First psychiatrist appointment

[wishes1111]

Hello

I was wondering if anyone could tell me what to possibly expect from my first psychiatrist appointment?

I am in my late 20s, traumatic first years of childhood, citalopram since I was a young teen, recently changed to Venlafaxine.

I have always felt my depression is much deeper than just "regular depression". I make rash decisions without thinking of consequences, I don't experience any extreme highs, I'm either on the floor with anxiety depression or numb, I rarely feel happy and if I seem it, it's an act. I have intrusive thoughts telling me I'm worthless and better off not here.

I've experienced a lot of grief, multiple miscarriages, the loss of my adoptive parents whilst they were still relatively young to cancer.

I'm wondering if anybody can give any advice to what will happen as I'm becoming increasingly anxious that I'm going to be shrugged off when I feel like this is my last change to get help.

I've tried counselling, CBT etc etc nothing works.

I always seem to be in self destruct mode, for example I'll take 2 sleeping tablets instead of 1 etc. I just want out most of the time and I can't go on like this, I feel like this is my last attempt to get proper help.

I know I'm rambling, thank you if you've read this far x

Have you had treatment for complex/developmental trauma? Psychologists tend to be better for this than psychiatrists to be honest (But still go to the psychiatrist because they are the medication experts)

Hopefully the psychiatrist will refer you for trauma therapy. Might prescribe different meds or mood stabilisers.

Have you ever had an EUPD diagnosis or diagnosis of anything eg chronic depression?

Oh love, please don’t worry too much. The psychiatrist will be wanting to help you.

They will ask about your upbringing background, losses and trauma but not in depth at the first meeting so you don’t have to go into graphic detail. They will ask about and therapy or medication that you have tried. They will ask a few questions about your mood and mental health difficulties.

They will probably talk to you about medication options and therapy. Medication tends to be a sticking plaster to help you cope whilst you do therapy and ultimately with your background - trauma therapies, stabilisation and support with emotional regulation will be the most helpful.

Your first post contains all the information they are looking for.

Good luck, take a deep breath and you will be fine.

A psychiatrist is largely going to be focused on meds. See if he can help you get some support from a psychologist or a mental health nurse who can take a much more holistic view and formulate how your past impacts on your present, and find some ways to move forward. This may or may not involve therapy. The first and most important thing here is developing a trusting relationship with your care team. A psychiatrist is likely to see you only very infrequently, so s/he isn't going to be the right person for this.

Not sure if it helps to know that whilst there is loads of evidence about how childhood trauma is at the heart of so much adult suffering, there is equally loads of evidence showing that people can move past it with the right support

Sending lots of positve thoughts your way. Hope this is the start of a positive journey for you

@Bluntasduck when they put me on Citalopram when I was young, I remember the dr explaining to me and my parents that a traumatic childhood can damage the brain as if a brain injury has occurred. It can alter the way it works but I've never had specific treatment for this x

@dane8 thank you.

It's NHS, I've been waiting a year as they referred me after I finally gave in to my bad thoughts and took a large overdose this time last year.

I will make a list, good idea. X

@HikeForward I don't know what EUPD is, I've never had a diagnosis of chronic depression.

Every time I'm going through a "bad patch" which is where it stops me from getting out of bed, eating etc, the Drs give me a short dose of Diazepam (7 or 10 tablets) x

@Incrediblytired thank you for your kind words.

I've tried talking therapy and CBT before but find that bringing up my experiences makes me feel worse x

@Restlessinthenorth thank you very much.

I really hope with the right help/team I can heal and find some happiness x

Hi OP most other posters are right, a psychiatrist can prescribe medication and give a formal diagnosis, and suggest treatment, bit are unlikely to offer any therapeutic intervention.
If it is something like EUPD - which is possible given your background - trauma focussed therapy will probably be helpful, there's dialectical behavioural therapy, and sessions may be delivered in a group setting.
These therapies are helpful as they can help your brain heal from the trauma, help you to learn emotional regulation skills and self soothing skills, which are in the area of your brain that probably weren't developed in childhood if you were neglected or abused.
It's available privately and on the bus bit the wait lists are long

NHS not bus.

You need a counselling psychologist. Don't bother with CBT or counselling. Waste of space for someone with your background.

Treatments for developmental trauma/ Complex PTSD, emdr delivered by the right person. Also research IFS therapy

Your psychiatrist could be just about the meds - this can be important to help you manage whilst you get to grips with psychological therapy- which can be very challenging and long term.

I'd be asking the psychiatrist to align me to a psychologist and worth in a tripartite manner with them- sounds like a team of people is what you need.

You have effectively had an injury that affected brain development- good therapy and with the right person can help 'rewire' your brain.

You experiences sound similar to mine and I've been through the mill of this for the past 10yrs. It takes time, but gets better.

Also the psychiatrist will have a great view of meds and can try different things and combos that the GP cannot - do let him/ her explore medications with you.

Ps good luck.

Hi OP. The first appointment is all about information gathering. They'll go through your entire life history from birth until now; family, friendships, relationships, big life events, education and employment etc. As well as getting information on what's happening for you right now in terms of your mental health and how it's changed over time. I would expect you'll do most of the talking and I wouldn't expect a diagnosis or huge treatment plan including therapy etc to come from the first appointment at all.

Psychiatrist will take a comprehensive background and prescribe medication (that’s what mine did). He also suggested which therapies would be most beneficial but advised me to stabilise on medication first so that I would be able to cope with whatever therapy dragged up.

I second EMDR. I had repeated childhood traumas (sexual and physical abuse, neglect) and trauma later in life. I have seen a number of psychiatrists over the years but none of them were interested in trauma, they were only interested in diagnosis and medication - neither of which helped. In fact, a diagnosis made it worse because whatever I was feeling was attributed to bipolar disorder and my traumatic history was swept under the rug.

It is only in the last couple of years, since having psychodynamic therapy, that I have begun to experience fewer depressions. I have just started EMDR after reading The Body Keeps the Score, which I would recommend to anyone who has experienced trauma. www.amazon.co.uk/Body-Keeps-Score-Transformation-Trauma/dp/0141978619/ref=nodl_?tag=mumsnetforu03-21 I tried to receive it on the NHS but they told me EMDR is only for ‘traumatised people’ which sums up their wilful ignorance of my history.

A psychiatrist may try to diagnose you with EUPD but be aware that there is a lot of controversy around this diagnosis, as it is often seen as a catch-all for people - particularly women - who grew up with trauma and thus rather invalidates their unique experiences. They may try to prescribe you antipsychotic medications like quetiapine or resperidone which can cause debilitating side effects such as weight gain or cognitive issues, and there is a lack of evidence to support their usefulness in trauma. Do read up on anything they offer very thoroughly so you can make an informed decision on whether medication is the right option for you.

There is a lot of evidence to support EMDR’s effectiveness in treating trauma and there are many people who make a full recovery after treatment. You also aren’t required to go into detail about the trauma, unlike other therapies that can involve talking about the trauma over and over, which is potentially retraumatising.

Good luck OP. Remember that none of this means there is something ‘wrong’ with you or that you are mentally ill. You are experiencing an understandable response to multiple traumas. The numbness you describe sounds like dissociation.

@ChaosEmerald
Sounds like a shite experience. I can't believe they declined your request for EMDR.
Have you looked at any of Carolyn Spring's stuff. All very interesting also though focused on DID. She's got some interesting blogs- very real and open.

Second the recommendation of Bessel van de Kolks book. An excellent read and something you will dip into again and again as things begin to make sense.

Agree to avoid diagnosis if possible. Developmental disorder is often misdiagnosed as eupd or borderline personality disorder.

You definitely will find talking therapies make it worse initially as you are bringing up a lot of trauma and focusing on the source of the pain. If you can stick with it, it will eventually really help - and much more so than meds!

Hey, oh man, sorry you've been through all that - but this is a good step!

Basically a psychiatrist is less in-depth and more symptom based than a psychologist - more like a doctor than a therapist.

In my experience they will ask about the symptoms and behaviours that led to you making the appointment. They'll take a bit of your history, background/abuse/trauma, family relationships and conditions. They might give you some diagnostic checklists to fill out, and they'll take a health history, and ask if you're receiving other treatments ie CBT, therapy, and might suggest that alongside medication.

Then finally they'll probably write a prescription and schedule a follow up in a few weeks to see how it's working/adjust the meds and dose.

Good luck!

Thank you everyone for your kind and helpful responses.

@dane8 I do work, full time. They are fully aware of my mental health struggles, recurrent miscarriages etc and are supportive when I've needed time off. I'm extremely lucky and grateful for that.

Before covid, I felt like going to the office every day and having a set routine/working with great people, lots of laughter and "banter" if you will helped. Since covid it's been a downhill slope.

I will update after my appt.

Thank you everyone x