Ask MetaFilter questions tagged with psychiatry

Non responsive psychiatrist. Am I missing something or should I look elsewhere?

Anonymous — Sat, 12 Dec 2009 14:09:53 -0800

Third week of therapy. My psychiatrist has let me talk for 2 hours so far and not offered anything much in the way of a response to anything I say. I feel like I am spending a lot of effort and money to talk to a blank wall. Is this normal or should I be seeking a different therapist? I have problems with depression, anxiety and alcohol abuse. I am actively seeking treatment with a psychiatrist, and have had 2 sessions so far.

My sessions have involved me sitting in a chair for 3/4 of an hour, talking, with little or no response at all from the psychiatrist to anything I say. While I am not suicidal I have been experiencing suicidal ideation, and I am also dealing with the fallout from a siblings incarceration for a very serious offense. I am unemployed, not sleeping or eating much and finding it very hard to get out of bed in the morning to deal with the bare minimum of what I need to do. All of which I have brought up with the psychiatrist and been met with a blank stare.

The doctor has given me almost no response to anything I have said, with the exception of nodding when I said I felt like I was drifting. Is this a normal part of therapy with a psychiatrist? Am I missing something here?

I have seen a psychologist in the past who was very thoughtful and gave me feedback and insight on my thinking patterns and behaviour. However they are no longer available. I am attending group meetings for the alcohol abuse.

I am not looking for a prescription, just help. I don't know if this therapist is just completely incompatible with what I need, or if I am just not getting it.

Unemployed, uninsured... how do I get my medication?

Pleadthefifth — Mon, 07 Dec 2009 16:09:26 -0800

So, I recently lost my job and, by proxy, my health insurance. I'd been seeing a psychiatrist for over 2 years, when I was employed and insured. Together, we found a good combination of medications that worked for me and my particular brain chemistry. Now, I am running out of medication and don't know what to do or where to look for assistance. (I'm 23 and live in New York City.) I take an SSRI and a benzodiazepine daily for depression and anxiety/panic attacks. I am worried about running out of the medication as sudden discontinuation of benzodiazepines can cause potentially life threatening seizures, as well as the discomfort of sudden discontinuation of the SSRI. What can I do to avoid having a seizure and causing even more medical bills to worry about? Both of my parents are deceased and I have no family to speak of and most of my friends are in similar situations. My googling has turned up nothing of use. Much thanks for any responses.

I think I might have Asperger's. What should I do?

edguardo — Sun, 22 Nov 2009 11:32:59 -0800

I think I might have Asperger's. In my case, should I even bother being tested? What would a confirmation/disconfirmaton mean? I'm 22 years old, male, college student, soon-to-be post-bacc medical student.

I've been medicated in the past for anxiety and depression (Lexapro), but I've been drug-free for a year and, I think, coping really well.

My coping methods, however, are optimized for living alone, as I did for a year before my girlfriend moved in with me a few months ago.

When living alone, I can take all the time I need to myself to chill out, calm down, and take myself out of overwhelming situations, generally involving other people. I've been controlling my anxiety and mood swings by avoiding the things that cause them, and now that I live with someone else in a small apartment, I feel like a lot of my "solutions" have just been temporary fixes.

Now, I'd say we just need to work things out and talk to each other, which we're good at doing when we clash, except for the fact that both my girlfriend and my mother think that I have Asperger's.

If it were just me, I wouldn't bother seeing a mental health professional, since I know there's no "cure" for AS and it's just something you deal with. But it isn't just me; I have my relationship with my girlfriend to consider, and I know I can be very difficult to live with (I find myself difficult to live with sometimes too).

My girlfriend says I've become easier to deal with since she's decided I have AS, and my mother says she's wondered for years if I had mild autism. It just seems so late in the game, so to speak, for this to come up.

I'm afraid that if I am determined to have AS, that I'll be considered a faker or excuse-maker since I'm fairly well-adjusted. I'm afraid that if I'm determined NOT to have AS, that I'm dealing with something like a mood disorder instead, and I'm not interested in going back on medication.

I've already sent an email to a local psychiatrist who works with autistic children, asking if she counsels adults or who I should see about it. That's a first step, but how do you think I should proceed?

Courting Ellen West

crush-onastick — Fri, 20 Nov 2009 11:45:28 -0800

“The Case of Ellen West” was published by the Swiss psychiatrist, Ludwig Binswanger, in 1944–1945 and (as far as I can tell) appeared in English translation in 1958. Anyone know where I can get a copy? Usual search suspects are turning up only the Carl Rogers article, "Ellen West and Loneliness", in the Review of Existential Psychology and Psychiatry (which I've requested via interlibrary loan) and some other scholarly pubs on Rogers (behind the usual pay walls).

Doc, I'm seeing things.

Fenriss — Fri, 13 Nov 2009 13:50:13 -0800

How would a psychiatrist treat an adult who was having visual hallucinations, but no other symptoms of psychosis? FYI, this is for fiction writing purposes. I've got character with no history of mental illness who has suddenly started seeing troubling things. He is otherwise entirely lucid, and would not exhibit any other symptoms, except a little understandable anxiety under the circumstances.

I'd like to know what a p-doc would realistically do in this situation. Would s/he medicate for the hallucinations? Or maybe just suggest therapy? Thanks for the help.

That Boy Needs Therapy

Anonymous — Thu, 13 Aug 2009 04:06:51 -0800

I'm a male in my early twenties who has washed out of college and is looking for a mental health professional of some sort in Northern Virginia. Issues I feel are likely to come up are my (long-ago diagnosed) attention deficit disorder, depression, and some form of OCD - I have a deep and (likely irrational) fear of psychosis and other impairments of cognition. I am deeply wary of psychiatric drugs, and want to work with someone who shares my attitude toward them, but would recommend them as a last resort. So what I'm after is some sort of talk therapy, preferably with a medical doctor (as oppose to "just" a PhD). I think would prefer CBT over other modalities. Freud, Jung, Lacan and their ilk aren't for me, but anything else is fine.

For private messages: M8R-sshtxg@mailinator.com

How Do I Give Myself a Chance to Get Better?

Anonymous — Tue, 14 Jul 2009 09:17:27 -0800

After a long and losing battle with depression, I am going to a short-term (10 day) partial hospitalization program at McLean Hospital near Boston. I need advice on how to convince myself that there’s hope for me and get into the kind of frame of mind that will allow me to benefit from this kind of program, despite its short length and limitations. I have struggled with depression since early adolescence, but felt like I was on the road to managing it and leading a healthy, happy life until a serious breakdown about 9 years ago, when I was 26.

I desperately want to live life differently and get better, and that’s what’s given me the ability to plug along over the last decade or so, trying new therapists, new doctors, new medications, and all kinds of lifestyle maintenance and changes (i.e. diet, exercise, supplements).

I’ve taken all the classes of anti-depressants, drugs for bipolar disorder, atypical anti-psychotics, thyroid supplements, stimulants, drugs old-fashioned and cutting-edge, 21 sessions of ECT. Mostly, they didn’t help. When it did, the effect soon wore off.

I was tested for everything: diabetes, vitamin deficiencies, thyroid problems, adrenal problems. Fancy doctors from various sorts of prestigious institutions tried looking at the problem from all kinds of angles, applying new diagnoses that might shed new light and help me get better, including bipolar disorder and borderline personality disorder, but the new diagnostic lenses and alternative approaches didn’t yield any results.

While much of the McLean program will have a diagnostic bent, it’s also supposed to have a therapeutic element, insofar as these 10 days will be a time-out and a potential physiological and psychological reboot.

I don’t know how much of the program's benefits depend on my ability to try to maintain a attitude that is at least open-minded (if not outright positive). But if there’s any chance at all that being able to feel less despair will improve my chance to get more out of the program, I desperately need to do so. I’m also afraid of getting written off as having a negative attitude by the program staff.

The trouble is that after years of encouraging myself, trying to maintain a positive attitude, and trying to get better, I can’t bring myself to believe that something else is possible. In another Askme on depression, a user here once wrote about how depression “ruins you inside,” and that’s a pretty accurate way of describing the effect this has had on me.

Not long after the breakdown, I picked up Andrew Solomon’s The Noonday Demon, hoping to find some insights into what I was suffering. It terrified me so much I couldn’t finish it: the book was replete was stories of people who had struggled with depression for years and whose lives were lunar landscapes of pain and failure. Nine years later, I have become one of those people.

Hope seems fundamentally irrational, and I feel like an idiot trying to improve my situation despite all the evidence that shows that I can't be helped. I know that McLean doesn't have access to some kind of special magic potion, and I don’t know what kind of new information they could get that might help provide a new diagnostic or treatment angle to my condition.

Psychiatry treats despair and hopelessness as if they were irrational, or symptoms of an illness, but right now they feel pretty damn logical, insofar as it no longer seems logical to believe I can live differently. Yet somehow I need to muster the ability to believe that this can help me. I don’t know how to do that.

I am very grateful for your ideas and feedback as to how to increase my chances of benefiting from this program and giving myself an opportunity to get better.

In the red corner, a bad mood. In the blue corner, an even worse mood. FIGHT!

Anonymous — Fri, 19 Jun 2009 22:41:49 -0800

I just got back from a psychiatric evaluation. The diagnostic impression is "chronic major depressive disorder versus dysthymia." What does "versus" mean in this context? You are not a/my psychiatrist. I know I should have asked him when I had the chance, but I was kind of thinking “hmm, I’ll Google that later.” Google didn’t really turn up anything. I could ask him again at my follow-up appointment in a couple of weeks, or I could call the office next week, but I admit I’m curious now.

I have a passing familiarity with the DSM-IV, but I’ve never heard “versus” used like this. My best guess is that, at this point, I seem to fit the criteria for both depression and dysthymia, and my psychiatrist has yet to determine which is a more appropriate diagnosis.

I was diagnosed with dysthymia a few years ago, so I suppose it’s also likely that “versus” means a revision of my previous diagnosis.

Or did I hear him wrong and he said something else?

Is this use of “versus” common in psychology/psychiatry/medicine in general?

If you have any ideas let me know. It’s not a huge deal, but it’s got me wondering. Thanks!

Help Me Find An Inpatient Psych Program

Anonymous — Mon, 01 Jun 2009 11:00:03 -0800

Please give me advice on inpatient psychiatric treatment programs for depression. I'm looking for recommendations and advice on specific clinics anywhere in the US. I'll spare you the long detailed background and try to give the most essential and relevant details. After a long and unsuccessful history with the entire gamut of psychiatric meds, ECT, and various forms of therapy, I'm still struggling with disabling depression. After some productive conversations with my current psychiatrist, it looks like the next best step is to try to make a sustained effort to get better within the framework of an inpatient treatment program at a psychiatric clinic.

Since this is not an emergency hospital admission, and because I've had such frustrating and unsuccessful experiences with previous attempts at managing my depression, I'm trying to find the best possible inpatient program. I'm willing to travel anywhere in the United States. I have private insurance that includes coverage for inpatient psychiatric treatment.

Obviously, much of the definition of "best" depends on the relationships patients develop with therapists, psychiatrists, and social workers within the clinic environment, and that's very much an individual process. However, I'd be grateful for any information, advice, and recommendations you might have about various inpatient treatment programs. I've heard some vague good things about the Meninger Clinic (in Houston, TX) and the Harvard-affiliated McLean clinic, but they're too vague to give me very much confidence and mostly consist of the fact that these facilities are well-known.

Of course, any more general thoughts you might have on what to look for in a treatment program would be welcome.

I've left more personal information on my situation and various details about my treatment history out because I wanted to try to make this as concise and direct as possible. Please post in the thread if you feel like you need more information, or you can write me at my AskMe email account: SeekingPsychClinic@googlemail.com.

I'm grateful for your help.

how do i address possible memory/cognitive issues with my doctor?

Anonymous — Wed, 20 May 2009 17:49:56 -0800

as a twenty-something, how do i address possible memory/cognitive issues with a doctor without both of us thinking i'm crazy? or am i crazy? I'll try to explain my situation as best I can; pardon me if I make any glaring omissions. Also, please direct any inquiries to thrwawayacct@gmail.com.

Back in January, I was happily chugging along in my coursework, when I suddenly started having the worst headaches of my life, along with trouble sleeping and remembering and concentrating on things. I didn't think much of it at the time, but I asked my GP anyway and he thought I was probably suffering from depression and anxiety and gave me an Rx for Lexapro. I was a bit reluctant to start taking this, however, since I don't have any history of depression, nor did I feel in any way down or depressed or what have you. At any rate, as days turned into weeks and weeks into months, it seemed that my headaches were getting worse, I felt constantly groggy, and that I had much greater difficulty remembering and concentrating, so I asked to be referred to a neurologist. Before my appointment with the neurologist, I had an MRI of my brain done which was "negative." At my appointment, the neurologist conducted his examination in which he asked me to tell him the current date and remember a few objects to recite back to him a few minutes later. I could not recall the exact date (it even takes me a while sometimes to realize what month it is), and I could only recall one out of the three objects he told me. After he finished his examination, I asked him what he thought and he proceeded to tell me that I was probably just suffering from depression-related concentration issues, so he sent me home with a referral to a psychiatrist. I have yet to see the psychiatrist, since apparently he's booked solid for about two months. Given that this isn't resolving itself, I don't really want to wait that long.

Am I wrong to be skeptical of taking an anti-depressant in this circumstance? I honestly have no idea what depression feels like, but I know I don't feel in any way sad. Should I try to find another neurologist and/or psychiatrist who can see me sooner? This whole situation got markedly more weird when I recently visited a close friend I've seen often in the past, and although I knew how to get to the friend's house, my surroundings on the way there seemed oddly very foreign and I felt like I was lost. I wasn't anxious up until that point, but I certainly am now.

For what it's worth, I've never done drugs, I rarely drink, all blood work was within normal limits, I currently live in Minneapolis, MN, and I have no health insurance. If anyone knows any good options for health insurance and/or good neurologists and psychiatrists in the area, please let me know. I don't really have the time or the money or the energy to guess and test doctors much anymore. I'm about at my wit's end with this and want to be able to return to my classes in the fall as someone who can actually think straight again, if that's even possible.

Also for what it's worth, what I'm going through seems somewhat similar to what this person went through, except for the fact that I haven't had a PET scan.

I hate to ask AskMeFi to be my doctor or to help me find one, but I don't really know what to do anymore. Any help would be so very appreciated. Thank you.

Antipsychotics when you're not (yet?) psychotic...

specialfriend — Fri, 08 May 2009 19:35:22 -0800

Antipsychotics-filter: A conversation with a friend has me turning to the hive mind. Feeling out of sorts for a year prompted my friend to see a psychiatrist. Her symptoms (foggy mind, problems with executive mental tasks, dull emotions, fatigue) and family history (sister has schizophrenia) led the doctor to consider that while she has no positive symptoms (hallucinations, delusions) she might be late prodromal (pre-schizophrenic) and is now considering treating her symptoms with low-dose antipsychotics. Looking around online, it appears that antipsychotics come with hefty side-effects. Our question is a 2-parter: 1: What is the rationale in treating someone before it's clear they have developed (or will develop) a psychosis? And 2: Do you have experience taking these drugs (especially for reasons less severe than schizophrenia or bipolar disorder)? Thanks so much, everybody.

Need a therapist in Salt Lake City

Nice Donkey — Sun, 26 Apr 2009 14:51:48 -0800

Recommendations for a psychologist or psychiatrist in Salt Lake City, Utah? My dad is looking for one, and I know from experience that it's very frustrating poring over directories, just guessing about who might be a good fit. He's an atheist, so someone who is of a similar mindset or for whom spirituality really doesn't enter into the therapy would be ideal. Any information about a particular therapist would be great. Resources for finding a therapist in Salt Lake are also be appreciated, especially if they offer something more than matching your zip code to a person in your area.

How to find an affordable psychiatrist in NY who can help with debilitating ADD and Anxiety?

Anonymous — Mon, 13 Apr 2009 09:36:13 -0800

Is there a place I can go to get help with ADD/Anxiety in NYC, which charges by sliding scale? I have no health insurance and very little income, but a recent AskMe thread has helped change my fanatical stance against medication, and I would like to seek some help despite the financial obstacles. I have tried using CBT methods on my own, practicing mindfulness, changing my diet, doing yoga, changing my job, excercising more, etc. However, I still cannot concentrate on anything, hold down a good job (despite an ivy league education and an MA--at schools which were very flexible and responsive to my needs), have a calm conversation with eye contact, go out for the night without spending days dreading it in advance (and usually backing out after I've gotten dressed and am about to walk out the door.) I can't even have a conversation with old friends without my mind darting all over the place, and being unable to simply listen, ask follow-up questions, or calmly talk about my own feelings. I'm 34 and female, and would appreciate any information on psychiatry schools, or individuals who might offer a sliding scale and seem like they could help me tackle these kinds of problems. A throw-away email in case anyone wants to use it: alittlehelpwiththis@gmail.com. Thanks for any info.

Serotonin Syndrome after quitting antidepressants?

Clay201 — Tue, 10 Mar 2009 12:30:01 -0800

Could I possibly have Serotonin Syndrome even though I've been off anti-depressants for two or three years? And whether I have it or not, what's the best way to get a doctor to hold my hand while I try the recomended treatment for it; an antihistamine called Cyproheptadine (brand name Periactin) that blocks Serotonin receptors? I've had health problems most of my life, but developed my current set in 1995. At first, I thought it was the flu. Fevers, night sweats, fatigue, constipation and diarrhea. But as those symptoms decreased, new ones arose. I was incredibly tense, agitated, and restless. I felt like I wanted to peel off my own skin. I literally could not relax. It felt like someone had my neck in a vice. When I tried to relax - laying down in bed, comfortable and peaceful - I'd feel a horrible surge of restlessness and agitation. It's hard to describe, but it felt like an electric eel wrapping itself around my spine, delivering a constant voltage. Then, the involuntary movements would kick in. I'd start flailing around, my head jerking to the side, my legs twitching. I wouldn't return to "normal" until I once again tensed up completely. In addition to all this, i was incredibly anxious. I could barely even talk to people. I couldn't do anything. Everything made me freak out.

During and prior to this period, I was on and off anti-depressants pretty frequently. If I took more than a tiny amount, they made me wired, talkative and fidgety. If I took too little or didn't take any at all, I was depressed. So I was always trying, and usually failing, to find a happy medium. I'd take them until I felt better, then stop. A few weeks would go by, I'd get depressed again, and the cycle would repeat.

For the mystery problems, though, there didn't seem to be any treatment. Finally, desperate, i tried a medication that had been prescribed to a family memember; a muscle relaxer called Flexeril. It permanently knocked my restlessness and tension down a notch or two, but my involuntary movements got more frequent (also permanently). Scared and having no idea what was happening, I didn't take any more Flexeril. I did, however, continue taking anti-depressants as before.

I's been fourteen years and, in that time, I've tried countless treatments. Nothing's done much good. I did finally stop taking anti-depressants in 2006 or thereabouts. I went through withdrawal for several months, but when all was said and done, very little was different.

Then, recently, I read a description of Serotonin Syndrome. This disorder is caused by taking anti-depressants or other serotonin boosting medications. It causes fevers, sweating, involuntary movements, restlessness, and dry mouth; all of which I have or have had. (I can't seem to find the links for the following info, but I did read it somewhere on the web). The involuntary movements tend to be in the head and neck, which is where mine are, for the most part. There's a characteristic foot twitch; you bend the foot upwards at the ankle, then push it back down again and the foot twitches repeatedly. My foot does that. The problems are made worse by a number of different neurotransmitter enhancing drugs, including dopamine boosters like Sinemet. Sinemet and others on that list do make my problem worse. The only thing that made it better was, as I said, Flexeril. And it turns out that Flexeril blocks serotonin receptors.

So S.S. sounds like a pretty good fit, right? Only one problem. I just got off the phone with a psychiatrist who was adamant to the point of raising her voice; you just can't have Serotonin Syndrome if you've been off serotonin-boosting drugs for years. I can't find any direct statements to that support this assertion, but it does seem implicit in all the available material.

So, question number one is... Is it possible for me to have Serotonin Syndrome even though I quit the meds a while back? I have been using magnesium and malic acid to keep my mood up. When I was taking a lot of them, I was behaving in a manner that might be considered manic (starting lots of big, complex projects; making overly optimistic plans, etc.). Could the magnesium and malic acid be increasing my Serotonin? It seems terrribly unlikely, but thought I'd throw it out there.

Now, the most popular treatment for Serotonin Syndrome (besides taking away the offending meds) is a drug called Cyproheptadine (brand name Periactin) which blocks certain serotonin receptors. It turns out, you can get this drug legally through pharmacies outside the US. I've already placed my order and it's supposed to be here in about five days.

Ideally, I don't want to just perform experiments on myself. I want a doctor to supervise and be there to take care of me should things go wrong. In addition, I want one who has actual experience treating S.S. But I've been calling people left and right and I just can't find a doc who's both experienced and willing. I did manage to score an appointment with a psychopharmacologist who has actually treated S.S., but he may very well look at me and say "No, you don't have it and I'm not giving you Cyproheptadine. Now that'll be two hundred bucks." (He doesn't accept my insurance and I'm planning to pay out of pocket).

I realize no doctor is going to commit to a diagnosis over the phone. But if I walk into the appointment blind, I've got to to risk a lot of time and money on the (apparently small) chance that he or she will go along. I could end up spending six months and thousands of bucks trying to get the okay for a medication I already have sitting on my shelf. I'm stubborn, but I'm not that stubborn.

If the doc in question were pushing a different diagnosis, that would be one thing. I could look at it and decide whether it was more or less likely than S.S. But none of them are going to offer anything I haven't heard before. So it's a choice between trying the cyproheptadine and possibly getting better or trying nothing (or nothing new) and definitely not getting better. I certainly choose the latter. Besides, even if it doesn't help the problem, it could tell me something important.

So question number two is: How do I get a doc to get my back while I try this medication? I'm open to suggestions.

(Don't try to talk me out of the solo treatment. Yes, I'm sure it seems kind of harebrained to some people. But I have an undiagnosable disorder that makes me miserable twenty four hours a day, prevents me from writing, keeps me from dating, and is slowly trashing my body. I require more and stronger meds for the headaches and am worried about my stomach, my liver, and addiction. I can't take much more of this; I've got to do something. My doctors just look at me and shrug, so it's up to me to come up with the ideas and this is the best one I've had so far. I am more than justified in taking this relatively small risk.)

what's good about private insurance instead of NHS, for shrinking my crazy-ass head?

By The Grace of God — Thu, 05 Feb 2009 10:01:07 -0800

What advantage will I get from getting on my husband's private medical insurance in the UK, in terms of getting psychiatric treatment? My husband gets private insurance for us from his work. Thus far I've just used the NHS, but I wonder if I used his private insurance if I'll get a better trained, or more patient, or more willing to work with me psychiatrist, or what other services I can get to support my recovery from depression and anxiety?

I'll post what insurance he has when he gets home. Seriously I have a high stakes and high stress job now and I don't want to fuck this up.

Glasgow, Scotland if that helps. Thanks as always.

I say he's crazy; therefore, he must go through an evaluation.

metalheart — Sun, 01 Feb 2009 09:37:51 -0800

Australian (and U.S.) Mental Health/Legal Filter. Can you just go and talk your GP into having someone put through a psychiatric evaluation? One of my close friends is studying medicine here in Melbourne, Australia, and in one of his various internships, a psychiatrist told him that anyone can recommend someone get a psychiatric evaluation, through their GP. In other words, if you wanted to, you could go through the process against another person, like so:

Go to your local GP. Talk to him about the person you consider to be mentally ill, and, if the GP agrees with you that this sounds like a mental illness that could cause harm to that person or those around him, that person must, by law, go through a psychiatric evaluation.

Psychiatrist telling him this or not, I call bullshit on it--at least some of it. It seems like, surely, there must be some evidence (other than words/hearsay) that a random individual has to provide for a GP to sign this off. Moreover, it would seem the GP would actually have to see said mentally ill individual, not just hear what some other person has to say about him.

If not, I can very easily imagine people doing this just to disturb someone they don't like/broke up with/fired, etc. It seems too easy: pick a mental illness, go speak with a GP, get him to agree with you, and in no time at all, the person you're saying is mentally ill has to go in for an evaluation. Talk about stressing someone out, if you're lying!

Is this true? If so, under what law? I've not been able to find it through searching. I'm looking for laws and policies, if possible, though anecdotal evidence is okay, too.

Extra Question: I know a bit about involuntary commitment and the like under U.S. law, and I know that a doctor himself can recommend involuntary commitment for one of his own patients that he deems a danger to himself or others, but is there anything similar to the above?

If these laws do exist in either or both countries, what provisions are there to protect individuals from being evaluated wrongfully? I.e., suing doctors and the like.

"So who's your doctor?" "I like tacos!"

curagea — Wed, 14 Jan 2009 14:59:56 -0800

Who treats kids with ADHD? Child psychiatry, general psychiatry, family practice, ??? Where can I find info about who children with ADHD see? One study I found listed them under Psychiatry, Pediatrics, Family Practices, and Other, but I'd like to get more specific than that. Specifically, what percentage of kids see a child psychiatrist? General psychiatrist? Neurologist? Other providers? The more specific the data, the better.

Help! I'm nervous and I can't do anything.

Anonymous — Mon, 24 Nov 2008 12:24:52 -0800

I have Stratterra, Adderall, and Xanax. What can I do to get serious anxiety and ADD symptoms under control, quickly and for the short-term? I'm struggling with the symptoms of ADD along with a very high level of anxiety (this is a recent and hopefully temporary development). I'm taking the LSAT in 2 weeks and suddenly dealing with an extremely stressful relationship situation on top of the pressure of last-minute studying for something that's very challenging and important to me; please understand that my question is motivated by my desire for a short-term coping strategy (I can only get an appointment with my psychiatrist/therapist after the LSAT, but he'll take it from there, thanks).

I took Adderall in the past and have a handfull of those left; recently, I was prescribed Strattera instead since Adderall isn't available where I live (outside the US). I've been taking about 25 mg a day for a bit more than a month, although I've skipped a few pills (accidentally, because, well, I have ADD, and purposely, because of the following...)

I haven't noticed a substantial improvement in my ability to focus and concentrate, which is very critical to me right now, immediately, until the LSAT (on Dec 6th). I have noticed a huge rise in my base level of anxiety since I started on Strattera - I don't recall having a "base level" of anxiety in the past at all, actually; whenever I have a calm or empty moment, i.e. when I'd usually be daydreaming for a minute in the middle of the day for example, I feel an underlying physical sense of dread. I've also had a lot of trouble sleeping and woken up before I've slept enough with my heart pounding an hour before my alarm is set several times recently. I don't know whether this is caused by the Strattera or having reached a threshold of stress and chaos that I can no longer cope with; however, I understand that Strattera is often prescribed off-label as an anti-anxiety drug, so it's surprising that it would have the opposite affect on me. Life's been rough and I'm constantly nervous in a way that interferes with my daily life, interactions, and (right now) ability to study for the LSAT. Is this anxiety a common, or even possible, side affect of Strattera?

I don't want to stop taking Strattera in case it is actually helping because I can't experiment with letting my concentration get worse right now (because of the LSAT!). It could turn out that I'd have even worse ADD symptoms and anxiety if I went off it right now. However, I also obviously can't handle any additional anxiety. So, one option is to experiment with a higher dose of Strattera to see if it helps me feel calmer or more focused - could I here some knowledgeable/experienced opinions on whether this is a good idea?

The other option is to take my small dose of Strattera plus an Adderall, which does significantly improve my concentration, mood, and performance more than anything else. My concern is whether it will be counter-productive or harmful to mix these medications.

I've also been dealing with the extreme anxiety by taking Xanax occasionally (maybe twice a week, when I'm really hurting for sleep) and/or over-the-counter sleeping pills, but the past week they've only kept me calm enough to sleep for about 6 hours and I'm exhausted. I don't want to mix drugs too much or do anything dangerous or habit-forming (I'm well aware of this risk and consider it each time I use these medications), but I need to have some measured input about whether this is the best thing I can do for the next 2 weeks. I don't need to "stick it out" right now and risk totally falling apart/bombing the LSAT (I also can't just take it in February, since I'm abroad and it's not offered abroad after December).

I really can't afford to lose another day to anxiety and distraction right now - not only will it affect the LSAT, but it's putting a huge strain on the relationship that's causing it, which is becoming a rapidly-accelerating vicious circle. So, how can I stop this and use what I have to make myself functional right now? I've also been using my normal, healthy coping methods (coffee, exercise in the right amount/at the right time, healthy food, chatting with positive and supportive friends, taking breaks, etc). I usually know how to handle myself but I feel like my brain is totally out of control and trying to sabotage me.

I can't get an appointment with my psychiatrist until after the LSAT, so I'm asking you in the meantime; I'd really appreciate answers other than "therapytherapytherapy". Yeah, I know, but it's just not possible right now, and I need a solution or at least a strategy right now; having stated that "go see your doctor" and "get therapy" are not relevant for me, I'll also say that seeing this page full of "therapy" answers would be totally demoralising as it's advice that I can't take, even though I will as soon as that changes. Please respond if you have advice that I actually can take, given what I've told you. Thank you very much if you can help me cope.

Can Wellbutrin SR be a short term (one day) substitute for Wellbutrin XL (in a bind here)?

Soulbee — Fri, 14 Nov 2008 06:16:50 -0800

I have left a msg for my pdoc, but haven't heard back from him yet, and see below, it wouldn't really matter. Anyway I've found myself out of Wellbutrin XL this morning (i take 1 300mg tablet every morning) and I'm out of refills AND there is no opportunity to get to the pharmacy till this evening. Just not possible, tho the pdoc will call in my prescription today. I do have a bottle of Wellbutrin SR 150mg tablets. The reason I switched off of the SR was because I generally can't remember to take a pill twice a day, and I needed to go up to 300mg which can't be taken all at once in SR form. I think that today, this once, I can remember to take the pill 2x a day -- but is Wellbutrin SR in 2 150mg doses ok to substitute for Wellbutrin XL 300 mg for one day? I don't want to get off my med schedule because it makes me crazy. Thanks, if you have an answer?

Advice on antidepressants

Anonymous — Fri, 24 Oct 2008 12:49:08 -0800

Antidepressant filter question #4529, I've searched the archive to no avail and I am wondering what antidepressant might be right for me. I know, I know, YANAD, but I am looking for anecdotal info. I have been struggling with anxiety and depression, and it is poisoning the well of the rest of my life.

Okay, so due to my job, having a small child, and having had a tumultuous life the problem has come to a head, I have finally decided to go talk to a therapist. I don't want to turn into my Dad, and I sure as hell don't want to mess up my kid. So despite not being confortable with the thought, it is time for me to accept this problem and deal with it. I have been going to a therapist (not an MD, but a counselor) for about a month and a half.

I have a unspoken about but clear family history of Depression and Manic Depression on both sides and am going to make an appointment with a psychiatrist to look into antidepressants and maybe anti anxiety meds, as I fear that in addition to my stressful circumstances I may have a physiological problem too.

I am a male in my late 30's. I have always had terrible sleep problems. About 10 years ago I once was put on a low dose of paxil for that and it made me feel weird and made me unable to have an orgasm. I pitched them out after a couple weeks.

I am concerned about weight gain as well (does that happen to men the same way it happens to women? I don't know). I think picking up an additional 40 pounds will make me even more depressed than I am now.

From my research I see that there are different pharmacological types of anti-depressants, for the fellas out there what have been your experience with this. Obviously this is something I need to discuss with a medical professional, but I am hoping to gain enough info from people's anecdotes to at least give me some talking points.

I don't need critical responses please! On a ledge here. I just want some friendly advice from those who have experience with these types of meds and their side effects.

How safe is my sister in Bellevue Hospital's psych ward (in NYC)?

korpios — Thu, 25 Sep 2008 20:36:31 -0800

My teenage sister has just been admitted to Bellevue Hospital's psychiatric ward (in New York City); should my parents let her stay put, or have her transferred to another hospital? Is there anything they should be aware of? My sister has been exhibiting symptoms of depression for several months; she's also been dealing with the effects of a benign brain tumor which was recently removed via surgery. (Perhaps the two are related, perhaps not; I have no idea.) Today, during one of her post-surgery follow-up visits, she spoke to a social worker about her depression; the social worker said she was suicidal and needed immediate care, and had her admitted to Bellevue in NYC.

My parents are understandably concerned at the quality of care my sister might be receiving at Bellevue; they aren't sure if they should let her stay there, or have her transferred to another hospital. (They won't release her to my parents, but they'll allow a transfer via ambulance.) Is Bellevue a safe, reasonable place for my sister to be receiving psychiatric care? Would someplace else be better? Is there anything my parents should watch out for? (My mother, in particular, is quite upset that she can't stay with my sister and watch out for her welfare.)

While we're originally from New York, my wife and I reside in Chicago; we can't do much from here, but we can at least query the wonderful hive mind for some advice to pass along to my parents. ::hugs hive mind::

Picking a psychiatrist

crapmatic — Mon, 08 Sep 2008 09:05:31 -0800

I have a minor psychiatric issue and I'd like to go see a professional. Question about picking one. The short version: last month I hit a moment of clarity and realized that most of the time I'm operating under some sort of cognitive fog; it's not just a mental energy issue but a little more complex. So I want to see someone.

Looking at psychiatrist listings in my large town, there are (A) psychiatrists listed at the hospital and (B) psychiatrists listed in their own clinics. What's the difference here, in regards to handling minor visits like this, taking time to evaluate me, and willingness to dispense a med if it's scheduled? (I'm already aware I may be in Adderall territory here)

I tried called one non-hospital psychiatrist. The receptionist said it was $300 for the initial evaluation, which is higher than the $200 that seems to be average. I asked what they specialize in and she said they mostly see people for medications. The receptionist said only the PA sees me on that first visit but has the ability to dispense. What do I make of that? A prescription mill? Or a psychiatrist that's valuable -and- wisely managing her time?

I looked at some medical ratings sites and found a scarce few ratings. Also I don't know anyone who's seeing any psychiatrists. So no help there. Any advice on picking a psychiatrist?

Happy happy happy all the time shock treatment, I'm doing fine

simbiotic — Mon, 11 Aug 2008 19:54:23 -0800

I found an antique electro-therapeutic apparatus at a thrift shop. Now what? I haven't been able to find any real information from googling. I brought it to an antique shop but they had no information about value or resources for finding a buyer. They estimated the date to turn of the century by looking at the hinges and the dovetails of the box and the cotton insulation and fine copper wiring. I have no idea if this is accurate.

It's kind of creepy to have sitting around but I am not sure if I want to sell it. I'd like to know the value or if a museum would be interested. At this point I don't have money to invest in an appraisal. Since we do live in LA, of course the apparatus already has a movie offer. I'd like to know if it should be insured and for how much.

There are pictures at the flickr link in my profile. I've also transcribed the instructions from the inside label. Maybe the language would be helpful is dating it?

Lexapro/bupropion: light at the end, or just a really long tunnel?

anthom — Fri, 25 Jul 2008 11:53:17 -0800

Without going into whole life stories/clinical history, I just want to know - does the exaggerated anxiety that appears as a side effect of Wellbutrin subside after a while? My wife was prescribed Wellbutrin (actually, generic bupropion) to augment her current antidepressant (Lexapro) Wednesday. Over the past week, she had been anxious, but able to function. Yesterday, after taking the bupropion, the anxiety became too much, she felt "fidgety" all day, and broke down into several panic attacks. She said she couldn't control her thoughts, or get out of her own way enough to do anything. Today, she's ever so slightly better (no major crying/panic attacks), but the crippling anxiety and fidgety-ness still seem to be there.

She's suffered from depression and anxiety for years, so naturally I'm curious as to why her psychiatrist would prescribe her something that lists anxiety and agitation among its first few side effects, but IANAD, so I'd assume he knows what he's doing. After talking to him yesterday, he also prescribed her some Xanax or something similar in an attempt to take the edge off. Understandably, she only wants to take them as a last resort, since they basically knock her out.

Of course, YA also NAD. That being said, is there reason to believe this will pass (or at least lessen in severity), or do we wait out the weekend and call her psych Monday to say "this isn't working"?

Doctor or Doctorate? To-may-to, To-mah-to?

Eudaimonia — Sun, 25 May 2008 02:39:05 -0800

What does it take to be a doctor (MD)? And what does it take to be a doctor (PhD)? Torn about what path to pursue, Background: studied psyc in college, am currently finishing up in public health. Obviously, I need a third degree.

My first reading for pleasure books were psychiatric non-fiction. I love psychology. I love psychiatry. I have, at various times, dreamt of being a neurologist, a psychiatrist, a psychologist (clinical, neuro-, or research). I’ve finally figured out that what truly fascinates me is elucidating mental processes by way of studying those with deficits or diseases – we’ve learned a whole lot about memory, for example, from Alzheimer’s patients.

I love people. Really, I do. I love learning, too. I want to find out more about why we do what we do and tell the world. I want to be the next Oliver Sacks. And yes, of course, I want to heal and help (though issues of self efficacy and fear of having someone’s life and/or mental health in my hands are a bit frightening)

Currently am torn between pursuing pre-med studies and doing more research (which I’m not keen on honestly, but that’s another post), trying to decide between clinical psyc. PhD or MD. I have perused the studentdoctor forums but am looking for the opinions of seasoned MDs and PhDs – what place does your profession have for a person like me?