"Hi yes I require pills please and an appointment today if possible thank you"

October 4, 2010 10:55 AM

My antidepressants are running out, and I need to make an appointment with some kind of doctor. Who? What do I say?

This is in Massachusetts, USA.

Last year, in my senior year of college, I started seeing a therapist for anxiety/depression. She was referred to me when I used up all my college counselor "free" visits, and although she wasn't covered by my insurance, she said she could give me a discounted rate. After a lot of consistent weekly visits she suggested I see a psychiatrist for possible prescribing of medication (I think it was a psychiatrist, i'm not sure, I'm just going to stick with that term for now).

My therapist referred me to someone at my campus that I could see, also outside of my insurance. I was prescribed a low dose of citalopram and she (the psychiatrist) said that I should probably continue with it for at least a year or so and see how it went (this was about 10 months ago). I graduated in June and on my last visit with the psychiatrist she gave me a few extra refills on my medication for the time while I was looking for a new psychiatrist. I also felt much better due to the medication and "ended things" with my therapist due to graduating and not knowing where I was going to be living and working.

Now I have a new job and new insurance and I'm down to my last four pills. Oh crap. I'd like to possibly start therapy again but also (I guess) continue with my current medication, or try a new one (a new set of side effects would be nice). I guess my short term urgency is that I get a refill (I've been taking one every other day to make them last, and I already had an 'episode' over the weekend, which made me realize I need to stop putting this off). New job and new insurance means I probably don't want to see the people I was seeing before (they aren't covered, and they're far away).

I am trying to figure out:
a) Do I want to contact a psychiatrist for a prescription? Is that the right title? Looking at lists of doctors on the insurance site is overwhelming. Even pulling down the drop box with all the "Behavioral Health" options is overwhelming (social worker? psychologist? psychiatrist? counselor? therapist?)
b) who I should contact first, therapist or psychiatrist/prescriber person? I don't really want to re-start therapy without getting a prescription refill first. I also don't want to make a therapist appointment just for them to tell me I need a psychiatrist appointment just to get a prescription refill. Or will I need a referral to begin with? How would I get one of those without having consistently seen a therapist first?
c) If I just call a psychiatrist (or psychologist... or... prescriber... ), what do I say when I'm making the appointment that doesn't come across as "I want pills NOW"? What if they can't take me for an appointment right away?
d) If anyone has recommendations for [insert doctor/counselor type here] in Boston, that would be amazing.
Thanks so much for the help.

posted by sarahj to Health & Fitness (17 answers total)

Do you have a primary care physician? Their office might be able to give you some direction. Because you may or may not need a referral (for either the therapist or the pill-prescriber) depending on how your insurance works.
posted by mskyle at 11:03 AM on October 4, 2010

Yes, the correct type of doctor for prescribing psychiatric meds is a psychiatrist. You will most likely not be seen as drug seeking, even if you approach a psychiatrist with some urgency, because Celexa is not the type of drug that people take for recreation.

If you already have a primary care doctor, they might prescribe you refills while you find and schedule an appointment with a psychiatrist. Many people have unpleasant withdrawals from Celexa and medications like it.
posted by OmieWise at 11:04 AM on October 4, 2010

You can get a prescription from a a family doctor. The insurance company that provides health coverage to your company probably has an online directory to help you find primary care physicians. Call them up one by one and ask them if they're accepting new patients until you find one who is and who is located near you.

Tell the physician about your existing prescription and there shouldn't be any problem getting a continuation it. If you cut it close in terms of running out, you can also ask a pharmacist to forward you a few days' dosage up front when you give them the prescription.

Finding a psychiatrist could be more difficult, so it might be better to just focus on getting a renewal of your prescription from the family doctor in the short, then, when that's take care of, moving on to finding someone who could facilitate your trying other medicines.
posted by Paquda at 11:08 AM on October 4, 2010

Response by poster: oh man, I haven't chosen a primary care doctor for my insurance yet. That's a whole other plate.

can I just hit the insurance directory, close my eyes and point?
posted by sarahj at 11:09 AM on October 4, 2010

Response by poster: Call them up one by one and ask them if they're accepting new patients until you find one who is and who is located near you.

Awesome.
posted by sarahj at 11:15 AM on October 4, 2010

Pretty much. My own experience, in a big city, was that it was hard to find one who was "accepting new patients", so I had to call a few. Also make sure to specifically ask whether they accept your particular brand of insurance (sometimes the directories are out-of-date). After finding one and making an appointment, you might have to call your insurance company to notify them that you've chosen a primary care physician.
posted by Paquda at 11:17 AM on October 4, 2010

I got antidepressants prescribed by a general MD in a walk-in clinic, with an aviso from them that I should be following up with a mental health practitioner, and a reference to a clinic where I could do so.
posted by L'Estrange Fruit at 11:25 AM on October 4, 2010

To get a renewal on a prescription you can pretty much go to any general physician. GPs prescribe antidepressants all the time. I can understand your apprehension, especially since your dose is lower. When I moved to a new city and ran out of Prozac, I randomly called one of the MDs in the insurance directory. I was very concerned that I wouldn't persuade him, that he'd want to do a whole exam, that I'd screw up in some way. What ended up happening was I sat down in his office and said, "I have anxiety and I ran out of meds." I started crying before I got the words out. He was filling reaching for a prescription pad as I was reaching for a tissue. I never had any other dealings with him; just called the office for renewals a few times till I found a doctor I liked better.

So yes, close your eyes and point. Or ask a couple of people at work who they go to, "just in case" you come down with something. When you call, you can say you want a consultation or an office visit, no exam right now.
posted by wryly at 11:29 AM on October 4, 2010

Given that you have an active, if almost expired, prescription you should not have a problem getting it renewed by a family physician. It is generally not a good idea to stop abruptly. Explain this to the new physician and try and get a refill for (X) days until your appointment. They maybe reluctant since they have not seen you. If your prior physician is in the same State you could also call their office and ask for a (x) day refill or have them call your new physician and suggest you need a refill. As a last resort you can go to an urgent care center--explain the situation and would guess they would give you a short term refill. You do want to secure a referral to psychiatrist for ongoing med management. A "bad episode" is no different from an infection or recurrent pain--do not hesitate to be seen even if it means an urgent care center or pushing your new physician just a bit
posted by rmhsinc at 11:30 AM on October 4, 2010 [1 favorite]

Sorry, I meant it's easy to get a renewal on antidepressants, not all prescriptions.
posted by wryly at 11:30 AM on October 4, 2010

I would definitely go to an urgent care center TODAY, explain your predicament, show them the old prescription, and see if they can write you a short term refill. Citalopram should be tapered off, not abruptly discontinued.

Additionally, you could try calling your old psychiatrist's office to see if they'd phone in a prescription for you. My insurance doesn't care who the prescribing doctor is, they'll fill anything and pay for it as long as it's on their formulary. My dentist prescribes me Ativan and my insurance covers it without a problem.
posted by elsietheeel at 11:47 AM on October 4, 2010

Just get a family practitioner (used to be called a general practitioner) through your insurance, explain the situation and ask for an urgent appointment; he or she will probably just renew the prescription. If your prescription were a controlled substance, "want pills NOW" could raise a red flag; for an SSRI, probably not.

It may seem alarming that family practitioners are prescribing psychoactive medicine based on a few minutes of discussion, but here's the thing -- your experience with a psychiatrist wouldn't be liable to take longer or look much different.
posted by Zed at 11:59 AM on October 4, 2010

You do not want to stop your meds without supervision from a doctor. Meaning you need to get a prescription asap, even if it's only a month until you can get a real appointment with a longer-term provider. If it looks like psychiatrists are scheduling a few weeks out, you need to call a GP and explain the situation, or schedule an appointment at an urgent care center. Bring your bottle and/or your old prescription, along with the prescribing doctor's name and information.

You might also call your last doctor and explain the situation. Ask for one more month called into your local pharmacy and confirm that you will be finding a new provider asap. You might have more leverage if you've already scheduled an appointment with someone too.
posted by barnone at 12:02 PM on October 4, 2010

Also: you can get medication management from a variety of providers. In some states (don't know about MA) there are nurses with the authority to prescribe psychiatric medications.

In your shoes I would go the urgent care route, schedule an appointment with a covered therapist, and ask them for help in finding someone who can prescribe things for you.
posted by SMPA at 1:09 PM on October 4, 2010

I've had an issue before with antidepressants where I realized I ran out with no refills on a weekend/holiday. Walgreens always gave me a small amount of a refill to tide me over, since they know that withdrawal is really really bad for antidepressants.

So find a doctor (others give good advice here) but you may just be able to go to the pharmacy and get an "emergency" fill to tide you over till your appointment.
posted by wildcrdj at 1:20 PM on October 4, 2010

Go to the local clinic. Tell the doctor your situation, that you don't have a GP, and show them your current prescription. Bluntly (but politely!) ask for a refill.

For non-scheduled drugs that you already take, you can all but count on them giving you a new script.
posted by pla at 2:04 PM on October 4, 2010

I'm sure if you called the doc who prescribed it and told them your situation they'd be happy to call or fax in a refill for you.

If for some reason the prescription drug is not covered by your plan you can get it partially filled and pay for just that amount. Some pharmacies are cheaper than others.
posted by mbird at 10:10 PM on October 4, 2010