[Hopeful Camel]

I have been seeing my general practitioner doc for psych meds for about a year now. I keep feeling like I should be seeing a psychiatrist, but my doc says she can handle it.

Do folks have an opinion as to whether a GP can handle someone with Bipolar I and PTSD - handle their med management, or whether I should find a psychiatrist or psychiatric nurse practitioner? I originally started seeing her because the wait to see a psychiatrist was 3-4 months long, and I can get in to see her in a week.

[RisuNeko]

I think psychiatrists are much better trained. I've had bad luck with a nurse practitioner. He's the one who put me on most of the meds I'm on now that I wish i wasn't on (minus the geodon and the clonopin and the ambien).

[Angelique67]

I agree, I think most psychiatrists are better trained in meds at least for psych conditions. But if you trust your GP and she/he is good, do what you feel is right.

[UCMATH]

Definitely a psychiatrist. Psychiatric illnesses are their business. They know more about how different psychotropic drugs will affect you and have a better understand of how BD works. They're usually up-to-date on the newest treatment options and research studies on BD. A GP is less likely to do that research, because they don't spend much time focusing their attention on Bipolar patients.

Yep, I have an opinion and it's "Absolutely not!" Not unless they're extremely unusual. Maybe you could ask her if she has had special training for psychiatry. How are you doing with her handling your meds?

[Crazy Hitch]

I see both.

My personal opinion is.

I have issues.

That my GP alone is simply not able to help me manage.

But this is just for me personally.

[Sinking Feeling]

your lucky your GP can handle it, mine wasn't so sure so I was sent to a pdoc. Believe me your not missing any thing. They are for the most part script writers, thats all. You may benefit more from seeing a therapist since your GP is taking care of your meds.

[UCMATH]

Originally Posted by Sinking Feeling

your lucky your GP can handle it, mine wasn't so sure so I was sent to a pdoc. Believe me your not missing any thing. They are for the most part script writers, thats all. You may benefit more from seeing a therapist since your GP is taking care of your meds.

It depends on what pdoc you're going to. I got lucky enough to be near a university medical center with some great psychiatrists. The doctor I went to always spent around an hour with me discussing treatment options and how I was doing. He allowed me to choose my own medications after he made sure I knew about the possibilities, because he knew I'd be more compliant that way. He's one of the best doctors I've had, and I've had more like him.

I would prefer a psychiatrist.

[Victoria'smom]

I wouldn't trust a gp enough. Luckily here they do emergency treatment then refer to pdoc. I do like that you have such little wait time.

It shouldn't matter as long as they serve you well. Are you stabile? Then they did well. Treating MI is all about treating the symptoms through a trial by error basis. Any monkey can do that. Pdocs are over priced med dispensers, IMHO. My NP and I zeroed in my meds before I saw a real pdoc who didn't do anything except dispense the same meds.

If you feel concern about your present medical providers competence, I'd do some looking elsewhere. Good luck!

[gayleggg]

You are lucky to find a GP that feels like they can handle a person with bipolar. Mine wouldn't touch my psych meds and refused to see me unless I was also under the care of a pdoc. But I think that a GP that has done their homework could be successful in treating you. Personally, I feel that my pdoc understands me better than my GP so I like seeing a psychiatrist.

[Nammu]

Depends on the person behind the label. Sometimes the GP is better, NP usually devote more time to you and Pdocs have a narrower view of overall health. If your GP is doing well why mess with a good thing.

I have an excellent GP, but he does not feel well-versed enough in the nuances/interactions, etc. of psych meds to handle more than mild to moderate depression and mild/moderate anxiety. He was very upfront about that from the beginning, and as soon as it was clear my issues were more complicated than the above, he insisted I see a pdoc. My pdoc's vast knowledge of psych meds and how they can be used in combination, etc. is vastly superior to what my GP knows, and he realizes that.

[scatterbrained04]

For the most part, I prefer a psychiatrist to handle pysch meds for both my son and I. They tend to have more training, clinical experience, and better knowledge of the medications and their potential side effects.

[Turtlesoup]

For myself I prefer a pdoc because I had some very bad experiences with regular docs-from a nursing standpoint I usually recommend patients see a pdoc. However I'm sure there are lots of good Docs out there that manage people well. If you are feeling stable, healthy & comfortable then that's a good thing. If not your doc should not have a problem writing you meds while you wait on a referral. Take care

I've had the worst awful luck with psychiatrists both in their medical advice and their manner so i just see my GP. He's better at handling my bipolar than any psychiatrist i ever saw. He knows anti-depressants cause mania and won't prescribe them -- my psychiatrist did. He recognized when i was manic last year and planning a vast and foolish renovation -- my psychiatrist didn't. She was also very cold and didn't even offer a word of human kindness. My GP is warm and offers appropriate support. I was dreading seeing her and feeling awful afterwards so it's a big relief to be back under the care of my GP. He's got good common sense. Whatever works for you, tho.

[~Christina]

My Gp was a therapist for 5 before he decided to go back to school to be a MD.. So he has more of a working knowledge of psych stuff that helps,. but I would not let any GP manage Psych meds ( I'm not on meds currently)

"Most" GP's just don't have enough training to handle more than a garden variety depression, IMO .

Psych meds and how the interact with other medications need a specialist..

If I have say ....epilepsy I'm not going to let my GP manage my treatment, I would see a Neurologist as they just know more about the meds and treatments.

Just my opinion of course...

[UCMATH]

Originally Posted by ~Christina

If I have say ....epilepsy I'm not going to let my GP manage my treatment, I would see a Neurologist as they just know more about the meds and treatments.

That's the example I was going to use, but I forgot to. Glad you used it. My bro has epilepsy, and his GP won't touch it. I feel like the same would apply to most mental illnesses.

[~Christina]

Originally Posted by UCMATH

That's the example I was going to use, but I forgot to. Glad you used it. My bro has epilepsy, and his GP won't touch it. I feel like the same would apply to most mental illnesses.

Yep !

A member here sent me a PM recently and they were in a mess, flu, chest crap , went to a walk in clinic and was given 2 shots .. one rochephin Antibiotic (fine) and one a steroid ( not fine) and a script for antibiotics as per the norm. ..

Had that provider "thought" to include the patients psych illness and medication , that person would have avoided the Steroid as it "usually " sends Bipolars into mixed or Mania... So this person had to not only recover and deal with that nasty bronchitis upper respitory crap , they also had to tame Bipolar back down , because the provider wasn't educated enough on Bipolar .

The member here didn't have a clue that the shot is what destabilized them so quickly. Know they know for the future, but meanwhile its major suckage.

Originally Posted by ~Christina

"Most" GP's just don't have enough training to handle more than a garden variety depression, IMO.

IMO too. Plus, it is what they most encounter. The problem for many is in simply not recognizing the less familiar. Presuming the familiar, there's a tendency to be kind of lax and rote about it.* Even if they don't mean to be lax about it, they often don't give enough thought to consider differential dxs and how to suss them out. And then there's meds.

A glaring example from personal experience…
I was first misdx'd with MDD by a GP. She "cross-examined" (the real word eludes me atm) for BP with three words. "So, no highs?" This is of course woefully inadequate information-gathering and also shows a lack of understanding of cognitive effects of severe depression. A brain in deepest mire just isn't going to make those leaps of meaning, especially if there is no knowledge about BP already residing within that brain(!)

A lot of (AD) hell stood between that moment and me realizing that dealing with my brain was way out of her depth. It's good when they can recognize this for themselves, but often, they don't.

Got a referral for a Pdoc. Later I went with a PMHNP. The only involvement my GP (not same one!) has with psych stuff is seeing my meds on a list.

For your situation, I think the biggest thing to determine is if the GP route is working for you. If it is, I'd still recommend being very informed. (You want to ramp up Lamictal HOW fast??!!) Being informed is a good idea regardless, but especially important when dealing with someone who doesn't specialize in it.



*There is an expression that I think applies to the situation in terms of most GPs, and here is the heart of it. From wikipedia.

"The concept known as the law of the instrument, Maslow's hammer, Gavel or a golden hammer[a] is an over-reliance on a familiar tool; as Abraham Maslow said in 1966, "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail."[1]"

Or with anti-depressants. Just sayin'.

(Wow, sorry so long!)

[BipolaRNurse]

I was lucky in that my internist recognized that he was out of his league in trying to treat my illness, and sent me to a psychiatrist. I'm also lucky because my pdoc is also my therapist---one stop shopping as it were. I love my internist, he's a great guy but I wouldn't want him to try to manage my psych meds. Getting my bipolar under control has been hard enough even for my pdoc. I wouldn't ask that of a GP.