Frustrated after Visit to GP

So I went and had my first consult since starting Lithium, my levels are 2.3 so he's upped the dose to 650mg, thats all fine and dandy but he then asks what my symptoms are ( is he kidding me ?? )

and proceeds to tell me that the chatter and music in my head is 'Normal' and that although there are different forms of Bi-Polar none would have my moods changing from up to down in the same day or within a couple of days !!!

He tried to tell me I'm perfectly Normal just anxious and depressed.

We discussed my wanting to change from Effexor to Celexa or Lexapro he asked why .... I said because I have read that the SNRI can actually cause manic episodes and I dont think the effexor is working because I AM NOT DEPRESSED !!

I dont think he liked the fact that I had bothered to look up my meds etc.

but if he doesnt think Im Bi-Polar WTF is he upping my Lithium dose ...

I know I should have insisted but I was so frustrated at the time that I just agreed to the 650mg of Lithium for a month and then he said he will look at referring me to Psych services !

All of the above demonstrates exactly why I want the referral in the first place, he has no idea of my full history nor has he asked about it and hes just chucking meds at me to see if they work.

I feel so disappointed

But there is no way I am leaving the next appoittment without a referral.

(Most, if not all) GPs aren't qualified to diagnose mental health issues... you need to insist on getting a referral to a psychiatrist.

Mine tried to give me seroquel right after I said that I probably needed to see the psychiatrist - she ignored my 1 request of not taking a med that had a huge chance of weight gain.. and I'd read somewhere that seroquel isn't recommended for people with a family history of diabetes. Plus, why on earth was she trying to give me an antipsychotic? I don't have issues with that. She was trying to give it to me because I explained just how little sleep I'd been getting since starting sertraline (zoloft). I don't think someone should prescribe an antipsychotic as a sleep aid when there is no other reason for an antipsychotic! So I flat out said no.

Thanks Red,

This is exactly why I have always checked and double checked any meds and contraindications that he gives me because I don't trust his judgement. Right now, for me he is just a means to an end ( getting the psych consult ) and so I will play along until the next consult.
I understand he wants to get the lithium levels correct to see the results first, that's fine, but I am holding absolutely no weight in anything else he has said .... in fact ... maybe the very very fact that I am not sat crying in a corner right now, shows the lithium is helping afterall !

If he won't give me the referral next month ( thou I believe he will because he said he didnt want to mess with my effexor etc and we should leave that to psych services ) I will be forced to get a second opinion which won't be easy because I live in rural Ireland where Dr's are few and far between.

I don't 'want' something to be wrong with me. I just want there to be nothing wrong with me which clearly there is looking at my History ...

big breath in ..... and .... relax

Unless there is a new/different therapeutic range test for Lithium, 2.3 would be toxic.

And, do not just accept. It is dangerous. (I speak as an RN)

Red Panda: Actually, it is not uncommon for them to use Seroquel as an aid for sleeping and while it is an antipsychotic, it is also used as a mood stablizer in Bipolar patients as well even though there are no voices or psychotic indications. I've been on Seroquel now for a couple of months and it helps with sleep(a little too much help) but I have been existing on samples. After finding out what it costs without insurance I had to ask the doctor to change me. He changed me to another one and after looking it up I found that it is more than the Seroquel. Ugh! I'm getting frustrated, too.

I, too, take an antipsychotic to help me sleep at night (saphris). I'm definitely not manic or psychotic at this point, but when my pdoc suggested I go off it, my sleep was horrible. My bedtime cocktail includes lunesta, saphris and klonopin, and that has me sleeping a pretty solid 7-8 hours.

Given the side effects and risk of APs (including having damaging effects on brain), this should NOT be common and as a first thing you get thrown on, though.

Using overkill medicine is not just psychiatry's thing. Look at how many doctors use anti-biotics for flu or cold... but it doesn't make it right.

That should have said 0.23 mmol/l

If at all possible (I realize you are in a different country and medical care protocols are different), please try to get to a psychiatrist. A GP really shouldn't be messing with lithium, and it doesn't sound like he really knows that much about BP. .23 is a very low lithium level. Therapeudic range is generally .80-1.2.

Before I saw a pdoc, I saw a GP - not my usual GP either- for my symptoms. He said I had PMDD and gave me Celexa. Even my old Pdoc gave me Celexa. It took a while to get referred to a pdoc and for that pdoc to say I am bipolar and then even longer to get told I am bipolar 1. You know what you know. Just keep sticking to your guns!

My 4 year old son with autism had a neurologist that wanted to put him on seroquel for sleep...uh, no.

It would make him sleepy, for sure! Some doctors seem to dole out antipsychotics like candy on halloween! That happened to me and my eldest when he was 12. We ended up putting him on an antipsychotic for a few months- risperdal- three years later, but now he's off and doing well in talk therapy.

Hi Sierra,

Here in Ireland The UK Electronic Medical Compendium recommends 0.4–0.8 mmol/l plasma lithium level in adults for prophylaxis of recurrent affective bipolar manic-depressive illness. My Gp is aiming for 0.4. the 0.23 is from my very first blood test after only 1 week on it.

Having had a chat with DH we have decided that he will come with me to my next appointment and insist that I need the full evaluation. He has no doubt in his mind that what he has witnessed are manic episodes and he feels if he comes with me for support the GP will comply.

I really appreciate your concerns and believe me I am doing everything I can to get where I need to me

I cried when GP sent me to pdoc, he said, "well you didn't like the med I gave you". (Lexapro). But I felt blindsided, no idea I had anything more than depression going on. And that he gave up so easy - why not just let me try the trazedone like he gave my mom? I wish I didn't have this bp bs.

It's sad to hear you got turned down when you want a pdoc.

He tried to tell me I'm perfectly Normal just anxious and depressed.

I don't know what 'normal' means here, but most certainly anxiety and depression are plenty to deal with and not to be minimized; I guess what I'm saying is that diagnoses of anxiety and/or depression are not necessarily any less of a challenge than a diagnosis of bipolar disorder: both can seriously affect your quality of life, not one necessarily more than the other.

But I know that in addition you are concerned about mood swings, and that your GP is not validating this. But he does have a point about the frequency of these mood swings --As I always say, I see bipolar as an experience of episodes of mood, pervasive, despite what is going on around you, which is why the criteria for length of time; I don't think it's random, I think it has meaning in the context of the pervasive nature of 'bipolar episodes' verses 'mood swings.'

My understanding is that mood stabilizers are not just prescribed for bipolar disorder, but also, at times, for Borderline Personality Disorder, as an adjunct to therapy in controlling mood dysregulation.

The frequency of your mood shifts is unusual in Bipolar, though not unheard of. I don't understand why your GP wants to wait, but I would make an appointment with a pdoc and by way of preparing for the visit, start journaling about your moods: what you're feeling at any given time (happy, sad, irritable, depressed, anxious, hopeless, empty, etc., etc.), how long these feelings last, and especially what is triggering them, which can be difficult to discern at times.

I'm sorry you're not feeling heard by the GP --I wish you the best of luck in finding the diagnosis(es) and treatment that works best for you; it sounds like your current medications are not entirely effective. Are you in therapy? Believe it or not, this can also help with mood swings/emotion dysregualtion, I highly recommend it!

I just wanted to say a huge thank you, for your advice. I started keeping a Journal the day after you made the suggestion and just that in itself has helped enormously. It's actually very theraputic because I can work through my thoughts and anxieties and see some answers in my ramblings.

Hey FaithlessCat- sorry to hear! My experience is limited but, I didn't have any success with Lithium or Effexor! Both have major side effects especially weight gain. For me, I love what I call the 4 L's...Latuda, Lamictal, Lexapro, and Lorazepam! I find that it's all about the right dose and med cocktail which only you can determine. Best of luck!!

You might ask about Ambien (zolpidem) as it is available as a generic. I take it and it is good for putting your right to sleep but doesn't always keep you asleep. It is supposed to work for 8 hours but it doesn't for me. Actually, I take 1 mg Klonopin at bedtime and if I am still awake after an hour I take the zolpidem.

Funnily enough I have asked to be switched to lexapro ( although I have tried it once LOVED it but not it's side effects ), I want to switch to that or celexa, but GP is saying he wants to leave that to the Pdoc ... If I ever get there !!