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Typical Psychiatrist Appointment?


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Hi, everyone.

I've been suffering mostly from generalized anxiety and mild depression for many years but only recently has it really affected my ability to function. My primary care physician had me start up on generic Lexapro in the summer but this did not work out well (my major problem is fatigue, which got a LOT worse during the weeks I was on the medicine - I couldn't even go to work after a while).

For the first time, I saw a psychiatrist today, thinking a medical specialist would be better for finding the right medicine and dosage. However...

- he was very dismissive of my blaming Lexapro for the debilitating fatigue I had during the summer. I didn't like that.

- after speaking with me for only 15 minutes, he was very quick to prescribe a different medication -- a more expensive one, and one he knows might interfere with liver function (which could be a separate issue I'm still trying to get to the bottom of).

- he "outsources" the therapy part of treatment. I'd have to see a social worker/counselor for that.

Is all this the typical way psychiatrists approach things (in the US, at least)?

On the positive side, he did ask some astute questions to help me look at my situation more objectively (which is always tough, esp. with psych. conditions). But, after this experience and the Lexapro prior, I'm VERY hesitant to jump to any new meds and I'd prefer to talk to a counselor a few times and just have my primary dr. help with meds later, if necessary.

I'm pretty new to this whole thing and was looking to see what other people think and experience.

Thanks.

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I don't have personal experience with a psychiatrist, but this is exactly why: they're always so quick to jump to a medication as a solution. Don't get me wrong, I have nothing against medications - they've certainly helped a lot of people - but I am a firm believer in a more well-rounded treatment as the best solution, i.e. medications in addition to some type of therapy, like CBT. The "outsourcing" therapy sounds pretty normal to me. As I said, most psychiatrists just deal in medications.

There's nothing wrong with questioning your treatment, nor is there anything that says you have to stick with a therapist even if you don't like them. If you're hesitant to go on another medication and prefer to start off with talk therapy, then by all means, do so. A good therapist will be respectful of your decision.

Edited by apple_bloom
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Hi Had Enough

My experience of 20 yrs seeing a Pdoc, is they usually see you for 15 - 60 min., ask lots of questions, about How You are. How are You sleeping? Is the depression better on the meds? Are you seeing a good psychologist using CBT therapy How is that going? When are you feeling the worse? Best? Etc.....

A good Pschychiatrist has to be a very good chemist these days, usually giving you 1 to 3 med mixture for How You are. Everyone is different--which makes his work harder. What works for one doesn't for another.

And Yes they usually deal mostly with the meds and encourage therapy thru a Pschycologist who works with CBT and EBT therapy.

All I can say is I've changed Pschychiatrist and Pschycologist to find one that fits for me over the years. That has been my experience.

Hope You get to feeling better.

Just Never Give Up----There is Help out there for You!

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Yes, a mental health specialist will be better than a primary care physician for these matters, all else being equal.

In my experience, not typical. 15 minutes to assess and prescribe a new medication seems woefully insufficient, but maybe i'm naive and he's a flipping genius. I've managed to choose physicians that took the time to exchange information not just to his or her satisfaction, but moreoever to my own satisfaction. They're ok with therapy on my own time, but they want sufficient time with me regularly themselves because (in part) they've felt a lot of responsibility in prescribing anything affecting brain chemistry.

So many factors can play a role in depression and there's so much information that can be gathered before shunting off a patient to tough out two months of trying a new med which may or may not be appropriate.

Do you have follow-ups scheduled with him to assess the status of the medication?

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apple: Thanks for validating what I was thinking. Sometimes I'm hesitant to trust my own instincts since I'm, by no means, an expert at this, nor can I be objective. Re the "outsourcing" I'm fine with that. I guess I was expecting that they do everything -- not sure why I thought that (1980s TV, maybe? lol). Is your approach to treatment exclusively CBT right now? I think that's the next logical step for me and I think it would help quite a bit, medicine or not.

coyote: Thanks for the encouraging words. I wanted to see how much of an "attitude adjustment" could help before I try another med (or combo. of meds - esp. since I'm a little gun-shy right now about that side of the treatment).

saros: The appoinment was probably a little over 30 min. in total, and while he didn't heavily push the pills on me, I guess you could say he was encouraging it w/ the free sample and everything. I sort of had a choice, but I'm very passive by nature and didn't feel it so appropriate to be so openly skeptical. Something I need to work on, I know. I have a follow-up appt. scheduled in about 3 weeks. I think the assumed topic would be the meds. But I'm not gonna take them for the reasons I already stated and I'm gonna postpone or cancel the appointment outright. The more I think about it, and based on what you wrote, I'm probaby better off not going back. I am going to call the therapist he recommended though.

It seems you've found good doctors. It's hard to find a good doctor around here (Central NJ), who takes insurance and has hours compatible with people who work regular business hours. Even much of those dr's have lousy-to-mediocre reviews online or none at all. Haven't seen any good reviews. I just happen to choose this first one b/c of proximity and the wait for a 1st appointment was within the same month (reviews were pretty good). It's daunting to just pick anyone out of the insurance directory, but maybe I have to. Any pointers?

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had enough,

I'm currently not in treatment, but when I was it was exclusively CBT. I felt like I was functioning well enough despite my depression and didn't need medication. My therapist agreed but it was always available as an option in case things changed. If you want to try working through your depression without medication, there's nothing wrong with that. Even if you're not an "expert," you still know yourself and what you're capable of.

I actually picked my therapist out of my insurance directory and looked into her online. It helps to look at their specialties, their credentials, and their methods of treatment. Usually you can get in touch with them prior to making an appointment and let them know what you're looking for in a therapist. You can even ask to have a preliminary meeting just to see if they're the kind of person you want to work with. There's nothing that says you have to stick with a therapist you don't like, just because you've had an appointment or two with them.

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Any pointers?

Well that stinks you feel he's a bad fit. For what it's worth, I have to pay out-of-pocket for my psychiatrist appointments, and that gave me more choice in the matter. The way I chose them was by asking peers who had therapy "what's your psych like?". When someone described what I wanted, I got the phone number. Consulting peers is probably too revealing a strategy for most people, though.

When it came time to change psychs, I asked for my current psych's recommendation selected from her peers, and that was considered over a few appointments. Recommendation based on what I wanted, mostly, but what she thought would be best for me too.

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