First time to a pdoc on Monday. What to expect?

So I have been seeing a therapist since January this year following the second and longest mental health issue I have ever had. Both were caused by my use of antidepressants and the latest bought that happened last December still leaves me feeling very anxious and unsettled daily. My T is treating me for PTSD, and he has truly helped with my over active senses and constant state of arousal. I have mild dissociation and we have been settling that so I can do some EMDR therapy. He's helped me with lots of anxiety based issues I have had for years, aside from the use of the meds.
Anyway ... It has taken 6 months to get this appointment with a pdoc. The main reason is to figure out why I have reacted so badly to very low doses of meds. (Extreme depression and insomnia to name a few things)
I'm actually a little scared it may be bipolar ... But I dont think I present with all the symptoms. I'm quite nervous about seeing her (it's a female pdoc) because I will NOT try any medications. I suppose my question is ... What can I expect from a first visit? Considering I am feeling so much better from even a month ago I honestly feel like I could cancel the appointment and be ok ... But my primary doc really wants me to go trough with it ... And so does my therapist.
Long babbling post ... But I am feeling nervous!!!!

I don't know that the pdoc will be able to do much for you if you don't plan to try any medications. That's primarily the reason for going to a pdoc since you already have a therapist.

The pdoc will go over your history with you and will probably recommend medication. A pdoc generally is very different from a therapist in that they will focus on the symptoms you are experiencing and work on treating the symptoms. Most don't spend a great deal of time going into much depth about your issues; it is more surface level as they leave the deeper processing to the therapists.

What does your therapist say about you not wanting to try medications?

I was super nervous for my first pdoc appointment too. My main advice is: be completely honest -- tell him/her about your adverse reactions to meds and that you don't want to try anything new. They may want you to try something anyway, but at least they will be aware of your feelings. They can't help you unless you let them know everything that's going on.
Also, and this may just be something I'm struggling with, keep in mind that pdocs are (usually) not trained in the same type of way that T's are. They are trained medically, and so they do have to learn how to interact with patients and whatnot, but they likely will not be at the same level of caring/understanding as a T is because that's not really their job. Their job is to get you medicine and/or a diagnosis that works.
Best of luck!!

Yes, she'll encourage you to take medication. That's up to you, but there are a large number of antidepressants out there - tell her what you've been on and she may be able to find one that works better for you. It's also possible to do genetic testing now for which medications would likely work best for you and which are likely to affect you adversely.

Was it your primary doctor who wrote the earlier prescriptions? If so, I think it's worth going just to see what a specialist says. But if you still don't want medication, I wouldn't bother going back - waste of time and money.

Thanks for the replies My T is actually not an advocate of medications ... We have talked at length about them and how they don't work for many people. My primary doctor did put in a note to the psychiatrists office that I was not prepared to take any medications. I am still recovering from meds I took in December that also lead to a month off of work. So I am a little nervous that I will piss off the pdoc because I have no intention of taking meds. I would like to know why I reacted the way I did to the medications, and off such small doses (both times it was within days I had terrible reactions that took me to the hospital)

I had a bad reaction to the first antidepressant I tried, even though the dose was not even at the minimum therapeutic dose. That's when we did the genetic testing I mentioned above and found a much better match.

Yes it was my primary doctor who wrote the prescriptions for the meds. Thankfully I don't have to pay to see the pdoc ... It is covered. I have however already spend over $3000 on therapy. But it's helping.

'Fraid I can't tell you what to expect, but I wanted to wish you good luck! I have to see my PCP for a med refill and I hate, hate, hate going to the doctor. I almost wish I could see a p-doc instead. Anything to avoid that awful exam room.

I agree with Atisketatasket. You should look into genetic testing. I got it done at my local clinic.

I guess w/o taking meds, you can maybe get a diagnosis from the Pdoc and some sort of explanation of why you had the adverse reaction to the other meds. But beyond that, if you refuse meds, they won't be useful to you.

There isn't really much a pdoc can do if you won't take meds. Did they say why they are referring you?

Because of how bad it got, and how slowly it is taking to get better. Suicidal thoughts, depression, insomnia, mood swings, the list is long.
My appointment is in an hour - trying very hard not to call and cancel it. It is not a good day today - and really just don't want to deal with any of this.

Please still go. Were the other meds you tried all in the same class, like SSRIs? If so, a different class of meds, like tricyclic antidepressants or something like Wellbutrin (it's the only drug in its class, I think), might help you without the negative effects.

I understand the fear though, as I'm quite sensitive to meds. Good luck!

It's perfectly okay to use an appointment for the reasons you stated--you want some clarity and information to help understand your symptoms better. In every first appt with the pdocs I have seen, I always said I wanted to think about what they said and not make any decisions while I was there. They all respected that.

I'm glad your therapist is not a drug pusher and that you've found some help through therapy. Hopefully this pdoc will be able to make some educated guesses as to why you reacted the way you did to meds last December. It's just good information to have.

She was a lovely woman ... and very understanding and helpful. Although I now feel numb. She is fairly confident I have Bipolar II and have been in the throws of it since the birth of my eldest. My anxiety over the years, and ability to control my emotions has gotten worse and worse. My adverse reactions to low dose antidepressants and other key points like hyper arousal, insomnia and more really point to it. And I sorta new going in ... just didn't think she would honestly say it. I see her again in three weeks - she wants me to thinking about going on a drug called Epivine?? We would go through a compounding pharmacy and start at the lowest dose.

I need to nap before I pick up my kids. This is all just too much to sink in.

Request genetic testing?

There is a test now that can predict which meds may be better metabolized by an individual, etc. Not sure how accurate it is or whether insurances always cover it. I suspect that is the test that is being spoken of. There are some threads I believe the medication forum about it.

Found this link from another thread: https://genesight.com/

My insurance did not cover the genetic testing (which is about 6K in cost), but the company my psychiatrist used caps their fee to the patient at around $300 if their insurance doesn't cover it. I don't have their name handy, but I think it was Genesight.

In my case the test flagged both medications with which I had had trouble, and one of the ones it recommended is working quite smoothly.

I'm sure it's hard to think that maybe your previous diagnosis was wrong. And scary. But this would explain your reaction to the other meds. And could lead to a more successful treatment.

Interestingly, I've been considering whether I could have bipolar II rather than depression and anxiety (actually, would probably be bipolar II plus anxiety). My T seems to think that diagnosis makes sense, but my p-doc seems much more skeptical. Though the questions she keeps asking me when I bring up BP II seem to fit more with BP I, like with the mania and feelings of superpowers. Whereas I think I have more the hypomania. From what I've read, people who have had recurrent bouts of major depression, particularly if they started in their teens/early 20s, are more likely to have bipolar II. And that describes me. Along with insomnia, some periods of feeling more happy and alive (but not true mania), some irritability at times (which fits with hypomania), etc. I'd suggest talking to your T about it as well.