Having a bit of a mental health crisis, not sure what to do next
July 16, 2013 8:40 AM   Subscribe

I've hit a low and am considering psychiatric hospitalization, but none of the psychiatrists in my area seem to treat the condition that seems to be at the heart of my problems (ADHD). I'm also very, very depressed. What can I do to get through the next hours, days and weeks?

As my question history attests, I struggled with depression and work and social issues. I'm employed, but over the last months and weeks have grown certain that I can't do it anymore--can't do the job I have now, and can't do the job search song and dance. Since I need to have a job in order to, y'know, survive, I have gotten very depressed and hopeless.

My thinking has gotten very circular and repetitive. I'm also socially isolated. I considered going to a psychiatric hospital but am worried that medicalizing this problem will only add a dose of debt (I have shitty insurance) as well as potentially not be very helpful.

I called the nearest psychiatric hospital and explained that I'm seeking treatment for ADHD and depression. The receptionist told me that there is a shortage of psychiatrists in the area who treat ADHD. She said there is only one that she knows of, and gave me his name--it's the same psychiatrist I saw last year and didn't like. He bluntly insisted that a side effect I believed I was having was not a side effect of the medication I was on. I know that medication anxiety is something that I have and is probably no picnic for doctors to deal with, but he seemed irritated and dismissive of my concerns. I'm too frightened by this memory to contemplate going back to him.

I've tried calling a handful of other psychiatrists but either they don't call me back or are not accepting patients. I also do not have a family doctor, as my last one retired and I haven't gotten around to finding a new one yet. I've seen many therapists throughout my life. I think this is a chemical thing.

I guess I'm wondering what next steps might be. In my worst moments throughout the day, I think I should go to the ER, but then think that would be a costly overreaction. But I'm at the point where I don't know if I can navigate this myself anymore.
posted by silly me to Health & Fitness (9 answers total) 1 user marked this as a favorite
What state do you live in? Are you within driving distance of a metropolitan area? I had run into some very VERY similar circumstances and have found it difficult to find a psychiatrist who takes adult ADHD seriously. Generally larger city areas will have mental health clinics that deal with these sort of issues and take them more seriously than other psychiatrists. That said, I've yet to find anyone myself that will help me with ADHD issues. I would suggest trying other large areas within driving distance of yourself and give that a go. I also know that there are, at least in my state, mental health networks that have hotlines for these kinds of issues that can give you more direct resources.

As far as the job goes, I again had the same difficulties and realized that ADHD and depression were really affecting my work -- and as a result of this and a myriad of other reasons, ended up resigning from said job. It was not worth the stress and there was a lot of crappy office politics and was not a well paying job in the first place.

I do wish you luck on your search!
posted by camylanded at 8:48 AM on July 16, 2013

I'm so sorry that you are suffering. I hug you from out here in the green.
I'm glad that you got one answer from the receptionist. He/ she was probably doing his/ her best to give you useful information. But the useful information probably came from a list of providers that you already found on your own.
Maybe it is time to just check yourself in to the hospital. No amount of debt is going to feel worse than what you are feeling now. Consider it an investment in yourself, and coping with debt will be much easier if you have taken action on making your life better and more controllable.
posted by pickypicky at 8:49 AM on July 16, 2013 [2 favorites]

At your worst points during the day do you think about hurting yourself? If you think you might act on those thoughts, then a visit to the ER is not a costly overreaction. You can discharge a bankruptcy stemming from medical bills in 7 years, but suicide is forever.

If you don't think you will hurt yourself, then I'm not sure the ER/inpatient route is the most effective route to get the help you need. It can work to stabilize a person in crisis, but figuring out what you need to take and/or do to actually stop feeling hopeless, worthless, and overwhelmed all the time is something that's going to happen on an outpatient basis anyhow.

My suggestion, therefore, is to call more than a handful of psychiatrists. I live in a major metro area with a shit-ton of psychiatrists, and it still takes a lot of calling around to get one who is taking new patients. I've basically given up on trying to find psychiatrists who are taking new patients, who are in-network on my insurance, and who are--you know, actually good (a classic three-variable, pick two situation).

I would focus on getting treatment for the depression first, which should open up the list of potential treatment providers more than tackling ADHD alone. Even if the depression is secondary to ADHD, it could (a) be a significant contributing factor in the symptom you experience as ADHD-like; (b) present an obstacle for seeking more nuanced treatment down the road that also addresses your ADHD concerns.

Even when depression is caused by some other factor that doesn't go away when taking (effective for you) anti-depressants, it can become easier to COPE with and DO SOMETHING about the still-existing shit in your life that is making you feel depressed. For example, medication can be helpful to people who are more-than-normal overwhelmed and shutting down in the face of stressors such as divorce or bereavement.
posted by drlith at 9:21 AM on July 16, 2013

Get the number of your local crisis line and give them a call.
posted by bonobothegreat at 9:43 AM on July 16, 2013 [1 favorite]

Does your employer have a confidential employee assistance program? Mine recently helped me and they were awesome.
The county mental health department can also be a great resource.
Seconding bonobothegreat about the crisis line.
Does your area have a "dial 211" information and referral service?
How's your relationship with your primary doctor? Is he/she someone who will squeeze you in on short notice, and someone you can talk to about this sort of thing?
posted by The Underpants Monster at 10:27 AM on July 16, 2013

I can't really speak to the psychiatric hospital but I can speak for ADHD. Depression and ADHD go hand in hand especially in adults. A lot of us with ADHD look around and see areas where we fail and get caught up in the whole web of depression. I really read a lot about ADHD when I was diagnosed and had a good therapist. Are you currently seeing a therapist and can he/she recommend a next step for you? I hate to hear about your pain but I am not sure going right to a psych hospital is the best option. Is there a health clinic (either mental or physical) whee you could at least get some guidance? On another note, I have found for me the ADDitude Magazine website to be really helpful at least for some short term respite.
posted by lasamana at 1:03 PM on July 16, 2013 [1 favorite]

I'd go to the ER based on your overwhelming depression and get admitted to the Psych Unit. It's amazing how much help you'll get there - and I speak from experience, having reached a point of seriously considering suicide due to the onslaught of Parkinson's symptoms many years ago. You'll have more than one psychiatrist to work with you - many counselors, psychologists, etc. - many personalities, and they know what they're doing since they've seen it all (no matter what you're feeling or thinking, it won't be new to them). They may not be shown as experts in ADHD in some psychiatrist's book, but you can bet they're used to dealing with ADHD in the hospital - absolutely.

Be sure you emphasize the overall hopelessness and end-of-the-road feelings you're having when you seek admission to the hospital through the ER; they need to eliminate the idea that you're drug-seeking or just going through some temporary crisis or mood swing which can be handled as an outpatient. It's important that they know that you're seriously desperate for help.

They were a godsend for me. First of all, it was a totally SAFE place; secondly, my very upsetting thoughts didn't upset them at all; thirdly, and most important, they actually taught me coping skills and gave me the courage to walk through the fire. And the thing is - I'd tried to get in to see a psychiatrist or into the local mental health clinic or anyplace else for help and it just wasn't happening. That's what sent me to the ER and I'm so glad it did.

I wish you good help and peace.
posted by aryma at 2:08 PM on July 16, 2013

1) Most psychiatrists are willing to treat ADHD even if they don't list themselves as specializing in it. Many are even good at it. My doc knows a ton about ADHD, but it isn't one of the specialties he lists himself under.

2) Anyway, worry about the depression first. Even if it and the ADHD are feeding and supporting each other, worry about the depression first. The connection goes both ways — getting your ADHD treated will make you less depressed, but getting your depression treated will also improve your attention — and nobody ever died of ADHD. Depression will fucking kill you. Treat it first.

3) If you call someone and they aren't taking new patients, ask to be put on a waiting list. That way, if the unthinkable occurs and six months or a year from now you're still in this mess, you'll eventually get a call back saying "Dr. Awesome can see you now" and it will be a godsend.

4) If you're desperate enough that you're considering checking into a psych ward, it's probably a good idea. I've done it and I'm glad I did. I also had good insurance, which is why I'm not 100% saying "GO CHECK YOURSELF IN NOW" — but at least consider it. If nothing else, it will guarantee you some time with a psychiatrist, and probably also with a social worker who can help you set up appointments with someone to see after you check back out.
posted by Now there are two. There are two _______. at 2:30 PM on July 16, 2013

I'm so sorry. This is hard. Certainly, if you at any point think you might hurt yourself, get to the ER or call a crisis line. Having a friend or family member check in on you every couple of days can't hurt either.

A few thoughts. Take a look at either your state or employer's short- and long-term disability benefits. A severe depressive episode may qualify you to get some time off, and it's one less thing to worry about while you focus on recovery.

Psychiatrists who deal with ADHD are rare. Are you in therapy? That may help you a lot in the short term (and long term, honestly — I myself did not see significant improvement with just medication alone). Your therapist may also be able to help you find a psychiatrist who can help you.

Finally, I've found that when I'm really in a bad place I cannot even fathom dealing with the medical system, insurance, paperwork, phone calls, whatever. It's all so oppressive and awful, but this is when you need it the most. Consider recruiting a friend (or even paying an assistant) to keep track of everything for you. Get help to get care, then focus on getting better.
posted by annekate at 4:27 PM on July 17, 2013

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