Psycho-Babble Medication Thread 503

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Finding the right Doc - Help

Posted by Lynn on September 2, 1998, at 10:36:55

Help -

I've written before with my history for those of you like me who read this page a lot! My question and dilemma is, how do I find a good pschyiatrist? I've been through half a dozen in the last 20 years (from Ann Arbor to North Carolina). My current doc is very nice, but frankly is used to dealing with patients who have very severe disorders requiting hospitalization and just doesn't see my bi-polar disorder as very problematic. He's been good about trying different meds, but waits 6 months before trying a different drug. I am very drug shy as every drug I have tried has made me very sleepy. Hard to deal with this and work with 2 kids.

Also, did "rules" change in length of time to see patients. I was also used to spending 45-50 minutes with a phsyciatrist (not phsychologist) and he schedules all of his patients for 15 minute sessions. I can hardly explain in 15 minutes what has happened in the last 3 months (as often as he feels I need to be seen).

So getting back to my original question, how do I find a doc who will listen and help. Contrary to theory, you cannot "interview" a doctor over the phone, and who has the time or money to "try a doctor out". Hospital referral services are not knowlegable about particular doctor theories.

If any of you docs out there knows of one who is in NC and is willing to "try" the alternative conventional drug methods, please let me know. I had written earlier about studies or articles I had read regarding combining stimulants with other antidepressents. I've got to got on living my life with some energy!

Thanks so much - and by the way, I am seeing current doc on Thurs. to ask about the stimulant route, so I may need this advice soon!


Re: By the way, thanks to the docs!

Posted by Lynn on September 2, 1998, at 10:39:03

In reply to Finding the right Doc - Help, posted by Lynn on September 2, 1998, at 10:36:55

> By the way - a major thank you to all you docs who take the time to answer our questions. You are well appreciated more than you ever know!


Re: Finding the right Doc - Help

Posted by Toby on September 2, 1998, at 12:46:54

In reply to Finding the right Doc - Help, posted by Lynn on September 2, 1998, at 10:36:55

I read your previous post from 8/25. You said your diagnosis is bipolar with frequent mood shifts but also that the primary mood is depressed. Have you really ever been manic (euphoric and all that) or are the mood shifts mainly depression and irritability? (Either way, the diagnosis may be right, it's just that different symptoms require different tracks of treatment.)
In any case, to your current question, I know good docs in NC but would need to know generally where you live in order to refer you to them.
Also, just finished an article in Clinical Psychiatry News, August edition on "Adding Stimulants Improves Depression Symptoms." Beware of increased irritability, but overall, benefits occur in about 1-2 weeks with peak improvement in 6-8 weeks. Symptoms that improved were mood, attention and concentration, energy, sleep, suicial thinking, and irritability/agitation (interesting that stimulants make some people irritable and relieved irritability in others). You may want to refer to the title of this article and the name of the paper it was in, in case the doc balks at even trying a stimulant.
Another new alternative for mood stabilization is Topiramate which is expensive ($1-3 per pill) but quite effective for depression, mania, irritability and energy without weight gain.
In slight defense of your doctor, making changes in medication too quickly can defeat any gains that might be made, but seeing you only every 3 months is perhaps too long if you are not stable yet. Managed care has indeed changed the way psychiatrists are allowed to practice in many areas and many are no longer reimbursed for seeing patients for more than 15-20 minutes at a time for medication checks, leaving the psychotherapy to less expensive therapists (of course, less expensive in the short term; if you don't get a chance to adequately get your problems addressed, you will require longer-term treatment and more frequent visits, ultimately making treatment more expensive -- we complain, nobody listens). If you can afford private treatment for 50 minute sessions, then you may want to call around to find which docs in your area will accept "fee for service" on an hourly basis. If you are insured though, call the insurance company to find out what their policies are for psychiatric treatment; you may be able to get them to pay for a 50 minute session with a physician; if not, then you are probably stuck with the 15-20 minute med checks. In that case, you just need to go armed with info to each session, keep a journal of your symptoms and response to medications, and engage in whatever psychotherapy is available to you. Ask if you can be seen every 4-6 weeks for awhile when new meds are tried.


Thanks for the advice, more info to Toby

Posted by Lynn on September 3, 1998, at 7:58:24

In reply to Re: Finding the right Doc - Help, posted by Toby on September 2, 1998, at 12:46:54

>Thanks so much for the quick response - The article will help (hopefully) in my quest for help. Also, now understand why 15-20 minute sessions are the norm - it's just difficult to have so many docs (GP, Psych, Therapist).

No, have never suffered from the mania, just the depressions cyles. I cyle during the week with 2-3 days being tolerable and 3-4 being awful. Sometimes cyle during the day as well. My mother was a daily cycle with episodes of wild mania and deep depression.

I'll let you know how it goes today before asking for specific area doctor requests.

Thanks again so much!

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