I'm floundering here

October 29, 2008 10:10 AM

I was supposed to see a psychiatrist today. I waited six weeks to get this appointment, after waiting five long months for my insurance to kick in. When I arrived they told me that my appointment had accidentally been given to someone else, and the soonest they could reschedule was another month. I honestly don't know if I can wait that long. What are my options here, and how can I manage my life in the meantime?

I have long been struggling with depression and am pretty sure that I also have ADD. I realized that I might have ADD because of a question on ask.mefi (I don't recall which one, though) about someone whose "problems" sounded a lot like mine. Someone suggested reading "Driven to Distraction" by Dr. Hallowell to see if it rang true. I did, and I cried through the whole book because I could have written it myself.
Anyway, I don't need you to tell me whether or not I have ADD, because that's why I made this appointment. However, waiting has been really tough, and I am finding it very hard to manage my life as I sink deeper and deeper into depression. I had a panic attack last night (and another one last week) working myself up over this- I have a lot of anxiety that the doctor will tell me that this is "all in my head" and there is nothing wrong with me... i.e. I will never get any help.
I know that this fear is irrational, but I'm sure it stems back to high school when I tried to get help for depression, and my parents and my guidance counselor told me that I was just making it up to get out of being a poor student (only they didn't say it so nicely, long story). I kind of locked it all away at that point. Like I said, I know its irrational but I just want to get it over with.
I have called all over town trying to get a sooner appointment, but no one has one before the end of November.
I have been self-managing my depression pretty well for the past year or so, but now its just too much to deal with on my own. My husband has been a huge help through all of this, but its taking a toll on our relationship. Honestly, sometimes I just want someone to talk to about it, but the past year or so has left me basically friendless due to a number of circumstances. Its been hard.
I know that there are ways to help alleviate depression, like exercise, supplements, etc etc. but all of these things are really hard to do when you can barely drag yourself out of bed every day. I still go to work every day, but I've been sleeping for 12-14 hours every night.
I'm sorry if this is incoherent, but I just want to know if someone can tell me if there's a way to see a doctor sooner (I'm on the waiting list right now with an appointment scheduled for the end of November), and how I can manage all of this in the meantime. I really have never been this depressed before. Its pretty awful.

PS. I haven't had any thoughts of suicide, so I'm not in danger in that way. But as you can imagine, this is kind of a bummer to live with.

posted by nataliedanger to health & fitness (24 comments total)

Keep the later appointment on the books, but call right away, tell them it's vital that you get in asap, and ask to be called in the event of another patient's cancellation. You may not have much notice to get there, so be ready.
posted by Fuzzy Skinner at 10:18 AM on October 29, 2008

Go to a regular doctor. A walk in clinic will do in a pinch. Any old doctor will prescribe you something for depression and panic attacks these days. You can use an appointment with a shrink to review your choice of meds and problems in a month. Good luck.
posted by crazycanuck at 10:19 AM on October 29, 2008 [2 favorites]

You kind of missed your opportunity for it, but there are 2 works you needed to use, that you might still be able to in a different fashion:

"That's unacceptable."

Because it is. Accidentally gave your appointment away to someone else? Ok. Fine. We all make mistakes. However it does not make their solution (making you wait a month, in your condition) acceptable. They are perfectly capable of creating a resolution to their mistake that is acceptable for your needs - they can bump someone else, they can book the doc past his normal hours, etc..

I'd suggest that you call them and calmly let them know that the situation is unacceptable. If they won't budge, I'd suggest you insist on talking to the doc him/herself so that you can simply let him or her know about the staff error and the unacceptable nature of it.

And if you still don't get moved up I'd suggest that you find a psychiatrist that won't pull this kind of BS with you.
posted by allkindsoftime at 10:27 AM on October 29, 2008 [19 favorites]

I second crazycanuck's answer. The doc might also be able to give you some of the diagnosis you;re needing. It's for sure a way to get by until you get to your appointment.

You could also call around, find someplace that might be able to take you sooner.

And as to what Fuzzy Skinner says, that works too. You could even go so far as to ask how often they have cancelations and if it would be worth your while to spend the day in the coffeeshop/bookstore/whatever across the street, so you could pop in at a moment's notice. I;ve done this with a dentist before.
posted by cjorgensen at 10:27 AM on October 29, 2008

oh dear. from someone who is frequently right where you are (i flip out before most of my pdoc appts) i have a lot of empathy for you.

Obviously IANAD or anything like that, this is just my experiences and what's worked for me. ok, first in terms of the appt waiting time, i experienced that as a MAJOR frustration when I was in crisis but someone recommended to just start calling around to all the pdocs in my comfortable geographic area and see when the soonest appt I could get was. I made appts with ANY doc that called me back. I did go see the one that could get me in soonest (canceling the other appts) and that turned out to be a great move as he has worked out excellently. Ask if you can get on cancellation lists (in case something comes open). You may find, as I did, that the psychiatrist who was most able to accomodate me turned out to be the right one for me!

i know it's really scary to think someone is going to tell you this is all in your head. but really, isn't that what it's all about? what's in your head? Even though it's frustrating, if the first pdoc isn't a fit for you, please try another one. Hell, make several appointments now, so that you're already on someone else's books if the first one doesn't work out.

Thirdly did you tell the admins in the office that you felt you were in crisis? You might try asking them who *they* think might be able to see you sooner. Sometimes a Psychiatric Nurse Practitioner is easier to get into.

Sorry this is so disorganized. If you feel you cannot wait for some sort of pharmaceutical intervention for your depression, see your General Practitioner. I find they are typically willing to dispense short term (at least) ADs if you have an appt with a pdoc upcoming. ALSO your GP might be helpful in getting you an appt with a psychiatrist with whom they have a relationship for whatever reason.

As for your ADD possibilities, I would consider this less of an imminent crisis but as a hardcore ADDer myself I do understand how hard it can be and frustrating once you perceive that you have a problem that COULD be solved or aided but isn't. I've gone through period where I couldn't afford my medication before and yes. It's freaking hard. I hope that I never have to do it again, and I have taken steps to avoid and lapses just in case something goes wrong (mefi mail me and i can talk to you about that!). In the meantime, caffeine can actually be your friend in reasonable doses. As someone that's been on amphetamine type meds for nearly 25 years, caffeine has almost no utility to be EXCEPT to get me through times in between taking one pill and taking another. Don't drink/take too much but take some in the morning, take some around noon. It may also help with your sleeping levels too.

There is nothing in your post to make me think that you won't be able to get the help you need once you can surmount the scheduling problems. Please don't worry about that if you can possibly help it. I just recently had it proved to me that yet again I underestimated the skill and talent of my practitioners and since I've found the right ones I can trust them to act in a way that is helpful to me. In the meantime, just be kind to yourself. One major trap ADDers fall into is self-criticism and self-blaming and that's just no way to live. Cut yourself some slack. Try to eat properly and if you can manage even a few minutes of exercise a day it will be helpful. I've heard yoga helps but I myself have never had the focus for it.

Sorry for the disorganization of this. I'm pretty tweaky myself right now but I hope something in this long rambling post helps.
posted by Soulbee at 10:29 AM on October 29, 2008 [2 favorites]

I also agree with what's been said above, especially allkindsoftime's answer.
posted by Soulbee at 10:30 AM on October 29, 2008

Try looking for a therapist - a psychologist, LCSW or MFT - they are the someone to talk to that you need right now. Most people end up with a combination of talk therapy and medication. Getting talk therapy from a psychiatrist can be very expensive compared to these other resources who are fully trained to do everything except prescribe medication.

In addition, you might ask your primary care doctor if he can get you started on some anti-depressants. The downside is a GP will stick with one of the well known basics, while there might have been a better one for you to start with. However, it is common to have to switch meds so that isn't such a big deal. (There are many, many medical options and doctors don't know which ones will work for you until you try it for a few weeks.)

By the way, it really is "all in your head" - a combination of thought patterns and brain chemistry that have been pushing you into a downward spiral. Where else would depression be - "all in your leg"? {joke} Still, it is very, very real and any professional will recognize that you need treatment.

Finally, be kind to yourself. Recognize that you are not your normal self and give yourself some slack. If you can go to work, shower regularly and remember to eat you are doing very well under circumstances. Help is coming soon, in the meanwhile if you don't have the energy to do your usualy activities, accept that it a symptom. If you had the flu, would you be upset that you needed more sleep and didn't feel like partying? No. So pamper yourself a little bit for now and in a few weeks you will have help in fighting back and getting better.
posted by metahawk at 10:33 AM on October 29, 2008

No walk-in clinic doctor who values his insurance premiums is going to prescribe psychoactive medication to you if you haven't already been on something and are currently under the care of a psychiatrist.

I don't know what the people up thread are smoking - but trust me, you're not going to be able to walk into a clinic and walkout with a scrip for an anti-depressant or ADD medication. It doesn't work that way...

I have called all over town trying to get a sooner appointment

I doubt you've literally called all over town. How many doctors have you really called? Most shrinks won't take on new clients without a referral... so, if you're problem is the lack of customer service from the shrink you've been referred to, then you need a new referral...

Who referred you to the initial shrink? Talk to that person again. Or, call your family medicine doctor, and ask him or her for a referral to someone else. Or, go to the walk in clinic, describe your depression and ADD to whoever sees you and ask them for a referral... the point is to get a new referral to someone who isn't making you wait 10 weeks. That's crazy.
posted by wfrgms at 10:38 AM on October 29, 2008

Yes -- call them back today, explain that your appointment that you waited 6 weeks for was mistakenly given to someone else, and tell them that it is not fair or acceptable for them to ask you to wait another month for another appointment. Be nice but firm. This was not your mistake, it was theirs, and they should fix it given the inconvenience to you.

If the receptionist gives you any problem, tell them that you have been suffering from both depression and panic attacks for the last six weeks and that you simply cannot wait for an appointment any longer than _____, and give a date (next week?). Keep repeating this, and the fact that the reason for your lost appointment was their scheduler's fault, and not your own. Unless they really not with it, they should recognize the gravity of the situation and fit you in sooner. If they still give you problems, ask to speak to their supervisor or the doctor him/herself by phone. Do this today. Good luck!
posted by onlyconnect at 10:43 AM on October 29, 2008

We spent months trying to deal with a psychiatrist who was unreliable. That time meant a significant delay in getting proper help and almost tore my family apart. If you cannot get an appointment, go somewhere else. And do it now.

From a strictly business viewpoint, your presence or absence means little or nothing to the doctor. But it means the world to you.
posted by tommasz at 10:50 AM on October 29, 2008

1. Call your GP and get in there as soon as possible.
2. Call the psychiatrist's office and tell them this is a crisis, like allkindsoftime suggested.
3. Go to the ER if you become suicidal.
posted by desjardins at 10:50 AM on October 29, 2008

Having worked in a doctor's office, I agree that it is totally unacceptable that they are treating you like this. Call and insist you be seen. This is not a routine checkup or preventative care visit - you are in pain and you have waited a long time already to be treated! If the receptionist/scheduler isn't helpful, ask if you can speak with the office manager or business manager.
posted by radioamy at 10:53 AM on October 29, 2008

No walk-in clinic doctor who values his insurance premiums is going to prescribe psychoactive medication to you if you haven't already been on something and are currently under the care of a psychiatrist.

Not only that - but most antidepressants take weeks to build-up to an active state - heck, even the non-stimulant types of ADHD/ADD medication can take up to 6 weeks to be effective.

Now a GP should be able to give you something for panic-attacks, because that is a short-acting, temporary solution.

But, get your GP to recomend someone else in addition to calling back, being firm and asking if they could call you for the next cancellation, or "bump" one of their on-going, long-term patients (someone who has gone bi-weekly for years may not mind a reschedule).

Be careful about ER - use only in-case of emergency, as your case may be treated FAR more seriously than it warrants, including "observation-time", etc. Definately go if you are truly suicidal. (Here are some warning signs)
posted by jkaczor at 11:00 AM on October 29, 2008

No walk-in clinic doctor who values his insurance premiums is going to prescribe psychoactive medication to you if you haven't already been on something and are currently under the care of a psychiatrist.

I have to disagree. I have been prescribed anti-depressants and sleep aids in this exact situation. Granted, the walk in clinic I went to was a regular doctor's office that accepted walk ins.
posted by crazycanuck at 11:11 AM on October 29, 2008 [1 favorite]

And also - you should not be calling all over town. I can't believe all of these people telling you to do a whole bunch of work when you are already stressed out and having panic attacks.

Please also don't feel like you did the wrong thing with the doctor. If you are truly sick you are in no position to advocate for yourself. Don't feel guilty, it's not your fault.

Either somebody (family or friend) should call all over town for you, or you should simply walk in the door to any medical clinic and get help. I am sorry you are going through this.
posted by crazycanuck at 11:15 AM on October 29, 2008

crazycanuck - were you prescribed them previously? I have a GP that won't mind prescribing things that you have had prescriptions for in the past, and will even change types of medications, but would not prescribe something completely new unless it was just a medical issue.

I think in Canada, things are a little more flexible, because our medical system is not sued as often and at the end of the day, almost everything is paid by the government anyways...
posted by jkaczor at 11:27 AM on October 29, 2008

See your regular GP. Tell him your situation with the insurance and if he can help you. Lots of GPs prescribe anti-depressants. Your GP may refer you to someone else and will probably ask them to sneak you in earlier than later. In the world of doctors the referral is king.

Get this workbook on anxiety and depression. Many therapists use it. Its kind of like seeing the book before taking the class. You can do your own exercises at your own pace until you can see someone.

Be your own advocate. Dont be afraid to "doctor shop" looking for someone who can help you sooner than later, but usually your own GP is the best place to start. New clients get the least attention.
posted by damn dirty ape at 11:27 AM on October 29, 2008

Call your insurance company and tell them that you are in crisis and need to see someone right now. If they are a decent insurance company, they should have a list of psychiatrist/psychologists, etc who accept emergency appointments and can see you the next day.
posted by nooneyouknow at 11:52 AM on October 29, 2008

hmm crazycanuck i do agree it is sucky to have to advocate for yourself when you're in pain and crisis. one of the greatest things that happened in the few days after my boyfriend suicided was the fact that someone found me a good psychologist and HE called ME to set up the first appt. i was unable to really appreciate how great that was at the time but it has meant a lot to me later. the pdoc on the other hand took some effort and it's great if you have friends or family to help you make these calls. i know i recently did internet research for a friend in need and made a list of names and numbers on a spreadsheet with columns for potential appt times and comments etc and handed it to her, and we talked about having a goal of reaching out to 2-3 every lunch time, if only to leave messages. but i couldn't do it for her. i hope that OP can either handle this in small steps herself or has the support (husband?) able to do this, and she is able to verbalize what kind of help she needs.
posted by Soulbee at 12:12 PM on October 29, 2008

oh yeah, nooneyouknow's advice is good also. i did express frustration at one point to my insurance company and they gave me another, longer list of names and told me to call back if i couldn't find myself an appt within a reasonable amt of time from that list.
posted by Soulbee at 12:13 PM on October 29, 2008

Furthering the notion above - "That's unacceptable" - my experience with this type of appointment has been twofold: the practices that dump this kind of thing on you and give you an appointment six weeks away, and the ones who, when you arrive, say, "So sorry. Something came up and it required us to use your appointment for another patient. Could you give me a choice of future dates that would be convenient for you and let me see how you can be accommodated as quickly as possible."

The former are generally not the type of people I wish to receive care from.

You should ask yourself that same question.
posted by micawber at 3:14 PM on October 29, 2008

Have you also tried private practice psychiatrists? They might be more expensive, and more of a mess for insurance, but they're typically easier to get a hold on, as they're scheduling for themselves, and know other people with more open schedules. I also second the person who suggested you call back the office that screwed up your appointment and telling them you're feeling more and more depressed and you really require a referral to someone who can take you immediately, or you're not sure how bad it can get. They don't want the malpractice crisis of having to deal with a suicidal person who claims to have reached out to them.

-clinical psych student
posted by namesarehard at 4:29 PM on October 29, 2008

I don't know what the people up thread are smoking - but trust me, you're not going to be able to walk into a clinic and walkout with a scrip for an anti-depressant or ADD medication. It doesn't work that way...

Agreed. Maybe more importantly and on behalf of OP's mental health, it shouldn't work that way. Having mental health concerns is one complicated pail of worms, but having a doc untrained in the specialty prescribing happy pills to a person with mental health concerns is a whole 'nother.
posted by mcbeth at 11:12 PM on October 29, 2008 [1 favorite]

It's possible that your outside doesn't reflect your inside. Receptionists often triage patients based on apparent need, and in this case you may not have "looked" like your situation was urgent. Compare it with a physical medical problem... if you have an ingrown toenail you may get an appointment next week. If you are having trouble breathing they'll see you right now.

I had trouble getting an appointment for depression until I became unglued on the phone.

And I agree with what's been said. It's unacceptable, and if unresolved you may need to find a different doctor.
posted by Breav at 5:51 AM on October 30, 2008