To think appointments with my psychiatrist are just a waste of both our time?

[JustNotBlueberries]

I was diagnosed with adhd more than ten years ago and have been taking medication regularly since then. I have a review meeting every 6 months. I appreciate that they are keeping an eye on me and giving me a chance to voice issues or to request changes but these meetings are just getting kore and more inane. Im OK. The meds are doing their thing and beyond prescribing me the meds there isnt really anything else the psychiatrist can do for me. I sometimes try to raise issues but it's just so frustrating because they obviously neither care nor really listen.

For example today I thought id mention the problems im having with procrastination at work:

Psych: "do you like your work?"
Me: "yes, i like my work. My core job is really interesting and i enjoy x y z but I just can't cope with any admin work"
Psych: "sounds like you don't like your work".

And then
Psych: "have you thought about applying to other jobs?"
Me: "yes many times but I can't get myself to update my cv so I fail at the first hurdle".
Psych: "i think you should try to apply for another job."
Me: "but I'm not able to update my cv"
Psych: " maybe try to apply for another job."

A bit later:
Me: "I'm really struggling with maintaining my health. I have got high cholesterol and am obese but I am not able to get myself to exercise or eat more healthily"
Psych: "i think it sounds like you could really do with some exercising and watching your diet to improve your health."

A bit later:
Me: "another thing i struggle with is getting enough sleep because I keep procrastinating going to bed. Ideally I need about 7h for the meds to work but I struggle to go to bed early enough"
Psych: "that's great that you manage 7h."
me: "no 7h is the ideal. It's usually between 5 and 7 as the best case scenario."
Psych: " really good that you are getting enough sleep"

And on and on it went. Maybe he just could not hear or understand half of whar i was saying but i think he just wanted to put a positive spin on everything and be done with it. And Everytime i mentioned an issue, I.e. something I struggle to do the psychiatrists response was to do the thing i said I just struggled with. I mean he obviously wasn't listening at all. I don't even blame him. Im sure compared to their other patients my case is trivial. Im neither a danger to myself nor anyone else. (I mean apart from the fact that I will probably die in 10 years or so because my life style is so bad.) Besides there isn't much they can really tell me. I'm not an idiot. I know what i need to do but i just won't do it. I am not sure there js anything anyone else really can do. But then why do we have to go through this farce?

Every review is the same. In the last one I mentioned the same issue around wanting to change my life style and the psychiatrists response was "well you just have to do it". No shit.

Sorry there is no point to this. I am just ranting. I mean except for 2 people they have all been reasly rubbish. (I have seen a lot because they keep changing) The worst was the first guy who kept insisting that experiences I had that I rated positively (like moving country, being exposed to several cultures) must have been traumatic and resulted in depression years later.

Had anyone had better experiences with their psychiatrists?

I sympathise
I don’t think mine listens either! Or at least puts a different spin on it than what I meant

you neee to keep seeing a psychiatrist to keep getting the meds. So don’t make any rash cancellations!!!

is it possible for you to move to a different psychiatrist? Is this nhs or private? Worth asking about a change.
Don’t need to say anything against this one other than you would appreciate a different view or someone with specific interest in supporting middle aged / peri / meno / working / obese women (whatever applies to you)

for example. There are treatments which may help you sleep - from getting progesterone - oestrogen ratio levels right to taking magnesium or doing a medication and drinking herbal tea!!!
cbt can also be helpful.
however sounds like your psychiatrist isn’t engaging. Which must be frustrating.

Sounds like you are struggling with executive functioning skills. The Psychiatrist needs to monitor the medication and any side effects.
Maybe you need a Psychologist or therapist to help with some lifestyle or mind set changes that you have been able to identify.

I seen a psychiatrist a few times. They were long awkward conversations about how I am doing that felt useless. I had a care coordinator and conversations flowed better and they provided actual support. I wasn't on any meds so I'm not sure what the role of the psych even was. I think checking for hallucinations/delusions possibly. Maybe they fed back to the care coordinator for their plan.
I've not heard of people with ADHD having 6 monthly reviews with psychiatrists, it does seem to be a waste of resources when it's of no benefit to you.

I think it just feels odd because it is really- what else would they be for apart from monitoring medication and re prescribing? I’d assume they are standard questions related to that and idle comments in response rather than advice or counsel.

family member has a psych review quarterly and like you leaves it not really knowing what it was all about, but with their prescription- so box ticked I guess.

Maybe just to check side effects and appropriate dosage? Not sure if adhd meds have many side effects

Thanks. It's NHS. I just see whoever is the current consultant in psychiatry in my local trust at that time or one of the junior doctors in that team. They have all been appalling across the board (except for 2 of them). 5he first guy (this was the consultant) kept making mistakes in my prescriptions so I constantly had problems with the pharmacists refusing them as they are controlled drugs. (His mistakes were so silly like copying over the same date from my previous prescription or totalling up the total dose wrongly or writing different doses as digits or in words). It would be hilarious but I worry that there are more serious cases than mine who actually need someone competent.

All the things you mention sound very sensible but genuinely the most they have ever done in terms of further tests is a BP check (even though the nice guidelines state that this is necessary initially and at regular intervals) approximately 5 years after starting the meds. The psych who recommended that is one of the two i deem as ok. She also suggested we try to change my meds or dosage or schedule to improve things which no one ever had entertained before her. And they keep wanting to prescribe anti depressants.

Yes I am. Id even appreciate if they said well that's just part and parcel of having adhd rather than this trying to sound sympathetic without actually having to listen shit.

Yes they do have side effects. They really suck and I absolutely hate having to take them.

My young adult daughter has adhd meds and sees a psychiatrist every six months. The appointment itself is largely pointless but she needs it to get re prescribed her meds.

her gp no longer does shared care.

Oh no why doesn't the gp do shared care? What does she do in thr mean time? Surely the psychiatrist cant prescribe 6 months worth of medication?

Mine is shared care with gp. Thr gp prescribes and the psychiatrist just reviews every 6 months.

I'll be very honest. They are a psychiatrist, not a psychologist. They deal mainly with medication. They don't do motivation coaching.

There is so much that can be managed with medication. There are no drugs that will give you complete motivation to get on with the tasks that are not pleasant and you don't want to do.

Ultimately, they should have suggested referring you to CBT or a psychologist. Was this not offered?

You say that the ADHD drugs are working ok, but many of the things you’re struggling with eg not being able to update your cv, not being able to apply appropriate self care protocols etc sound like executive function issues, which being on the correct medication should/could help with.

At your next medication review, could you make the link explicit for your psychiatrist and ask to trial a change of dose, or a different medication?

When we're seriously short of psychiatrists in this country you'd think there would be someone else who you could check in with once things were stable. I agree OP, sounds like a complete waste of your and their time. Your heart etc might need to be monitored but surely it doesn't require a psychiatrist at that stage.

What do you think the blocker is with updating your CV, is it just that it is a bit of a ballache? (I certainly couldn’t be arsed to update mine unless there was a job I desperately wanted to apply to). Is it something you could outsource?

Sorry @JustNotBlueberries but your therapist sounds like the one in that Mitchell and Webb bad therapist sketch ! I think you maybe need a different therapist?

As others have said though it’s a psychiatrist- they’re for medication and medical treatment. They don’t do therapy.

Have you been on the meds for 10 years and seen no improvement in your ADHD?

Ask to try changing regime.

Increasing water intake if methylphenidate based can help.

The likes of antid sertraline can really stabilise mood. Help you get out of a rut and intiate healthier habits.

The type of food your eating can also impact medication absorption

I think you are misunderstanding the role of a Psychiatrist. They deal with the medical side of mental health issues not the practical side.

ADHD meds don't remove symptoms - they make it easier to manage. Did you see an improvement when you started these meds, and has that continued? If not perhaps you need to consider changing meds.

CBT or ADHD coaching might be a better option. CBT should be available on NHS, ADHD coaching is sometimes available on access to work or similar schemes. There's also all sorts of books on managing ADHD.

I'm diagnosed combined ADHD but currently manage without medication. I have to work really hard at certain stuff and it's a never ending battle with some aspects of life admin, housework etc. A good tip from an ADHD book I read recently was to focus on just one area for 3 months. That could be exercise, diet, job hunting or whatever else you think is most urgent. Try to put small steps in place to support that one area. Trying to change or consider too many things at once leads to burnout and nothing getting achieved. I've done this with exercise and it's made a huge difference.

@sunshine244can you share the name of the book? I’d be interested!

I've seen six psychiatrists due to clinical depression.

The first two were really fun to visit - both professors (paid by my workplace BUPA) who did listen. They enjoyed slightly rambling conversations around psychosocial issues.

Three were disengaged, miserable and almost seemed hostile, though I accept my depression could've influenced my perception. One of those did recommend a really helpful change to my meds.

The sixth was a genius who not only listened and discussed, but put me on a different diagnostic pathway. Unfortunately she was a locum from New Zealand and went back home!

@JustNotBlueberries, I agree a psychotherapist would be a better bet in terms of understanding the difficulties you're having and working towards handling them.

I'd suggest spoon-feeding your shrinks. When describing a problem, LABEL it first - executive dysfunction, disrupted circadian rhythm, impulsivity, and so on. You'll have to look these up. Also TELL them you feel psychotherapy would help you learn to better manage your symptoms.

Good luck!

My experience was that my psychiatrist was interested in hearing about everything but the only outcome ever was a change of prescription. She was good at taking my lead on that though. But hold on to those appointments - you might miss them once they’re over! I’m 5 years in so don’t get a regular check in appointment any more.

Therapist? OP is talking about a Psychiatrist?
A psychiatrist is not a therapist (although some might do brief therapy....not common in NHS). A psychiatrist is there to diagnose and prescribe. Medication reviews are part of that, and involved asking a range of questions to ascertain any changes in mental health presentation.
I honestly think Psychiatry is one of the most misunderstood professions with such unrealistic high expectations placed on it.
Psychiatrists are not miracle workers any more than any other doctor is.
OP - it does however sound like you have had a psychiatrist with very bad listening skills. If you are not happy with that Dr, ask to see another if that is possible. Sorry it's been a frustrating experience for you. I also echo the suggestion to look into therapy particularly CBT, to help you with the things you want to change. Wishing you all the best.

I used to work in Adult ADHD and the shared care agreements with the GPs were that the GP prescribed so long as the persons prescription was stable but reviewed by the ADHD specialist as GPs can't start, stop or adjust the prescription on their own.

For my team it was annual reviews, sounds like it's 6-monthly in your area.

We were strict in that the review was around ADHD and ADHD meds only, if there were other MH or physical concerns the person would be advised to see their GP or we might refer to a secondary MH team if the person seemed unwell enough to meet criteria for secondary MH services.

Other than that, it was just a meds review and has to happen per whatever your GPs shared care arrangements are, regardless of it seems pointless.

I didn’t find speaking to my psychiatrist helpful at all. But I don’t think that he was specialised or even enjoyed talking therapy. I think he actually admitted as much. He would ask probing questions but tbh it’s not like my answers really had any bearing on anything imo. So it did seem like a complete waste of time when he asked things like why do you think you don’t like talking about your emotions. I would give an answer and it would just hang in the room.

I wish we could just say hi on zoom for 5 mins and then both log off. But we both perform this less than helpful dance every month.