Does your psychiatrist actually do anything other than shove various medications at you?

[Ecdysis]

I used to have a great psychiatrist but he moved to work in a clinic.

The new Dr is okay, I guess, but way too young and relatively useless.

I mean, being useless is better than doing active harm, but still...

Whenever I talk to him, I feel like all he says is "Let's try this med" or "Let's try a higher dose".

I miss my old pdoc.

I have no idea where on earth to find a pdoc anywhere near as good as he was.

 

[Sideways]

I’ve seen a psychiatrist who used medication heavily and did not do psychotherapy. It has its place, but yeah, it’s not what I need now!

Have you asked if he does psychotherapy, and if so, what type?

 

[Lost in the Woods]

I have only seen three psychiatrists in my life. The first one was a few years ago. He really strong armed me into taking lexapro. The starting sub therapeutic dose was fine but then he doubled it and I had a severe reaction and ended up in the ER. I never went back. The second one was about 4 months ago after my wife decided we needed to live apart, maybe permanently. She was at the Mayo Clinic and she was really good. She asked me about all aspects of my life and prescribed Buspirone which has been very helpful modulating my emotions. The third one was just a month ago. I had read about sub therapeutic doses of Zoloft to ease frustration, anger and temper for people with PTSD. I made the appointment to get the prescription, the guy is definitely a pill pusher so I have to keep hm on a short leash. For therapy I have a PhD psychologist. I also worked with another PhD psychologist that does short term CBT specifically for PTSD symptoms, not causation. He was super helpful and I made a lot of progress fast with him. My next endeavor will be some ketamine therapy to deal with some attachment issues, another gift from my abusive childhood.

When it comes to medication I feel that less is more. I hope to not be on them forever but they do give me some breathing room while I deal with the underlying causation in therapy. I really don’t like talking to a doc for 5 minutes and then have him prescribe powerful meds with suicide warnings without really knowing anything about me.

 

[Friday]

I mean, being useless is better than doing active harm, but still...

2 points, to your side! (It’s funny, because it’s true).

Whenever I talk to him, I feel like all he says is "Let's try this med" or "Let's try a higher dose".

I miss my old pdoc.

I have no idea where on earth to find a pdoc anywhere near as good as he was.

Most psychiatrists are purely there for med-management and work best as part of a “team”. (Therapist+Psychiatrist+Medical). So you do all of your therapy with your therapist, and then they loop in your psychiatrist, so you almost never spend more than 5-15 minutes with your shrink, as they touch base with you on your meds.

Whenever I would decide to try a “new” ADHD med? I’d find a therapist I liked (usually PsyD, occasionally LCSW, or NP… so we’re baselining with doctorates to ) and ask them for a short list of psychiatrists they prefer to work with.

A FEW psychiatrists, very very few, ALSO do therapy… in addition to medication management.

WTFO?!? Well, consider this: PURELY specialising in ADHD patients means staying abreast of over 80 meds in common use, another hundred or so in uncommon use, peer review journals, symposiums, etc. which is apt 10-20 hours a week of reading. ON TOP OF a full patient load. Psychiatrists who don’t specialize? In theeeeeeory are “staying on top of” THOUSANDS of meds, for hundreds of disorders and conditions. Which mean they really don’t. They glance. They skim. They occasionally research. Mostly they rely on a general knowledge of the half dozen most popular meds, for the most common disorders.

Which is why I find a therapist first, and then use their preferred partners/docs, who they not only get on with, personally, but who also usually specialise in the same handful of disorders the therapist specialises in. MAJOR shortcut.

 

[arfie]

i had one psychiatrist in the 90's who kept a ball cap on her desk. when i attempted to treat her like a talk therapist, she put the cap on backwards and chimed in a ghetto accent, "hey, lady, i just deal the drugs."

she worked in tandem with the talk therapists on the staff. she trusted their assessments completely.

for what it's worth
her ghetto accent was quite impressive.

 

[Ecdysis]

Thanks all for your replies...!

Most psychiatrists are purely there for med-management and work best as part of a “team”. (Therapist+Psychiatrist+Medical). So you do all of your therapy with your therapist, and then they loop in your psychiatrist, so you almost never spend more than 5-15 minutes with your shrink, as they touch base with you on your meds.

Yeah, this is basically the set up where I live too...

My old pdoc was just *amazing* tho... He was an incredible human being who just went above and beyond... He's unreplaceable... Sigh...

I get that this young whipper-snapper replacement pdoc is officially ticking the boxes of what he's "supposed to do" I guess... It's just he's soooo heavy on the pill-pushing and soooo light on the listening... I feel like it's almost irrelevant, what I say... like I could walk in there either saying "I'm having trouble sleeping" or "I think I'm a zebra" and he'd basically suggest a med, possibly the same med in each case...? It sort of feels like I go to see him (and it's a 1.5 hour drive each way, and then I see him and we play "medication chess" for 10 minutes and then I drive home again for 1.5 hours... Sigh...

Like there's not even any time to get into the details... And it feels like he thinks the details are irrelevant anyway... It's like his reasoning is: if you're unwell enough to be seeing a pdoc, then you should be taking meds... And then based on how your mood "seems" to him, he's gonna try ABC medication as opposed to XYZ medication.

I'm not even sure how much I "believe" in psych meds these days anymore, either... I mean, there's soooo much doubt about whether the whole "serotonin hypothesis" is even like 1 % true or not... And when people have done meta-studies of the pharmacalogical studies, then often anti-depressants have basically no efficacy greater than a placebo... Many people question whether it takes "about 6 weeks" for many anti-depressants to kick in is because that's how long many people take on average to get out of a depressive slump... Basically the same thing as that adage "the flu takes a week to go away without meds and 7 days with meds".

I mean, I know there are *some* psych meds that are obviously effective - tho even with those, when you read up on the mode of action, basically scientists and Dr's don't have a *clue* how they work or why they work... Ugh...

I'm 47 now and have taken psych meds on and off since my early 20s... And on the whole I literally could not tell you whether any of the approx. 10 or 12 anti-depressants I've ever tried has worked AT ALL... I've certainly never felt an effect where I thought "Ooh, this medication is helping me".

The only psych med I've found genuinely helpful has been benzos... I've taken them verrrrrrrrrrrrrry carefully as to make sure I never, ever get dependant on them. But in bad panic attacks or bad bouts of suicidalness, they've been the only thing that's helped and have certainly saved my life and my sanity countless times.

Other than that, I'm finding my Ketamine treatment helpful.

But all other psych meds? I would say have caused way more side-effects than that they've ever done any good.

I've taken them anyway, in times when I was desperate... Hoping that they would help... Hoping that what the Dr's said might be right...

But I'm not convinced that any med has ever "changed my brain chemistry" in any helpful way, other than benzos and Ketamine.

I guess my growing scepticism about psych meds and this young pdoc's mantra of "meds, meds, meds..." is just not harmonising very well right now...

I think I'm going to cut down my appt's to once per quarter...

There are occasionally other things he's helpful with... Where I live, you often need a pdoc's "stamp of approval" for stuff, like applying for therapy coverage from health insurance and similar stuff like that. So I guess I have to accept that he's helpful/ useful in that regard, and accept that I'm never going to get an even half-way decent conversation out of him regarding any psych issues, and just ignore the pill-pushing as best I can. With the latest med he's prescribed me, I'm just going to get the prescription filled and shove the med in a cupboard. I'm just not up to fighting him about the meds and this seems like the path of least resistance right now.

Maybe I'll try and find out if there's ***any*** possible way of seeing my old pdoc as an outpatient or a paying as a private patient to see him, or what...

 

[sidptitala]

Whenever I talk to him, I feel like all he says is "Let's try this med" or "Let's try a higher dose".

This is my experience too! I try not to say too much because they always want to change meds and doses if I do. I once asked if they could suggest a book I could read to get some info on ptsd and they said I should ask a therapist instead.

 

[thetattoolady]

I used to have a great psychiatrist but he moved to work in a clinic.

The new Dr is okay, I guess, but way too young and relatively useless.

I mean, being useless is better than doing active harm, but still...

Whenever I talk to him, I feel like all he says is "Let's try this med" or "Let's try a higher dose".

I miss my old pdoc.

I have no idea where on earth to find a pdoc anywhere near as good as he was.

From my experience, I think most of them only do medication management. I had 3, and they all basically just either recommend meds or let me tell them what meds I need or want to try. Appointments are only 15 mins (even though I always keep them on longer), and they really are just wanting updates in terms how I am doing on the meds. Meds, meds, meds. Also, I’ve only had one where I actually met with the psychiatrist, the other two I see nurse practitioners or physician assistants.

 

[Sideways]

Appointments are only 15 mins

That’s pretty much confirmation all they intend to do is medication management.

When you’re in your first appointment, or even before asking for a referral, ask ahead what kind of treatment they offer for complex trauma patients. The ones who offer psychotherapy will necessarily need 45+ min appointments.

 

[thetattoolady]

That’s pretty much confirmation all they intend to do is medication management.

When you’re in your first appointment, or even before asking for a referral, ask ahead what kind of treatment they offer for complex trauma patients. The ones who offer psychotherapy will necessarily need 45+ min appointments.

Yeah, I just keep them separate .

 

[anthony]

Psychiatrists are useless nowadays. Psychologists are the ones to visit for actual treatment, less reliance on drugs.

 

[Lost in the Woods]

Yes, keep them separate and on a short leash.