Is there ever a more uncaring doctor than a psychiatrist

[LunchpackOfNotreDame]

Had an appointment today with a psychiatrist (I have severe depression and anxiety complicated by serious physical health issues) and all she could say to me was hmm I can see why you're depressed there isn't really anything I can do to help so let's try some new medication

What did you want her to say? Psychiatrists don't really do talking therapies or counselling, do they.

No but she basically took my history, again, for the 4th time in 10days. The cpn had indicated she would be the person who needs to refer me for the talking therapies.

I'm sick of having tablets thrown at me by the medical profession. Doctors seem to think tablets are the answer to everything and then say it takes at least 6 weeks to work. Oh and they nearly all interact with my existing medications and health conditions. She seemed so dismissive of everything and pretty much told me to suck it up and deal with it.

I am afraid psychiatry is the Wild West of medicine.
My bro had some dreadful 'psychiatrists' treating him who did not seem to know anything at all, nor to give a fuck.
Good luck OP.

did you ask the 'psychiatrist' to refer you for counselling or CBT or sim ilar?

No. She just said up my current medications to try and reduce the levels of pain I'm in. Consulted her book for an antidepressant, decided against that route with my current health conditions and said see you in a month.

I did ask about the therapies the cpn mentioned as they sounded very good and not something I've tried before and was told the list is too long and it's not worth the referral.

Bearing in mind there is no cure for my conditions and I have them for life and I am suicidal I found her far too dismissive. She only cared I wasn't going to impact on others.

I don't know why I bother any more

that sounds terrible.
Could you ask for referral again?

I'm sorry. There seems to be so much variance in their approach and quality

Do you have Mind in your area? I've heard very good things about ours (NE, I can find details if you're near here) and they do counselling and help groups, lots of other therapies.

Can you be referred to Talking Changes? Again, they aren't in every area.

I'm sorry again. You don't need that too.

Psychiatrists are there to diagnose and medicate accordingly - they aren't counsellors.

Sorry if that sounded cold, OP - it wasn't meant to. I've been under NHS mental health 'care' for nearly 20 years now. The only people who ever gave me any form of counselling, or who really listened to me, were the alcohol treatment services. I found myself drinking just so I could go back to them - how crap is that?

The mental health services are underfunded, understaffed, and oversubscribed. The government are still cutting them. I really fear for people like us.

Frustrating isn't it? The best psychiatrists make you feel listened to and discuss treatment options. I've met two of those, one of whom worked as in inpatient psych and one crisis team psych.

The two community psychiatrists I've dealt with have pretty much been how you have found it today, and it's not great practice. God I hate the BNF book when the community psych gets it out, especially for common medications.

Yes, they are there to take histories, diagnose and medicate, but if the role in their setting includes referring to talking therapies, they should do that as well.

Unfortunately, like in any profession, there's some who maybe should've considered being in a different field.

the list was too long and not worth the referral

Well, you're never going to get it if you're not even on the list to start with are you?

Oh OP, I'm really sorry.

I realise it's the last thing you'll feel like doing, but could you look into the therapy directly? Most offer sliding scales of charges. Maybe contact that lovely CPN again and ask their advice?

By upping your pain medication, was this Psych trying to address the cause of the depression?

Thank you for your posts. It's just so frustrating, I'm going to go back to the cpn and see what she says.

One of my pain medications is a tricyclic antidepressant so she said up it to the maximum therapeutic dose (which I'm close to anyway) and see if it helps. My GP had put me on sertraline for the depression but it triggered major muscle spasms and neuropathy so was taken off it sharply.

If I'm honest I don't know what her thinking was other than what felt like 'get her out my office asap'

I get they aren't counsellors but a bit of empathy wouldn't go amiss in this line of work

I know exactly what you mean Lunch - the first psychiatrist I had was a nightmare - he had the social skills of a slug and I was an IP at the time. Reviews were Q and A sessions between him and me, while the rest of the participants could have been cardboard cut outs - they were all intimidated by him. Fortunately he went off on long term sick leave soon after I was discharged. The second one was ok, but inconsistent, sometimes very caring and other times dismissive. He left and whilst waiting for the new psych to start I had the misfortune to see a locum psych who was a complete idiot. He told me my depression would be better soon as the summer was coming! I refused to see him again.

I have had extensive counselling on the NHS with a clinical psychologist and we had some interesting discussions but she couldn't really take on board that my bad days (bouts of up to 15 plus in succession) emerged without any trigger, so that wasn't much help.

The new psych started at the Trust in Feb this year and she's really nice, very gentle, softly spoken, caring and never rushes me but all she can do is change meds/doses, and nothing really works.

I have a wonderful CPN who has become a friend really and she is incredibly supportive but there's not a lot she can do either when I'm in a bad state.

I sound ungrateful really because I think in comparison to others I get a very good service, but with the medics it's drugs and with the psychologists it's "talking therapy" which I accept is very helpful for some people especially when the cause of the MH issue is some trauma in early life, or a bereavement or whatever, or loss of some kind which is almost always at the root of depression. The other thing is that a psychiatrist many years ago (forgot about her - she was very reserved, kind but had an odd affect) when I was an IP in 1995, told me that depression was the "common cold of psychiatry" - and I am aware that psychiatrists see patients with far more complex and enduring MH issues and so maybe seeing someone with unipolar depression and anxiety is like a GP seeing someone with a sore throat as opposed to someone with symptoms of cancer. My depression can be very severe and is getting worse year or year, and I have absolutely no belief that it will ever leave me, and I frequently have suicidal thoughts. The only thing is I am 71 so hope for an early death.........72 would be good, but could cope with 75, but the thought of this lasting another 20 + years is too hard to bear.

Sorry I'm rambling on about myself.

I was a social worker/manager for some 30 years and I'm sure I was dismissive sometimes, it's just that the abnormal becomes normal if that makes any sense, and it's often a case of "oh here we go again - have heard this a hundred times" and because we're human we can't always offer the empathy that is needed.

Oh and I'm about to have lithium added to the 2 ADs I already take - quite effective in bipolar I understand but some evidence of its benefit in unipolar depression. Takes weeks apparently to know whether it will be of benefit and then of course the side effects............if that doesn't work I shall be asking for ECT, which my CPN suggested recently when I was in a very bad state.

Hello UB how are you doing?

Sorry lunch it's so hard for you to be struggling with physical and mental illness. Total crap and yes the psych should have shown more empathy.

yes lunch, see your CPN next or inform your GP of your meeting with the consultant. in my area psychiatrists tend to be moved around the service or move to a post outside it. i've been lucky in that my main two consultants have been fine, compassionate even (funnily enough they are married to eachother), but one i saw once left me feeling distraught, last thing you want when you are not well and seek care and expertise. can your GP or CPN make a request to see a more senoir consultant who knows about meds and therapies?

In my opinion, the big Psychiatric Hospitals of thirty years ago treated the patients and their families much better than the present system.

They only treat the patient these day and fail to notice the damage being done to children and spouses.

Some years ago, they wanted to "section" my partner. The psychiatrist had a conversation with me in the busy corridor of the main foyer of the hospital. No privacy. When I disagreed with him on Sectioning. He then said my partner was MY responsibility. But He had given me NO information on how to care for my partner.

Lithium is toxic. I believe.

Lithium has been used mostly for bipolar disorder with good effect for many years, but there is now evidence that it can be effective in unipolar depression. It has (like all drugs) some potentially serious side effects and blood tests and an ECG are undertaken before it's prescribed. Also in the first 3 months of taking this drug, there is a need for weekly blood tests to ensure the dosage is right, as there can be an adverse effect on kidneys. So yes there needs to be care taken to ensure that it doesn't build up to a toxic level in your body, but the whole process is overseen by a consultant psychiatrist.

I think consultants generally can be very up themselves sometimes. That said, I have a smashing endocrinologist.

My psychiatrist was arrogant and dismissive. Part of the problem was that, because you have a mental health issue, I think he just thought I was exaggerating things. He was a private one as well, and it was all kinda 'there there little girl' type of approach ... very patronizing.