Is there anything I can do while waiting for a psych referral?
October 3, 2017 6:18 PM Subscribe
So my doctor suspects I'm bipolar. Unfortunately even an "urgent" consultation with a psychiatrist is expected to take several weeks, at minimum. I'm at a bit of a loss as to whether there's anything I can do to obtain quicker treatment, and whether there are any other possible medical causes for my symptoms that I should try to advocate for my doctor to test for.
Basically I spent the past month or so feeling like I was constantly on stimulants. I was waking up after 3 to 5 hours of sleep completely ready to go, baking cookies at 2am, turned from my usual introverted self to someone who wanted to talk to everyone all the time, and was pretty much completely unproductive at work because I couldn't focus or sit still long enough to accomplish any of the detail-oriented work my job requires. Also I was entertaining plans of moving across the country to become a yoga teacher, but not to the point of actually making the plans.
Eventually I saw my doctor, who asked a bunch of questions that I recognized as diagnostic questions for bipolar disorder. He also requisitioned some bloodwork to test for thyroid and blood sugar issues. While I waited for the results of the tests I did some research on bipolar disorder, and upon realizing that hypomania could include irritability and attention problems, I started to think it described my life history pretty well (I used to think my cyclic depression couldn't be bipolar because my periods of increased energy coincided with my least productive periods in terms of schoolwork, and people in hypomanic episodes were supposed to be productive).
So when my doctor suggested his diagnosis after my bloodwork came back normal, I was completely unsurprised. But since he doesn't feel comfortable treating me himself, and my symptoms aren't severe enough to require hospitalization, I'm in limbo while I wait to see a psychiatrist.
I ended up asking for some time off work starting last week (I have some vacation time saved up, but I might need to take sick leave if this isn't resolved soon) since my work performance was non-existent, but today I seem to have crashed back to normal. At least, my brain feels like it's back to working at a normal pace instead of on overdrive, although all I want to do is sleep. It's hard to tell whether that's just the sleep deprivation catching up to me or the beginnings of depression, though.
Essentially I'm wondering:
-Are there any hormonal or other issues that could be causing my symptoms that I could push my doctor to check out? I realize that's a question for a doctor, but I feel like my doctor isn't very...proactive, and if I want any further steps taken I need to advocate for them. So far googling has only led me to possibly-made-up disorders like adrenal fatigue. Also, even though my doctor said he'd ruled out thyroid problems, I've had issues with my thyroid in the past, and I'm pretty sure my doctor only tested for TSH, not for T3/T4/antibodies.
-If it is bipolar, is there any way of obtaining quicker treatment/diagnosis? I was on Wellbutrin + lamotrigine for a period a few years ago for depression (prescribed by a psychiatrist who I no longer have access to), and I'm wondering if it would be reasonable to ask my doctor to put me back on the same medication, or if it would be irresponsible to do so prior to consulting with a psychiatrist. Also, my doctor implied the fastest way of seeing a psychiatrist would be to go to the ER (my city has specific mental health ERs), but I'm under the impression there's no point to going to one unless I'm suicidally depressed or bordering on delusional...
-Is there anything else I should/could be doing for my health while I wait for the referral to a psychiatrist?
Other relevant info:
-I have a therapist I've seen for a few sessions (for other issues). I have an appointment with her this week.
-I'm in Canada
Basically I spent the past month or so feeling like I was constantly on stimulants. I was waking up after 3 to 5 hours of sleep completely ready to go, baking cookies at 2am, turned from my usual introverted self to someone who wanted to talk to everyone all the time, and was pretty much completely unproductive at work because I couldn't focus or sit still long enough to accomplish any of the detail-oriented work my job requires. Also I was entertaining plans of moving across the country to become a yoga teacher, but not to the point of actually making the plans.
Eventually I saw my doctor, who asked a bunch of questions that I recognized as diagnostic questions for bipolar disorder. He also requisitioned some bloodwork to test for thyroid and blood sugar issues. While I waited for the results of the tests I did some research on bipolar disorder, and upon realizing that hypomania could include irritability and attention problems, I started to think it described my life history pretty well (I used to think my cyclic depression couldn't be bipolar because my periods of increased energy coincided with my least productive periods in terms of schoolwork, and people in hypomanic episodes were supposed to be productive).
So when my doctor suggested his diagnosis after my bloodwork came back normal, I was completely unsurprised. But since he doesn't feel comfortable treating me himself, and my symptoms aren't severe enough to require hospitalization, I'm in limbo while I wait to see a psychiatrist.
I ended up asking for some time off work starting last week (I have some vacation time saved up, but I might need to take sick leave if this isn't resolved soon) since my work performance was non-existent, but today I seem to have crashed back to normal. At least, my brain feels like it's back to working at a normal pace instead of on overdrive, although all I want to do is sleep. It's hard to tell whether that's just the sleep deprivation catching up to me or the beginnings of depression, though.
Essentially I'm wondering:
-Are there any hormonal or other issues that could be causing my symptoms that I could push my doctor to check out? I realize that's a question for a doctor, but I feel like my doctor isn't very...proactive, and if I want any further steps taken I need to advocate for them. So far googling has only led me to possibly-made-up disorders like adrenal fatigue. Also, even though my doctor said he'd ruled out thyroid problems, I've had issues with my thyroid in the past, and I'm pretty sure my doctor only tested for TSH, not for T3/T4/antibodies.
-If it is bipolar, is there any way of obtaining quicker treatment/diagnosis? I was on Wellbutrin + lamotrigine for a period a few years ago for depression (prescribed by a psychiatrist who I no longer have access to), and I'm wondering if it would be reasonable to ask my doctor to put me back on the same medication, or if it would be irresponsible to do so prior to consulting with a psychiatrist. Also, my doctor implied the fastest way of seeing a psychiatrist would be to go to the ER (my city has specific mental health ERs), but I'm under the impression there's no point to going to one unless I'm suicidally depressed or bordering on delusional...
-Is there anything else I should/could be doing for my health while I wait for the referral to a psychiatrist?
Other relevant info:
-I have a therapist I've seen for a few sessions (for other issues). I have an appointment with her this week.
-I'm in Canada
People with bipolar sometimes react really differently to meds than people with major depression. If your doctor isn't comfortable treating you further, it's probably because they're worried about that interaction (with some justice) and are really unlikely to agree to prescribe you anything without a psych consult. I don't know if there's a chance it'll work differently than it did before just because you're coming off a suspected manic episode, but I have seen a couple of bad medication interactions with bipolar secondhand, and it is not a fun time for anyone in the blast radius, let alone the patient.
posted by restless_nomad at 8:21 PM on October 3, 2017
posted by restless_nomad at 8:21 PM on October 3, 2017
I don't have anything helpful to say about expediting your waiting time, but I agree that mood tracking in the meantime would be useful.
In particular, watch out for depression following the hypomanic period you just had (particularly since it's season change time right now). "What goes up must come down" is kind of a crude way of putting it, but unfortunately it seems to be reasonably true with bipolar - I've definitely found that I'm more likely to crash mood-wise after I've been elevated for a time. And it'll potentially be much harder to go through the diagnosis and treatment process if you're depressed by the time your referral rolls around.
posted by terretu at 1:06 AM on October 4, 2017
In particular, watch out for depression following the hypomanic period you just had (particularly since it's season change time right now). "What goes up must come down" is kind of a crude way of putting it, but unfortunately it seems to be reasonably true with bipolar - I've definitely found that I'm more likely to crash mood-wise after I've been elevated for a time. And it'll potentially be much harder to go through the diagnosis and treatment process if you're depressed by the time your referral rolls around.
posted by terretu at 1:06 AM on October 4, 2017
If you can muster any reason to go to the ER (I think this would be reasonable - 'I've already been diagnosed as bipolar, I'm untreated and I've only had X amount of sleep in X days'), do so. Lamotrigine is a very common and reasonable drug used to treat bipolar, so I do think you could ask your doctor to start you back on that (I'm bipolar II, I take it). You should be closely watched by a psychiatrist, though, if you take any antidepressants with this diagnoses as they can cause (hypo)mania.
If you're in Edmonton, memail me.
posted by kitcat at 12:30 PM on October 4, 2017
If you're in Edmonton, memail me.
posted by kitcat at 12:30 PM on October 4, 2017
The primary-care physicians I've talked to around here, at least (US West Coast), are really, really reluctant to start anyone on medications for Bipolar Disorder, even if they're willing to take over prescriptions for clients who have been stable on their medications for a long time. It sounds fairly normal that your primary-care doctor is wanting to have you see a psychiatrist for the medications, so that may not be a sign of a non-proactive doctor.
posted by lazuli at 5:24 PM on October 4, 2017
posted by lazuli at 5:24 PM on October 4, 2017
Response by poster: Just to clarify, I understand (and agree with) my doctor's reluctance to treat possible bipolar disorder himself. My reference to his non-proactivity was intended to be about suggesting other possible causes, not about prescribing psychiatric medications. I had an episode of thyroiditis previously that really reminded me of these symptoms, and it seemed like he only tested my TSH levels because I mentioned this, which made me wonder whether there were other things he hadn't thought to test for.
I'm considering trying to push for a referral to an endocrinologist or a more thorough blood test including thyroid antibodies, but maybe that's just me being in denial. The past few days my mood has been normal but I've been completely exhausted in a way that not even 12 hours of sleep a night can help.
Thanks for the suggestion of mood tracking. I've started doing so.
posted by ersatzhuman at 7:05 AM on October 5, 2017
I'm considering trying to push for a referral to an endocrinologist or a more thorough blood test including thyroid antibodies, but maybe that's just me being in denial. The past few days my mood has been normal but I've been completely exhausted in a way that not even 12 hours of sleep a night can help.
Thanks for the suggestion of mood tracking. I've started doing so.
posted by ersatzhuman at 7:05 AM on October 5, 2017
This thread is closed to new comments.
Keep to a very set routine for sleep, eating, exercise etc...
Read everything you can find about Bipolar disorder.
Best wishes.
posted by SyraCarol at 8:18 PM on October 3, 2017 [1 favorite]