[ImNotHere]

So my therapist is concerned that my Dr (who prescribes me medication) hasn't been helping me. I have been put on 5 different anti anxiety/depression medications over the last 7 months and so far not much has helped except for the most recent which has sort of .

So she gave me this number to call to see a psychiatrist so that they can prescribe me medication. Should I do this instead? I am nervous and don't know if I really want to. Will this be a better experience? I feel like if I don't do what my therapist says she will be upset with me? But I just don't know if I am open to talking to someone new.

[HazelGirl]

Psychiatrists know much more than GPs. I highly recommend you make an appointment with the psychiatrist.

[LaborIntensive]

I had to this when I lost my recent job. I can't seem to keep a job and regular medical docs have tried to help me with carious pills but the side effects were crappy and I got thinking maybe I am being misdiagnosed. I have 2nd visit to the psychologist this week. Be ready to fill out a ton of tests. Keep in mind that you should be honest on the tests and fill them out as you feel now not as you used to feel. You'll see what I mean when the process starts.

[ImNotHere]

I have avpd. I am extremely socially anxious. I am so nervous and scared I don't think I can meet a new person and do all of this over again, I really can't. Also it isn't just any psychiatrist, I have to call some low income psychiatrist program (i have insurance so I don't know why she set me up with this program) and have me work through this place where I may have to wait up to 6 months to get an appointment, she gave me no other references for any other psychiatrists I may be able to see sooner, so it is just really confusing and I don't understand why we are doing it this way.

[Outcast_of_RGaol]

When you use the term "Dr.", are you referring to your primary care physician... a GP? as Hazel puts it?

Psychiatrists have extensive knowledge about bio-chemistry like a GP does... but also has added to that, "Brain-chemistry"... much more specific, right?

I'd encourage you to go see your "Dr." and discuss it with them... they shouldn't feel offended by it. Especially if you express that you're asking because psychiatry is a different field of science than physiology and that you sincerely don't want to overtax your doctor with psychotropics. ASK if they are comfortable with dealing all these head-meds because your therapist brought it up as something to consider.

On a side note... merely my opinion, okay?
Therapists should never be recommending specific medications... they're not generally trained/knowledgeable in chemistry. Likewise, a GP isn't always up-to-date on psychotropics... but should always be aware of whatever meds you're taking. It sounds as if your T is doing a good thing in recommending that a "P-doc" get involved in overseeing the psychotropics. But it does kinda mean that you'll need to take on the role of ambassador to all parties concerned. That shouldn't be too difficult because as professionals, they should recognize the experience that each has in their field while focusing on your personal well-being.

[Mactastic]

I'll be frank -

You wouldn't take your car to a body shop to get your brakes fixed so why go to a GP to get psych meds?

A gross simplification, but just how I see it.

[Lauliza]

I don't like the idea of GPs prescribing psych meds. From my own experience they just don't have the in depth knowledge of a psychiatrist (sometimes called psychopharmacologists just for this reason). Brain chemistry is tricky and GPs only know the basics, which in my opinion isn't enough. Don't worry about offending your GP by seeing a specialist or feel like they need to give permission. You might need a referral or whatever else your insurance might require, but other than that it is 100% your decision.

[ImNotHere]

The problem is just the 6 month waiting period, meeting an entire new person and explaining everything again with my severe social phobia/avpd and I just feel like I don't really want to do it. Honestly every time I tell my therapist no about something all she does is pressure me and make me feel bad, I don't get much support. I know a psychiatrist would probably be better at prescribing me medication but really at this point do not feel like adding another person into the mix, I was comfortable with how things were going.

What kind of different medications could a psychiatrist give? I have been on effexor, celexa, buspar, topamax, wellbutrin and etc.

[HazelGirl]

Could you find one through your insurance that you can see more quickly?

[ImNotHere]

I asked her if I could do that and she was like No I would prefer if you would do it through this program even though there is a 6month wait, i am really confused by her.

I would do some research through your own insurance rather than get stuck on a 6 month waiting list. A few months isn't particularly out of the norm, but 6 is ridiculous. Could she have your insurance/finances confused with someone else?

[Lauliza]

Originally Posted by ImNotHere

I asked her if I could do that and she was like No I would prefer if you would do it through this program even though there is a 6month wait, i am really confused by her.

If you have insurance then you can call the insurance company directly and ask them for a list of providers who accept your insurance. My (and many) insurance providers have websites where you can search for doctors of any specialty in your area that take your insurance. I don't know where you are but I know it can be difficult to find psychiatrists who are taking on new patients in some areas.

I would ask your T why she wants you to go through the process she is suggesting and not your own insurance, does she know something that you don't? You are the consumer here and it's your choice who to choose as a provider. Your T should be discussing options with you, not just telling you what to do.

A psychiatrist can prescribe all the meds you listed like your general doctor. The difference is they have more in depth knowledge of them as well as the advantage of seeing them in practice with other patients. A pdoc has knowledge about augmenting meds, off label uses and are able to tweak your treatment so it suits your needs. I used to use my GP and she knew the basics but nothing specific. If one didn't work, she'd switch me to another. It wasn't helpful at all as she put me on meds that a psychiatrist, knowing my issues, would not have chosen.

[ImNotHere]

The thing is I never asked for this. I have no interest in opening up to a new person. I could care less about going to a psychiatrist. I don't want another person involved. I was just starting to feel comfortable with therapy and my doctor and things were going well, I don't want to add a third person into this. I feel like if I don't do exactly what my therapist wants she will be upset with me.

[elliemay]

Originally Posted by ImNotHere

The thing is I never asked for this. I have no interest in opening up to a new person. I could care less about going to a psychiatrist. I don't want another person involved. I was just starting to feel comfortable with therapy and my doctor and things were going well, I don't want to add a third person into this. I feel like if I don't do exactly what my therapist wants she will be upset with me.

I understand this feeling completely,but all you have to do with a psychiatrist is tell them your physical symptoms.

They will take a history, of course, and may want you to take some diagnostic tests, but the nitty gritty of your life? Nope.

I think the best of every possible resource should be on the table to help you feel better.

[ImNotHere]

The thing is I don't want anyone else involved, I don't want any more help. I am perfectly find with just the way things are. My therapist does not understand this. I don't want to take tests or talk anymore.

[Lauliza]

Originally Posted by ImNotHere

The thing is I don't want anyone else involved, I don't want any more help. I am perfectly find with just the way things are. My therapist does not understand this. I don't want to take tests or talk anymore.

I understand that having to see a bunch of specialists can be a pain, but they are a great resource to have. Once the pdoc figures out which (if any) meds might work better, you can get the refills from your primary doctor. Some people only see their pdoc twice a year if they want to. Your therapist probably just thinks having a psychiatrist involved in your treatment would be more helpful than your GP, who really just goes through the list of AD's until you say one works. A pdoc knows a lot more about side effects (especially odd ones) than GP's, who really only know what you can find online. Pdoc's also are good with augmenting with other medications or off label uses, which in some cases can be really helpful. I am a big believer in using specialists for many medical conditions. If you have a heart problem you should see a cardiologist and most GP's will tell you that. I think it is the same with mental health. She may be suggesting someone in her group so you don't feel over burdened with doctors. If that's the case, then why not just wait the 6 months and see what happens?

A pdoc is probably more for medication management than talking/therapy. Apparently what your medical doctor has been trying isn't working, and a pdoc who deals with these meds and conditions as his speciality may be more successful than the regular doctor and help you get some real relief from your symptoms.

[ImNotHere]

I am confused, so basically a psychologists will give me the same type of medications? so how will this be different? other than costing me more money probably. I feel like it would be no different, I mean yes they may specialize in different psychological areas but they are prescribing the same medications. I also don't have extra money to spend.

[HazelGirl]

Originally Posted by ImNotHere

I am confused, so basically a psychologists will give me the same type of medications? so how will this be different? other than costing me more money probably. I feel like it would be no different, I mean yes they may specialize in different psychological areas but they are prescribing the same medications. I also don't have extra money to spend.

Psychologists cannot prescribe medications. They are not medical doctors.

GP's can provide medication, but they are not trained in psychiatric medications.

Psychiatrists can also provide medications, and they are trained in psychiatric medications. If you have mental health issues, they are the best ones to see.

[Victoria'smom]

will give me the same type of medications?The thing is psychiatrists are specialized in mental health medication.

I would not see a psychiatrist to appease your T, but I understand your anxiousness and why it would be hard for you not take her advice.

For someone presenting with depression symptoms, after medical issues are ruled out, a GP would likely prescribe the same medications as a psychiatrist because they both would use the same or similar evidence-based guidelines and prescription algorithms.

If you went to a psychiatrist, you'd still have to deal with the trial and error. They would want to know if you gave any of those medications that you listed a full trial of about 8 weeks. Did you stay on any of them for that length of time, or did you quit because of side effects or because they wouldn't work/made you feel worse?

Also, have you tried any of the ADD drugs such as Strattera?

[ImNotHere]

A few I could not make to 8 weeks because the side effects were too terrible to withstand, some made me feel so much worse. I was on wellbutrin and that was supposed to help me with add but it made me feel worse so now I am on topamax for almost a month and so far all it hasn't helped all that much with anything. I have another appointment with my Dr. and Therapist later this week and I will see what they say, I really want a medication that will work. Part of me feels like nothing is ever going to work. Someone has mention drugs like Xanax or stronger drugs like that, would that help? should I bring that up? no one has ever brought that up to me.

Honestly every time I tell my therapist no about something all she does is pressure me and make me feel bad, I don't get much support.

Do you generally have a good relationship with this therapist, or do you think that your fears you wrote about in your other posts prevent you from trying someone else? Because what you wrote above does not sound good. I don't work with therapists who try to tell me what to do or pressure me, and this behavior seems unusual.

Sometimes people do perceive things differently because of transference and/or misunderstandings, so it's always best to ask her to clarify. Maybe she is not pressuring you, but instead, showing her concern in a way that seems intrusive and manipulative? Or maybe she is intrusive or controlling or manipulative...

I feel like if I don't do exactly what my therapist wants she will be upset with me.

I don't think a good therapist would get upset with a patient (or at least they wouldn't show it) for not doing what they want. That sounds really controlling. I still have to ask --are you familiar with the concept of transference? There's at least several possibilities - she is controlling; she seems controlling because of transference; there is a misunderstanding here.

Usually the best thing to do is to talk about these feelings with your therapist, but I know that is easier said than done.

Originally Posted by ImNotHere

A few I could not make to 8 weeks because the side effects were too terrible to withstand, some made me feel so much worse. I was on wellbutrin and that was supposed to help me with add but it made me feel worse so now I am on topamax for almost a month and so far all it hasn't helped all that much with anything. I have another appointment with my Dr. and Therapist later this week and I will see what they say, I really want a medication that will work. Part of me feels like nothing is ever going to work. Someone has mention drugs like Xanax or stronger drugs like that, would that help? should I bring that up? no one has ever brought that up to me.

Your experience is not uncommon, but the side effects can often dissipate while you wait it out. For example, Wellbutrin could have made you irritable and shaky at first, even cause headaches, then those symptoms may have gone away had you stayed on it longer. (But it's often used as an add-on rather than alone.) If you don't go through the full trial of the basic beginner meds, you might be missing out on something that would have worked. Of course some side effects are not tolerable.

One possibility is to schedule with the psychiatrist, waiting the 6 months; in the meantime, you could ask your GP to do another trial of say-Celexa or Effexor, staying on it for at least 6 weeks, then if you don't have enough improvement but can tolerate, seeing if s/he will add Wellbutrin to it. Some people take Klonopin for social anxiety. Another alternative is Straterra alone. Of course, like everyone else said, a psychiatrist would be best to help you find something that works. These are just suggestions if you want to avoid seeing a psychiatrist. Also, is it possible that your T suggested the low-income clinic psychiatrist because of your money concerns?

That's great your GP is working with you like this. I don't want to scare you but want you to be aware that there is a risk your GP will not want to experiment with psychotropics anymore if s/he no longer feels comfortable with more and more trials. Then you'd be left with no option but to see a psychiatrist anyway. Maybe if your GP helps you out some more, you will be less anxious, maybe just enough to establish a relationship with a psychiatrist.

Sorry you're having such a rough time.

[ImNotHere]

Originally Posted by skies

Do you generally have a good relationship with this therapist, or do you think that your fears you wrote about in your other posts prevent you from trying someone else? Because what you wrote above does not sound good. I don't work with therapists who try to tell me what to do or pressure me, and this behavior seems unusual.

We have an ok relationship, it just took me forever to actually see one so I would hate to have to start all over and explain everything again, I don't want to do this again, it has been exhausting. My therapist does tell me what to do, and I feel like if I don't do it, she gets sort of mad at me or she doesn't understand why I did not do it.

Sometimes people do perceive things differently because of transference and/or misunderstandings, so it's always best to ask her to clarify. Maybe she is not pressuring you, but instead, showing her concern in a way that seems intrusive and manipulative? Or maybe she is intrusive or controlling or manipulative...


I don't think a good therapist would get upset with a patient (or at least they wouldn't show it) for not doing what they want. That sounds really controlling. I still have to ask --are you familiar with the concept of transference? There's at least several possibilities - she is controlling; she seems controlling because of transference; there is a misunderstanding here.

Usually the best thing to do is to talk about these feelings with your therapist, but I know that is easier said than done.

I know part of this is my fault because I have been on so many meds that she just wants me to see someone who I guess specializes in them but the thing is I do not want to start all over like I said before, I do not feel comfortable bringing a new person into all of this and explaining and talking, I don't always feel comfortable talking to her. She does make me feel guilty when I do not do exactly what she wants.

Your experience is not uncommon, but the side effects can often dissipate while you wait it out. For example, Wellbutrin could have made you irritable and shaky at first, even cause headaches, then those symptoms may have gone away had you stayed on it longer. (But it's often used as an add-on rather than alone.) If you don't go through the full trial of the basic beginner meds, you might be missing out on something that would have worked. Of course some side effects are not tolerable.

One possibility is to schedule with the psychiatrist, waiting the 6 months; in the meantime, you could ask your GP to do another trial of say-Celexa or Effexor, staying on it for at least 6 weeks, then if you don't have enough improvement but can tolerate, seeing if s/he will add Wellbutrin to it. Some people take Klonopin for social anxiety. Another alternative is Straterra alone. Of course, like everyone else said, a psychiatrist would be best to help you find something that works. These are just suggestions if you want to avoid seeing a psychiatrist. Also, is it possible that your T suggested the low-income clinic psychiatrist because of your money concerns?

I am not sure what my problem is with medication, I have had depression for over 12 years now and anxiety, I just don't understand why I can't seem to take or be helped by any of these pills. A lot of them I do wait the correct amount of time or the side effects are just too terrible that I have to come off (effexor made me sleep so much I almost lost my job), I don't know If I just need something much stronger or what but I don't know what to ask for.

I am sure the low income suggestion was to save money but she could have gave me an alternative list if she really wanted me to get help that badly, I just don't know if I want to talk to anyone new.

That's great your GP is working with you like this. I don't want to scare you but want you to be aware that there is a risk your GP will not want to experiment with psychotropics anymore if s/he no longer feels comfortable with more and more trials. Then you'd be left with no option but to see a psychiatrist anyway. Maybe if your GP helps you out some more, you will be less anxious, maybe just enough to establish a relationship with a psychiatrist.

Sorry you're having such a rough time.

thanks for the help

That's why a pdoc would be a better idea than a GP. Pdocs specialize in these meds and generally have better success and insight into the subtleties and interactions of various meds.