How do you find a good psychiatrist? Or, alternatively, what am I doing wrong in my relationship with my psychiatrist?

[littleoc]

I have never been satisfied with psychiatrists in the past. Not because they aren't good people, but because I feel they either aren't listening or that they're just kind of not researching what they're doing, and not including me in the decision.

Extremely brief history:
My very first psychiatrist told me I was faking an allergic reaction to Lamictal (not sure of spelling) when my tongue and throat was swelling. My mother was trying to show him (I was 13) and he kept repeating that only 1 in 10,000 people get that reaction, and therefore I was faking it.

I was taken to a new psychiatrist called Ms. Strawberry (obviously wasn't her real name) and we got along well enough, except that then she wanted to talk to me exclusively via webcam and it terrified me, felt awkward, and I was positive my dad was spying on us so I wouldn't say a word after a while.

I started going to a nonprofit office called Centerstone after that. First doctor I had asked me what suicide attempts I had had right in front of my mother and my sister. He told me I smiled too much.

Stopped seeing him after that. My mom was in charge of my life at the time and was offended at the man, told me I was never going back there. She then said there were no other places to go so I had no psychiatrist for a long time.

After I was last hospitalized and was over 18, I got a new psychiatrist but due to a mistake in the hospital's records, I was given a children's psychiatrist who told me she wasn't able to prescribe me anything (but I could play with the moon sand and the doll house). After I was out of medications, I was transferred to a nice person who is an alumnus from my high school. So there was some bonding there and it seemed promising. Sort of went downhill when literally five minutes after I said that I had used Clonodine to attempt suicide, she began prescribing me Clonodine.

I decided to keep her anyway because it seemed like a dumb idea to keep shopping around after that incident. It probably didn't seem like a big deal to her anyway.

Problem is, when I first started really posting on this site (less than a year ago), I posted in one person's thread that I felt my psychiatrist wasn't taking me seriously. She wasn't prescribing me anything new for my symptoms of anxiety, depression, or for OCD. She would comment every time I asked for something to help me, "Are you sure you want to take the big drugs?" She'd say it doubtfully like I didn't know what I was asking for. Or maybe didn't believe me that my symptoms were bothering me.

I've finally convinced her about the anxiety after several months, though. She started giving me prazosin in the day time (makes me tired), and when that didn't work, she added on a new medication Buspirone, which I take with Prazosin morning and night.

She also gave me a ton of Concerta, which is 130$ with insurance, but seems to lift my depression and help organize my thoughts (especially related to impulsive or racing thoughts). This was only after I had been asking for about a year, for school-related reasons. She said the law was in her way. I'm not sure what she meant, though, because later she just prescribed it without there being any issues.

I think she's a smart person, though, and I don't personally know drugs like a psychiatrist does, so I don't know if she's helping me or not? She seems to care about asking me how I've been, and she doesn't seem hateful or anything. She seems to like me and she always thanks me for my honesty. Which makes me think that this might be more of a me problem.

Can you tell from this post alone?

Thank for any help :) or support, it's okay if you have no idea. I sure don't

 

[Teamwork]

When it comes to medication of any sort, of which I’m on quite a bit for an inherited disease, I see myself as being in the drivers seat. Yes my neurologist has prescribed a regime for me to follow, but there are some doses that I cut in half. I know what I would function like if I took it in the amount he prescribed. Same with an arthritis drug I’m prescribed two a day, but I know I can do fine on one. I know the drugs by name and how they affect me. I know the side effects and if they are tolerable. I’m open and honest with neurologist regarding how one of the drugs make me feel, but when he asks if it is manageable I say yes, as it is for now. One of my medications increase my anxiety so I have to reassure myself it is the drug and deal with it. It in the end you need to decide if there are medications that are helping you function better so that you can learn skills to get off them if possible. For example, concerta is great so if for example, while on it you can learn meditation skills and organizational skills and then wean down a bit to see if you can slow your thinking down unaided then it’s a good way to go. Drugs do quite a bit, but sometimes if you still have symptoms the doctor will increase the drug without asking if the you can live with the symptoms as they are. In my opinion that is what I do with my medications, less is best. The only drug I can’t fiddle with is my seizure drug as that is courting disaster, but some of the others I know how many a day decreases symptoms to tolerable without wiping my function level right out. Every single one of my prescribed medications come with the label, may cause drowsiness, so yes I adjust them and drink a lot of coffee!

 

[ILoveLife]

In my opinion that is what I do with my medications, less is best.

Completely agree with this statement.

Regarding psychiatrists, or any other doctor in the medical field really, one who works with you is definitely the best one.
Since you have trauma, it would be particularly nice if they had a post grad in psychotherapy too. It's not a necessity, but it goes a long way in common understanding and sharing information easily.
They don't always keep up with the research, they work long hours too - it's understandable not being easy. Mine does, but there is so much research and so much conflicting information that I have printed some to take to her.

I would share my pdoc with you if I could.

That doc that prescribed you Clonodine made me angry as hell.
And you should smile as often as as much as you want to.

 

[Justmehere]

For help in the US, check out needymeds.com. They have some patient assistance programs that might be able to help.

I have had a few experiences like yours with less than helpful and totally awkward docs. They get so used to what they do, and most have little to no training in practice management, therapy, and well, people skills. They learned meds, brains, and bodies. No therapeutic alliance skills. Ugh.

If you and your doc click on an interpersonal level, and you like her, it might be good to stick it out. You can also consult with another doc, get another opinion, and see what you’d like to do. Good docs don’t mind second opinions. Also, if you have a good therapist, they might be able to advocate for more assertive medication management.

Prescribing clonidine after using it for a suicide attempt using it actually makes sense. I am not a doc, but it’s my understanding that it’s actually one of the meds that is less dangerous to overdose on than many others. It’s not safe to OD on it by any means, I’m not stating that. One can die, but it’s a much more safe option to prescribe to a suicidal patient than many others. The process of switching meds can also be destabilizing. She was actually probably taking you quite seriously. She probably didn’t explain this at the time, because she didn’t want you to go find more lethal options. I’m super glad you survived the attempt, and I can totally see how it would feel really invalidating to continue to be prescribed it without it being explained it’s actually a decent option to manage anxiety for a suicidal patient.

There are some fairly effective meds for OCD in particular. The most common ones are generally much older medications, and they do come with sizable risks and side effects. I took Luvox. My doc said it was like a vitamin.... The relief was amazing. Side effects almost killed me. Her hesitancy makes some sense and her route to use newer meds with less risks and side effects makes sense. It’s also reasonable to want a different, cheaper, and more effective approach. Totally reasonable.

Have you flat out asked her why she is so hesistant to prescribe more often? If you approach it with a “help me understanding your thinking in greater detail” attitude, some smart docs will explain more.

The best docs I found by cold calling therapists and asking who they recommended. Sounds weird I know, but a surprising number would call back and say who they recommended easily. If more than one therapist could vouch for a doc, it dramatically increased the chances they were better than other docs.

One of the funniest and really screwed up bad-psych-doc experiences I had was when I went to one clinic and sat down. Looked like a house. Waiting room looked like a living room. Then an older woman came out and sat next to me and said she was his mother.... he then came out, and as I picked my jaw up off the floor, he pointed to his “psychiatric garden” in his front yard, and explained the person I thought was a gardener, was a patient.

What. Even.

Hello privacy and ethical violations!

I ran. Just ran. (Yes I reported the situation too. That doc? No longer practicing.)

The good eggs are out there. You may have one, and just need to get more clarity and information on her approach. She may also be a good doc, but not the right approach for you.

I hope you find the best doc with the best approach for you!

 

[MyWillow]

I lucked in with my psydoc. My psychologist referred me out as I was just getting worse - dissociation, flashbacks, nightmares, no sleep...ugh. My psydoc is now my T but meds are not her first port of call. Wish I could share her as she got me stabilised just by managing our sessions better. I still see my old T for equine therapy every few weeks as a bit of an adjunct.

Best of luck to you x