Disappointing visit with psychiatrist

Monday I had a appointment that I needed for a long time with a psychiatrist after suffering from worsening anxiety that has left me feeling constantly overwhelmed.

The room was packed with patients. This was a red flag to me. I arrived on time. There is one doctor, and 5 other patients in the room. Two things went through my mind... that I would be waiting a long time or he was going to breeze through these people.

20 minutes later a receptionist took me in a room and began asking questions on why I was visiting, what I was feeling etc. It was more of answering questions than being able to explain.

10 minutes later the doctor comes in. Thick accent. Seemed to briefly read what the receptionist wrote. Asks me about my history, parents, partners. Didn't ask me anymore questions about my problems. Five minutes later he hands me a prescription and tells me to come back in a week. I spent more time with the receptionist!

Maybe anxious me is always going to find something wrong, but this just didn't seem right. I never really got to explain myself, and (know how forgetful I am) wrote down a good list of what to tell him. I never got to. He smiled, said "We'll get through this" and went off to the next patient.

He prescribed me Klonopin and a med I've never heard of- Brintellix? He gave me a sample of the Brintellix in case my pharmacy couldn't give it to me in time. It all happened so quickly I didn't get a chance to even ask him about the Brintellix.

Guh, I'm not sure what to think. My mother who also works in the medical field said to make another appointment with a recommended doc and just see this one until I can see the other.

The Klonopin I'm ok with. Has some things that worry me, but more things that make me feel it will help me. The Brintellix makes me nervous. It's not been out for very long and all the reviews for it are from people with major depression... I'm not depressed. I know anti-depressants can help with anxiety, but I'd prefer something more... common.

Since he is a doctor after all, I'm not sure if it's proper to just take the Klonopin and not take the Brintellix when he's the one who prescribed it for me. Honestly I'd rather just try one at a time...

Thoughts?

This is what Pdoc's have turned into........drug pushers.
I pay $100 for 15 mins, just to get my meds refilled. The office is like a herd of cattle being shuffled around.

I am a bit alarmed as well as I would definitely get an appt with another doctor. This sounds like he is too busy and a pill pusher. I really hate that pdocs or docs are so wiling to hand out meds without having a good reason. I would see another doctor and use your own discretion if you only want to take one med at a time. Best wishes.

Definitely seemed like a pill pusher. Came in the room with his prescription tablet loaded and ready.

I'm just scared if I say, "I don't want to take the Brintellix" he'll also take away the klonopin and... I'll be back at square one with no help. My thing is, if the klonopin is fast acting for my anxiety and works... why do I have to take an AD? I now these are questions for a doctor, but curious.

I agree, it is totally up to you as to what pills you do or don't take. Also Brintellix failed in testing to be effective for anxiety (GAD) so it does not even have any off-label uses.
However your other Rx (Klonopin) is good for panic disorder and my doctor just recommended it to replace Ativan for anxiety, so you do have that working for you.

Brintellix comes with a withdrawal warning so I would be hesitant about even starting it until I could see another Dr.

Yikes. Was aware of the possible Klonopin withdrawal, but the benefits make me comfortable with taking it. I wasn't aware of the Brintellix. Then again I don't really know much about it except seeing it was more for depression than anxiety. I've taken two doses but think I'm going to stop with that one right there... I'm not too comfortable taking something that's not been tested in the area I needed it for!

Will bring up to the doc about going on something with more proof of working for anxiety. To make an appointment with a doctor as a new patient seems... difficult, but I found a doctor with better ratings. Can't see him till March though.

Big Pharma owns psychiatry now and mental health workers just lapped it up. Talk is out. We just need drugs, right? Drugs drugs drugs drugs drugs. I used to see a psychiatrist for an hour and talk and try things out and ask questions and get support. He was old-school. The last one I saw would only see me for 10 or 15 minutes (though she booked me for a half hour and no one was ever waiting to see her so I don't know why I was so rushed), knew nothing about me at all, told me they don't even learn any counseling skills in school anymore, prescribed devastating drugs, then quit her job and I was on my own again with a drug that made me enraged for the entire time I took it. No one noticed because the Pdoc quit and left town right after prescribing it. I got totally screwed up and my life is much worse now because of what happened while I was on the drug. Now I won't go to healthcare at all for anything. I'll fix my own broken arms and mental problems from now on, I do a better job than these morons. I guess I'm still a little angry and that's why your post spoke to me.

THINK FOR YOURSELF! You are right to have a red flag about your experience. I was diagnosed with delusional disorder in a hospital because me and my son believe that my schizophrenic boyfriend still love me..yeah, right..they put me on Seroquel and I was confused because the nurse practitioner said it was because my thinking wasn't right? Really? This man told me he was more in love with me than he had been with his now dead wife and I am delusional to think he does love me? And then she put me on a heavy duty anti psychotic? WHY? Don't take the bril whatever its called and find another psychiatrist...sadly we have to police the doctors nowdays...especially as you went in for anxiety..I am surprised he gave you klonopin...not zanax..klonopin is highly addictive zanax is not..RUN from this guy and Do NOT take that drug especially as it is new and especially as you are not depressed....

I recommend that you see another psychiatrist for the following reasons:
Insufficient time and questions
Writing of two scripts with said reason

Brintellix is a selective serotonin reuptake inhibitor (SSRI). It's mostly prescribed for depression. Furthermore, if you are 24 years of age or younger, it should not be prescribed because there is chance that it may cause suicidal thoughts and/or actions.

Klonopin is a benzodiazipine (benzo). Benzos should only be prescribed in the smallest dose and shortest amount of time because they can cause physical and/or psychological dependence.

When the psychiatrist said "we'll get through this" you should have said that we will get through this right now, and then read your list to him. You need to be more assertive, but don't get down on yourself if this was your first time interacting with a psychiatrist.

I believe that a combination of psychotherapy and medication is best. The psychotherapy should be increased over time and the medication should be decreased over time to the lowest, effective dose.

I am NOT a psychiatrist, so please do not use this post in lieu of professional advice.

I wish you the best.

If this was your first encounter with a mental health facility or you were new to this one then that is horrible practice. Psychiatrists because of the expense and the shortage of them seem to have been relegated to 15 med checks and writing prescriptions. Good practice would mean meeting with a psychologist for up to two hours to do a thorough evaluation of your symptoms, history, family history, etc. Taking of a couple of tests. And listening to everything you have written down and any questions you have. Then see a psyche nurse who would ask medical questions, make sure you have a GP that you see, order a blood test to check all the standard panels including thyroid. The last thing is to see a pdoc and discuss the possibility of meds. It should not be a receptionist but a trained psychologist. The five times I have had encounters with different institutions or psych practices this is how it was done. Two were with the same institution and they made me go through the whole shebang all over again for some reason.

Brintilex is a new SSRI that acts on a wider range of serotonin receptors. Why he would prescribe it if you were not complaining of depression makes no sense. Klonopin is highly effective for anxiety but has it's dangers that you should be aware of. I wouldn't take the Brintilex if it were me.

I agree with Zinco that finding a mental health professional who can do a proper (not a few minutes) assessment of you is a good idea.

As far as the Brintellix (Vortioxetine) is concerned, I suggest that you do not take it. A couple of Randomized Control Trials showed that Vortioxetine was no better than placebo for Generalized Anxiety Disorder:

A randomized, double-blind, fixed-dose study comparing the efficacy... - PubMed - NCBI
A randomised, double-blind, placebo-controlled, duloxetine-referenc... - PubMed - NCBI

Klonopin and Xanax are equal in regards to physical and/or psychological dependence.

I think we should be careful with the word "addiction". In my mind there is a big difference between addiction and physical dependence. By any definition of addiction there is a big difference. I may be building a physical dependence to klonopin but I am not addicted. I am a recovering addict with many years of sobriety so I know something about addiction. If I were addicted I would be taking more than prescribed for the sole purpose of getting high. Then I would be compelled to look for more because I would runn out before I could get a refill. If it got bad I would be buying it on the streets or on the internet and my use would increase. Benzo's have the potential to cause this especially in people prone to addiction like me. I take it exactly as prescribed and never more and don't have an urge to take more so I am not addicted.

If I stop taking it and have withdrawal then I am physically dependent. This last week I missed three days (6 doses) because I was out of town and ran out. I didn't have any withdrawal symptoms. Lucky me.

I see lots of people label themselves as addicts with benzo's when that is not the case.

Xanax may be more likely to causes addiction or physical dependence because of it's short half life. For a true addict the quicker it acts the more addictive it is. Smoking anything is the most addictive because it takes 2/5 ths of a second to go from lung to brain.

Thanks guys. Yes this guy was no good. I'm a new patient who he should have spent more time with. Pretty discouraging...

And I'm absolutely not taking the Brintellix. Not only am I NOT depressed, but my insurance won't cover it. The Pharmacy called me and told me that the insurance company feels there are better medications out there so they won't cover Brintellix! To get it without insurance is over $100. Not happening.

The Klonopin (.5mg), for right now, I'm ok with because I feel (or hope) it has the potential to help me. But, this doc prescribed it to me for nighttime. By noon the next day, at the very latest... I don't think it's working... and then I'm back to square one with my anxiety.

He didn't even address my concentration issues that I was trying to also stress but, of course, didn't get to explain.

I've made an appointment with another psychiatrist. This time I did some research online about him, reviews from patients, etc. Unfortunately it's not until March. Wait times for new patients are so long...

I have a follow up with this crappy doc in a few days and will try to explain to him that I'm not taking the Brintellix (and all the reasons why). Because I have times (very often, it can be daily) with some pretty bad anxiety and need help, I feel like I should still see him until I do get my appointment with a better doc.

Ah! The frustration!

You might try the .5 mg klonopin in the morning on a day you don't have anything to do in case it makes you too tired. It has a long half life so maybe has to build up in your system. I take .5 in the morning and it doesn't make me at all tired. It is my night dose I am cutting out. If say I took 2 mg during the day I would be out cold.

Your post spoke to me! I can totally relate to how you feel.

This is not a case of you just being over-anxious and hyper-critical. I think your take on this is dead on accurate. I've had lots of visits to different psychiatrists over the years. When you mentioned the assistant asking you a bunch of questions - like a survey - I knew exactly what you were talking about. I've been to a pdoc like that. I'ld say you were in an office that is run like a mill, as I have been. That is not the standard procedure for all pdocs, but it certainly is for some.

Although, pdocs are mainly only doing med management these days, it is not usual for a first time appointment to be the way you describe. Normally, the first appointment with a pdoc is at least 30 minutes, and more like 45, and the pdoc gives you ample time to talk about what's going on. Subsequent visits are shorter, often just 15 minutes.

By all means, find another psychiatrist.

Also, I would like to commend you on your intelligent approach to medication. When you get started on 2 new meds at the same time, it then becomes harder to distinguish which med is doing what. When you find a new pdoc, tell him outright at the get-go that you prefer to introduce one med at a time. This may necessitate you having a few more appointments to get a med regimen that is optimal for you, but it is an sensible way to proceed. You don't even know what side effects are coming from which med when you start 2 or more at once.

I'm glad the Klonopin is helping you. The indication for that other med, the antidepressant, is kind of hazy, so I would see nothing wrong with you going a week just taking the Klonopin. Then you might try taking both together and compare. The doctor just made an assumption that your anxiety was connected to depression, which is quite common. Also, he is possibly trying to limit your exposure to a benzodiazepine, by prescribing an anti-depressant that may have some anti-anxiety properties, as a number of anti-depressants do. He is seeking a synergistic effect from the two drugs. That's fine in theory, but I can see it from your perspective as well.

Definitely find another pdoc whose office is less like an assembly line.

I am so terribly disillusioned with psychiatrists at this point. I've been in psychiatric care for three decades and I've seen the quality of care plummet. It seems to me that p-docs are not much more than quack doctors. Every p-doc says something entirely different from another p-doc. And they are all extremely expensive. They don;t seem to listen to me; instead they have an agenda of their own and refuse to divert from their course. I wish I had some helpful advice for you. All I can say is, I've gained a lot more knowledge and compassion from other patients than I have from psychiatrists.