Can/should I just go to another doctor for my psych meds?
July 26, 2013 3:06 PM Subscribe
Yesterday I went to a psychiatric nurse practitioner to get my anxiety meds refilled after having to change psychiatrists after grad school. He wants to take me off the 2 meds I've taken for years, put me on a new one, and doesn't agree with a 2nd diagnosis I had while in grad school. I feel uncomfortable with this and want to stay with my current meds. But it's not easy to see a psychiatrist soon as a new patient. Be my reality check here?
I just finished grad school. I'd been using student health services for 2 years and seeing a psychiatrist there who prescribed the medications (Celexa and Buspar) that I've taken for general anxiety for 9 years total now. They work well for me--never had the Celexa poop out or had to raise it, either.
While enrolled I went for an ADHD screening at the academic resource center and the psychologist there thought I have moderate ADHD. He gave me a referral to a 2nd psychiatrist at student health who did another ADHD assessment, confirmed the result of his screening, and prescribed ADHD meds, first Ritalin and then Concerta. She did what she was supposed to: she started me low and we tapered up to an effective dose, monitoring my vitals and other symptoms all the while. I saw her weekly as I got used to the new medication. I was also required to go to ADD coaching with the psychologist. Things aren't perfect but they are better and I'm glad I got the screening. My friends were all completely non-surprised at my diagnosis, too.
So I graduated and because I need new prescriptions, I went to a nurse practitioner who practices in my town in a psychiatric practice with a another doctor who has a good reputation (the doctor, that is). The psychiatrist is not taking new patients right now but the nurse practitioner was able to see me. I went thinking I would get the meds that have been working for me for a long time now, or something similar. Long story short, the NP did my intake and said, "Nobody with your grades and success in school has ADHD." He wants to taper me off my SSRI and buspar I've been stable on for a long time, put me on an atypical antipsychotic for my anxiety (Geodon), and see if "lowering my anxiety" will "help my concentration." He also kept referring to my "mood disorder" even though the times I've been depressed were due to circumstances and situations: when life got better, so did my mood.
I'm definitely not asking MeFites for clinical advice. My situation is that I feel uncomfortable with a person I've known for one hour tossing out the med combo I've taken successfully for years, and acting like changing from an SSRI to an atypical antipsychotic is just business as usual, as though he had never heard of any problems ever with that. I'm starting a new job/career soon and the idea of changing tried and true at the beginning of that IS making me anxious.
Also the idea that someone who makes good grades in school could never have ADHD seems like a silly blanket statement for a clinician to make. I'm female and have the inattentive/impulsive type of ADHD. My academic record when I was younger was spotty: grades in some subjects were stellar and others poor. I concentrate well when I'm interested in a topic or task--I have hyperfocus, in fact. But I have a tough time switching from one task to another, or picking one task to start with, or finishing things I start. I'm smart and developed ways to cope--and for years I used nicotine, too, which probably helped as an undergrad. In fact, after I quit nicotine my ADHD symptoms became a lot worse and noticeable, which led me to seek the screening at school.
So my question is: is it reasonable for me to feel uncomfortable in this situation? Honestly I also didn't feel much rapport with the NP or as though he were listening well to me, and like he was pressuring me to give the the new medication a try. I also felt weird and on the defensive about my ADHD diagnosis even though two very seasoned professionals screened and assessed me. Can I just go to another doctor (if I can find one) and not fill the script for the new med? If I find another doctor I will give the NP plenty of notice that I won't be coming for the next appointment.
I just finished grad school. I'd been using student health services for 2 years and seeing a psychiatrist there who prescribed the medications (Celexa and Buspar) that I've taken for general anxiety for 9 years total now. They work well for me--never had the Celexa poop out or had to raise it, either.
While enrolled I went for an ADHD screening at the academic resource center and the psychologist there thought I have moderate ADHD. He gave me a referral to a 2nd psychiatrist at student health who did another ADHD assessment, confirmed the result of his screening, and prescribed ADHD meds, first Ritalin and then Concerta. She did what she was supposed to: she started me low and we tapered up to an effective dose, monitoring my vitals and other symptoms all the while. I saw her weekly as I got used to the new medication. I was also required to go to ADD coaching with the psychologist. Things aren't perfect but they are better and I'm glad I got the screening. My friends were all completely non-surprised at my diagnosis, too.
So I graduated and because I need new prescriptions, I went to a nurse practitioner who practices in my town in a psychiatric practice with a another doctor who has a good reputation (the doctor, that is). The psychiatrist is not taking new patients right now but the nurse practitioner was able to see me. I went thinking I would get the meds that have been working for me for a long time now, or something similar. Long story short, the NP did my intake and said, "Nobody with your grades and success in school has ADHD." He wants to taper me off my SSRI and buspar I've been stable on for a long time, put me on an atypical antipsychotic for my anxiety (Geodon), and see if "lowering my anxiety" will "help my concentration." He also kept referring to my "mood disorder" even though the times I've been depressed were due to circumstances and situations: when life got better, so did my mood.
I'm definitely not asking MeFites for clinical advice. My situation is that I feel uncomfortable with a person I've known for one hour tossing out the med combo I've taken successfully for years, and acting like changing from an SSRI to an atypical antipsychotic is just business as usual, as though he had never heard of any problems ever with that. I'm starting a new job/career soon and the idea of changing tried and true at the beginning of that IS making me anxious.
Also the idea that someone who makes good grades in school could never have ADHD seems like a silly blanket statement for a clinician to make. I'm female and have the inattentive/impulsive type of ADHD. My academic record when I was younger was spotty: grades in some subjects were stellar and others poor. I concentrate well when I'm interested in a topic or task--I have hyperfocus, in fact. But I have a tough time switching from one task to another, or picking one task to start with, or finishing things I start. I'm smart and developed ways to cope--and for years I used nicotine, too, which probably helped as an undergrad. In fact, after I quit nicotine my ADHD symptoms became a lot worse and noticeable, which led me to seek the screening at school.
So my question is: is it reasonable for me to feel uncomfortable in this situation? Honestly I also didn't feel much rapport with the NP or as though he were listening well to me, and like he was pressuring me to give the the new medication a try. I also felt weird and on the defensive about my ADHD diagnosis even though two very seasoned professionals screened and assessed me. Can I just go to another doctor (if I can find one) and not fill the script for the new med? If I find another doctor I will give the NP plenty of notice that I won't be coming for the next appointment.
Yes agreed with St. Alia, you don't necessarily need a psychiatrist just for maintenance prescriptions of a psych med you're happy with -- many GPs are more than happy to continue prescribing these for you. That may make your doctor shopping easier for now.
posted by brainmouse at 3:21 PM on July 26, 2013 [1 favorite]
posted by brainmouse at 3:21 PM on July 26, 2013 [1 favorite]
It is totally reasonable to feel uncomfortable, and in your same position I would not be down with this NP's suggestions at all. I also had a p-doc once who, after meeting once for an hour, tried to change my diagnosis and my prescriptions -- fortunately I was in therapy, and my therapist called and disagreed with the new psychiatrist, which then led to me getting a NEW new p-doc.
Resolved: It is definitely reasonable to call your previous psychiatrist and (1) ask for a referral and (2) ask for a prescription to tide you over until (3) you can see a new new doctor. In fact, it would be unreasonable for you to change course so quickly. Also it would be unreasonable for you to continue to see a person who, based on one meeting with you, can un-diagnose your ADHD.
posted by brina at 3:23 PM on July 26, 2013 [6 favorites]
Resolved: It is definitely reasonable to call your previous psychiatrist and (1) ask for a referral and (2) ask for a prescription to tide you over until (3) you can see a new new doctor. In fact, it would be unreasonable for you to change course so quickly. Also it would be unreasonable for you to continue to see a person who, based on one meeting with you, can un-diagnose your ADHD.
posted by brina at 3:23 PM on July 26, 2013 [6 favorites]
Whoa, whoa. I am really surprised that somebody who has known you for one hour thinks that he can switch your meds and make you feel better. I also disagree with his blanket statement about your performance and our ADHD. I have a PhD, work as a postdoc in a competitive lab in the biological sciences, and do good work in my field, but I am still dependent on my Adderall to even function close to the normal concentration level of a real human being.
I suspect that this new guy thinks that your previous doctors were overprescribing for you, and has made it his personal mission to put you and others like you on fewer meds.
DO NOT TAKE HIS ADVICE.
Don't let him fix something that ain't broke. Get a second opinion. Anxiety meds and SSRIs are not to be toyed with, especially by someone who hardly knows you. If you came in with problems, that's one thing, but you're doing fine on what you're taking' so it'd just be asking for trouble to mess with them. Don't take his advice, and go see somebody else who will give you what you need to keep you stable and functioning.
posted by the_wintry_mizzenmast at 3:23 PM on July 26, 2013 [14 favorites]
I suspect that this new guy thinks that your previous doctors were overprescribing for you, and has made it his personal mission to put you and others like you on fewer meds.
DO NOT TAKE HIS ADVICE.
Don't let him fix something that ain't broke. Get a second opinion. Anxiety meds and SSRIs are not to be toyed with, especially by someone who hardly knows you. If you came in with problems, that's one thing, but you're doing fine on what you're taking' so it'd just be asking for trouble to mess with them. Don't take his advice, and go see somebody else who will give you what you need to keep you stable and functioning.
posted by the_wintry_mizzenmast at 3:23 PM on July 26, 2013 [14 favorites]
This is so not right I can't even say how not right it is. Do not take the new medication. Find someone to prescribe what you have been on already. I would just call the office and say you are cancelling the appointment with the NP. I know its hard to find a psychiatrist but this is just not right, as others have said, try your GP and explain you are trying to find a pyschiatrist for long term.
posted by SyraCarol at 3:23 PM on July 26, 2013 [2 favorites]
posted by SyraCarol at 3:23 PM on July 26, 2013 [2 favorites]
My original ADD diagnosis came from a guy who said that he'd previously used grades as a bit of a check, and that he didn't think I could have it with my grades, and after some talk (and my bringing in pictures of my apartment on my phone) he changed his tune. Some people can manage to get good grades without much work, or happen to enjoy their course of study well enough to focus on that but not other things--but it does seem to be a thing in the profession that requires some professionals getting beaten over the head with the facts a bit to register.
You do not have to be that person, for this particular NP. Go find somebody else.
posted by Sequence at 3:28 PM on July 26, 2013
You do not have to be that person, for this particular NP. Go find somebody else.
posted by Sequence at 3:28 PM on July 26, 2013
...acting like changing from an SSRI to an atypical antipsychotic is just business as usual...
Yep, this would have alarm bells screaming in my head were I in your situation, having been on both classes of drugs and dealt with the side effects both can give rise to. Sudden change of long-term mood altering drug regimes is in no way to be taken lightly.
The description you've given is one of a mental health practicioner who sounds at best cursory in their assessment, and at worse incompetent in it.
I would echo what's already been said; for now first priority should be to find a doctor who can sort you out with a maintenance prescription.
If and when you find one who gives a decent impression of understanding the gravity of the shit they're messing with in your brain, then by all means talk to them about whether different drugs might make things better for you. 9 years is a long time in mood altering drug development and research; something better may be possible for you, although these kind of drugs are poorly enough understood in their detail of action that there will always be some risk in making this kind of change.
If you're acceptably stable now, you should only make this change whilst under the care of a professional who acknowledges the risk such an action poses and who will watch your back whilst you do so.
posted by protorp at 3:47 PM on July 26, 2013 [2 favorites]
Yep, this would have alarm bells screaming in my head were I in your situation, having been on both classes of drugs and dealt with the side effects both can give rise to. Sudden change of long-term mood altering drug regimes is in no way to be taken lightly.
The description you've given is one of a mental health practicioner who sounds at best cursory in their assessment, and at worse incompetent in it.
I would echo what's already been said; for now first priority should be to find a doctor who can sort you out with a maintenance prescription.
If and when you find one who gives a decent impression of understanding the gravity of the shit they're messing with in your brain, then by all means talk to them about whether different drugs might make things better for you. 9 years is a long time in mood altering drug development and research; something better may be possible for you, although these kind of drugs are poorly enough understood in their detail of action that there will always be some risk in making this kind of change.
If you're acceptably stable now, you should only make this change whilst under the care of a professional who acknowledges the risk such an action poses and who will watch your back whilst you do so.
posted by protorp at 3:47 PM on July 26, 2013 [2 favorites]
Just another voice added to the chorus that your gut is right: this is not a good approach.
If your combination of drugs is working well for you and is stable, it's a poor standard of care to mess around with it, especially after this practitioner has only seen you once for a consult.
posted by quince at 4:12 PM on July 26, 2013 [3 favorites]
If your combination of drugs is working well for you and is stable, it's a poor standard of care to mess around with it, especially after this practitioner has only seen you once for a consult.
posted by quince at 4:12 PM on July 26, 2013 [3 favorites]
is it reasonable for me to feel uncomfortable in this situation?
Yes - because of this:
Honestly I also didn't feel much rapport with the NP or as though he were listening well to me, and like he was pressuring me to give the the new medication a try.
Go with your gut.
posted by heyjude at 4:14 PM on July 26, 2013 [3 favorites]
Yes - because of this:
Honestly I also didn't feel much rapport with the NP or as though he were listening well to me, and like he was pressuring me to give the the new medication a try.
Go with your gut.
posted by heyjude at 4:14 PM on July 26, 2013 [3 favorites]
Nthing trust your gut.
And this is something of an aside, but: my aunt once gave me that advice that your medical insurance pays for you to see a doctor, even if your medical office schedules you to see a NP. Insist on seeing a doctor rather than an NP if considering such a momentus change in your medical treatment. And then see another one.
posted by vignettist at 4:17 PM on July 26, 2013 [3 favorites]
And this is something of an aside, but: my aunt once gave me that advice that your medical insurance pays for you to see a doctor, even if your medical office schedules you to see a NP. Insist on seeing a doctor rather than an NP if considering such a momentus change in your medical treatment. And then see another one.
posted by vignettist at 4:17 PM on July 26, 2013 [3 favorites]
I've learned with p-docs to listen to your gut. It took me a really long time to realize that my last didn't really "get" me or have my best interest in mind.
posted by radioamy at 4:23 PM on July 26, 2013 [4 favorites]
posted by radioamy at 4:23 PM on July 26, 2013 [4 favorites]
Everyone in my support group has had extensive experience with "new doctor wants to change all my meds immediately" practitioners. The verdict: this never goes well, it's definitely OK to cut ties when they start this crap. Make sure to tell the next person exactly why you left the first guy.
Feel free to go to your regular doc for refills, and ask your old psychiatrist for provider recommendations and a letter giving a brief case history and reasons for your diagnosis (should seriously take like half a page.) Also fill out the mental health CV on this webpage, and take it to your regular doctor and anyone else you see after this. Something like this might also help psychiatric/therapy types to get a good conceptual understanding of what your problems are and are not.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:49 PM on July 26, 2013 [3 favorites]
Feel free to go to your regular doc for refills, and ask your old psychiatrist for provider recommendations and a letter giving a brief case history and reasons for your diagnosis (should seriously take like half a page.) Also fill out the mental health CV on this webpage, and take it to your regular doctor and anyone else you see after this. Something like this might also help psychiatric/therapy types to get a good conceptual understanding of what your problems are and are not.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:49 PM on July 26, 2013 [3 favorites]
"Nobody with your grades and success in school has ADHD."
What? No. No no no. Your instincts are right on. Don't let someone with this sort of simplistic misunderstanding of your condition change your medications.
posted by limeonaire at 5:03 PM on July 26, 2013 [4 favorites]
What? No. No no no. Your instincts are right on. Don't let someone with this sort of simplistic misunderstanding of your condition change your medications.
posted by limeonaire at 5:03 PM on July 26, 2013 [4 favorites]
horrible! wrong! go someplace else!
posted by DMelanogaster at 5:09 PM on July 26, 2013
posted by DMelanogaster at 5:09 PM on July 26, 2013
My response to him throwing you on an antipsychotic with absolutely no indication of worsening of symptoms or treatment resistance and no complaints of current drug intolerance: what the fuck?
Antipsychotics can be really rather harsh, and there's no, no, no reason to start them unless immediately indicated by your condition, lack of treatment response, or by a profound decompensation in your functioning. It sounds totally demented to me.
Dump the nurse practitioner, find yourself a new doctor, definitely.
posted by Keter at 5:25 PM on July 26, 2013 [2 favorites]
Antipsychotics can be really rather harsh, and there's no, no, no reason to start them unless immediately indicated by your condition, lack of treatment response, or by a profound decompensation in your functioning. It sounds totally demented to me.
Dump the nurse practitioner, find yourself a new doctor, definitely.
posted by Keter at 5:25 PM on July 26, 2013 [2 favorites]
As someone with ADHD and anxiety, and on meds it has taken 10 years to get right but would probably look wrong to anyone but my meds NP (who is excellent, but I've had terrible pdocs), I agree with above people who are telling you to find someone else. A good practitioner wouldn't question your working diagnosis and want to change meds that are working for you after only one visit. Particularly since you haven't asked about it!
And Geodon is total overkill. My NP doesn't use it ever because there are better antipsychotics out there, and doesn't use them in general except as a last resort. Especially for ADHD and anxiety.
I've had bad ADHD my whole life, and I did very very well in school. Sorry it isn't very grammatical, but my Adderall has worn off!
posted by monopas at 6:33 PM on July 26, 2013 [1 favorite]
And Geodon is total overkill. My NP doesn't use it ever because there are better antipsychotics out there, and doesn't use them in general except as a last resort. Especially for ADHD and anxiety.
I've had bad ADHD my whole life, and I did very very well in school. Sorry it isn't very grammatical, but my Adderall has worn off!
posted by monopas at 6:33 PM on July 26, 2013 [1 favorite]
Guy sounds like a tool. Go to the Minute Clinic and get the meds you like refilled.
posted by Ruthless Bunny at 6:35 PM on July 26, 2013
posted by Ruthless Bunny at 6:35 PM on July 26, 2013
Find a different doctor. You've already been through too much.
posted by InsertNiftyNameHere at 9:49 PM on July 26, 2013
posted by InsertNiftyNameHere at 9:49 PM on July 26, 2013
This NP has no business prescribing anything to anyone. His cavalier attitude about messing around with that big squishy organ between your ears is scary and dangerous. We're not talking switching brands of antacids here. Your instincts are right. Find someone with knowledge and competence. And nthing x 1000 the advice to trust your gut.
posted by Kibby at 10:29 PM on July 26, 2013 [1 favorite]
posted by Kibby at 10:29 PM on July 26, 2013 [1 favorite]
Long story short, the NP did my intake and said, "Nobody with your grades and success in school has ADHD."
As everyone else has said, this is so wrong I'd be thinking about finding out how to complain to the company that owns the medical office. Your gut is right.
He is more invested in his ego than doing what is best for the patient. Run away.
posted by winna at 10:42 PM on July 26, 2013 [1 favorite]
As everyone else has said, this is so wrong I'd be thinking about finding out how to complain to the company that owns the medical office. Your gut is right.
He is more invested in his ego than doing what is best for the patient. Run away.
posted by winna at 10:42 PM on July 26, 2013 [1 favorite]
Imagine having to pay for an appointment with this fella sans health insurance. Wouldn't that be awful? Complain on Yelp and switch providers.
posted by oceanjesse at 12:18 AM on July 27, 2013
posted by oceanjesse at 12:18 AM on July 27, 2013
Just wanted to say I heard that exact line from the university psychiatrist when I was in grad school. It's such bullshit... Never did get an ADD diagnosis and ended up dropping out of grad school.
posted by désoeuvrée at 7:03 PM on July 28, 2013
posted by désoeuvrée at 7:03 PM on July 28, 2013
This thread is closed to new comments.
posted by St. Alia of the Bunnies at 3:17 PM on July 26, 2013 [7 favorites]