Panicked And Walked Out On Psychiatrist

[anonymous12345!]

Why not call, leave a message asking if you can increase just your trazodone? Make a direct request if you are playing phone tag.

Because I really need to discuss my potentially bad reaction to one of the drugs (trazodone or paxil - not sure which). I feel that that is more important than getting permission to increase my trazodone. For all I know, my reaction is bad enough where he would recommend I get off it.

All of the reasons you listed are the reasons why I wanted to try trazodone. He recommend I take it about an hour before sleep, which is what I've been doing.

 

[joeylittle]

He recommend I take it about an hour before sleep, which is what I've been doing.

Yep. It does just take some time to titrate up to a working dose. It's always up to the individual doctor, but I took four weeks to get to 100mg.

I know it's really hard navigating this stuff and feeling like you don't have a conduit to your doctor.

I also had to ask about how I could contact him in case I ran into any issues with the meds. I thought it was odd that he didn't just provide all this info up-front to me. I mentioned it to my therapist and she didn't really comment on it, so I thought maybe it was standard practice. I'm wondering why you're saying psychiatrists are hard to reach. How is that possible?

What you are going through is very similar to what I remember feeling. My very first psych saw me for 40 minutes, gave me cymbalta and a dosing schedule, and said he'd see me in a month. I relied heavily on my then-therapist just in order to take the damn stuff, not to mention having never really taken any regular medication in my life and not understanding why it was OK for me to be waiting four weeks with no exchange of how it was going.

Psychiatrists are not therapists; it's useful to remember that they are physicians. Most physicians will not consult on anything over the phone, they want to see you in the office or they want you to go to a hospital in crisis. Otherwise, they need you to follow the standard protocol for what they are dosing. It's partially liability, I think, but I also understand the logic behind it - they need to have your physical body in front of them to really do what they do, even when it is making determinations about anti-depressants.

Your job as a patient is to read all the literature that comes with your prescription (which it sounds like you have done). When you go to the pharmacist and they say "do you have any questions for the pharmacist?" it's not just to be nice - its because many people end up with questions they didn't ask their doctor about. Pharmacists are really, really knowledgeable, and you can consider going to talk to yours about your interactions. They are trained for that.

I think I am lucky that I ended up finding a psychiatrist who also does therapy, and she does have an interest in making sure her patients are not having anxiety about the medication process. But it was for sure hard for me, before I had her, learning how little emotional support (as in none) I could count on from my psychiatrist. It's just not what they do. They start with the drugs that they believe will work best, and adjust from there.

Maybe you can get more direct support from your therapist for the anxiety you are experiencing around the medication, go and see your pharmacist and discuss your interactions and concerns there, prioritize taking the call from your doctor (if you can at all excuse yourself from whatever you are doing for 15 minutes), and if you cannot shake the feeling that something is medically wrong, then go to the ER.

(I'm not going to tell you that you don't have seratonin syndrome, but it is important to remember that it has onset within a few hours of taking whatever is pushing your seratonin too high, and that the symptoms really show up like symptoms and they don't lessen. So, shaking that happened for the first 24 hours but now is gone is an indicator of a side effect, not a syndrome response.)

 

[anonymous12345!]

I relied heavily on my then-therapist just in order to take the damn stuff, not to mention having never really taken any regular medication in my life and not understanding why it was OK for me to be waiting four weeks with no exchange of how it was going.

Exactly - I can so relate! Thank you so much for your very detailed response. It helps tremendously. I wasn't really comparing psychiatrists to therapists as much as I was comparing them to primary care doctors. In my case (I don't if this is unique to my doctor/location), any time I contacted my primary care physician with medication-related concerns she always got to me the same day. I just figured it was standard protocol and had to do with liability. I really figured it would be same for psychiatrists given that they, too, prescribe meds. I'm truly not looking for a second therapist, in fact, quite the opposite. I just need him to be my doctor and work with me to get me on some meds that actually help.

Your response clears up a lot for me, I feel really dumb that I didn't know how psychiatrists work. I even ran my questions by my therapist, who has tons of experience, and she really couldn't explain why a psychiatrist wouldn't return calls. In retrospect, perhaps she felt professionally uncomfortable answering since my question pertained to a specific doctor whom she referred me to. I think her answer was somewhere along the lines of, "I really don't have a good answer for that."

About the pharmacist. When I picked up my prescriptions, she actually questioned me whether both the trazodone and the paxil were prescribed by the same doctor. When I confirmed that they were (and said the traz was for insomnia), she then warned me to be on the lookout for reactions specifically between these two drugs. She seem to disapprove or be concerned or something. Your idea to speak to her is a good one, however I am kinda embarrassed to do so given the lack of privacy in the pharmacy and my unease over taking anti-depressants. I wish they were called something else, because I'm sure the pharmacist just thinks I'm depressed (I'm not). To be clear, my comments are not meant to ridicule anyone who is taking anti-depressants for depression, it's just my own personal hang up.

That's great that you were able to find a psychiatrist who does therapy. That must make the medication and therapy processes much more effective overall. I have spoken to my therapist several times in the last week about the medication issues, and she's been quite supportive, but she wants me to speak with my psychiatrist because only he can actually provide proper medical advice.