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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by fido on January 29, 2015, at 19:04:25
I would like to have a psychiatrist who has adequat time for me as patient, at least 15 minutes.
I'd like a doctor who asks about symptoms and then really tries to come up with a personalized treatment plan.
But instead when I go to my psych there's little time, maybe 10 minutes max. He also doesn't really put much thinking into it. Trying to describe my many symptoms is useless cause he doesn't seem to be able to work with them at all.
I feel really lost.
I feel like unless I know exactly what drug I want to try next I am pretty much lost. Cause then he will suggest something which comes to his mind and usually that's not really what I want.What also totally bothers me is that he never suggests or wants to try out drugs which are more experimental and not primarily used for depression but which have a positive record for depression.
I have been to a few psychiatrists and none of them really sticks out. I guess it doesn't make sense to keep on searching. It sucks when you feel like you're on your own.
One psychiatrist simply told me he has nothing left to offer to me even though I have not even tried all antidepressants! He never offered TCA or Moclobemide or real MAOI.
I also don't even know how much knowledge my doctor has. If he doesn't have much theoretical knowledge then he also cannot come up with "out of the box" ideas.
But if normal ADs don't work then what do you do?
Giving up on drugs would mean feeling even more hopeless.
Posted by hello123 on January 29, 2015, at 19:19:21
In reply to Is your psychiatrist a huge help?, posted by fido on January 29, 2015, at 19:04:25
ive never found a psychiatrist who was a huge help. my favorite one was one who was willing to try experimental treatments. but she eventually said she didnt know what else to try and stopped seeing me.
every other psychiatrist ive been to basically works like this: i tell them my symptoms. they pick from a list of meds FDA Approved for those symptoms, making sure not to combine meds with bad interractions. then send me out.
the psychiatrist i liked actually described to me the mechanism by which she thought a prescribed med could help me. going beyond just saying somethin like "This med increases Serotonin, which is good for Depression."
my very first appointment with a Psychiatrist, i figured the guy was probably around the genius, considering he us working with what is, as far as we know, he most complicated thing in the Universe. But over the years of seeing various psychiatrists, ive just not been aware of much of the knowledge youd expect one to have after all the schooling they do.
Posted by ed_uk2010 on January 29, 2015, at 20:05:23
In reply to Re: Is your psychiatrist a huge help?, posted by hello123 on January 29, 2015, at 19:19:21
>ive just not been aware of much of the knowledge youd expect one to have after all the schooling they do.
I know just what you mean.
Posted by rjlockhart37 on January 30, 2015, at 0:52:32
In reply to Re: Is your psychiatrist a huge help?, posted by hello123 on January 29, 2015, at 19:19:21
i have difficult psychiatrist, i have plenty of bad things to say but im not saying it, but i can't really work with meds with them, im on heavy doses of bipolar medication, which really.....i just have ADHD, but new symptoms started, it's a long story and burdening to talk about too, just the cocktail im on right now is the only way i can go......
the real obvious thing, mainly is to just say, thank you for all your help, and just leave and get another doctor, some take insurance, but some are vary expensive, just like getting a high paying lawyer, some psychatrist change large amounts of money, so.....look around, google, find a doctor that you think would help, includde anxiety related doctor, or whatever symptom you have and find a speicalist psychiatrist in the area
r
Posted by Tomatheus on January 30, 2015, at 12:06:02
In reply to Is your psychiatrist a huge help?, posted by fido on January 29, 2015, at 19:04:25
Fido,
My current psychiatrist sounds a lot like your psychiatrist: he asks few questions, keeps me in his office for no longer than 10 minutes, and doesn't seem interested in prescribing much other than first-line treatments for depression and psychosis. Lately, his suggestions have been along the lines of trying medications that I've tried before, while hoping for better results a second time around. I stick with him because he's willing to prescribe Abilify at the dose that seems to suit me best, so although I would say that my psychiatrist does his job, I wouldn't describe him as being a "huge help."
Right now, what seems to be helping my depressive symptoms is vitamin D3, which I'm taking because my vitamin D level came back low after a doctor at an orthomolecular treatment center ordered a blood test. The Abilify that my psychiatrist prescribes does seem to help with my psychotic symptoms better than other treatments that I've tried, so I wouldn't say that my psychiatrist isn't of any help, but in my case, medications, psychotherapy, and all of the other depression management strategies that others seem to benefit from were of no help as far as my depressive symptoms were concerned. As of right now, only vitamin D3 seems to help with my energy and concentration on a long-term basis.
I'm not a psychiatrist or any kind of mental health profession, but I fail to see why anybody with a treatment-resistant depressive disorder deserves anything less than to have the opportunity to try second and third-line treatments that might potentially provide the antidepressant relief that is needed. Just because a medication is old doesn't mean that it isn't still useful, at least in my opinion. In your case, it might make sense to specifically bring up any medications that you might be interested in taking, considering that you said that what your psychiatrist suggests isn't usually what you're looking to take. With some doctors, I think we need to ask as many questions as possible (which I know can be hard to do when we're really symptomatic) to find out the reasoning behind their treatment decisions and to get their thoughts on medications that they might not think to suggest.
At any rate, I don't expect that anything that I write here will change the fact that your psychiatrist doesn't seem to meet your expectations, but if the treatments that your psychiatrist is prescribing you don't seem to be helping you, it might be a good idea to try communicating with your psychiatrist differently and to specifically bring up any medications that you might be interested in taking. If you're still dissatisfied with your psychiatrist's prescribing decisions, then the option to seek a second opinion is always there.
Tomatheus
Posted by fido on January 31, 2015, at 18:43:20
In reply to Re: Is your psychiatrist a huge help? » fido, posted by Tomatheus on January 30, 2015, at 12:06:02
Hi,
I also take D3 but it doesn't help my depression at all.I just dont think that there are many really good doctors out there. I have been to many different doctors of all kinds and most of them really suck and dont care. It's sad.
I mean even if there is a good psych in my area how shall I find him? The one I go to now also has only good reviews.
He is friendly and also open towards suggestions which is good.
But I dont think that he has much experience and knowledge. Basically I have to figure out what I want to take. I cannot count on him to lead me into the right direction and this is scary.Another problem is that drugs which are not allowed for depression also arent covered by insurance! This means even if there is a drug which worked wonders in me if it's not allowed for depression I'd have to pay it myself!
This narrows down my drug options a lot.
Posted by Tomatheus on February 1, 2015, at 8:30:47
In reply to Re: Is your psychiatrist a huge help?, posted by fido on January 31, 2015, at 18:43:20
Fido,
You might find word of mouth to be a good way of finding a good psychiatrist. If you can join a support group (if you're not already part of one) and ask the members of the group for recommendations, I think that you'd be likely to get better results than just picking from a list of doctors.
As far as getting off-label medications covered by insurance is concerned, asking your doctor to appeal the decision might be an option, although I understand that the likelihood of that happening with a doctor who's not so good isn't, well, so good.
I actually had a positive opinion of the first psychiatrist that I saw, but I can't see him now because I stopped seeing him for a while and he closed his practice to include only the patients he was seeing at that time. Still, though, he took the time to ask lots of questions and was willing to try second and third-line treatments when needed, so I would say that good psychiatrists do exist. I'd agree that finding a good psychiatrist is difficult, but it may be achievable if you ask around enough.
Tomatheus
Posted by Chris O on February 2, 2015, at 22:53:28
In reply to Is your psychiatrist a huge help?, posted by fido on January 29, 2015, at 19:04:25
Fido:
Wow, I don't like your psychiatrists very much. It's no wonder you feel upset and lost. The fact that none of them will think outside the box and will not even offer a TCA or MAOI inhibitor shows (to me, at least) that they are probably not the best people for your condition. My psychiatrist's attitude is (he even said this to me today), "I'll try anything." And he has not given up on me in six years, even though I've given up on myself many times. I know there is someone out there who can give you more hope than the people you are currently seeing.
And I've seen psychiatrists like the ones you are describing. One gave me a list of three drugs I could choose from after only talking to me for 15 or 20 minutes. Another would never prescribe benzos (handed me an article the first day I came in, even though I was in the midst of the worst panic attack of my life). Still another would do like 80% of the talking in our sessions. It was like a lecture with me as his student.
Anyway, don't give up hope. Keep trying things. You'll find something that works eventually.
Chris
Posted by phidippus on February 10, 2015, at 14:53:21
In reply to Is your psychiatrist a huge help?, posted by fido on January 29, 2015, at 19:04:25
I have been working with the same psychiatrist for many years now. In the time that I've seen him, we have been through many drugs. He is not afraid to take chances with meds and as a result have been on some very experimental drugs.
He doesn't just throw medications at me haphazardly, though. Both he and I research the drugs he prescribes and there's a lot of teamwork that goes on. I often come to him with ideas for medications I can take and he will research them before he gives the go ahead and prescribes a drug.
He's usually available 24/7 and I hardly have trouble getting a hold of him. Appointments with him range from 20 to 40 minutes.
Its unfortunate there aren't more psychiatrists like him.
Eric
Posted by brynb on February 22, 2015, at 21:53:52
In reply to Is your psychiatrist a huge help?, posted by fido on January 29, 2015, at 19:04:25
Hi fido-
I'm sorry you feel that way and admit to having felt like that w/ most of my docs. After literally years and years of trying to find the "right" psychiatrist, I'm finally seeing someone who is fine, perhaps even good. (We have a relationship now--as patient/doctor--and respect our roles, though it took some time.) I say "fine," because although I've dealt w/ depression for over 20 years, can identify my triggers, and know all of the "things" I'm supposed to do to stay healthy and avoid destructive patterns and self-sabotage, I haven't "perfected" remission yet, lol.
Where other psychs have given up on me, made me beyond angry and been flat out poor physicians, mine (who I've seen for a bit over three years now), is supportive, reminds me of my patterns, and continues to listen to me (I've pissed off many "professionals" because I either thought I was smarter than they were about my health, or because they were inpatient and inflexible).
Mental illness is such an individualized disease, and labelling patients is myopic and dangerous. We should, being educated about our afflictions, be able to have suggestions for medications.
One medication I'm prescribed is something I stumbled upon while taking it for something completely unrelated to depression. It's Tramadol, which is not a psych med but works on our largest neurotransmitter (glutamate). Tramadol (in combo with Lexapro and Ativan) has been an absolute life saver for me on so many levels. When I first began seeing my current pdoc, he had no problem with my taking Tramadol and understands its benefits. He was open to me taking it because of how much it helps me with pain and depression. Now, he's not exactly traditional or conservative (he does Ketamine treatments in his office), but when dealing with any mental illness, it's paramount to find a true professional who will listen to you and is willing to think outside of the box to help you. By the way, this med IS covered by my insurance.
I'm very thankful for this. Don't give up--it's like dating; keep going at it until you find the right one!
-b
And knowing me f
> I feel like unless I know exactly what drug I want to try next I am pretty much lost. Cause then he will suggest something which comes to his mind and usually that's not really what I want.
>
> What also totally bothers me is that he never suggests or wants to try out drugs which are more experimental and not primarily used for depression but which have a positive record for depression.
>
> I have been to a few psychiatrists and none of them really sticks out. I guess it doesn't make sense to keep on searching. It sucks when you feel like you're on your own.
>
> One psychiatrist simply told me he has nothing left to offer to me even though I have not even tried all antidepressants! He never offered TCA or Moclobemide or real MAOI.
>
> I also don't even know how much knowledge my doctor has. If he doesn't have much theoretical knowledge then he also cannot come up with "out of the box" ideas.
> But if normal ADs don't work then what do you do?
> Giving up on drugs would mean feeling even more hopeless.
Posted by fido on February 23, 2015, at 15:43:23
In reply to Re: Is your psychiatrist a huge help? » fido, posted by brynb on February 22, 2015, at 21:53:52
Hi folks,
sorry for not replying sooner.Thanks for your replies. It's not easy for me to for an opinion on doctors. Often times I question my own judgement and think what if I am wrong and the doctor is doing all he can and I only think that he sucks? But I'm sure now that he really sucks and doesn't do everything he might be doing.
I just wish I knew how to find a good pdoc, if there even are good ones in my region. :/
@ brynb
Is tramadol safe when you take it long term?
Does it have many side effects?
And isn't this risky because of dependence or addiction? I always thought that opiates aren't really an option for depression cause they cause addiction.
Posted by Chris O on February 23, 2015, at 15:59:20
In reply to Re: Is your psychiatrist a huge help? » fido, posted by brynb on February 22, 2015, at 21:53:52
So eloquently put, brynb.
Chris
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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