I'd like to not feel crazy anymore, but I'm scared of the doctor.
June 30, 2011 3:27 PM   Subscribe

I suffer from severe anxiety and PTSD stemming from an abusive childhood. I have frequent panic attacks, flashbacks, and bouts of derealization that are terrifying to me. I'm going to see a psychiatrist soon, and I'd like to know what to expect. Help?

I'm seeing a cognitive therapist right now, and our sessions have certainly helped - I can get myself out of a more physical panic attack with relative ease now. But the derealization and depersonalization are a tougher problem to tackle, and I always feel like I'm just barely keeping afloat. It's becoming really disruptive in my life.

So, I set up an appointment with a psychiatrist. It's later this month, and I don't know what to expect - about psychiatrists, possible medication, anything. I'm kind of scared, really. My therapist explains it all in very clinical terms, so I think some perspective from patients would be more helpful to me.

You can email me at reallyscarythoughts@gmail.com if you'd like. Thanks so much in advance. :)
posted by anonymous to Health & Fitness (10 answers total) 5 users marked this as a favorite
I think trying to prepare yourself and enter into a situation with a psychiatrist "prepared" is probably counterproductive. Approach it with an open mind and ultimately trust your own judgement.
posted by dougrayrankin at 3:57 PM on June 30, 2011

Based on limited personal experience and having worked in the social work field with psychiatrists many years ago, I can only offer a little insight. I would guess that the initial session will be similar to initial therapy appointments but with a more medical bent, which is to say probably mostly fact finding (getting personal/family medical history, presenting issues/problems, symptoms and how they manifest, history of prior treatment, etc.). I don't think most psychs do much therapy or coordination of services when outside of in-patient treatment settings, so his or her main focus would likely be medication and possible referral to other suggested or possible services (continued cognitive therapy, group sessions, etc.)

As for medications and what to expect, that's an incredibly broad gamut to try and cover or guess at. Severe anxiety and PTSD could range from mood stablizers to anti-psychotic medication, etc. depending on symptoms and their severity. The side-effects (and intended mood effects, etc.) can range from barely noticeable to profound. A good psych will carefully walk you through what to expect and possible outcomes before you start any program of medication, and should monitor you closely as you adjust. Most psychotropic and related medications require a bit of trial and error to get just the right types, levels, etc.

Don't know if this helps at all, and not much detail I know, but I hope that you find a good doctor who works very well with you, and I wish you the very best in your healing and recovery. Good luck!
posted by BigHeartedGuy at 3:58 PM on June 30, 2011 [1 favorite]

The psychiatrist will ask you a lot of questions on your first visit, mostly along the lines of your history and your reasons for coming in, and probably some about what your day-to-day life is like. Note: you don't have to go into detail. You can say things like "I was abused but have a really hard time talking about it." They will understand. They will also understand that just coming in at all is hugely stressful for most people.

Explain any concerns you have about medication. The psych should be willing to spend time with you discussing side effects, ramping up, etc. Chances are very good that they will start you on a low dose of something and see how you feel before adjusting.

Remember, you are the one in control--you can leave if you feel uncomfortable. And ultimately, you don't have to take the medication if you don't want to.

All the very best to you. This is a really hard step and you're doing the right thing in taking care of yourself.
posted by corey flood at 4:19 PM on June 30, 2011 [1 favorite]

Oops, forgot to add that you can bring a friend with you if you want to. Most docs are fine with it.
posted by corey flood at 4:20 PM on June 30, 2011 [1 favorite]

What corey flood said is spot on.

They tend to be a bit...businesslike about everything. It can be a little disconcerting. I try to remember that they are trying to figure out a complicated puzzle and apply many years of experience and knowledge. So, while they should be polite and respectful, they have to ask the "hard questions" and get as much information as they need even if it's hard.

Don't be afraid to tell them that you're not comfortable with a certain treatment, or that symptom X bothers you more than symptom Y so you want to make sure that's what gets focused on in your treatment.

I personally find it very stressful to see a new psychiatrist and go over my whole history, so I always plan for some kind of support afterwards--time with a friend, a call to my partner, or an appointment with a therapist.

I think it's great that you're getting help. I have some similar issues and have improved with time and appropriate medications. Hang in there!
posted by the young rope-rider at 4:34 PM on June 30, 2011 [1 favorite]

I think trying to prepare yourself and enter into a situation with a psychiatrist "prepared" is probably counterproductive.

Hmm. I disagree.

You definitely don't want to try to "game the system" — and maybe that's what dougrayrankin is getting at. Definitely a bad idea to walk in thinking "I'd better act like X or I'll get diagnosis Y," or "I want medication Z so I should really play up symptom Q." But it can't hurt to be informed.

One thing that'll probably be a surprise to you if you've done therapy but not seen a psychiatrist before: you should expect the meeting to be much more businesslike than a therapy session. You won't get to spend much time just ruminating on whatever's on your mind, or sorting through your thoughts to figure out how to express them. The doc will have a list of questions to ask you, and he'll also want a summary from you of what problems you're having — but it'll need to be a ten-minute summary rather than a weeks-long getting-to-know-each-other process the way it can be in talk therapy. If you've got particular symptoms you want to make sure you mention, you might write them down ahead of time and bring them with you, just so you don't forget. This goes double if you tend to get scatterbrained or spacey when you're talking about difficult stuff. You mention derealization, so I figure that might apply to you....

Also, a bit of reassurance: This will absolutely not be something out of "Catch 22." You don't need to prove to the doc that you're "sane" (whatever that means) or competent to make your own decisions. And on the other hand, you don't need to prove that you're "crazy enough," that you're really having the symptoms you claim you're having or whatever. A good doctor will take you at your word and take your descriptions of your symptoms at face value. Just speak honestly and don't worry about whether or not you're making a convincing case. It's really not about that.

For that matter, it's not gonna be "One Flew Over the Cuckoo's Nest" either. You aren't gonna wind up in a padded cell.* And you have the right to express doubts or disagreement, to contradict the doc, to say "I think you misunderstood what I said a minute ago" or "I don't want to talk about that right now" or "No, those side effects sound like a dealbreaker to me, I don't want to take that medication," and generally to behave like you're in a doctor's office and not in police custody. If your doc gives you a hard time for asking questions or expressing doubts or whatever, that's not because they're a psychiatrist — it's just because they're an asshole. Walk out and find a better one.

*Okay, hypothetically speaking, if you walked in and said "I'm going to shoot the president tomorrow afternoon. I've already bought the gun," then yes, you would probably be committed to a hospital. But you absolutely will not get committed over any of the symptoms you mention in this post. And even admitting to violent or suicidal thoughts is totally okay, as long as you can honestly say "I'm not planning on acting on these, they're just thoughts that come into my head sometimes." Point being, there's no need to be walking on eggshells over this shit.
posted by nebulawindphone at 4:43 PM on June 30, 2011 [2 favorites]

Expect an encounter that's likely to be much more mundane than you imagine.

There's been a big shift in the nature of psychiatry over the past years. Rather than being therapists, psychiatrists are mostly all about the medicine these days. Some of the older docs are pretty frustrated with the ways their careers have turned out, but they feel that they can't afford to practice therapy anymore, which is what they got in the field to do.

Just to say that, rather than the stereotypes of Svengali like mysterions, or kindly wise helpers, or harsh sadistic punishers, psychiatrists have become a lot like every other doctor. They'll ask some questions about what hurts, how long it's been going on, what you've tried, etc. and then they'll, most likely, recommend that you try this or that medicine, and give you warnings about what side effects to look out for, and so on. They are also fully aware that prescribing psychiatric medicine is somewhat hit or miss, so they'll probably tell you that if the one thing doesn't work, you should know that they'll try something else. And then they'll rush you out because they have another appointment in a few minutes.

Feel free to prepare or not, as you wish. I often find it helpful to write down questions or concerns. Your therapist can help you think of these, if you'd like to spend some of your time in session discussing them. Above all, remember that you are the boss of your health care provider - they work for you, and if one isn't helpful, absolutely feel free to fire him or her and find someone else.
posted by jasper411 at 7:10 PM on June 30, 2011 [2 favorites]

It sounds like you have a dissociative disorder, which can only be effectively resolved with psychotherapy. Dissociation is not responsive to medications, but they can help significantly with your anxiety symptoms. The resolution of dissociative symptoms ultimately lies with the processing of traumatic events, which is not entered into lightly. If you can find someone with experience treating dissociative disorders, it would help considerably. It is usually a three stage phase oriented process that starts with symptom resolution and improving your functionality.
I can go into much more detail if you are interested.
As far as medications go, antidepressants might help, but antianxiety medications like benzodiazepines are very effective in calming down physical symptoms.
posted by provoliminal at 7:59 PM on June 30, 2011

From an unexpert anecdotal point of view: for my own problems (different from yours) I've seen two psychiatric medical professionals during the last half-decade or so. The first one I had a poor interpersonal relationship with and seemed somewhat rudderless as far as having a plan for treatment; it ended up at a point where it seemed like I was developing all of the ideas about what to try next and she was simply rubber-stamping them.

The second person I saw had what seemed like a much more directed and comprehensive approach and communicated better and more clearly and was better able to explain his reasoning behind trying out a particular class of drugs or a specific drug. It's not like I don't have my own input into the decision process but it's a much more cooperative effort. This provider, who I'm still seeing now, has helped me to make progress more steadily and it has felt much less like randomly taking shots in the dark.

In the end, I wish I'd moved on sooner from the first person and the less effective treatment I was getting. The difference in my experience with these two professionals might have more to do with my understanding of myself and my own problems and my own ability to communicate about those things; but one way or another it seems to me that like with a therapist you need to find the right psychiatric provider for you at the place you're in.
posted by XMLicious at 6:12 AM on July 1, 2011 [1 favorite]

I had (well, still have to a certain extent) symptoms very similar to yours. Just be honest with the psychiatrist. Tell him the symptoms you're having.

I started out (before the PTSD dx) on a simple SSRI. As my symptoms escalated (thank you repression) so did my cocktail. In the end, I spent nearly a year across various psych facilities. What finally got me to the point where I could live and work independently was a combo of antidepressants, benzos, antipsychotics (for the intrusive thoughts and flashbacks), a mood stabilizer (I was also dx with borderline personality disorder and I could jump from emotion to emotion in seconds), sleep meds and cytomel (which is a thyroid drug but can enhance the effects of antidepressants).

I'm not saying your going to walk out with a handful of pills. But this is what did it for me. For various reasons, I've had an upsurge of PTSD symptoms and I'm currently on an AD and a benzo and a sleep med. I'm also on Neurontin for fibromyalgia.

I'm the kind of person who asks questions. Basically I make myself a huge PITA, but I get my questions answered. I think people who are going to take powerful psychotropics should make sure they have their questions answered. As a friend said to a doc recently "Welcome to the age of informed psych patients".

There can be notable side effects from the meds. Don't be afraid to call your doc and say, hey, xyz is happening. What should I do?

And if you aren't clicking with your psychiatrist, don't be afraid to try another one. The first one I had was a real dick. And we won't even talk about the one who dumped me as a patient while I was in the hospital. And the other one who simply disappeared off the face of the earth leaving me with no med refills.

Good luck. Feel free to memail if you want to talk. There is a light at the end of the the tunnel. 10 years ago, I didn't think I'd make it to 30. Now I'm past that and living and working in Korea.
posted by kathrynm at 3:43 AM on July 2, 2011

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