10 replies to this topic

[penisbreath]

Out of interest, I was curious how in-depth people here go in their discussions with psychiatrists? Are you willing to betray specific insight about a drug's mechanism, or acknowledge the existence of neurotransmitters other than serotonin? Do you out-and-out declare that you suffer from anhedonia, or are you careful to phrase it more delicately?

When I first began seeing psychiatrists, I was very enthusiastic about bringing in research etc. though I've probably swung too far the other way at this point .. partly because cognitive problems and lack of pleasure don't seem to register as priorities, and also because it's easy to label the behaviour as another pathology/obsession.

[Sciencyst]

IME pdocs assume you are a druggie if you seem to know too much about their magical pills.

My pdoc flipped out when I used the word amphetamine when referring to adderall and asking about dexedrine, lecturing me on how they arent study drugs and shit.

It all depends on the doctor but many have some weird sort of learned ignorance or bias against curious people who know how to use google. But maybe Im just being defensive about my experience haha.

But no honestly mentioning research youve done on none-abusable drugs is fibe, but expect it to be an awkward conversation cuz the doctor wont know what youre talking about. Most docs are like.. "An SSRI? It gives your brain serotonin."

So act competent around nonabusable drugs but pretend ignorance if you care about your ADHD or anxiety meds.

[username]

I thought of bringing some research with me, but didn't. They wanna be in charge. They wanna know more.
Instead I don't go there anymore since they can't do anything for me anyway. If I choose to go on a medication, I'll just make an appointment, have a short talk and get my prescription.

One psychiatrist was actually really good and friendly. I think I would have talked openly with him. But he left to get further training

[penisbreath]

I don't think I've ever met one who was like explicitly ignorant. Most are just neglectful, in terms of readily attributing e.g. all concentration problems to anxiety (as opposed to ADD).

I'd been thinking about this because I have to see a psychiatrist next week to get help with akathisia. I've seen a couple of GPs and a neurologist so far who think it's anxiety .. however, the problem tends to respond well to dopaminergic supplements (theanine, Uridine .. and Nicotine too), and I can feel overwhelmingly anxious and able to sit completely still, whereas I'm still restless (but very calm) on a beta-blocker.

So I was trying to think of the best way to convey that sentiment without sounding like I've just done too much research.

[nupi]

With your average shrink, talking anything past garden variety Antidepressants (i.e. SSRI and SNRI) is a waste of time (or might get you almost yelled at 'these are not toys' and other bullshit)

Most frankly also do not have much of a clue outside the VERY well trodden paths.

[celebes]

It all depends on the doctor but many have some weird sort of learned ignorance or bias against curious people who know how to use google. But maybe Im just being defensive about my experience haha.

No you're not. And they're actually quite justified: It's a major career threat and it's only going to get worse for them. The era of doctor-knows-best will end with our parents.

[Sciencyst]

Absolutely correct sir. It is far too easy for them to get their licenses pulled with an arsenal of such powerful chemicals so you can't necessarily blame them. But yes their infallibility is coming to a stop with the interwebs.

[penisbreath]

This ended up being kind of redundant, anyway. Here's how my conversation with the psychiatrist went (a professor of neuropsychiatry at an esteemed university, I should add .. and I'm not making this up):

Him: You don't appear restless. You've sat here for an hour.

Me: I took a beta-blocker and nicotine gum before I came. I find the combination controls the problem, but isn't a cure.

Him: And what do you do when you don't take a beta-blocker?

Me: I writhe around in bed.

Him: And what would you do if there was no bed to writhe around in? Maybe you would be forced to face your fear of the restlessness?

Me: No, I'd probably commit suicide.

Then later ...

Him: Chucking a drug at this isn't going to solve your problems.

Me: Well, actually it is because that's why I'm here .. to medicate the restlessness.

That's completely verbatim.

Edited by lucky.pierre, 29 March 2014 - 12:33 PM.

[penisbreath]

No you're not. And they're actually quite justified: It's a major career threat and it's only going to get worse for them. The era of doctor-knows-best will end with our parents.

The best psychiatrist I've ever seen (a dual psychotherapist) often had the humility to simply admit he did not know why a particular phenomenon (side-effect, symptom etc.) was occurring. It was infinitely more powerful to hear than "oh it's just anxiety".

Unfortunately, such specialists are probably likewise a dying breed.

[formergenius]

If anyone does find a competent psychiatrist, we should get him or her awarded for most controversial psychiatrist.

I have to agree with nupi on this one; my experience with psychiatrists was a complete waste of time and money. They thought I was some kind of junkie when I told them about my trials. Especially when I told them that at the time I took Phenibut every other weekend, I got the full "well we can't help you until you're off drugs". They told me to quit Phenibut, which I did, and come back after a month. Nothing changed suffice to say, and I still got nowhere. Hell, they didn't even know what Modafinil was, and got freaked out even more when I told them about tDCS. Not to mention that they didn't know about DPD or HPPD despite it being in the DSM. I had to print out the page myself before they would even acknowledge they existed. Finally I got diagnosed by a specialist I went to see by myself.

I now have a GP who's pretty cool luckily. Told her about some stuff I'm trying, and all she said was "OK, hope it helps you, because I have no clue what you're talking about.". No "how dare you" or "let's try -insert generally ineffective antidepressant- first", which is nice.

What I learned: get your diagnosis, then gtfo.

[socialpiranha]

The problem is the leading edge of science itself can't explain most of whats going on let alone an individual. Anyone with sufficient interest and motivation to really delve into the deeper end of pool are in research not clinical practice. Those in clinical practice at most keep up with the journals and clinical trials which is easily and often done by the patient themselves. It is not uncommon now for the patient to know more about their condition than their doctor even a specialist due to the accessibility of information. People who are sick just have more motivation to dig into the particulars, the new breed of doctor will need to include more specific specialists.