What do you think of my psychiatrist?

[GetDownYouWillFall]

I had my DD in December 07. By January I was showing signs of PND so went to the GP. I just kept getting worse and worse until I went back to the GP and basically ended up lying on the floor of his office saying I wanted to die. He sent me straight to A&E where I spent a tortuous 4 hours waiting to see the emergency psychiatrist. Got packed off home with yet more drugs and a daily treatment visit from the Crisis team.

The psychiatrist came to visit me at home and gave me an anti-psychotic (olanzapine) along with the other mood stabilisers and anti-depressants I was already on. I believe this was wrongly prescribed because I never had any psychotic symptoms at all. I finally got referred to a mother and baby unit where I stayed for 3 months.
I saw the mother and baby psychiatrist for a year (who was great BTW), but now I am back under my CMHT. I started to get much better, and now generally feel very good. But the particular psychiatrist I see now is so awful, I dread the appointments, and always come out feeling 10x worse, anxious and upset and feeling back in the ?ill person role?, like I will never get better. I had my latest appointment yesterday and couldn?t sleep last night because of it. I just feel like he sets me back every time I see him.

My CPN suggested I write him a letter, explaining exactly how these appointments make me feel and the issues I would like to discuss. So I did that, taking time to write a careful letter saying everything I wanted to say. There was no reply (I sent it in October), and no acknowledgement of the letter in my appointment. I asked him yesterday if he?d read it and he just said ?yes I read the letter?.

I have been making attempts at reducing my medication because a) I believe some of it was wrongly prescribed and b) some of it is now no longer necessary c) the side effects are bad e.g. weight gain d) because we are thinking of trying for another baby.
Rather than being supportive he is very negative, and said his usual mantra of ?well, you were VERY ill? (yeah, I know, I was the one who had to live through it!), and ?some people just have to be on medication for the rest of their lives?. He says this at every appointment. He is not supportive of me coming off. My husband came with me yesterday for moral support and basically together we agreed I could try to start reducing some of my medication. The psychiatrist?s words were ?well if you want to try, so you can see for yourself that is up to you?.

Am I to be a passive, submissive recipient of his ?treatment?? I feel so disempowered. I thought the NHS was supposed to be all about your ?choices? and ability to participate in your treatment plan. I just feel like in mental health, your opinion does not really count.

[adelicatequestion]

I would ask to see someone else.

How does he compare to the one you saw that you liked?

I think the fact that you clearly have no trust in him, you should look to change.

Is there anyone you can go to, to ask to change?

Deep down, do you want to change to someone else?

[GetDownYouWillFall]

thanks delicate, the thing is I did ask to see someone else. I was supposed to be seeing her yesterday but when I arrived on the day she was on A/L and this particular one was covering for her. I didn't want to wait another 3 months for an appointment so felt I had no choice but to see him.

My CPN has given me little hints that he is not well-liked and I should ask to see the other one, so I don't think it's all in my head, but they have a way of undermining you and making you lose all confidence in yourself, so you start to wonder if it's just me?

The mother and baby specialist was completely different - so down to earth, a mum herself, lovely to speak to, reassuring, kind, well basically human.

[FabIsGoingToBeFabIn2010]

I would stop seeing him and ask to see someone else.

I saw someone once who said I was annoying her. She said to wait to hear for an appointment. A while year later she rang to offer me an appointment. I said no thank you.

I am seeing someone else now and have told her I hate going, doing like the silences as I don't know if I am meant to speak and feel like I am a victim.

[fairycake123]

Anti-psychotics are sometimes prescribed as anti-depressants. I know this because it has happened to me in the past, I queried it and my psychiatrist explained it to me.

Personally i think that messing about with your medication against the advice of a doctor is a bad idea, and there is a risk that if you do it you will antagonise your current psychiatrist, and possibly any other psychiatrist you see in the future. It is difficult to treat someone who wants to make up their own treatment.

That being said, I would definitely try to get transferred to a different psychiatrist. I have had a shit psychiatrist myself and it basically makes getting better impossible. I don't know who you would have to sppeak to to get a new pdoc - you could start by speaking to your GP, perhaps?

[choosyfloosy]

My dh always feels much worse after any sort of medical appointment. The only ones he seems more OK after (sometimes) are the CPN ones. It's grim for you, I'm so sorry.

When's the next appointment?

I think reducing medication is a good idea. It doesn't sound as if there is anything in your history which would suggest that you will be someone who must be on meds all your life. Who knows? Certainly not the psychiatrist, not for sure anyway.

Did he give you any ideas on how to reduce safely, which one to start with etc?
I thought this page from Mind was useful - you've probably seen it before. Right at the end it starts getting into specifics about which one to start reducing first, e.g.:

'Withdraw from one drug at a time if you are on more than one drug, and leave withdrawing from 'side-effects medication' (eg procyclidine) until last.'

That's counter-intuitive to me as I would have assumed it best to start with the one that's giving you most problems!

I hope you will be able to take this really really slowly (maybe 5mg a month of each drug?) and maybe keep a diary so you have a feeling for how it's going, any symptoms coming back etc?

Maybe your CPN could put you in touch with other people who have gone through this?

Very best wishes to you all.

[domesticslattern]

I don't think you are being silly at all. When is your next appointment and will it be with the different psych?

I much prefer dealing with women about PND than men. I just find that the men I have encountered in the mental health system don't get it at all.

[thelunar66]

I would write to the Clinical Director of the Dept of Psychiatry and request a change of consultant. You have been under this consultant for two years and are not 'connecting' with him. State you have no confidence in him, there is no rapport between you and feel anxious and upset after every visit. Finish the letter with ... 'I look forward to hearing from'.

[GetDownYouWillFall]

choosyfloosy - thank you so much the link you provided to Mind was very helpful, I hadn't seen that before. I asked to reduce my medication really really slowly, I am thinking over one full year. However, he said I could reduce by 25% each time which is more than I would like. Can't help thinking he is setting me up to fail. I can't cut the pills myself as they are controlled release type which cannot be cut.

Domestic - thanks for your support, I agree it's easier dealing with women than men on this issue.

fairycake - I agree that as a general rule you shouldn't go against your doctor. In fact I have followed all of their prescriptions to the letter since I first got ill (BTW I never had any problems with mental health issues before PND). I am now starting to get a bit cynical about whether they really know what's best for me. They seem to over-emphasise the benefits of drugs and underplay the risks of being on these drugs long term (some of the effects are irreversible). It panics me that I may be doing long term damage to my kidneys, risk excessive weight gain, tardive dyskenisia etc. not to mention the risks of abnormalities if I decide to have another baby which utterly terrifies me. They seem to think some risks are worth taking. I do not.

[GetDownYouWillFall]

My next appointment is in 3 months. I have requested it be with the other psych. but they cover for each other and you just have to get who is there on the day. I can't just not go if it happens to be him on the day as I have to book time off work in advance.

[choosyfloosy]

Re the appointment, is there anything the psychiatrist is good at? If discussing reduction of medication causes angst, then maybe leave that until the last ten minutes. Discuss how things have been going generally, give him a potted review of your symptoms/mental state diary (assuming you do keep one). Then you can say, and I've cut the citalopram (or whatever) to 10mg, what are the options for a prescription for a smaller pill size of olanzipine in the future? Then he's dealing with specifics (can I or can I not prescribe olanzipine in 5mg pieces) which he may react better to. Also perhaps ask hiim what the clinical implications are if you do succeed in coming off drugs a, b and c but need them again in the future? I think there's at least one drug that is unlikely to work again once you're off it - sorry to be negative

TBH the 25% each time sounds much too much I agree. I wouldn't imagine he wants you to fail, it may just be that he can't prescribe anything smaller than 25% less?

I can't personally blame psychiatrists for being far from whoop-di-doo about medication reduction, as they see casualties from it every day, but more often the kind of crash reduction people do when they are just beyond the limits of being able to stand the side-effects any more. Also dh had one psychiatrist who was a manic reducer (if that's not a rude way to put it!) - he would barely let dh get onto a drug before he started reducing his dose. That was awful - we had no stability at all. That's what I mean about taking it really, really slowly. Best of luck.