Seeking: Boston-area psychiatric care; a treatment plan; hope

November 2, 2016 5:03 PM

I have a pile of treatment-resistant psychiatric symptoms, a long list of possible diagnoses given to me by different doctors over the years (including various mood disorders, ADHD, autism, and borderline personality disorder), and nearly a decade's worth of history with different psychiatrists trying different med combos with limited success. I want a knowledgeable professional who is a good diagnostician and listens well to help me dig through this shit and work out a treatment plan that makes sense. Can you recommend someone like that in the Boston area?

Everyone agrees I have depression.

Beyond that, no two mental health professionals seem to agree on what's wrong with me, or what to do with it, and that scares the shit out of me.

I'm honestly not even sure how to describe or label my symptoms at this point. Is that zoned-out state I'm in dissociation, ADHD inattentiveness, a depressed stupor, or a shitty coping strategy I use to distract myself from anxiety? Do I struggle with social cues because of ADHD, or because of Asperger syndrome — or is it just that social anxiety or depression is making me think I struggle with social cues? When I slide rapidly into suicidality after tiny setbacks, is that BPD impulsivity and manipulativeness, or some kind of weird bipolar thing, or just evidence that my depression is way less well controlled than I think it is? When I get so upset it feels like I'm glowing and the universe is vibrating around me, is that an anxiety attack, or a bipolar mixed state, or an autistic meltdown, or a mild hallucination (oh shit oh fuck please let it not be that), or what?

I'm pretty functional. I've only been in a psych hospital twice in the past ten years. I have a middle-class professional job that I show up to most of the time. I'm also badly underperforming at work, falling down on personal obligations, and terrified that the life I've put together is going to fall apart.

I've seen a bunch of Behavioral Health Professionals over the years — done lots of therapy, had a couple different psychiatrists, tried lots of meds. Since moving to Boston I've been getting my psych prescriptions written at Fenway, but the 15-minute appointments, overworked doctors and high turnover there don't feel conducive to getting good care.

I am exhausted. I want to figure out what's actually wrong with me and make a plan to get better. I am open to literally any arrangement for doing that, as long as it's accessible to someone with ok insurance who isn't independently wealthy. Can you recommend a local psychiatrist who's good with hard, ambiguous diagnoses and treatment-resistant shit? Should I be seeing some other kind of specialist instead? Looking for someone who specializes in autism or personality disorders? Some other thing that I'm not thinking of?

posted by nebulawindphone to Health & Fitness (11 answers total)

You'll have a hard time finding a psychiatrist who doesn't operate in rushed 15 minute appointments that basically serve as medication refill visits so I would recommend finding two separate behavioral health professionals. The psych to prescribe the meds, and a psychologist who can really take the time to help you work through social issues. In my experience psychiatrists are often open to suggestion from other sources, e.g. "my psychologist recommends this...", for prescribing.

You've probably already thought of that and/or done that in the past but I think it's the best workable way to get the intensive help you need.

And yes, there are psychiatrists/psychologists who focus on specific disorders. This info is usually listed under their name, when searching on the health insurance website for providers.

Best of luck! Wish I had more specific advice!
posted by bobobox at 5:31 PM on November 2, 2016

Not to be flip, but do you care what is really wrong with you? You would like a treatment that works. There are novel research treatments out there for treatment-resistant depression, maybe you can go to a research centre and see if there are some for you. For example, there are rTMS programs at Beth Israel. There's ketamine studies at UMass. If you're desperate for a change, try a referral to a research program.

Also, I don't know if these exist yet in Boston, but if you can get into a program with group psychiatric visits for medication management this is an excellent option. Even though you still spend under 15 minutes directly interacting with the psychiatrist, you are in the room for an hour learning about psychiatric treatments and what they are used for. Also in the practice I'm in, appointments are much easier to come by and you can visit more frequently, which makes up for the lack of extended contact and general rushed-ness of the interaction. Email contact in between visits is a bonus if there is a psychiatrist that offers it (the group I'm in does) so med changes can be quickly evaluated.
posted by crazycanuck at 7:35 PM on November 2, 2016

Not to be flip, but do you care what is really wrong with you? You would like a treatment that works.

Assuming my doctors aren't just handing out meds at random, having a correct diagnosis raises the odds that I will get appropriate treatment. That's the only reason I care.
posted by nebulawindphone at 8:12 PM on November 2, 2016

But, like, the point is that I'm not sure this is just treatment-resistant depression.
posted by nebulawindphone at 8:28 PM on November 2, 2016

Can you go to a good internist? When I had a b12 deficiency I was told I was depressed/ had anxiety etc. For a while year! Another friend was treated for several years for various things including bipolar disorder and anorexia but actually had an adrenal tumor. Pyroluria is another physical condition that primarily manifests with psychiatric symptoms. A good internist would give you a really thorough work up and possibly find some kind of metabolic or other physical reason that you are treatment resistant or that is contributing to your condition. If you could tease out your physical problems from the whole situation it might help a lot with your psychiatric treatment.
posted by fshgrl at 9:52 PM on November 2, 2016

Re: other types of professionals, have you considered a neurologist? IANAD, but it might be good to rule out some flavor of epilepsy (having "spaced-out" states and mild hallucinations made me think of that). I also remember hearing that some other MeFites also prefer talking to neurologists vs. psychiatrists about stuff like ADHD -- possibly worth a shot, especially if you're not getting anything productive from psychiatrists.
posted by en forme de poire at 10:23 PM on November 2, 2016

Re: other types of professionals, have you considered a neurologist? IANAD, but it might be good to rule out some flavor of epilepsy (having "spaced-out" states and mild hallucinations made me think of that

This is why you want to cover your bases with a good internist and/or neurologist, because a sleep disorder (in addition to the vitamin or hormonal issues mentioned upthread) will also cause many of your issues as well.
posted by blue suede stockings at 6:24 AM on November 3, 2016

See if you qualify for the Pavilion at Mccleans. Two week residential comprehensive assessment and plan. It's pricey and you would have to negotiate with insurance company.
posted by SyraCarol at 10:56 AM on November 3, 2016

If you're in the market for a psychiatrist who will actually listen to the problems you describe, and who will rapidly and aggressively adjust your medication schedule in line with what you're reporting, I can thoroughly recommend Danielle Federov, at Boston Psychiatric Care in JP. It took us six months to land on a solution, but that was after five years of intermittent failures with a GP.
posted by Mayor West at 12:20 PM on November 3, 2016

Small world -- I also came here to recommend Danielle Federov, especially since you mentioned your frustration with rushed fifteen-minute meetings. She's willing to the take the time to listen and understand what's going on, and she trusts my self-assessments. Our meetings are collaborative, not like with people I'd seen in the past who wanted to make my decisions for me. She's the exact opposite of what you're describing at Fenway.
posted by sleepingcbw at 5:22 PM on November 5, 2016

Final update from the OP:

Danielle Federov is indeed amazing. I'm still working with her and would recommend her highly to people with treatment-resistant mood disorders -- she's been tenacious and creative in looking for a solution.

posted by restless_nomad at 1:07 PM on December 3, 2018