Not Getting The Care I Need

[Kassandra]

Hello all,

I hope that you are doing well (or as well as possible).

I saw a new psychiatrist (my third this year) this morning, and it did not go well. I've found that psychiatrists in my hometown are either a) impossible to get appointments with (I know there is a shortage, particularly in my area), or b) not willing to work with me. For the record, I've been diagnosed with generalized anxiety, panic disorder, OCD, DIDNOS, and (of course) PTSD. I work tirelessly on this issue. I see an amazing therapist once a week, exercise daily and have taken up meditation as part of my routine. I eat healthy and try to eliminate stressors, but I have only gotten less and less capable of functioning in life. As a 25-year-old woman, this is incredibly frustrating.

The biggest issue is with my psychiatric care, namely medication. I've been on the following over the past four years (and given each a strong chance at success; multiple weeks on each, in other words):

Luvox
Zoloft
Lexapro
Wellbutrin
Buspar
Nortriptyline
Seroquel
Risperdal
Lamictal
Effexor
Hydroxyzine
Propranolol

None of these work for me in the least, but I've covered almost every class of medication with the above. I currently take a low dose of Lexapro, and have been taking the benzodiazepine Clonazepam (Klonopin) for the past few years. My current Clonazepam dosage is the very high 4-5mg/daily. I don't have the concerns with this medication that others have. I obviously am physically dependent and tolerant of the medication at this point, but it is the only thing that has had even a mild affect on my anxiety in particular. I had one honest MD who admitted that the concerns about bentos are primarily due to a particularly difficult decade when doctors prescribed these with opiates in abundance, and that combination is now known to be toxic. So most concerns about this class of drug comes from fear of the medical board. This is understandable, but doesn't help me, and I'm working to taper down on the medication at this time, but no other psychiatric medication does anything for me.

I've been working with a therapist for years, and done the gamut of therapy techniques: CBT, DBT, EMDR, etc. to no avail.

I'm very concerned at this point. My mental health has decreased steadily since the event that incited my PTSD to the point that I'm not sure I can make it until the end of the year even (I'm open about this with my practitioners, but they don't appear to take me seriously).

I'm wondering what else I can possibly do? I am currently an Oregonian, but thinking I may even need to move out-of-state (or out-of-city) to get the care I need. My efforts aren't leading to any successes.

 

[Silver.]

I was never allowed to declare a ssri's/ssni's ineffective if I didn't give it at least 12 weeks (which was seriously frustrating because I am allergic to them)
I live in a town of 3k people, so there is one psychiatrist. Primary doctors here no longer prescribe antidepressants or benzos, and that is the reason for the incredibly long wait with psychiatrists. I have yet to find one in an hours drive that takes my insurance, so I understand your frustration with the profession.
But I believe these problems span the US on a whole and not necessarily region specific.
Having recently weaned off klonopin after being on it for 12 years, I will tell you it was one of the worst experiences I have ever been through (and I was at 2mgs), and am still experiencing side effects of the weaning 7 months later. It's definitely not worth being on it.

What do you mean when you say this new psychiatrist didn't go well?
Have you thought of putting yourself into inpatient care?

 

[Kassandra]

I was never allowed to declare a ssri's/ssni's ineffective if I didn't give it at least 12 weeks (which...

My condition is too severe for inpatient care. That is to say, the loss of the things that keep me going in life (having my family around me, knowing that I'm in a safe, familiar environment, having my cat and dog, access to my exercise equipment, television, etc. etc.) would be worse for me than anything, I would say. I've considered it, and I could do outpatient or extreme oversight of medication, but nothing more. My agoraphobia and PTSD triggers are just too high for inpatient right now.

And I feel you with the SSRIs. I'm seriously allergic, but had to stay on them for that amount of time as well, and ended up having multiple trips to the ER during that time (SNRIs put me into anaphylactic shock, but my psychiatrist at the time still insisted that I take them).

The new psychiatrist recommended going off the Clonazepam cold turkey, which I think we all know is just not done. I'm not sure what she was thinking, but she didn't seem very reputable, and also accused me of lying about taking the medication (even though I handed her my prescription bottle from my MD, who had been previously prescribing). I don't know...I haven't had luck with psychiatrists.

I'm not a fan of benzodiazepines as a concept, but they're all I've found that even remotely help me in a minute, small way. I'm always open to trying new things, tapering down off the bentos, adding new medications, trying things that are not medication-related, etc., but I haven't had any luck in the seven years that I've been trying. It also doesn't help that every practitioner I see has very different ideas about medications, and which ones are "good" and which ones I should stay away from. The whole thing is an inconsistent mess that has left me essentially incapacitated.

 

[joeylittle]

Inpatient trauma therapy. Meds won't address PTSD, they can only help alleviate various symptom groups.

PTSD has three main evidence based trauma therapies - Cognitive behavioral (CBT), Prolonged Exposure (PE), and EMDR.

There are a number of inpatient trauma facilities that are nationally recognized. Sheppard Pratt in MD (I believe) is one that a number of members here have written about.

PTSD doesn't shift on its own. Once you've processed the trauma and gotten those specific symptoms to vacate, then you can address the right ways to treat any co-morbid mood or anxiety disorders.

To be honest, anything else is wasting time. It sounds like you've put energy and time into medication, and that traditional inpatient isn't going to help you.

You could do outpatient trauma work, but if you are considering moving in order to get better care, I'd say you are motivated enough to go and do some targeted trauma work in order to take a big step towards eliminating unmanageable PTSD symptoms.

 

[Mona]

I have done inpatient a number of times - I am 50+, and have worked with two different therapists and a number of dr.s. The only thing that has really produced results is the inpatient and consistent therapy. It has been slow but I have had long periods of not being suicidal over the past few years. River Oaks psychiatric hospital in Louisiana has a specialized trauma unit with excellent therapists. They have saved my life more than once.