I have a relatively new doctor. I told her I wanted to get back on the SSRIs (for anxiety) She gave me a script for some Wellbutrin but told me the psychiatrist would have to fill out any further scripts.
I guess this is fine but I have no idea what I’m going to talk to a psychiatrist about. There’s nothing in my life that’s particularly haunting. So what the heck are we going to talk about?
And how often am I going to have to see this person?
Can I bring my teddy bear?
Typically, you don’t have a lot of talk therapy with psychiatrists, compared to other types of therapists. There will be an initial appointment where she will evaluate what’s going on with you and if you’re a good candidate for drug therapy. After that you’ll have infrequent meetings to see if the drug therapy is benefitting you and to manage your medication.
I know folks who still see therapists on a routine basis for talk therapy or CBT, for example, but check in with the psychiatrist for oversight of drug management every six months or so.
The vast majority of psychiatrists don’t do talk therapy. They are medical specialists just like any other and usually very focused on the medication side of things. A standard appointment with a psychiatrist is only 15 minutes and you would be lucky if get one that listens if you do have something to say. The most common scenario is you go in, they ask you about symptoms and side effects and then you get a prescription update if one is needed.
You may be thinking that psychiatrists are the same as psychologists or clinical social workers. They are not. It is the latter two that do talk and behavioral based therapy. Psychiatrists usually don’t.
And that is one reason that most MDs won’t bother with them. I used to see one - 30 years ago just as SSRIs were becoming a thing, for med checks every six months. But my doctor was much older and psychiatric medication was changing quickly. At this point, once you know what works for you and its working for anxiety and depression, there isn’t a lot of reason to add in the costs and bother of a psychiatrist. Those drugs are now fairly well understood and pretty low risk.
(My aunt, who is really seriously ill, does see a psychiatrist because her medication needs are more complex than the family doctor can take care of and she needs to be monitored more closely).
Ah, okay, so I guess I grossly misunderstood what a psychiatrist actually does.
Thanks guys.
You can still take Teddy, if you want. It’s cool.
I recently saw a psychiatrist for the first time for depression and I was really struck by the seemingly cavalier manner in which psychotropic medications were doled out without so much as a second glance.
After less than 15 minutes, I was “diagnosed” with a particular form of depression and given prescriptions for three different psychotropic medications; all of which were on top of the anti-depressant I was already taking. This was done with a follow up appt made for 5 weeks later. Well I didn’t make it to that appt before I had to take myself off of those medications due to side effects. What’s even worse, I didn’t know which medication was responsible for which side effect, it was like solving a Rubic’s Cube of medication.
Now I am back to where I was prior to seeing the psychiatrist, and am feeling grateful, if somewhat depressed. I am continuing my original anti-depressant (Zoloft) and seeing a psychologist for talk therapy. I feel much better about this scenario than that of putting all these different chemicals into my body and having them interact in unknown and unpredictable ways.
I got ambien for years from my gp. He passed away, & my new doc wasn’t comfortable with giving me any sleep meds and referred me to a psychiatrist. I was a little perturbed by having to see another doctor, and unsure what to expect, but my gp was right and strictly going by the book. Anyway, the psychiatrist is a pleasant enough fellow who pretty much just gives me my scrip and collects his copay. Might periodically ask a few perfunctory questions so he can bill for psychotherapy, at least according to my insurance statements. Still feels a little odd to say “my psychiatrist”, but that seems to be the way the game is played these days.
Agree with what everyone else has posted concerning the depth of your interaction with the psychiatrist. I just wanted to ask whether you’d had Wellbutrin before, as it has antidepressant qualities, but isn’t an SSRI. If you have, then no worries. (Edit, pun not intended. Sorry.)
Moreover, I am not an M.D., nor PhD or licensed mental healthcare worker, but Bupropion wouldn’t be my first choice to address anxiety. Especially as it’s one of the more common side effects from the medication. I’m sure your doctor has good reasons for prescribing this specific medication; it just sounds strange, given the information you’ve told us so far.
Well damn, I did not know that.
This is my first time on Wellbutrin, and to be honest, I’ve been on it for a month now and haven’t noticed any real effects.
Dang it! Now I’ pissed, I told her very specifically I wanted to get back on the SSRIs.
You don’t tell them about the voice that told you to murder Peter Greenaway. Cos there ain’t no meds and besides, the doctors might want to get in on it and I swear, honest, cops, I was just kidding.
I find this really disturbing. I’ve had a few different psychiatrists over the years, and I wouldn’t say they played fast and loose with new medications at all. To prescribe three right off the bat on top of an already existing one, and not even have you ease onto them, just strikes me as very irresponsible on the doctor’s part.
Right now I’m off meds, and somewhat stubbornly refusing to go back on them, because while things aren’t perfect, I’m managing well enough.
[QUOTE=Shakes]
Dang it! Now I’ pissed, I told her very specifically I wanted to get back on the SSRIs.
[/QUOTE]
Reason #1,042 GPs shouldn’t be writing scrips for psychotropic medications. You should have been told flat out that Wellbutrin is not an SSRI and given a rationale for why it was being prescribed. This is a thing psychiatrists tend to be good at - knowing the difference between types of medications and giving a rationale for treatment.
FWIW, I have been on 12 or 13 different medications in various combinations over the years (never more than three or four at a time) and the only thing that ever made a dent in my depression was Wellbutrin.
Wellbutrin didn’t give me anxiety, but it did make me feel jittery and restless.
My experience with psychiatrists is that they are all about the drugs. Which is fine if you’re on board with that, but not so fine if you want a less medicalized approach to your care.
I’d say the biggest benefit to seeing a psychiatrist over a GP is that the former will tend to be much more familiar with the side effects of the drugs you’re taking. If they are a good doc, they will listen to your complaints and either adjust your dosage or come up with another strategy. But even psychiatrists can suck in this department. I have fired a couple because they told me my side effects weren’t related to the med they’d prescribed me, despite the fact they were listed by the drug maker. I can’t tolerate that kind of wrongness. I’d rather fire an incompetent psychiatrist than a misinformed GP, especially one that’s good in every other way.
Some psychiatrists are going to do a much more thorough history at the initial visit. Things like any psychiatric ailments in any family members, any developmental issues growing up, what was school like for you? and do you have an adequate support system in your life, etc.
A psych eval from a resident takes 45 minutes or more, because they are trying to cover every possibility and don’t want their attending saying “Why didn’t you ask this?” “Why didn’t you rule out that?”
Full fledged psychiatrists outside teaching settings, without supervisors, can be brief and done to business when the case seems straight forward to them.
If you don’t get referred to psychotherapy or put in a study subsequent visits will likely be short. Med checks are typically about ten minutes and just involve quick questions about how your doing.
When getting a psychiatric exam and they ask how you’ve been sleeping don’t ever respond “Sleep is for mortals” For some reason that seems to raise red flags. ;)
Just never say all them Baader Mienhof guys are the rule and your dad has the address.
If he says you’re crazy, don’t say you want a second opinion. He’ll say your ugly, too.
I see a psychiatrist once a month for med management. She is new (to me); my former psychiatrist got transferred.
The first appointment we had was an hour long, and she asked a bunch of get-to-know-you type questions, as well as reviewing my history. We also went over my current medications, but made no changes.
Since then, we meet for 15-30 minutes once a month. She asks how I’ve been doing - I tell her honestly. Sometimes I notice a side effect with a medication, or another problem I’m having, and have a suggestion. Last visit I wanted to try Luvox (because I have some skin-picking issues) but she said that since I was on Zoloft, it would be too dangerous to take both at once. We settled on an alternative, which was increasing one of my medications, which has been somewhat effective.
If you do a search for SSRI’s online, you may be able to get a list of the currently available ones, and investigate yourself which one/s you might prefer.
However, if your main problem is anxiety, you may be looking at a Zoloft + Xanax combo. The Zoloft is technically an antidepressant, but it has anti-anxiety effects as well. Xanax is mainly for anxiety.
Try to not let your doctor put you on more than one new medication at a time. That way, if you have any side effects, you’ll both know what caused it. When you’re on multiple meds, things get a bit more complex. :-/
If you end up going to a therapist, get a good one. (If you don’t “click” with them after say 3-4 visits, cut them loose and go to someone else.) It doesn’t matter if you don’t have any deep, dark issues - My therapist and I mainly talk about my friendships and family, and how I can better set boundaries, etc. to protect myself. It has been EXTREMELY helpful.
Whatever you end up deciding, take care, and be kind to yourself. 