Psychiatrist? Psychologist? Counsellor? Need help navigating mental health pros.

In My Humble Opinion
1

A friend recently suggested that she thought it might be a good idea for me to seek the care of a psychiatrist, specifically. I’ve got a strong family history of clinical depression, fit the description of symptoms pretty closely, and it’s starting to have a strongly negative effect on my life. I have a hard time feeling emotion and empathy, I have a “decrease in the amount of interest or pleasure in all, or almost all, daily activities” insofar as I often don’t want to do anything. Life feels overwhelming. Insomnia, fatigue, “intense feelings of guilt, helplessness, hopelessness, worthlessness, isolation/loneliness and/or anxiety,” “trouble concentrating, keeping focus or making decisions or a generalized slowing and obtunding of cognition, including memory” and recurrent thoughts of death and, occasionally, suicide. It looks like a lot of heavy blues going down the DSM checklist, but what it amounts to in my daily life is a lot of feeling inadequate, overwhelmed, and incapable, and a lot of feelings of deep inertia along with the physical fatigue and insomnia.

I also feel like I have compulsive or addictive traits, one of which is compulsive eating with a long history of bulemia. It’s under control at the moment but I feel like I’ve got this tiger at bay and could very easily lapse if I don’t get to the bottom of the compulsion.

A friend suggested I find a psychiatrist. I’m puzzled about how one chooses between the types of mental health professionals out there–how do you know which you need? Also, how do you find a competent one? I had a hard enough time finding a good MD or dog trainer or mechanic, much less someone with whom I’m supposed to entrust my mental health.

In my completely uneducated state I’m inclined to look for a psychiatrist or psychologist being as they’ve got (ostensibly) extensive education, but I am also aware, having worked in the medical field myself, that there are just as many idiot MDs out there as there are idiots in any other field.

I’d appreciate any insight anyone has on finding someone. I feel like an idiot saying “I think I need help” but… I’m starting to think I need help.

2

Well, here are some places to start:

Are you a student? Most (all) campuses have student counselling services. Depending on your job, HR may have access to that sort of thing as well.

If you were in Canada I would suggest getting a full physical from a family physician to rule out any physical causes of your current state (hypothyroidism can cause your symptoms, for instance) - then ask for a referal to the appropriate professional. If you’re in the US I would still suggest it, but I’m not sure how the medical system works there.

I think a psychologist is more along the lines of what you’re looking for, but I’m sure others will be along with opinions.

3

Well, I’m not a student, and I am fairly well-versed in the routes one takes to find mental health care. I also could just pick up the phone book and start making calls, I suppose.
I guess I have more trepidation about finding a good doctor, or a competent person, you know?

4

Hi, don’t feel silly, it’s always tough finding a new doctor, and especially tough if you’re in the middle of a depression. I remember when I went through the same thing, and it was hell, and waiting for the appointment was hell. Now that I’m feeling much better (!), here’s my advice…

If you are feeling totally at loose ends and think you may need medication, you need someone who can prescribe meds. Ideally that would be a psychiatrist. Also, there are specialized nurses (“clinical nurse specialist”, or R.N.C.S.) who can also prescribe for psychiatric conditions (I see one and she’s great).

When I was in the middle of a crisis, my son’s psychologist at the time recommended that I see my regular medical doctor, and that most of them can prescribe for the more common ailments, such as depression. In my case, I went to my regular physician and he did not prescribe and recommended that I see a specialist, and I ended up with the RNCS. I found her because she worked with my son’s therapist at the time.

Anyhow, generally, what tends to be recommended if you need help finding someone good is to go to whatever large teaching hospital might be near you. They should have a good psychiatry department and can set you up with someone.

Also, perhaps your regular doctor can refer you to someone. The only other method would be if you have a close friend who is seeing someone good. I would definitely NOT just pick someone out of the phonebook.

5

p.s. – a psychologist does “talk therapy” and does not prescribe medication. If you want to try that first, that would be the thing to do. But if you’re feeling desperate then you need to see someone with medical expertise. If they don’t think you need meds they will not prescribe them. They can also refer you to a psychologist, in addition to the meds.

6

I guess, partly, I feel (hope? imagine?) that these are things that can be worked through and I would prefer to avoid meds if at all possible. That’s not to impugn folks who do, just that I tend to avoid medication in all realms whenever possible. I also worry that a psychiatrist is more likely to choose medication as a first line treatment, whether or not that’s a valid concern I have no idea.

7

First let me recommend www.wingofmadness.com - specifically their message board. You might ask for recommendations there. They are also very supportive of people in exactly your position.

My advice is to find (referral if possible) a therapist first. If that isn’t available, I would go for a psychologist next.
I was seeing a therapist for a while, and was eventually recommended a psychiatrist to try some medication. From talking to the therapist, I was kind of concerned that the approach of most (and this is a BROAD generality) psychiatrist start right off with meds along with sessions. It’s kind of a attack from different angles hoping one or more would work. I was really leery of medication, so I was not real keen with this philosophy.

I would recommend a therapist or psychologist first. If they feel meds are in order, they can refer you to someone (and they all have lots of contacts to refer patients to). I think the talking it out approach is the best way to start.

Be discriminating in who you decide to work with. I did a couple months of sessions with one therapist that simply did not work. You go through a lot of questioning and frustration when this happens. And it is important to realize that, just like any other relationship, some patient/therapist combinations just don’t work. If you don’t feel like they’re hearing you, or understanding where you’re at, it is NOT necessarily because you’re not communicating.

Also, as an initial step: start doing some exercise daily. Even just walking for at least 1/2 hour is good. Aside from the releasing endorphin thing, just getting your body moving will help get your head “acting” as well.
(Note: if the therapist or psychologist you find doesn’t make this same recommendation, you might want to keep looking :wink:

8

Thanks for the advice, I’ll definitely check out the site.
As far as exercise goes, I’ve got that well covered. I’m working out (cardio and light weightlifting) 4-5 times a week for about 45 minutes to an hour. I’m very aware that it makes me feel (mentally) better to feel (physically) healthy, so I do think it’s helping.

9

Be aware that psychiatrists can force treatment upon you against your will, and/or have you incarcerated on a locked ward against your will. (There may be zillions of psychiatrists who have never utilized that power, but some sure as hell do, and not only on people that, say, 95% of the people on this board would agree were incapacitated and dangerous to self or others). Be aware that there’s a difference of opinion with regards to the efficacy and safety of the various psychiatric treatments that can be prescribed, and that while some people have had excellent results and credit psychiatric treatment with saving their lives, others charge psychiatric treatment with ruining theirs, doing permanent brain damage and/or imposing permanent changes in personality or emotions and/or giving rise to other side effects that have proven to be severely bad for their health. And all in between as well, of course.

Be a well-informed consumer and read up both “pro” and “con”, and familiarize yourself with your rights ahd your legal liabilities as a mental patient.

10

Yes.
Thus my trepidation about finding someone to help with mental health concerns. It feels like awfully high stakes.

11

I’m a social worker in the admissions department of an outpatient mental health clinic. Our assessment process has you meet first with a social worker (or social work intern) and then with the psychiatrist at a separate appointment for a medication evaluation. This is just how my particular clinic does it, but just to let you know, not every client that comes through is automatically put on medication. Some are staunchly opposed for whatever reason, some are just hesitant, and some are totally gung-ho. No matter what, you’re a client with rights choosing a voluntary service, so our doctors work with them to help make the best decision.

I would recommend trying to find out if there are outpatient mental health clinics in your area. *Pro? * Your therapist and doctor under one roof, so your treatment is coordinated and you don’t have to go to one place and then hopefully find another and have the two never communicate. Con? Public mental health usually means you’re waiting around 3-4 weeks for that initial assessment (aka “intake”). Some agencies in my area are reporting wait lists of 2-3 months which makes no sense, but generally it’s 3-4 weeks.

A therapist or psychiatrist in private practice may be able to fit you in sooner but you’re likely to pay a higher cost, depending on whether or not you have insurance, and if you do, whether or not they even *take *insurance. This is something else to consider - at my place we can still help people who have no insurance as we will create their fees on a sliding scale based on their income.

If you do have insurance, I would also recommend calling your provider to find out who is an in-network provider in your area. This will save you the trouble of calling various places and saying “Do you accept ___ ?”

I hope this was helpful!

12

Well, it is high stakes. It’s you, and you’re worth it! Sorry for the hack theraputist line, but the confusion of depression or compulsion tends to do a number on how one values onesself. Also, I’ve known a few people who were depressed because they were trying to act how they thought someone else wanted them to act, and they were shortchanging themselves in the process.

saramamalana gave some good advice. You might also ask friends or your priest or pastor (if you are the churchgoing type; if you aren’t then that’s great as well), or a school counselor or someone that seems like they have bettered themselves somehow. They may know of someone who has worked for them or for someone they care for. Maybe it shouldn’t be like this, but finding the right therapist for you is a bit of a crapshoot, and you may need to change therapists once or twice until you find someone that you work well with.

Also, in the afterword of The Road Less Traveled, 25th Anniversay Edition, Scott Peck gives some pointers on finding a therapist that is right for you. It might be worth a try.

13

Thanks for the replies.
Isn’t there a SDMB depression group?

14

Not that I’ve found.

Sounds to me as if you are pissed off rather than depressed

Why ?

15

FRDE, while I’ve never suffered from clinical depression, I know that when I’m down I come back up “guns blazing” - same for my brother (the one who may be bipolar). Sometimes giving yourself a kick to the ass is how you get yourself to walk out of bed when you’d rather not even crawl out of it. Sometimes you need several kicks. And sometimes you kick yourself a lot and all you get is a bruised butt, because what you really needed was someone else’s help.

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Earlier thread with some pointers.

17

Tell us what is wrong.

Also minor details like age, marital status …

The SDMB has a lot of f/cked up people - it seems to be a qualification for being pretty smart - and also pretty benign.

On review …

Shit - Nava you have been Glove Puppeting - ‘NajaNivea’

You will be fine, you have natural arrogance - I recognize the type - Das bin Ich.

18

What was it those bumper stickers used to say? ‘If you’re not paranoid you don’t understand the situation’? Well, I think there’s a perfectly valid case to be made for “If you’re not often miserably unhappy, you just don’t understand the world around you”.

While I readily agree that emotional states should pertain to something, (and I am well aware from personal experience that one’s emotional state is inclined to ‘get into a rut’ and stay there), the persistently-mentioned category of emotions that have nothing to do with anything that’s actually going on always makes me wonder: how the heck do you know it doesn’t?

19

Even such veiled accusations are not allowed in this forum. Keep your attitude in the Pit.

20

Just so you know, many psychologists will talk to you on the phone for a bit before you make an appointment. I am a psychologist, and while I won’t do therapy on the phone, I will answer questions about my style of therapy, etc. Also, if you want to use insurance, check your insurance company’s website to see who is in-network for you.

Then, when you make an appointment, think of it as a chance to get acquainted with the therapist and see if you can work with him/her. Sometimes, the first person you see isn’t a good fit. If that is true, don’t give up.

Good luck!