[Nessa213]

I just don't understand. I had my two week follow up today after starting Lamictal and I just got the feeling he was being incredibly dismissive the entire time. I mean do they just not care about past symptoms at all? I got the feeling that since I was currently not feeling anxious (and I mean like paralyzing anxiety) or highly paranoid that he just didn't care.

And then at the end of the appointment he just couldn't get me out of there fast enough.

I don't know... the whole process is just weird and freakishly slow. I tell him I have been having issues sleeping... to the tune of waking up about every hour and taking about 15 to 20 minutes to fall back to sleep. He says to just take some melatonin. I was just surprised was all I guess.

And a little disillusioned.

[ultramar]

I'm sorry he was so dismissive. I think they must see a gazzilion patients a day considering how little time they spend with each one. Was he like this last time you saw him?

Were you telling him about symptoms you've had since your last visit (aside from the sleep) over the last two weeks, or earlier symptoms? I ask because if these issues were covered in your initial visit/eval, maybe that's why he wasn't as interested (not that that's an excuse for being a jerk, just trying to figure out why). Did he at least note these down for your chart?

As far as sleep, maybe he really does believe in the effectiveness of melatonin, so it wasn't really dismissing your sleep issues. The alternatives tend to be very strong medications, and sleep meds I think can be addictive (in the sense of having trouble sleeping after discontinuing them), so maybe he's particularly cautious about it.

Did he increase the Lamictal? I'm glad you've been doing so well on it!

[bluemountains]

Yes, my experiences have been short pdoc appts. as well. Next time, I suggest you take a list of questions and concerns. Don't let him leave until you are satisfied with the appointment. When is your next visit? If it is soon, a few weeks, then he is in the process of getting your meds regulated, so you need to be precise as you can about how you feel.
Bluemountains

[Nessa213]

He was like that a little the first appointment, but I chalked it up to his tactic to try to see if I was faking it or something. Like for example I would tell him sometimes I will wake up at 3 in the morning with a lot of "chatter" going on in my head. And sometimes I'm so amped that I have to physically pace the house. Then he'd turn it around a few minutes later and say something like "but you haven't had any issues sleeping or anything, right?"

Um... yes... I just told you I did... did you not listen???

In this appointment I really tried to only talk about symptoms I've had in the last two weeks. But when I told him how amazingly paranoid I was or how I had such a hard time on Friday that I just couldn't think straight or walk in a straight line... he just really didn't care. I even went into some of my "husband is cheating on me" paranoia and he puts his hands up and is like "ohhh I can't help you with that kind of thing. Ok sure... you're not a therapist... I get it dude... but give me a ****ing break.

He upped my Lamictal to 100mg and set up another appointment for 4 weeks from now. I AM going to start keeping a list, this is a great idea.

Once I get my meds sorted out I think I might started looking for a new pdoc. :-( Shame because I've been working on this whole process since mid January. I'm just so frustrated.

[eskielover]

I would definitely appreciate his telling you to take the natural melatonin for sleep they try to cram another chemical drug into your body for sleep......sounds like he's on the right track for the sleep issues & glad he upped your dose a little to see how that works over the next 4 weeks.

Definitely keep notes on the days & times that you are experiencing things....that way he knows exactly when it is happening & won't think that you are thinking back to before the medication he's giving you now.

Pdoc's aren't the easiest Dr's do deal with...but then we aren't the easiest patients either....

[ultramar]

Ugh, he sounds so dismissive I know it's a pain, but I would really look for another one. I'm sorry he's like this.

[ultramar]

To add -in re-reading, it sounds like he had a very specific agenda of symptoms he's looking out for and is being kind of literal in that sense.

So when he asked about sleep, it sounds like all he wants to know is if you're sleeping (not if you're having other issues with sleep). As far as the paranoia, I'd guess he didn't think it rose to the level of clinical 'paranoia.' All kinds of people get jealous, think these things when there's no evidence to bear it out. But again, it's dismissive. He should have asked you questions about it, explored it, rather than coming to that conclusion so easily.

So it sounds like he has a set agenda of symptoms he's looking for and really doesn't care about anything that doesn't fit neatly into it.

One alternative is to tell him that you feel he's being dismissive of your symptoms and that these things are really bothering you, etc. If I were in your place I'm not sure I'd bother, but the alternative is looking for another psychiatrist. I think I would. I think sometimes they tend to not be so great interpersonally, but they're certainly not all so dismissive. Good luck.

[~Christina]

Wow , sorry you were treated this way.

I'm a B*itch about my health care needs ( I worked for Doctors my whole life) They do not scare or intimindate me at all , they put there pants on the same way as me.

I was Inpatient a couple years ago .. the Pdoc on staff is a dismissive jerk. he rambled on telling me what I was and wasnt going to do. He got up to walk out the door and I said .... EXCUSE me , we are not done here, You will listen to me and my concerns and Then and only then will this "appt" be over when we agree on a treatment together. He sat his smug *** down and we figured it out.

Ok so maybe that would be a tad over the top for your Pdoc but.... Maybe at the begining of your next appoint start off with a " I think maybe at our last appointment I didn't express myself to where you were able to understand my concerns, Can we make sure we are both understanding my concerns and what treatment we can agree on?"

Good luck !

I'd get another psychiatrist. When he throws his arms in the air and says, "I can't help you with that", you need someone who has compassion, at least. There are good, conscientious doctors out there who are open-minded and considerate.

He does sound dismissive, but lamictal is SLOW to start working and you have just started with it. It will take probably a couple of months to get it up to a truly therapeudic dose. He should be explaining that to you, but I suspect that is why he isn't particularly jumping on your symptoms right now; he knows you are way below therapeudic range yet.

[pink&grey]

Hang in there. I avoided psychiatrists for many years because almost all I had dealt with were non-compassionate drug pushers. I recently found one that spends 30 mins to an hour with each patient and seems to genuinely care. So they do exist.

[Nessa213]

Thanks everyone for the responses!!

It's funny because I'm usually pretty forceful when I really have really strong convictions about something. I've been known to face down the big boss at work and tell him his idea is stupid and won't work. But at least in those particular cases I know what I'm talking about.

I guess I fall under the problem (that probably a lot of other people do I'd imagine) that you get to thinking or doubting your own issues... and if a doctor tells you that it's "no big deal" well then clearly he must be right. What the heck do I know?? I don't know anything... he's the one that went to school for this or has been in his practice for decades.

And as a side note: I'm wondering how immediate the melatonin is supposed to work. I took it last night and it made me SUPER tired... but I still couldn't sleep. It was so ungodly frustrating. I woke up at 2:30 and couldn't move, my body was so tired... but it still took me over an hour to get back to sleep. And then AGAIN at 5am.

And then your head starts working. And working. And working. And it won't EFFING stop working! "Ok.. I need to fall asleep. Am I asleep yet? I wonder what time it is. Hm crap, it's been 20 minutes and I'm still not asleep. Ok... and now.... ok so that didn't work. Maybe if I think about a river... or the woods... or taking a walk. Maybe I should get up and take a walk. Maybe that would help. Nah, then I'll just walk to the kitchen and eat something. And I've really been trying to lose weight lately... although I DID just have Dairy Queen for lunch. Yeah that was a fail. God these ear plugs are really hurting my ears. I should take them out... but yeah then I'd hear my husband snoring, that's no good either. Him being all smug and sleeping. Oh... wait... yeah... sleep. Ok... and NOW!"

And on. And on. And on... for over a freaking hour. How do you make THAT stop???

[cool09]

I totally relate to you. I think PDOCs overlook lots of stuff. I don't get it. They don't dig into your life (past or present) at all to see patterns or how you function on a daily basis. They diagnose you in one session. (I really don't think that's possible with any complex mental disorder.) And they constantly downplay problems or issues that you have that are bothering you. You tell them that your socializing is very dysfunctional (ie can't hold a conversation) and they say, "Well, we're having a conversation right now!" Or I tell my PDOC that agitated depression ran thru one entire side of my family and he has no reaction whatsoever. I feel like my PDOCs never see me like everyone else in the World sees me and it eats me up. Psychiatry is like The Twilight Zone to me.

Melatonin for a serious sleep problem like that? That's unbelievable. Melatonin will hardly do anything to you.

If you're waking up in the middle of the night with lots of energy you might be hypomanic. I had that side effect with Prozac - wide awake at 4 AM and wanted to run around the block a few times.

[Nessa213]

Originally Posted by cool09

I totally relate to you. I think PDOCs overlook lots of stuff. I don't get it. They don't dig into your life (past or present) at all to see patterns or how you function on a daily basis. They diagnose you in one session. (I really don't think that's possible with any complex mental disorder.) And they constantly downplay problems or issues that you have that are bothering you. You tell them that your socializing is very dysfunctional (ie can't hold a conversation) and they say, "Well, we're having a conversation right now!" Or I tell my PDOC that agitated depression ran thru one entire side of my family and he has no reaction whatsoever. I feel like my PDOCs never see me like everyone else in the World sees me and it eats me up. Psychiatry is like The Twilight Zone to me.

Yes! YES!!!! ****ING THAT!

[ultramar]

In terms of questioning yourself, one thing I have learned on this forum is the enormous variety of experiences we all have. And I suspect that many psychiatrists -the 'experts'- may be less open than they should be about the fact that everyone is so different. So if he has in his head: no sleep = bipolar episode, and you talk about serious sleep issues, but that don't fit into his box, he's having some tunnel vision.

I mean your sleep issues may not be directly related to bipolar, but so what? I think psychiatrists should be helping us with whatever is going on, not just things that fit into neat boxes, or even only things directly related to our primary diagnosis. Even if he didn't want to prescribe something stronger than melatonin (as I've said, not necessarily a bad thing) he could have given you advice on what I think they call 'sleep hygiene' (the not exercising before bed and that sort of stuff) -advice, in any case, specifically related to your issue.

If he didn't think that what's going on with your husband rises to the level of 'clinical' paranoia, so what? That's no reason to dismiss it. He's not your therapist, but as a psychiatrist he could talk about what he considers 'paranoia' versus other things. They're supposed to do 'psychoeducation,' right?

There's no good reason/cause to be dismissive. It's not you. I think he's a poor communicator or just doesn't have much interest in communicating with his patients.

Maybe he's been having mini-strokes and it'll pass, it'll get better. I would try to press him, though. Maybe, for example, "Whatever 'this' may be, it is affecting me a lot/causing a great deal of distress/making it very difficult to function during the day, what you do think I can do about it/can you help me with it?" If he says, 'no' at least then he's being honest in a way, instead of skirting the issue...

Good luck

[Trippin2.0]

Originally Posted by Nessa213

"Ok.. I need to fall asleep. Am I asleep yet? I wonder what time it is. Hm crap, it's been 20 minutes and I'm still not asleep. Ok... and now.... ok so that didn't work. Maybe if I think about a river... or the woods... or taking a walk. Maybe I should get up and take a walk. Maybe that would help. Nah, then I'll just walk to the kitchen and eat something. And I've really been trying to lose weight lately... although I DID just have Dairy Queen for lunch. Yeah that was a fail. God these ear plugs are really hurting my ears. I should take them out... but yeah then I'd hear my husband snoring, that's no good either. Him being all smug and sleeping. Oh... wait... yeah... sleep. Ok... and NOW!"

And on. And on. And on... for over a freaking hour.

This is how I always fall asleep, Idk any different save for the 3 nights a month I basically pass out cold. I've only discovered in recent years that not everybody spends 2hrs falling asleep. It irritates me sometimes and idk any better, I can only imagine what it must be like for someone who isn't used to it