Getting good psychiatry
April 30, 2010 5:23 AM   Subscribe

First psychiatry consult: how to get the most out of it.

After asking about ways to handle my anger, I've made an appointment to see a psychiatrist this afternoon.

Based on comments here and from talking to friends who know me in person, I have decided to focus on dealing with depression or anxiety. I'm strongly considering medication, but am somewhat frightened of the whole "putting a psychoactive substance in me" thing.

What are the kinds of questions I should ask? Any good advice on this process is welcome, as well as suggestions on how to overcome my fear of medication.

Things I've learned this week: NYC is a horrible place to find a psychiatrist who takes insurance.
posted by anonymous to Human Relations (13 answers total) 4 users marked this as a favorite
Let it all hang out. Don't censor yourself or try to direct the conversation so that you get the answers you're looking for. Don't have an agenda, beyond letting the psychiatrist/therapist know what's going on with you. Don't self-diagnose and try to confirm it.

This is a getting-to-know-you session, and it can be frustrating, since I think we're all wired to want immediate diagnosis/treatment upon any visit to a medical professional. That may happen, and you may get a trial of medication, but it may be just to start to see the issues so that you can form a therapy plan.
posted by xingcat at 5:33 AM on April 30, 2010

I have decided to focus on dealing with depression or anxiety.

This is sort of missing the point of seeing a doctor. You see a doctor so that the doctor can diagnose you. This is like going to a cardiologist and telling the doctor "I've decided to focus on high blood pressure" when there could be any number of other things wrong.
posted by dfriedman at 5:41 AM on April 30, 2010

Seconding the suggestion to be as open as you can. They can't help you if they don't know what's really going on. The more info you give, the better they can assist in your healing.

RE: Meds - listen to your body - if something isn't working, don't be afraid to speak up. AD meds are infamous for having a zillion different reactions with people. You may have to do some trial and error but listen to your body, pay attention and if you don't start to feel better, SPEAK UP. :)

Good luck!
posted by Mysticalchick at 5:49 AM on April 30, 2010

Is this a psychiatrist that does talk therapy? I have had those, but they seem to be a rare breed - often psychiatrists do med management.

(And I don't think naming depression and anxiety is self-diagnosing any more than saying "I have a nosebleed" is self-diagnosing. It is totally possible to recognize feelings of depression or anxiety in yourself.)
posted by needs more cowbell at 6:03 AM on April 30, 2010

--This is not "the" psychiatrist, there are a lot more where this one came from!

--Sometimes they are cranky and asocial, it's not you, it's the specialty (weird, but having seen a lot of different types of specialists, psychiatrists are the least agreeable of all of them!)

--Don't be afraid to tell them "that treatment option isn't going to work for me"

--Don't be afraid to call later with questions or to request med changes

--Be very, very clear and concrete about how it's affecting your life, use examples (I was so angry I..., it is really hurting my relationship)

--Research your meds thoroughly before you take them, don't rely on the shrink to tell you everything you need to know

--Ask when you should expect to feel them kicking in

--If you need or want a second opinion, get one.

--Weill Cornell has a great psych referral line, actually all the medical schools/hospitals do. That's the best way to find excellent specialists who take your insurance, in my experience.
posted by internet fraud detective squad, station number 9 at 6:03 AM on April 30, 2010

(I should say, psychiatrists have been the least agreeable. I don't know if it's an actual thing with psychiatrists.)
posted by internet fraud detective squad, station number 9 at 6:06 AM on April 30, 2010

Seconding being open with the doctor - part of a doctor's job is diagnosis, they're not really expecting you to turn up with everything sorted for them (a good doctor will be open to your ideas about what's bothering you most, but you don't need to have diagnosed yourself before you see them).

The Royal College of Psychiatrist have a helpful list of questions you might want to ask your psychiatrist (third one down in the list of checklists). Don't feel you have to use all of them, but they're a good list to help you think about what you want to know.

Whatever questions you ask, write them down and take them with you. There's something about being in the presence of doctors that makes everyone forget what they were meaning to ask.

Medication fear: medication changes things inside you. All medication. Some medication that isn't for mental health problems can do weird things to your head. Are you scared of taking other prescription medication? Then you shouldn't be scared of taking mental health meds. As mentioned above they can be very idiosyncratic in their side effects, and most people have to try a couple before they get one that works/doesn't have nasty effects on them - but the same can be said for medication for epilepsy.
posted by Coobeastie at 6:07 AM on April 30, 2010

Be prepared for a lot of weird and uncomfortable questions during the first consult. Do you ever feel like the TV is speaking directly to you? Do you own a gun, and have you ever considered killing someone with it? Don't be offended. Your shrink is not seriously suggesting that you are quite that crazy. They're just doing their job, and they have to rule out the worst case scenarios before they can start treating you for the problems you actually have.
posted by embrangled at 6:23 AM on April 30, 2010

Be prepared for a lot of weird and uncomfortable questions during the first consult. Do you ever feel like the TV is speaking directly to you? Do you own a gun, and have you ever considered killing someone with it?

I have sat in on psychiatric evaluations with a number of different doctors and have never heard questions about hearing voices or desiring to hurt oneself or others put in this fashion. I personally would not be comfortable seeing a doctor who phrased his or her diagnostic inquiry in this way. Questions about hearing voices are standard for determining whether or not someone is suffering from a psychotic disorder and questions about self-harm or harm to others are to determine whether someone is in a state of psychiatric crisis and needs emergency care. They aren't weird questions, they are necessary to determine what kind of care a person needs. A psych eval shouldn't feel weird, if it feels weird you should find a doctor with a better manner, as you'll be interacting with him or her on an ongoing basis should you decide to engage in treatment and nobody should feel weird about seeing a doctor for any reason, ever.
posted by The Straightener at 6:37 AM on April 30, 2010

It might help you to write a list of the things you want to mention before you go. During an intake with a psych or a therapist, it's easy to forget things because you're not feeling them at the moment, or to get distracted because they're asking a whole bunch of questions, or to start talking about something and think wait that sounds too weird and start backtracking or lowballing it because you're not that crazy. (Sometimes describing your symptoms out loud for the first time can startle you.)

Regarding medication, ask the psychiatrist what your medication options are, what your non-medication options are, and if there are any non-psychiatric conditions that might explain things (e.g. hypothyroidism, anemia). A good psychiatrist won't just throw a prescription at you - he'll look at the whole picture and work with you to figure out a treatment plan. If your psych does just throw a prescription at you, find another.
posted by Metroid Baby at 7:27 AM on April 30, 2010

I have a great psychiatrist here in NYC who takes most forms of insurance. He doesn't do therapy, exactly, but he spends a lot of time talking to patients. He's friendly and reassuring and seems to remember everything I have ever said in previous visits. MeFi Mail me if yours doesn't work out and you want info for mine.

I've been on anxiety meds for about a year and my life has changed dramatically. I'm happy to talk about this too if you are worried about taking meds.
posted by miskatonic at 8:13 AM on April 30, 2010

Be open, tell them whatever you want. You have nothing to lose and you have HIPPA to be confident that it won't wind up everywhere. Don't force things and try to make them work with the Psychiatrist. If it isn't a good fit, point blank tell them and ask them for a referral.

As for medication:
Medication doesn't solve problems. Medication though, might give you enough of a perspective so that you can start talking and dealing with your problems. It isn't the solution, its a starting point. If one pill stands between you and being able to relax enough to talk about how you feel, why not take it? Sure you might be able to do it on your own; however, from what my experience was - 'doing it on my own' was ultimately what got me to a position where I wanted/needed therapy. Therapy with medication was less about my problems, and more about finding solutions and finding ways to make sure that I won't be back in therapy working on the same things.
posted by Nanukthedog at 10:04 AM on April 30, 2010

Part of the issue is that I'm not functioning terribly well and having to make more than a few phone calls exhausts me.

Is there someone who can do this for you? Romantic partner, friend, relative? If you have a romantic partner I am sure that he/she wants to help you be happy (along with their own motivations for living with a less angry person). I make doctor appointments for my husband all the time, simply because he's so busy, and no one cares that I'm calling and not him. They ask for his name, phone number, insurance, and general reason for wanting to be seen.
posted by desjardins at 10:16 AM on April 30, 2010

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