Depression doctor: How make a wise & informed choice?

September 13, 2016 10:49 AM

I’m open to the main treatment approaches, and grateful for any high-level or more detailed answers. tl;dr: If you were speed-dating psychiatrists, and planned to enter treatment with one, what key questions would you ask of all?

I doubt there's true speed-dating, but hey, it's a metaphor.

Basically I want to be more proactive in finding a doc/treatment that works, and if that means interviewing a fair number, so be it. (I'm insured, but cost is a factor at some point, of course.)

So: How could I begin? What do I need to know before I even call for an appointment? How could I filter a list of 'psychiatrists'? And then what could I ask of him/her to determine suitability?

_______________________

Some of my own particulars:

Mid-60s, diagnosed 2 years, though it goes back decades (hard to spot w/o sadness).

I seem to had had an MDD epsiode recently; symptoms exceed DSM-5 criteria. Mainly lethargy, irritability. No sadness, no suicidal thoughts.

Some success with cymbalta, but after a year of little rapport I said goodbye to the doc who diagnosed it. Nobody's fault.

Pharmacology or talk? Overall I’d rather take a med than spend hours in conversation, but I don’t reject either, or hybrids. Or others, within standard medical guidelines.

Comorbidities: ADHD, alcoholism (recovering), metabolic disorders.

posted by anonymous to Health & Fitness (3 answers total)

Pharmacology or talk?

In my part of the world, psychiatrists are generally about pharmacology. If they determine that talk therapy could be beneficial, they usually refer a patient to a psychologist or social worker for that part of treatment. That said, it's a good question to ask in a psychiatrist speed date.

If you are a USian, the easiest place to start looking for a psychiatrist might be your health insurance directory -- for various reasons, in-network is often much easier to deal with than out-of-network. Once you have that, consider looking at Psychology Today's Find a Psychiatrist, and/or asking any doctors you're currently seeing (and who you like) who they'd recommend.

Comorbidities: ADHD, alcoholism (recovering), metabolic disorders.

I would look for someone who has strong familiarity with these, as any of them could affect what medications are the best choices for you.
posted by gnomeloaf at 12:16 PM on September 13, 2016 [1 favorite]

(hard to spot w/o sadness)

This makes me think talking is a good idea. Maybe it's not super relevant for your current issues, but it would seem to be a thing that hangs around the back of your head, being depressing.

Everything I've read says talk and pharmacology is the killer combo, especially for depressing situations.
posted by rhizome at 12:39 PM on September 13, 2016

I would start with a good, thorough GP before moving on to a psychiatrist.

Mainly lethargy, irritability. No sadness , no suicidal thoughts.

metabolic disorders.

alcoholism

You could have one or more nutritional deficiencies (eg thiamine, D) that could mimic the non-sadness-related symptoms of depression. (Vitaimin D deficiency is implicated in poor thyroid function, also.) Or something else altogether.

(I once had a severe D deficiency that left me bone-achingly fatigued and amotivational in a way I had only previously experienced with depression. Except I wasn't sad, at all. I just couldn't move or do much, or think very clearly, and I was just so tired. One test, ordered by a perspicacious doc, and a good few months of supplementation later, I was feeling much better.)

Rule out other causes before (or while) you work on talk therapy, at least initially, maybe.
posted by cotton dress sock at 6:14 PM on September 13, 2016 [2 favorites]