Choosing a doctor
June 21, 2010 1:18 PM   Subscribe

I believe I have some sort of mental illness. I'm not interested in self-diagnosis or diagnonsis via MeFi. I need help choosing a type of doctor.

For reference, here are some of my symptoms:

In 2006, I cut off all contact from all my friends and family and lived alone; I felt worthless, that I needed to work hard to become a better person and then I would re-establish contact. I made a living online. I was afraid to leave my apartment during the day. I was afraid to collect my mail. I let it sat for the entire year; the post office sent it all back.

In 2007, I got a job. Still have the same one. Over time, I've started using the following: fish oil, exercise, a multivitamin, vitamin d. Things have improved; I get the mail about once every 2 weeks.

Still, I have no interests and no motivation. My apartment's a mess, and I don't do anything except zone out and read the internet. I never have an answer for "What did you do this weekend?" I have trouble paying my bills on time. etc etc.

How do I proceed? I have insurance. Should I look up a random psychiatrist in the area and schedule an appointment or should I to go a GP? How do I choose a doctor and what kind do I choose?
posted by anonymous to Health & Fitness (14 answers total) 2 users marked this as a favorite
Does your job offer an Employee Assistance Program? I would start there - they can hook you up with a variety of resources.
posted by jquinby at 1:22 PM on June 21, 2010

I would recommend starting with a psychologist or other therapist (social worker, licensed mental health counselor, etc). Psychiatrists only rarely provide therapy; often, medication is better as part of a comprehensive strategy that includes some sort of talk therapy. Medication can make things easier, or better, or less hard, and that's great, but they aren't a magic bullet most of the time. It's like wearing flippers - you can swim faster with them on, but if you don't know how to do the stroke, the flippers aren't going to help you. If you are interested in pursuing medication, your psychologist can recommend a psychiatrist to you.

It is pretty hard to find a good therapist on the first appointment, but I'd try a few and see if you click with anyone.
posted by quadrilaterals at 1:22 PM on June 21, 2010 [1 favorite]

If you're in the US, it depends on your insurance. Some require a referral from your primary care physician. If not, you can choose. There are doctor ratings online for major metropolitan areas, but beware that the people most likely to post a review are those with strong negative feelings. With mental health professionals, those can be warranted... or not.

I would suggest just trying one. Try not to be intimidated-- he/she works for you. If you don't like him/her, go to a different one. That probably sounds difficult, considering your lack of motivation, but finding the right person to help you is key in getting better. Each will have different subspecialties inside the areas of psychology or psychiatry. I'm sure you already know this, but only a psychiatrist can prescribe medication*, and would be more likely to do so. A psychologist may work with your PCP/GP to put you on antidepressants or whatever.

* There are proposed laws to allow clinical psychologists with X amount of extra training to prescribe. This, in my opinion, is a bad idea.

Good luck.
posted by supercres at 1:25 PM on June 21, 2010 [1 favorite]

Oftentimes your insurance will provide a list of "preferred providers" or some such thing (and it's often online!); that's how I found my GP. It was through my GP that I figured out what kind of mental health professional I wanted, and it took a couple of tries. It was worth it.

If your insurance allows you to pick a mental health professional without a referral, and you'd rather do that, you can "shop around", so to speak, on-line at places like Psychology Today.
posted by ldthomps at 1:34 PM on June 21, 2010

Nthing a psychologist/therapist first. If they think you would benefit from medication, they'll refer you to a psychiatrist.

As for choosing one, ask online for recommendations in your specific area if you feel comfortable doing so; maybe use another anonymous AskMe.
posted by Metroid Baby at 1:38 PM on June 21, 2010

You say you're not interested in a diagnosis, but you list symptoms. It sounds like you're experiencing some agoraphobia and maybe some social anxiety and depression. I say this not to diagnose for its own sake but just to point out that all of those things are very treatable.

Do you have a GP? If so, just ask for a referral. Or try searching for mental health resources in your area. Here's New York state's Psychological Association's website just as an example. You may have to try out a number of psychologists or therapists to find someone you click with and feel comfortable being honest and open with. People are advocating therapy because it's been demonstrated empirically to be generally more successful by itself than medication is by itself, but together, they're even more effective (generally speaking). So, just to treat your case by general trends, you might start out with therapy and move on to medication if you and your therapist think it might be helpful.

Things will get better.
posted by clockzero at 1:42 PM on June 21, 2010

I would suggest that you see a psychiatrist first. Assuming you are suffering from a mental illness, you've waited a long time to seek care for symptoms. Treatment and subsequent improvements in your quality of life could take much longer if you spend time going from therapist to therapist trying to find a fit. This would be costly as well. And if you're prone to procrastinating, as it sounds like you are, it would be too easy for you to enter a cycle of deferring treatment via therapist-jumping (I've seen my mother do this).

Another reason you should see a psychiatrist or even just a GP first is that your symptoms *may* have a biological cause that a therapist is not necessarily trained to recognize(thyroid problems is one example). Even if he/she suspected this, he/she could not make up a requisition for the necessary lab tests.

Finally, I tend to feel suspicious about the level of bias in therapists and psychologists. I've known of some that will not diagnose clients because they 'dislike' diagnoses. Or, they may diagnose but be reluctant to reveal the diagnosis from the patient for fear that labels will interfere with treatment. Since my view is that information is power, I don't agree with this approach. Likewise, some do not 'believe in' certain diagnoses. And finally, some don't believe in therpies x, or x, y and z... This being the case, when you see a therapist/psychologist, you're giving yourself over to treatment by someone who is more likely to have an agenda than a psychiatrist. 'Agenda' may be too strong a word, and the so-called agenda may be harmless, but it still throws limitations on what may be discovered about your and your symptoms and problems from day one.

No person is completely without bias, but I think due to the strenuousness and duration of their training, not to mention the strong ethical standars that they are inculturated with in medical school, a psychiatrist is a better choice for an initial diagnosis. Keep in mind, too, that while the psychiatrist may want to prescribe medication, you do not have to accept the prescription or take the medication. From your diagnosis, you might end up with a better idea of what sort of therapist you should see afterwards.
posted by kitcat at 3:11 PM on June 21, 2010 [1 favorite]

You have already made such progress, starting things like exercise and motivating yourself to seek some professional help. That's huge, and I think you deserve some acknowledgement for it. From what you've described, I'd say it might be most advantageous to look for a therapist AND psychiatrist simultaneously (my reasoning: in terms of research on effective treatment for Major Depression, the most significant results come from people who are using talk therapy and medication simultaneously, and you can always subtract the medication [slowly and under the care of a medical doctor] if you feel like it's not going anywhere). The therapist directories mentioned above are great places to start looking for a good therapist match, but I want to encourage you to try out a couple or few different people, and see what seems to work for you. Seeing online therapist profiles will help guide your decision there at least a little bit.

For the psychiatrist, generally it works well for people to go through insurance unless you can absorb the cost of a couple-hundred-bucks per appointment. I know I wouldn't be able to do that, so I'd encourage you also to look for someone through your insurance or an EAP if you have one. Googling psychiatrists can be extremely helpful--it's how I found out that the psychiatrist I was seeing as a teenager had been accused of malpractice because several elderly people died under his care in a convalescent home, likely because of medication interactions he should have been aware of. Online doctor review sites also frequently have info on psychiatrists, but it's harder to find reviews of therapists.

Good luck to you--this is a great start. You've already gotten past a few of the hurdles, and you're on your way.
posted by so_gracefully at 3:37 PM on June 21, 2010

I would seek the help of a psychiatrist first, if only to rule out biological issues. Can't fix the software if the hardware ain't right.
posted by gjc at 5:08 PM on June 21, 2010

I don't know if you're in the US, but if you are (sounds like you are as you distinguish yourself as "having insurance" -- As you're comfortable browsing the 'net, dig into Psychology Today's therapist database. IANAD, but it sounds like you're just depressed. It's OK, lots of people are (as I'm sure you've already read).

* As for the mail: You could have a lot of fun getting off mailing lists (I know I did). All those catalogs & local coupons ads usually have a website where you can choose to get off their snail-mail list. I enjoyed doing it, and now I get hardly any mail at all.
* As for the bills: Switch all your bills to online statements and online bill-pay.

After the mailing list reduction & online bill-pay switchover, I only get a couple pieces of mail each week. It's awesome.

* As for the apartment, just choose one little spot, and clean it up. Then everytime you walk into that room, look at that spot and how much cleaner it is and recognize that small accomplishment. Or maybe think of one thing in your apartment that's buried but that you wish wasn't, and unbury it so you can enjoy it again. Oh, and don't overthink this :)

If you need some help w/ the Psych'Today search, MeMail me. My therapist helped me :) If you're in my neck of the woods, I've got (had) a great one. I've always been against popping pills, but I know they help some people. I say start w/ some good talk therapy (CBT).
posted by Lukenlogs at 5:57 PM on June 21, 2010 [1 favorite]

The mail thing for one-- I'm on my phone
or I would link it but I posted a question
about that a few years ago and totally get it.
Online bill pay helped a lot. I also got a great
therapist via psychology today's website and
strongly recommend that route over a psychiatrist
posted by sweetkid at 6:58 PM on June 21, 2010

Also everything Lukenlogs said, and I really wish you well. You
can do this.
posted by sweetkid at 7:43 PM on June 21, 2010

clockzero: sounds like anon just wants to clarify that he is not looking for dr metafilter to diagnose his problem.

That said, anon, it sounds like you have classic unipolar depression. Good for you for deciding to take charge of your situation! That is a HUGE step. Also trying to have a good diet and exercise are great!

I would recommend trying to find a both a psychiatrist and a psychologist/counselor/therapist. Drugs are great, but they're not miracle workers. On the flip side, cognitive/behavior therapy is often much more effective when you are on anti-depressants. I have a great counselor that I go see weekly at a local mental health clinic. Once I found a became much easier!

Some people are anti-anti-depressants, but I really think they can be such a lifesaver. Once you get the proper amount of neurotransmitters pumping in your brain, you just feel so freakin better! There is no "magic bullet" pill that is going to cure all your ills - but they can be a great starting point. You often need something to break the depression cycle, and a course of anti-depressants can really do that. Some people don't have to take them forever. Sometimes you have to try a few before you get it right. But I'll be totally honest here: right now I'm dealing with serious family drama shit and staying at my mom's which is super-stressful...I think the only thing that's getting me through it is my good friends Cymbalta and Wellbutrin!

In terms of finding mental health professionals, I find that the best recommendations are from current patients. Do you know anyone who sees a psychiatrist or counselor (or perhaps who has a child or spouse who sees one) that you could ask (discreetly)? Or if you have any friends or family members who are doctors, they may know a good psychiatrist. Doctors tend to know all the best doctors. Also calling your GP and asking for a referral is a good starting point.

Good luck and congratulations on starting a new chapter in your life!
posted by radioamy at 1:00 AM on June 22, 2010

Int he UK, generally we see a GP first who may give us a prescription or, if they feel it is more serious, refer you to a specialist. Waiting times for the latter, especially in cities, can be long, and there are false starts - it took me almost seven years after my first manic and depressive episodes to be diagnosed with bipolar disorder, and any major illness takes time to be diagnosed as we are unreliable witnesses to ourselves. So please don't be discouraged. We don't get to go straight to the psychiatrist, adn sometimes I wish we did.
posted by mippy at 9:03 AM on June 22, 2010

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