often compare it to a calm version of speed. I've had luck with low-dose Risperdal, and it didn't sedate me. I've never tried it, but I've heard that Latuda is not very sedating for many people. Both of these meds are useful for depression, and in the US, Abilify is approved as an adjunct medication precisely for depression. It's the only med that has raised my mood above a depressed baseline.

 

The med that keeps me from falling into suicidal depressions is Tegretol. It is an anticonvulsant like Lamictal. It doesn't do much for my baseline mood, but it does prevent the wheels from completely coming off my mood. I consider Tegretol as the reason that I am here writing this right now.

 

Lamictal helps a lot of people. You will find people who absolutely love Lamictal. It doesn't do much for me, but I recognize that it is a great med. The risk of "the rash" is small. Lithium too is a good med. Depakote helps some people.

 

So your doctor has plenty of options to help you that do not involve antidepressants. My own personal experience is that antidepressants do not help me (with depression). That's why I rely so much on anticonvulsants and Abilify. My antidepressants are primarily for anxiety and sleep which they do seem to help with.

[crazyguy]

I can understand not wanting to be sedated. I hate sedation, and it is one of the reasons that I don't do well on tricyclic antidepressants. The only sedating med that I currently take is mirtazapine which helps offset the insomnia due to Abilify.

 

Not all AAPs are sedating. For me, Abilify is the complete opposite of a sedating med. I often compare it to a calm version of speed. I've had luck with low-dose Risperdal, and it didn't sedate me. I've never tried it, but I've heard that Latuda is not very sedating for many people. Both of these meds are useful for depression, and in the US, Abilify is approved as an adjunct medication precisely for depression. It's the only med that has raised my mood above a depressed baseline.

 

What side effects, if any, do you get from the Abilify and what dose are you on? 

[jt07]

I take 30 mg but that is because I also take another med (Tegretol) that reduces the level of Abilify in my blood so it takes more to achieve the same level of Abilify that others have at a much lower dose. I don't really have any side effects (so far). Well, in the beginning, I had anxiety from hell but that abated when I got over 10 mg. Maybe Abilify increases my appetite a little but that's hard to tell because I also take mirtazapine which greatly increases my appetite. Mostly it's like taking an aspirin for me ... not even any noticeable side effects.

 

One thing is that it can take time to work like an antidepressant does. It took me almost 8 weeks and only began to work once I hit 10 mg. Some people find it works within days. For me it was weeks. YMMV.

Edited October 26, 2014 by jt07