I wasted one year with my psychiatrist in an insomnia crisis. This is the letter I sent her after a new one agreed to see me (took a while). I've obviously built up a lot of anger, but here it is.

Att Dr. G-n

I decided to go with another doctor because, in a year, my insomnia is just getting worse under your care.

After three evaluations, the new psychiatrist decided to take me on as a patient, the day after my last appointment with you. She prescribed the same 5 mg. of Zyprexa I was begging you for, and she added the 5 mg. Ambien you wouldn't give me to wean me off Restoril. She'll see me in a month and is available by phone for urgent matters. She returned a call in a few hours when I wanted to know if there would be any seroquel withdrawal symptoms. With you, I have to wait until an appointment to discuss really critical issues, like insomnia.

The new psychiatrist also upped my lamictal to 200 mg. I had been inching up the dose and not telling you because you told me to leave it at 100. The new psychiatrist said I should have been on a bipolar dose all along, not the anti-depressant dose of 100 mg.

The most disconcerting point in my treatment with you was when you switched the low-dose Seroquel prescription from an insomnia drug to a mood stabilizer version (Extended Release) without discussing it first. I was caught in a bind at the pharmacy, where a pharmacist questioned your bedtime dosing instructions for a med that kicks in four hours later and the copay had jumped from $5 to $20. When I contacted you by email, you said you intended to give me a different form of seroquel and you were unwilling to give me even a few doses of the instant release Seroquel to carry me through to our next appointment. My anxiety really broke through at that time.

I should have never had to call my primary care doc to extend my script of instant release seroquel and restoril. He agreed I was prescribed the wrong type of seroquel and that I was doing my best to get off of restoril. My new psychiatrist also concurred on the Seroquel and said she would never prescribe a new drug without first discussing it with a patient.

You also didn't respond when I emailed I was running out of restoril so I started rationing them by splitting capsules and dumping powder in water. Your assuming I had enough implies I'm making things up.

I also should never have had to go to Urgent Care on Feb. 3 for low dose Seroquel after begging you in an email for a single dose just to try to break the cycle of getting snatches of 1 to 3 hours of sleep by popping restorils throughout the night. It gradually slowed my breathing and speech and had made me depressed.

I'm made to feel I'm to blame for my side effects and symptoms. Like when you say all your other patients on Seroquel XR get knocked out immediately not four hours later, and you're baffled why I didn't. And then I tell you a side effect or symptom I have and you say you've never heard of it. That makes me feel that something is wrong with me. Same with trazadone. Asking me what I meant by foggy really upset me, because the trazadone hangover is well known. And being baffled by a drug that works for me for a time then stops makes me feel like it is my fault. With the restoril side effects and tolerance, you said, I picked these drugs, so I have to live with it, at least til our next appointment. That's like, you made your bed now lie in it.

Telling me I need a better therapist to help get to the psychological root of why I can't sleep or can't cope with chronic insomnia is throwing up your hands in frustration and blaming me for the problem.

In my long years of psychiatric care I have never sought out doctors to fill scripts or had to go to the ER or urgent care for a mental health reason. Never have I had to manage my own meds. Psychiatrists get back to me by phone for urgent matters or try to find a 15 minute slot between my regular med checks. And, the only urgent matters I've had are insomnia, paralyzing anxiety from major flare ups and hospitalization due to ulcerative colitis and prednisone psychosis. Every other symptom or side effect of a drug I've been able to manage with a psychiatrist on a non-urgent basis.

As far as the rapid weight gain issue and metabolic syndrome, I met with my PCP to discuss how, if possible, I can outsmart Zyprexa on a gluten free diet and with mental retraining and exercise. Last time I took it I was on weight-gaining steroids and 25 pounds underweight from disease. I wasn't interested in another SSRI after you took me off Lexapro because four made me gain weight. Without addressing the sleeping issue, Lexapro and other SSRIs are worthless to me. I've always been on something extra for sleeping, and addictive sleeping pills only during my many months on steroids.

I have lost a couple of pounds on Seroquel. Maybe it will be different with Zyprexa this time around. I also apologize for this, but I don't feel that comfortable dealing with you personally on weight gain issues because your are morbidly obese. And, your witholding of Zyprexa because of tardia dyskenisia, that's for large doses. I wouldn't have been put on Zyprexa four years ago for several months if it was such a big risk at a low dose. My insomnia began when I ran out of my occasional off-label doses of 2.5 mg. Zyprexa last year. And you wouldn't fill it because of potential tardive dyskenisa and I haven't had a good night of sleep since.

There are so many times that I felt you were 10 steps behind me, and just validated what I was doing during appointments and wrote scripts for it. I also feel you didn't study my complex case seriously. You gave a cursory reading of a thick stack of medical records from California right in front of me as opposed to assessing it thoroughly before the appointment.

I just feel I've wasted a year with mismanaged care in your mandatory 45 minute sessions that were unneccessarily frequent and too long. I feel like you manage patient care on the fly, have no plan, and are inflexible about backups and options if something doesn't work. And when the care gets tough and complicated as in the case of possible bipolarity and insomnia, a patient has to wait for a session when every night can be an ordeal. I was desperate for options and it was hard for you to move forward until an appointment. So I had to advocate for myself by seeking outside help.