Going to a psychiatrist

[Inertia]

This thread was moved to the BP board to give it more exposure.

[Breeze]

Maybe if you write down your symptoms, and share them with Dr. New Person, then he/she will see that you 1) are concerned about your MI issues 2) have been around the block and 3) have been on Lithium and it didn't work.

They are human after all, not mind readers, and start from the Logical Point A. If you politely suggest that you have been down that road, maybe you can move on to Point B.

Just a thought.

Breeze

Edited by Cerberus for clarity

[AirMarshall]

Yes, you should provide a laundry list of symptoms and behaviours.

A doctor MAY ask you what you think is wrong, but in my experience, a good doctor will ask you what your symptoms are.

Most doctors don't want to hear your self dx.  And when I have done that (even with purely physical problems) it often derails or misdirects the doctors' logical process and misleads him.

I would suggest that you begin your first appointment by stating this very concern.  Print out this post and hand it to the doctor. This will let the doctor know that you have not been well served in the past and that is almost your greatest concern next to MI issues.

I have had to do the same thing with internists, allergists, and even a couple optometrists. 

Good luck

A.M.

[celestia]

Print these posts and take them with you. You sound like you're really, angry and frustrated with the process and many of us have been there. If that's true, I can relate. Nothing sucks more than trying to get good psych help when you're wigging out (speaking for myself).

Good luck,

S9

Edited by Cerberus for clarity

[grousemouse]

hi,

so you ARE prepared to be involved in your therapy. awesome. if actually going to therapy is the first step, then having the courage to participate is the second. one of the members here felt that she wasn't contributing to her therapy because all she did was cry through the whole session. but i would argue vehemently that she was contributing 100% to her therapy because she was trying to confront painful emotions in her. that to me speaks of profound courage.

so kudos to you for taking the step to enter therapy. as for which approach to take i, would think that you should list your symptoms. it is possible that your doc's interpretation will be different from your own. and if it is it will be good to hear from him or her why it is different.

good luck,

grousemouse.

edited for a wee typo.

Edited by Cerberus for clarity

[Guest Llamanator]

Docs, in general, tend to respond poorly to hostile and combative. They believe in what they see far more than what they're told. This is from experience. However, they can see things about you that you can't, and that is an incredibly valuable thing if you have a good doctor. Yes, it can lead to dxes that are different than you'd give yourself. There is often a reason for that. Many times, our illnesses obscure our own symptoms from us - that why the dxes are different thing.

Pure text and subtle-to-moderate sarcasm don't mesh very well. Adding sarcasm tags can be a solution to that, if you're so inclined.

Mimi

Edited by Cerberus for clarity

[Cerberus]

I have an appointment with a new guy, and since my past experiences have sucked sour frog ass, I have no clue how to handle things.

[Loon-A-TiK]

From the fact that you posted in the Depression board, I am assuming you believe yourself to be unipolar depressed.

Remember, the current trend in psychiatry is BP2- and all you need for this DX is having one lifetime experience of at least 4 days where you are markedly more productive, energetic, and "high" than usual. Not your classic mode of BP1. Think that over...

And sometimes mood stabilizers can be used to augment antidepressents. Don't be afraid to assert yourself, and don't be afraid to explore options like Lamictal if your AD doesn't do the job at a reasonable dose, or with tolerable side effects.

If you can find them,  check out my threads on what you can do to make your life better without meds. I'm attempting to write a book on that right now (all this time on my hands going for SSD/SSI) and see if you can lessen your symptoms and need less medication that way.

As the others have said, it is important to document your feelings, symptoms, previous experiences, and efforts for your new pdoc. S/he will want to see facts. If you keep a mood journal on moodtracker.com along with a journal of your feelings, S/he could see the trend that you are depressed. Yoou could also have "double depression", where your "normal" mood is slightly depressed and you cycle through  boughts of major depression. Listen to the Loon 

---------All-Knowing Loon hahahaha----------------

[revlow]

Hi, Inertia:

If you haven't already, you might want to check out this site: Mood swings without "manic" episodes: Bipolar II -- more than plain depression, but never delusional or psychotic. It's got a lot of good information. If some of this seems to fit for you, you might want to print it out and bring it with you to your appointment.

Best,

revlow

[robotlove29]

Yep I agree with the above...write down your symptoms.  Any Dr. who prescribes Lithium without a second thought is  probably not a great Doc. A diagnosis takes time, not 3 seconds.  I hope you find a better, more in-tune doc and get a more accurate diagnosis.  Meds are tricky whether you're just depressed or bipolar like me... 

PS---  How did the lithium work for you???  If it helped, you may well be bipolar.....

[Amethyst]

Well, I know how you feel about being mistreated. And I also have just been to my first visit to a new pdoc. When I saw her she just started with "tell me why you're here, start anywhere you like" *gasp* Where do I begin?! Ha. It took 3 hrs for my last intake interview, lady. So, if you don't want to be caught off guard, take a list of things that you want him/her to know. Symptoms, previous treatment and dx. All that jazz.

Good luck.

Ameth

[ncc1701]

Heya Inertia,

What they said.

So, all that.  Plus:

We (docs) *do* need to be allowed to make a 10-page list in our heads of what might be the diagnosis.

This we call the "differential."  Which sounds like a car part to me.  But whatever.

We *do* want to know what you *think* might be going on, but not until we ask.  This is not (usually; there are bad docs, like ANYDOC who would Rx lithium without a lease on your VEINS) b/c we're jerks; it's to keep our minds open to weird and wild dx's.

I, myself, *only* got dx'd and tx'd when I came clean to my FP (family doc) about my symptoms, and she confirmed what I was fearing, that I am BP. 

I didn't say, Heya, ___, I'm bipolar.  I said, Heya, ___, this is what's been happening, and I'm scared.

She figured it out by history and physical.  That's her job.

I hope your next doc is better than what you've seen so far.  If not, keep looking.

--ncc--

[NARS]

Great questions, Inertia.  I don't think you're being hostile or confrontational if you want to give your input.  But I'd suggest, as others have, that you remember what you're doing: going to a specialist who's job it is to diagnose and treat you.  He needs to know what your symptoms are.  This means he should either ask you many very specific questions about your life history and experiences, or he should listen for a long time while you spill your guts. 

My basic advice is to be specific and honest about symptoms .  Sure, share your previous diagnoses (not your own, but your previous whacked out doctor's) and that the previous doctor never asked you for symptomology.  Share your theories.  But that's not what your initial visit is about.  It's about giving him info so he can make the most accurate diagnosis and start the most effective treatment he can think of.

IMHO, it's OK for a pdoc to ask "have you ever been manic."  But it's simply stupid of a pdoc to accept your answer without asking a bunch of questions about symptoms of mania and hypomania.  You can't be expected to know all the symptoms of all the different flavors of mania, so you simply might not know the answer.  You might have never had euphoric mania, but have had tons of hypomania with anxiety or mixed states and not known what that is.  So be careful not to color or characterize the symptoms to tilt the scales towards a particular diagnosis.

And do share concerns or suggestions about meds, and tell him what you've thought might be your problem.  Just don't force it on him.  A decent pdoc will let you express your opinions and take them into consideration.  But again, he's the expert; let him do his job.  And if you think he's another whack job, dump him and try another.  Just don't get mad if you don't get the diagnosis you expect.

Best of luck, and let us know how it goes.

(edited for typos)

[LikeMinded]

Most docs (this is just MY experience, your mileage WILL vary!) tend to be complete idiots.  They want their 15 minutes with you up as quickly as possible, and the $30 insurance copay (much higher if you're in the US and uninsured).  Read up on the DSM-IV terminology and find the terms (not necessarily diagnoses) that suit you the best.  Research the web, including this board, for treatments applicable to your case.  Look these meds up on rxlist.com if you want to find their more egregious side effects.

But, as has been said here before, don't act hostile or combative.  The doctor may immediately well put you on the strongest AP or sedative s/he can find. My suggestion is to come on as a very articulate, calm, and intelligent individual (which I have no doubt you are), and merely suggest modifications (with solid reasoning) to any treatment plan the doctor suggests.  Furthermore, be as thorough as possible in describing your symptoms; this helps the pdoc, or any other doc, to a very high degree.

Pdoc example: My current pdoc tried to put me on Lithium the second she suspected BPII.  I convinced her this was a Bad Idea , as Lithium doesn't do too much for depression (my worst symptom), and that consuming lithium requires a commensurate increase in sodium intake, which is bad as my blood pressure is already 150/100.  She'd even told me that it could make one hypothyroid, and this is a Bad Thing as I'm already moderately hypothyroid.  Her suggestion? "Oh, you can just raise your thyroid meds!".  Fortunately I'd convinced her of the wonders of Lamictal, and the next week, a medical seminar reinforced that to her.  So now I'm on it and happier.

Again, I'm speaking from the viewpoint of a guy who's had many good experiences with doctors (especially the ones who listen to my educated-guess reasoning), but many terrible experiences, which have caused me near-death as well as significant disability.  (Example, I had 'blue-baby' syndrome while living in Trailerhasse... uh, Tallahassee, FL, and the docs there repeatedly told my parents that it was chronic pneumonia (leading to lack of oxygen, causing skin to turn blue) and I'd grow out of it, and they'd follow-up with regular CXRs.  My parents (God bless them) then took me to the most advanced hospital in the state, Shands Memorial in Gainesville, and got a second consultation.  Result? Half of my ventricular septum was gone due to a birth defect.  My entire body, including the brain, was receiving less than 50% of the oxygen it should have been.  Even by then, I may have suffered significant brain and body damage.  This might or might not explain the Aspie thing and the fact that I have a slightly asymmetric bodily build.  The cardiologist then confidently told my parents that I had two weeks at most to live, and that he was prepping the OR (at 10 PM!) as they spoke, and they'd do a marathon open-heart surgery overnight and through the next day.  There's one example of a good doc, at least.)

Oooh another rant.  I'd suspected upper back scoliosis when I was 15.  Orthopaedist x-rayed lower back due to back pain, results negative.  I asked for an upper back XR, he replied he didn't want to 'expose me to unnecessary radiation'.  4 years later, I go in for another scoliosis consultation with another doctor.  Apparently the curve had gotten so far out of line that bracing would no longer be a method of treatment.  In fact, if it went one more stinkin degree forward, the spine would blow up... umm, I mean I'd need major surgery.  The past 6 months I've been having severe digestive issues, so I suspect I might be getting a hiatal hernia and will need the op soon. :-X

OOPS!  Take home message... BE YOUR OWN PATIENT-ADVOCATE!!!!!

Dear God I talk way the fvck too much.

[AirMarshall]

Herrfous,

a point of correction. Lithium was the only mood stabilizer proven to be effective in helping depression, until Lamictal came along 4 years ago.  In fact, Lithium is the only one proven to reduce suicides.

A.M.

[LikeMinded]

Oooh my bad.  Correction accepted with apologies; I knew it had some antidepressant effects, just neglected to realize that in my post.

(Still not right for me, with my Hashimoto's autoimmune hypothyroidism and moderate hypertension [extremely severe for my age and physical fitness].)

Herrfous,

a point of correction. Lithium was the only mood stabilizer proven to be effective in helping depression, until Lamictal came along 4 years ago.  In fact, Lithium is the only one proven to reduce suicides.

A.M.

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