Sick of being sick
June 2, 2016 10:25 PM   Subscribe

I am chronically ill. My former GP blew me off, and the stress of being constantly sick ruined my mental health, which led to a full on nervous breakdown. I'm seeing a psychiatrist this weekend. What is that like?

I have a history of depression and anxiety, which was kept in check with a daily SNRI and Ativan as needed, prescribed by my GP. My physical health has declined rapidly over the past few years, but my GP refused to do any tests beyond bloodwork, which showed a Vitamin D level of 8. She told me that I'm too young to be sick. She is no longer my GP, but I haven't yet found a new doc. I have an intermittent LOA in place at my workplace, because of chronic headaches (pituitary tumor) but I'm currently on leave because I'm so anxious about my health. Panic attacks every night. Every local psych MD is either not taking new patients or is booked through July at best. But I found a psych urgent care walk in across the state, and I'm going there Saturday. I'm doubleplus anxious about this. What is like to go to a psychiatrist? How does it work? I am absolutely terrified about this. Please hope me.
posted by Ruki to Health & Fitness (10 answers total) 2 users marked this as a favorite
I don't know this particular psychiatrist, and there are obviously crappy ones and awesome ones, but I will say that I have never had a better supporter and advocate for my physical and mental health than the psych I'm seeing now. She is absolutely amazing, validates my concerns, tests for everything, considers every abnormality that comes back to be of paramount important to address and treat, and is so kind and knowledgable and eager to do research for the most recent studies on what's going on for me.

Vitamin levels are *so* critical to health (especially as low vit D is correlated with depression and anxiety OMG), I am saddened and shocked that your GP is brushing this off. Have your new psychiatrist also test for how you metabolize stuff, especially B vitamins.

I really hope this person works out for you. Don't worry. You are hopefully going to be in the hands of someone who can turn all of this around for you.
posted by ananci at 10:39 PM on June 2, 2016 [3 favorites]

I've had two different approaches to psychiatric care. Both started with an hour long 1:1 intake session. At the end of the intake you have a treatment plan, which usually involves pills. You have follow up appointments to track progress, closer together at first and then spacing out over time. The appointments cover your symptoms and medications, not your feelings and emotions. They tinker with the drugs until you get a good balance between symptom relief and side effects.

My first psychiatrist was more traditional and offered 1:1 appointments. My second psychiatrists offered group medical visits for follow ups. I prefer the latter. You get more education on your condition, its manifestations, and its treatment by participating in a group. You also get an hour instead of 15 minutes worth of education.

The overall patient experience varies by office. My first psychiatrist offered appointments in an office park and the waiting room had People magazine. No more stigma than going to the dentist. The second psychiatrist's practice was in a hospital initially right outside the locked psychiatric ward. Certainly was lacking in ambiance but was an ever-present reminder of what happens when shit goes tits. The psychiatrist relocated to an office building and the patient experience greatly improved.

Your mileage will certainly vary by provider. I find visiting the psychiatrist rather pleasant now, I prefer the psychiatrist to most other specialists as there are no unpleasant medical procedures involved. Good luck.
posted by crazycanuck at 11:05 PM on June 2, 2016 [1 favorite]

Your first visit will probably be sort of interview-like. Not in a stressful omg will they accept me kind of way, but just in the way that they will need a rundown of who you are and what you're dealing with, and they will be telling you how they work and what they can offer and what you can expect.

You might find it useful to write down in list form your various symptoms and challenges, including physical things as well as mental. You can also include family history if you have that information. They will probably take notes. They will ask you what you have tried in the past, what symptoms are recent, what you would like to see happen in terms of your health and lifestyle. You can ask them for referrals to other specialists who will take you seriously, and for explanations of different kinds of therapies and medication strategies. Since you are currently at odds with your GP, they might ask for you to have certain tests and exams done by another doctor before they prescribe any drugs, but in the meantime you can work on other non-prescription ways to help.

It really isn't scary, but I totally get why you feel scared. You are doing a great thing taking initiative like this. It's okay to be scared but don't let that keep you from asking questions or sharing details.

It is smart to schedule a follow up visit before you leave the office after your first time, especially if you will be starting any drugs or large changes. This could be any time between a week to a month later. They will probably have ways for you to contact them before then with a phone call or email if you have questions or concerns; don't hesitate to do so!

Don't let your panic keep you from going to this appointment. If you feel like you're panicking once you get there, tell someone - they will understand because it's a psychiatrist's office. But I really think you'll be okay. It is something to look forward to, getting a handle on your problems and an ally in your corner.
posted by Mizu at 11:48 PM on June 2, 2016

Basically, you want to stress that you would like any physical contributing factors (such as low Vitamin D, which did send my husband to the ER twice, the 2nd time he had low B12 as well, now he takes 5,000 IU per day of D and a dose of B12 every day), addressed as well as mental health. He was just tested again and all his levels are now normal (yay). This is after being vigilant with the D and B12 doses. So this Spring he did not fall into the D-caused depression.

So things like low D, which addressing can really turn some folks around into "still anxious but functioning" level, depending on the cause, and any other conditions that could cause or contribute to anxiety, such as thyroid levels being off, etc. I'd ask those questions.

Those should all be looked at first. And if the psych meds have worked for you in the past, there is no reason why you can't take those still (or again) while waiting for the blood tests to come back, if the psych doc prescribes them.

One other thing to note is if the doctor listens to you and responds to you as an adult. I have had some that just take notes and write things down and I never even knew what their diagnosis was, just, here's a 'scrip, come back in 3 months.

Others have really listened to my concerns (about side effects, for instance) and then also referred me to therapy in conjunction with meds and lifestyle changes (more exercise, less stressful occupation, yoga, etc.).

Anxiety isn't just out there as a bunch of thoughts that are upsetting you: it's in your brain, and your brain can be treated for it. I have found various methods that have worked for me for my generalized anxiety disorder, and some that don't (i.e. watching stressful TV shows, over-exposing myself to bad news, not taking care of myself before taking care of others, etc.). And there is nothing worse for someone with anxiety than a dismissive doctor, I know, because then it sets up a cycle of not wanting to seek treatment.

Think of it as car shopping: sometimes the first car you come upon is great, and a fantastic price, and the sales person is honest, and you walk away feeling like you got a great deal and you're happily running around town in your spiffy new car.

But if you bought a car you really didn't like, the sales and finance guy double team you to push it down your throat, because they know your old car is broken down and you really need a car to get to work, and you end up buying it, and then you drive around feeling sad because of your crappy car and feeling like a sucker... well, it would suck, but the right answer is to dump the crappy car and get something that works for you and makes you happy.

So you are shopping for a new doctor, and of course you want to feel safe and have them listen to you, and you want to build trust with this person. But you are limited in your choices right now, due to lack of availability. It's like your car broke down and now you are forced to get whatever one is out there, just so you can keep running and get to work.

Go with an open mind, of: I will get the car (doctor) I want, and if not, I will get something that will work for me. If not, I will continue to shop around, because I deserve a car (brain) that gets me from point A to point B and makes me feel happy about my choices.

Try to answer the questions honestly, and briefly, and yes, do bring a list! That is excellent advice. And take notes, because I always forget stuff when I am in a new and stressful situation, and don't be afraid to ask someone to repeat it to make sure you are clear on things. Also, I would avoid knocking your GP and say, that you feel more comfortable addressing your physical and mental health issues with a specialist, as that is not your GP's area of speciality.

Good luck and hope it works out for you.
posted by Marie Mon Dieu at 1:03 AM on June 3, 2016 [2 favorites]

There are docs and there are docs. Some psychiatrists are not therapists in the 50 minute appointment, talking therapy sense. Their office visits are shorter, and are primarily about assessment and meds management. Some do the talking therapy thing. At a first appointment, it's very appropriate to ask their view of all the services you need, and what part they expect to play. You describe this place as "urgent care walk in" and I expect they would want to refer you to a different doc for the long term.

Where I live, there is a provider that provides talking therapy at reduced rates for those who can't get a doctor otherwise. Perhaps there is in your area as well.
posted by SemiSalt at 6:53 AM on June 3, 2016

Are you seeing an endocrinologist to manage your pituitary tumor? Endocrine problems can definitely cause psych issues.
posted by brevator at 9:33 AM on June 3, 2016

It is very calming. You will have to answer questions but you will be in a quiet environment with dim lighting, possibly with a fish tank in there somewhere. It isn't at all like a regular doctor's office.

It is very common for GPs to call someone crazy instead of dealing with vague symptoms. It's all related- you get depressed which unbalances the rest of your body or you get sick which makes you depressed- ideally, you would have a GP who addressed everything. While you are looking for that person, eat as healthy as you possibly can, exercise daily, drink lots of water and no soda, and look for something relaxing to do like mediation, prayer, or putting a puzzle together.

It does get better.
posted by myselfasme at 9:44 AM on June 3, 2016

Make a written list of all your symptoms and problems before you go because it can be easy to forget stuff in the moment.

I am a little worried that driving across the state to an urgent care clinic might be perceived as drug-seeking behavior if you request anti-anxiety meds from them. I think your focus at the urgent care place should be getting them to help you get an appointment set up with a local psychiatrist.

Once you've got a regular local psych doc, ask about clonazepam (klonopin). 1mg/night was a miracle for me.
posted by Jacqueline at 10:21 AM on June 3, 2016

I went to the urgent care and spoke with a social worker. She referred me to a Partial Hospital Program, which I will be starting on Monday. Thanks for your responses and support!
posted by Ruki at 2:23 PM on June 4, 2016 [3 favorites]

That sounds great. I am sending doubleplus good thoughts your way. Chronic pain is a bitch as I know all too well. You can memail me if you want. :)
posted by futz at 10:00 PM on June 4, 2016

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