I want a new drug, not Dr. Freud

December 22, 2010 8:27 PM

Talk therapy sucks. Did it, doesn't work for me, have the t-shirt. Meds work (or have); how do I get them without having to grovel to another therapist?

I've done three long term stints with therapists, attempting to work on my (commonplace, non-precious snowflake) issues: shitty childhood, inconsistent parenting, total unpreparedness for adult life, anxiety and depression resulting.

The thing is, I get it. I really do. But it doesn't work for me. I communicate well, I explain my problems, therapists want to talk with me because they respond well to me. But nothing changes. I don't know whether they don't want to give me advice, or they give me the wrong advice. Whatever. It just doesn't cut it. I view it as sort of "soft science", i.e., part of this complete breakfast, but not the only piece of the puzzle.

Meds, on the other hand, work. I feel like a totally different person. I feel a thousand miles away from turning out like any one of the nutcases I'm related to, and as though my anxiety, ADD and self-loathing are COMPLETELY manageable. So, how do I get them without the lengthy stint with another therapist or psychologist, listing family members and all the shitty Christmases of the past just to get my wonder drugs?

And yes, I realize I'm glorifying drug therapy a bit. But for me, it really worked. I lapsed out of it when I changed insurance providers years ago and couldn't figure out how to start again without more dull talk therapy. The only kink in my plan (that I can see) is my last meds were primarily for BPD1, and I disagree with that diagnosis. Can't a medical doctor handle this stuff, without all the "tell me about your mother" business?

posted by anonymous to Health & Fitness (24 answers total)

A psychiatrist will ask fewer questions than a talk therapist and will only update meds in subsequent maintenance appointments.
posted by sweetkid at 8:32 PM on December 22, 2010 [12 favorites]

Can't a medical doctor handle this stuff, without all the "tell me about your mother" business?

Ask this question to whoever is prescribing you the drugs. Only they can tell you why they think you need to talk with them in order to be prescribed the drugs.
posted by dfriedman at 8:33 PM on December 22, 2010

Neurologist consult? The meds that manage my brain also manage my migraines. Happy accident, that.
posted by fairytale of los angeles at 8:34 PM on December 22, 2010 [1 favorite]

my gp prescribes my crazy pills. yours can do the same.
posted by KathrynT at 8:37 PM on December 22, 2010

Can't a medical doctor handle this stuff

Yes, absolutely. Just make sure that you go to a psychiatrist rather than a GP, since psychs are more familiar with the wildly complex nature of drugs' effect on brain chemistry. My psychiatrist just asks me general "how are things going, how is the medication working, do you have any concerns" questions.

If drug therapy works for you, it works for you. There's nothing wrong with that.
posted by corey flood at 8:39 PM on December 22, 2010 [1 favorite]

You may be the anomalous person for whom medication works just as well without talk therapy, though studies have shown that they are most effective in combination.

In which case, you need to find an M.D. psychiatrist who specializes in psychopharmacology; psychopharmacologists are almost never interested in doing talk therapy with their patients, just in meeting with them periodically and tracking their response to medication. (I meet with my psychiatrist three or four times a year, for instance, for half-hour sessions each time.)

A general practitioner/internist is not going to be a specialist in psychopharmacology, so you'd be better off looking for a specialist than trying to go to the same person for your mood issues and your sore throats.

(Also, you seem only to be paying lip service to the "this doesn't work for me" thing--it's clear from your language that you have only contempt for talk therapy, which might be why it doesn't work for you. Too bad; you may be missing out on something that could be really helpful, but either you'll figure it out or you won't. In any case, finding a good psychiatrist who specializes in psychopharm will help you with your current concerns.)
posted by Sidhedevil at 8:41 PM on December 22, 2010 [6 favorites]

Obviously, people can get psychopharmaceuticals from general practitioners, but if you're starting from scratch and you have good insurance options, seeing a specialist is wise. Especially if you feel like your most recent diagnosis is off--a psychiatrist is going to have a lot more expertise in psychiatric diagnosis than a general practitioner/primary care doc.
posted by Sidhedevil at 8:42 PM on December 22, 2010

It all depends on the psychiatrist - some insist that you see therapist. Some do not. My counseling center insists that I see a therapist as well as a psychiatrist but she knows I'm like you and our "sessions" go like this:
her, "everything still good?"
Me, "yep."
her, "good, see you in three months."

I pay out of pocket ($8 for therapy and $50 for pdoc) so that probably helps.
posted by patheral at 8:45 PM on December 22, 2010 [1 favorite]

You might have better luck building a relationship with a GP, if that's where you want to get your meds. A GP is generally willing to continue meds psychs have prescribed, but not as willing to try lots of different things. So if your meds are working, that should be fine.
posted by Margalo Epps at 8:47 PM on December 22, 2010 [2 favorites]

To back up Margola Epps' comment above, when I wanted to get more of my anti-depressants but was no longer seeing my old shrink, I went to a walk-in clinic and saw the doctor there (not a psychiatrist, a GP, I assume). I explained that the current regimen of pills I was on (that my former psychiatrist had put me on) was working well for me, and could he write me a prescription for that - he did, for a 60 day supply, with a bunch of renewals. The meeting at the walk-in clinic cost 50 bucks, and then all I had to worry about was paying for the pills. The whole thing took <10 minutes.
posted by that possible maker of pork sausages at 9:15 PM on December 22, 2010 [1 favorite]

I meet with my psychiatrist about once every four months. We chat about how the current doses are working out, update subscriptions etc. He has no interest if I'm in therapy or not.

I pay him premium prices because he is also right on top of the latest studies and research reports. He able to answer definitively questions like "is there a safe dosage of ecstasy I can take while on these drugs?", and "Is it likely that side effects can show up months after starting this particular dosage?"

If you can afford a little extra (or can get insurance to cover it) it's probably worth it to rely on a well informed psychiatrist over a GP.
posted by Tell Me No Lies at 10:04 PM on December 22, 2010

Get a copy of your records from whomever prescribed you the pills and that is usually sufficient documentation (if any is even required!) to get refill prescriptions from another doctor. Since amphetamines for ADD are a controlled substance, it's probably better to error on the side of having backup or a new doctor might be suspicious of drug-seeking.
posted by Jacqueline at 10:59 PM on December 22, 2010

I think you may be missing something: when a psychiatrist is trying to figure out whether a given drug is working or not, he observes how you behave during your office visit: what you say, how you say it, how much energy you have, whether your speaking is coherent or not, and so on. He's also observing your body language, whether you're slumped over, whether you meet his eye, and a lot of other things like that.

The talking is mainly for him, not so much for you. It allows him to evaluate the effects that the drugs are having on you. Without that, he's stuck relying only on your subject evaluation -- and people who are depressed are legendary for being poor observers of themselves.
posted by Chocolate Pickle at 12:01 AM on December 23, 2010 [1 favorite]

Sorry, that should have been "your subjective evaluation".
posted by Chocolate Pickle at 12:01 AM on December 23, 2010

If all you want is the drug, and you know which drug works, you might be able to order it from the Internet. I think that might be of questionable legality, depending on where you are, but that way you wouldn't have to talk with anyone, because even a doctor might want to ask you some questions.
posted by overglow at 1:48 AM on December 23, 2010

my therapist makes recommendations for my medications and my GP prescribes, including determining dosage. i call my GP for renewing my prescriptions.
posted by violetk at 2:44 AM on December 23, 2010

Just see a psychiatrist. None of them ever made me see a therapist. (I did at times but my choice.)
posted by St. Alia of the Bunnies at 4:43 AM on December 23, 2010

In my experience, if you go to your GP with a request for psych meds, they will likely give you a prescription, but they will only give it to you for a limited time. They prefer that you see a psychiatrist for long-term treatment.

But at least it's a start.
posted by Evangeline at 5:13 AM on December 23, 2010

I'm suspicious that therapists "respond" to you and yet you're so angry at them. Did you ever express how angry you were or do you have to "behave" for them, perhaps so they wouldn't withhold your drugs?

At any rate, GPs can prescribe meds if you know what works for you (as it appears you do.) If you have a relationship with them, they probably won't make you talk to them or anyone else.
posted by Obscure Reference at 6:22 AM on December 23, 2010

If you're asking to get the drugs without the talk therapy you need to go to a psychiatrist. I see one every few months ($150 a pop too and then submit a claim. Grrr). All she wants to know is how I"m feeling--any side effects? How's it going? etc. I'm in and out without "tell me about your experience when you were 12"

I get the talk therapy. It worked for a while but like you, I'm burned out. Most of them just tell me to read XYZ book. Really? At $175 billed to my insurance you're telling me to read a book?

In the end, change is up to you--it's work, it's noticing behaviors you hate in yourself and making them stop. The problem for me is I am a crazy-person magnet so I'm the one on meds and in therapy yet people like my abusive parents or undiagnosed but probably ADHD husband aren't. It's annoying to deal with those who don't want to change yet they're more messed up than I am.

Otherwise you can go to a GP. I wouldn't fully advise it since they follow what the latest and greatest drug the rep gave them. But if you 100% know a drug is working for you, you can go that route and tell them "hey this drug works wonders". The problem is if it wears out and you need to switch, they will definately guinea pig you more than a shrink will.

Good luck and sorry you're burned out.
posted by stormpooper at 6:42 AM on December 23, 2010

So, I'm not the OP, but I was actually just about to post a very similar question. I definitely agree that a psychiatrist is exactly what you want. It's exactly what I want--long story short, I weaned myself off my meds a couple months ago because money was tight, and have been getting steadily crazier ever since. At this point I definitely can't afford a talk therapist, even with a sliding scale/insurance coverage (also I've done 'therapy for the poor' before and it was a huge waste of time... therapy is really something you need to pay money for to get the good stuff, in my experience). And the only psychiatrists I've ever seen have been through referrals from talk therapists. They've also required about $300 for the initial visit, then $150/month for the next few months after that while dosages were being adjusted, and I really just can't afford that right now. My insurance is terrible about covering doctor or therapist visits, but reasonably OK about covering meds, so in an ideal world, I'd just find a cheap psychiatrist who could write me my prescription every few months. I already know the precise medicine and dosage that worked best for me, so I really just need an automaton to write the prescription for me.

OP, I don't mean to hijack your thread, but it does seem logical that the next question you'd ask after learning that what you want is a psychiatrist would be, "so how do I find a psychiatrist, preferably without having to spend too much?" And that's precisely my question at the moment. If you don't want to take this thread in this direction, you can probably just ask a mod to delete this comment and any that might reply to it.
posted by poxofit at 7:19 AM on December 23, 2010

I went to a psychiatrist to get my diagnosis and medicine dosage down. They definitely weren't interested in keeping me talking in the office longer than necessary. Just wanted to know how I was doing with symptoms and side-effects and here's your scrip and out the door with you.

Once I got stable on my meds I switched to having my GP write it and now I can get my refills without a visit at all five months out of six.
posted by cross_impact at 8:51 AM on December 23, 2010

Where were you getting your prescriptions before? In most US states, non-MD therapists can't prescribe (Louisiana now allows licensed clinical psychologists to prescribe, but most "talk therapists" don't have that ability). I'm confused by the question - were you already seeing a psychiatrist who insisted on verbal evaluation?
posted by catlet at 12:01 PM on December 23, 2010

My GP prescribes my crazy meds. He asks me what a psychiatrist would (how're you doing, how're the drugs doing, etc.). We adjust, or not, as needed.
posted by deborah at 11:25 PM on December 23, 2010