How should I handle a psychiatrist appointment on a day when I feel fine?

April 21, 2006 9:47 AM

After struggling for years with depression and anxiety I've finally worked up the nerve to see a psychiatrist about it. When it's bad, it's really bad — can't-leave-the-house bad, end-up-in-the-hospital bad — but the past week or two have been good ones and right now I feel fine. (Not on top of the world, mind you, or otherwise manic, and not numb either — just normal.) How can I make the most of my upcoming appointment with no symptoms to show?

More specifically:

1. How can I give her an accurate picture of what the bad days are like if I'm seeing her on a good day?
2. She may want to write me a prescription for something. How could I judge if it was working if I started taking it on a good day?
3. Does it even make sense to be seeing a psychiatrist for a problem that comes and goes from one day (week, month) to the next? (Or should I try to postpone my appointment until things get worse? That doesn't make sense either, does it?)

(Someone will probably poke their head in to tell me that drugs are bad and I should be in therapy instead. So let me say now that I am in therapy and plan to continue with it. My goal in seeing a psychiatrist is to confirm or rule out the possibility that I should be taking meds as well.)

posted by nebulawindphone to health (25 comments total)

Nebula--

1. Tell her what you described in your first paragraph above. She'll also ask you lots of questions to draw more description out of you. Answer them as honestly and as fully as you possibly can. No need to hold anything back. She's there to help you, not to judge you.

2. The meds, if they're right for you, will flatten out the hills and valleys so that your mood has fewer variations. And they won't take effect right away. Ideally, you'll notice that over time, your periods of depression will be much fewer and much less severe. If not, you tell her about it.

3. Go now. You finally worked up the nerve to make the appointment -- and it's one of the very best things you'll ever do for yourself. IANAP, but my sense is it's completely normal for depression to be cyclical. She'll be able to help you talk through it.

Good luck!
posted by shallowcenter at 9:55 AM on April 21, 2006

1) A capable shrink will know what you're talking about when you describe your depressed/anxious episodes; she won't need to experience them first hand. She'll know what to ask to get the information she needs. She'll be very familiar with good and bad periods.
2) Well, if you keep having good days....or when you do have bad days they aren't as bad?
3) You don't need to wait for the worst symptoms to get treatment.
posted by TimeFactor at 9:56 AM on April 21, 2006

Realize that you feeling better is partially due to the fact that you're considering getting treatment. You're finally addressing a problem that's been bothering you for some time now.

If you feel better at just the thought of getting treatment, just imagine how good you'll feel if you actually do.
posted by Bighappyfunhouse at 10:02 AM on April 21, 2006

Depression isn't like a sprained ankle, where the coach sends you back into the game the moment it stops hurting. Psychiatrists know this. Make a detailed and accurate report of the ups and downs over the last few years, and do your best to describe the feelings you have in clinically standardized terms.
posted by squirrel at 10:03 AM on April 21, 2006

Good for you. Don't put it off, go now and simply explain to the doctor what you feel like when things are bad. Psychiatrists are used to working largely through patient-related symptoms, there are no blood tests or anything, so you'll find that there is no problem with this. Be prepared for a bunch of questions about things which you may not have thought of as symptoms, especially, from your brief description, questions about whether or not you are on the manic side when things are going well.

As far as medications go, going to a psychiatrist in this situation is pretty much a guarantee that you'll be prescribed medications. Today's psychiatry is very focussed on medications. Again, it's no problem that this is not one of the bad times. Psychotropics for the most part take a while to really foster change in mood, in part because that's what they do, rather than being a cure. When you start taking medications what you'll basically be looking for is whether or not your life is going better. But then, this is what you should be looking for from therapy as well. Symptom relief and amelioration is important, but more important is what that allows you to do in the rest of your life. You want a life filled with all kinds of things, not simply a life free from symptoms.

Again, re. medications and what to expect: psych meds can be very helpful for people, and are certainly a tool for improving lives. At the same time, they come with side-effects, and you should do some thinking about the diagnosis that the psychiatrist gives you as well as thinking about whether or not the side-effects are something that you are willing to risk. This is less of an issue for anti-depressants, and more of one for the mood stabilizers and anti-psychotics of all stripes. I'm not suggesting that you shouldn't take medications, simply that you should be prepared to evaluate your doctor's recommendations from all fronts. For this reason it's a good idea to go during one of the good times.

Best of luck. You're doing the right thing. Keep talking to your therapist and your doctor.
posted by OmieWise at 10:05 AM on April 21, 2006

Like the others have said, tell the doctor what you've told us. The pyschiatrist will ask you lots of detailed questions and answer them as best as you can. Going in when you are feeling "fine" is just as important as any other time.

You've made a big step. You have a medical condition. You can't "snap out of it" any more than a diabetic can control his insulin levels by "snapping out of it". If someone has a cold or a headache, it's ok for them to take some medication so that they aren't suffering, right?

Good luck.
posted by luneray at 10:07 AM on April 21, 2006

What shallowcenter said.

Therapists know very well how debilitating depression is, and thus they are aware that you're more likely to be up for an appointment when you're, well, "up" instead of when you're down. Be ready to describe your symptoms, maybe offer an anecdote or two about behavior or feelings you particularly don't care for. (Example: a time you had to bail out of what might have been a pleasurable activity because of your depression.)

Antidepressants work rather differently than most other types of drugs in that the positive effects become apparent only very gradually -- we're talking months rather than days. If your medication is working properly, you might eventually upon reflection, say, "I don't get spells of depression as often now as I did six months ago, and when I do get depressed, the feelings are a lot less severe." The paradoxical thing is that the unwanted side effects (if any) tend to crop up very quickly and then vanish within a few days. I found it an odd feeling to be taking these pills every day for weeks and weeks and "getting nothing" but, as I mentioned, eventually there is a rather subtle sense of "you know, I do feel better now than I did then."

Presumably your therapist will be in touch with your phychopharmacologist so that they may monitor your progress together. You are correct (IMO) that medication alone is not the optimum treatment for depression; really it takes regular talk therapy as well to provide the best outcome.
posted by La Cieca at 10:09 AM on April 21, 2006

1) What you said in the first paragraph is fine.
2) What shallowcenter said. Not everybody responds the same to every medication - right now the field of psychiatry is still trying to fix every problem with a neurochemical sledgehammer, so not all medications are equal for all people. On a sidenote, mountains of anecdotal evidence suggest asking for something other than Paxil (WP, but it neatly sums the problems I constantly hear about), if that's what your doctor offers. They have tons of other options, so you have no reason not to. In any case, if things aren't getting better after the time period they'll inform you of, you can call them or bring it up at your next appointment.
3) Yes it makes sense to get treatment - any medications you'll be taking will take weeks to fully kick in, so waiting for a specific moment won't solve anything. In bipolars cycling can get quite nasty to treat as SSRIs only aggravate the manic symptoms, but for straight depression that shouldn't be a factor.

Good luck.
posted by Ryvar at 10:17 AM on April 21, 2006

Re: #2, Well, you can't. Many prescriptions do not take effect immediately; they often won't have a noticeable effect until after several weeks. So please, if your psychiatrist prescribes you medicine and you decide to take it, do not expect immediate results.

This delay in effect is a known problem for people suffering bipolar disorder (I'm not saying that's you, I'm just saying it's a known problem)--patients will often quit taking their prescriptions once they feel better, then they begin to feel worse, and then it's another one to four weeks before the (now-renewed) prescriptions take effect again.

Also, it would probably be good if you could try to think of specific things that might trigger your depression, whatever they might be--things that you do, or don't do, or things that you hear, the kinds of things that keep you awake at night, etc. Part of treatment is trying to figure out the root cause of the problem, which is not always chemical, so your psychiatrist will likely want to try to figure out patterns to the things triggering your depression so that they can be addressed.
posted by Tuwa at 10:20 AM on April 21, 2006

As far as medications go, going to a psychiatrist in this situation is pretty much a guarantee that you'll be prescribed medications. Today's psychiatry is very focussed on medications.

This is not true. Plenty of psychiatrists also believe in the power of cognitive therapy (which it sounds like you're already doing) and alternative therapies. One very well trained psychiatrist that I know, for example, is trying hypnotherapy on some of her patients and found that it has helped. It's best not to go into this assuming one thing or another -- go in with an open mind, tell your psychiatrist everything you have told us and more, see what he or she has to say. If you don't like it, you can always ask her for other optinos or seek a second opinion.

Good luck!!
posted by echo0720 at 10:23 AM on April 21, 2006

one to four weeks

oops. I was deleting and rewriting and shuffling things around and accidentally axed an "often." It can, of course, take longer than four weeks. Sorry.
posted by Tuwa at 10:26 AM on April 21, 2006

1. Tell her what the downtimes are like. She will believe you even if you feel fine at the time. I have done this; it's not a problem at all.
2. Hopefully, the way that you will tell that it is working is that you will not get horribly depressed again. But admittedly, it's a waiting game for you, if you're feeling fine now.
3. Yes, yes it does. You do not want to get depressed again, and this may help. In your case, it's preventative, but still completely reasonable.

My only extra pieces of advice are:
1. Try to go with an open mind, even with respect to your diagnosis. BUT at the same time:
2. Don't assume that this psych is the best one for you. If you don't get along with her, or anything feels "off", consider shopping around. It's perfectly fine, and lots of psychiatrists expect that you will do this anyway. YOU are the focus of this, and the whole point is to make YOU feel better. So if YOU don't feel like your psychiatrist is friendly or appoachable or whatnot, see someone else!
posted by unknowncommand at 10:47 AM on April 21, 2006

Just wanted to join in the pile-on of congratulations and well wishing. Good for you!

Also wanted to add a note of caution--if medication is prescribed, it can be very tricky to determine the right drug, and the right dosage (everyon'es different). Keep your therapist and psychiatrist posted about how it's working, and don't give up if the first drug / dosage combo doesn't solve everything instantly.
posted by Squid Voltaire at 10:55 AM on April 21, 2006

1. Keeping a mood diary may be useful. Otherwise, a good psychiatrist will be able to extrapolate from your account and good questioning. Kind of like when you can't get in to see the dermatologist until your breakout has passed, but they can use their imagination.

2. This depends on you and the drug. Some take a while, some can help that day (e.g. the anti-depressant effects some people receive from Lamictal, even at the non-therapeutic 25mg dosage - prescribed frequently for Bipolar II). As for down the road, sometimes it is hard to tell if it's working. Depending on the meds, they may loses effectiveness over time or vary in how they work for you from day to day based on other factors (e.g. other drug interactions, menstrual cycles, etc). You may need a cocktail that will have to be tinkered with as you go to work as desired. A mood diary can help you track this as well.

3. Go now. When you're in a good period you may feel like it's not that bad and things have improved. But chances are you will have a bad spell again, and it will be harder to motivate yourself to go at that point. Of course I am not a doctor.
posted by Marnie at 10:59 AM on April 21, 2006

Another quick note: Give your therapist your psychiatrist's number and vice versa. And specifically ask your psychiatrist to talk with your therapist so that, in addition to the info you give her, your therapist will be able to contribute a clinical perspective on your case.

Most psychiatrists will prescribe you something in the first meeting and then see you again in a month. But if you feel odd side-effects or have a sudden downturn while taking the meds, you can always call your psychiatrist and schedule an earlier meeting. They do this sort of thing all the time.

Also, I'd like to echo Squid Voltaire's comment. Don't get frustrated too quickly if medications don't work. Most people have to play with the meds some for months or even years before they get the perfect combination. (I've been on ... let's see ... six or seven anti-depressants and a variety of anti-anxiety medications and about two years ago I finally found the right mix, thanks to a doctor who really knows what he's doing).

Congrats on making the decision, and good luck!
posted by brina at 11:06 AM on April 21, 2006

I was you 10 years ago. Getting the right medication took about 2 years for me. Partly because I would "fall off the wagon" when one didn't work. I would just give up for a few months until it became unbearable again and try something else. By accident, while taking Paxil, which was working great but then began to fade after a few months, my doctor and I discovered a "cocktail". It was by accident because I wasn't sleeping and she prescribed a very small dose of Elavil. In a week, I was better. It has been 8 years and I have been through all kinds of experiences, good and bad, since then, and it's pretty steady. Without it, I would be completely unable to enjoy life at all. What the medication did for me was put me at a basic level of okayness, from which I was able to gain some perspective of my life.

I believe you WILL notice if it's working. Because what I felt was a sense of, "My god, this must be what it's like to just feel normal." Something I had not felt for 30 years. However, medication does not eliminate the need for therapy. I can guarantee you that there is a source from which this depression sprang. It is really important to resolve it.

Good luck.
posted by generic230 at 11:11 AM on April 21, 2006

echo0720 writes "This is not true. Plenty of psychiatrists also believe in the power of cognitive therapy (which it sounds like you're already doing) and alternative therapies."

That "plenty...also" believe in the power of therapy does not make my statement less true. My statement is absolutely true. Given the described symptom set I would be very surprised if the psychiatrist did not suggest a medication. All of the psychiatrists I know and work with would be similarly surprised. It's better to start to think about what that means now, since it's likely, than to play the naif and have to do all your thinking when you get there. Hence, I would guess, this question.
posted by OmieWise at 11:14 AM on April 21, 2006

The Doc will probably administer a Depression Screening Test, which should help with the diagnosis, even if you are feeling OK that day.
posted by lilboo at 11:20 AM on April 21, 2006

I concur with most everything that has already been said in this thread, and encourage you to stick with it. It is not easy, and it requires a lot of patience, but the payoff is worth the effort. On a personal note, I'd suggest staying away from Effexor if you possibly can. Discontinuing it is...uniquely hellish. Most antidepressants have some degree of crappy side effects, but try to keep in mind that they should eventually pass.

You may want to consider keeping a daily log of some kind. It doesn't have to be an exhaustive confessional; just jot down a few lines about how you're feeling. It might help you determine what has a positive/negative impact on your mental state. And when you go to see your psych, you'll feel better for being able to really dig in and work during your appointment, instead of spending the hour/half-hour trying to remember how you've felt for the past few weeks. (On preview, Marnie already covered this.)

Hang in there--you're on the right track! Feel free to drop me a line if you want to compare notes...I've been doing the meds-and-talk shuffle for a while now.
posted by Vervain at 11:26 AM on April 21, 2006

You can even do a depression screening test of your own, if you think it'll help you sum up your range of moods. (Serves the purpose of a diary, when a diary seems like too much effort.) Print out one or more questionnaires such as the Goldberg Depression Inventory and the NYU Depression Inventory. Fill them out once with today's answers, and then do them again with your 'bad mood' answers. Take them with you when you visit the therapist.
posted by wryly at 11:49 AM on April 21, 2006

I think for most people, it's extremely difficult to find and schedule an appointment with a psychiatrist while at your lowest point. Usually, you have to rise up a little on your own before you can manage it.

I'd like to recommend a book in addition to your therapy and psychiatric appointment. I found it very comforting and it's written in layman's terms. It's How to Heal Depression by Harold Bloomfield and Peter McWilliams.

Kudos on having the strength to reach out for help. I wish you much happiness.
posted by AuntLisa at 4:57 PM on April 21, 2006

Just a little personal experience on "knowing if it's working".

Sometime after the month ramp up period I noticed that I wasn't having the horrible lows that I used to, but I couldn't tell if this was due to the cognitive work I was doing or the antidepressants. Everything else felt normal.

After a year or so of feeling like a normal human being, I trailed off the antidepressants to see how much effect they were having. Answer: lots. I was much more capable of dealing with the depressions when they came, but they came every bit as hard as they ever had. I went back on the antidepressants right quick.

The experience was a good one, in that it showed me very clearly the difference between the normal ups and downs of life and biological depression. Normal depression really does feel very different from biological depression, so much so that we should use two different words to describe them.

(btw: one of the reasons I tried going off of the antidepressants was emerging evidence that a certain percentage of people's bodies learn the trick of regulating neurotransmitters, etc. after a year or so of having them regulated by drugs. I do not have one of those bodies, but you may.)
posted by tkolar at 5:38 PM on April 21, 2006

I find that beating down Depression seems to leave me with more energy to accomplish things, which makes me feel better about myself because I accomplished something. Once you get your life back on track, it's positive feedback city.
posted by Megafly at 5:43 PM on April 21, 2006

I have similar mental health issues, and for me it is always easier to get myself to a doctor when I'm having good days. Times when I've been really down and don't have a specific mental health professional to go to it is hard hard hard to get myself to one. When I've been mostly well, I find that seeing a professional is not only easier to do, but treatment is more effective. So you may just be doing the best thing by seeing someone now, and not when you're at the worst parts.
posted by saffron at 5:59 PM on April 21, 2006

Do you think you would get help when depressed? I doubt it. I think you're most likely to give your doctor an accurate account now when you are dealing with things well. I don't know if your doctor will start you on medication, now- IANAP--but you will be in a better frame of mind to work with him or her for those times when you might need it

I've found that medication did incredible things for my ability to make progress in therapy. It gave me the engery and ability focus. I personally don't think medication has leveled out my good times. It's just given me more of them.
posted by gesamtkunstwerk at 9:59 PM on April 21, 2006