What should I ask for at GP appointment? Anxiety, depression, suspect bipolar and ASD..!

[LeftoverCrabsticks]

I have a GP appointment on Wednesday morning and I just don't know what I should say or ask for.

I've had a few rounds with depression and anxiety in my life but they've mostly been circumstantial and I have used CBT successfully in the past. This time I don't feel the techniques are enough, sometimes I feel like I am losing it entirely even though there's not a clear trigger this time, so last week I made the earliest appointment they had, which was for this week.

On top of the anxiety and depression, the symptoms of bipolar seem to fit me very well. And in addition to this, I am 99% sure I have autism (very strong family history - and it explains much about my life) - I would like an autism diagnosis one day for my own personal reasons, but realise it is probably a huge amount of effort.

I also have PCOS and the time of the month can really affect how I feel. I already take supplements which help a bit, but not enough.

I am not sure what to ask for though. I've never taken any medication for previously diagnosed anxiety and depression. I am worried about side effects, and medication taking away the "spark" in me. I'm also still breastfeeding my two year old a small amount every few days and I want her to self-wean. That said, I am beginning to feel that I need something in the form of medication - would a GP prescribe me anything?

If they did refer me to somebody, where would that be? A psychiatrist, psychologist, counsellor, therapist..? I'd need a person that understood autism because I'm aware it can make a difference.

I am lucky enough to have very decent private health insurance which would cover most mental health stuff - does that change what I could ask for?

Any thoughts very welcome as I need help and something needs to change, but I would love to be better prepared for this appointment and know the options available. Thank you!

Just tell your GP what you have written here, you could even print it out and take it with you. It will be a good starting point.

I've been on antidepressants a few times over the years and rather than take away my spark they have given me it back. I believe that there are antidepressants you can take when you are breastfeeding. If your GP thinks you could be bipolar they may have other suggestions as I think antidepressants are not necessarily the right thing for bipolar, but its your GP who will know what to do and where to refer onto. They will certainly be able to talk you through the options and you what they would reccommend you look at privately. You will certainly be able to access help more quickly privately.

I'm a GP. You can print out your post and take it in? Explains everything very well. You don't need to know what to ask for, your GP will you the options/opinion.

Mental health problems and PCOS is a lot to get through in a 10 minute appointment - can you call back and ask for a double? If not, don't worry, but I'd focus on your mental health problems this time.

Thank you both! Actually given my tendency to witter on (I edited my post about ten times for brevity, it was sooo much longer to begin with!) it might not be a bad idea to print it out and hand it over. It would give more time at the appointment!

AnxiousCarer - that's good to hear that antidepressants brought the spark back for you. I definitely don't have it when I'm low, that's for sure, but I like the feeling I have when I'm "high", even if it's not always a good thing. It gives me a drive and courage I don't normally have, and a fast brain, but with it comes side effects of brain never stopping, and impulsive decisions that are sometimes good ones, but not always. I guess I just want it in moderation!

DipsyLaLa22 - I'm not really expecting much help with the PCOS but I do wonder if the hormone imbalance is not helping matters. I definitely agree I need to focus on the mental health issues first.

I've been offered metformin for PCOS in the past but been reluctant because of potential side effects and I'm not sure if it would help me or not, and I'm trying the supplement route first. They've not helped my mood much, but for the first time in my life in the last year I actually have regular monthly periods (I'm 40 now!) versus up to 60 day cycles, and far fewer migraines. So I don't know if metformin could actually do any more for me than what I'm getting already.

I asked the receptionist for a GP who knows about hormonal issues and mental health (it's a big surgery) and apparently there's one suitable that I'll be seeing so fingers crossed :-)

Google PMDD which is very often mistaken/misdiagnosed as depression or bipolar (speaking as someone with a track record in this misdiagnosis) and look up hormonal depression. It may not be you but it might. Or actually Dr Michael Craig in the Maudsley treats hormonal depression issues and separately has an autism speciality, he may be the quite niche doctor you're looking for. Good luck.

The trigger btw, if it is a hormonally induced depression, may well be hormonal fluctuations from weaning.

Thank you! Yes, hormones definitely play a big part, and are not helping. The reason I think it's something more is because these phases last longer than one cycle.

So I saw the GP. I am not sure what to think. She minimised me basically (I took in what I'd written here) and seemed to think I just needed more personal time. She also tried to convince me to wean DD and I do not want to, plus it would not be good for her as she's very anxious herself (understatement - even the health visitor agrees she's unusual) and is currently trying to settle with a new nanny.

She said she did not want to refer me and prescribed me a low dose (10mcg) of Citalopram. But I'm not sure, I mean it says not to take if you have manic episodes and the way I was in the summer there was no doubt.

My problem is that I am so used to masking in life is that I come across as reasonable and controlled, even as my brain is exploding with racing thoughts and panic. I hide it all very well, I've had to.

She reckons I'm just normal and blames it all on having lots of children and working full time. But it's more, I know it is. I was like this before I had children. She didn't even mention the autism stuff.

I'm seeing her again in two weeks but I'm not sure if I can be assertive enough.

And I don't know if I should take the Citalopram either. I have to drive lots and I do like a drink and I'm worried about the effect it might have on my already crap libido.

I'd think carefully before going on that. It's really hard to get off it.

It also makes things worse at the start before you see an improvement.

Ugh, that's exactly what I don't need - things worse right now! I need a clear head for work and I see one of the side effects is loss of focus - I struggle enough with that as it is.

I think she thought I was over-exaggerating and just wanted rid of me :-/

http://www.mumsnet.com/Talk/feeling_depressed/1033298-Citalopram-first-day-feel-terrible-is-it-worth-bothering

Previous MN thread about it

Wow leftover I could have written your OP and subsequent bits (about masking, for example).

Sadly, I had exactly the same experience repeatedly with GPs.. since having DD 3 years ago. Must have highlighted issues incl. the strong suspicion I need to be assessed for ASD around 20-30 times. GPs minimise, negate, make it clear you are taking up a 10 minute time appointment unnecessarily (contempt, discouragement from coming back), try to thrust anxiety/depression meds upon you and when you question that (well am I anxious, or depressed?) act as though you're unwilling to accept help (and should just leave). One told me outright 'you don't have aspergers'. Same one sent me for CBT, I sat with the CBT therapist for an hour and at the end of it she wrote a detailed letter to the GP explaining that she was entirely the wrong person for me to speak to. I went back to the GP and asked for an appropriate appointment - the GP referred me straight back to the exact same woman, we both sat in another CBT appointment (wasting that appointment, that someone else could have had) just discussing how nuts the situation was.

Eventually, I've been referred to the local mental health services, even then it took a 6 month waiting list to get a single appointment. However, when I did that - after an hour and a half the first thing they said to me was 'we think you need to be assessed further for autism/aspergers'. I cried with relief. It's another long road to the next available appointment but it's something.

I'm writing this to emphasise you should trust your own instincts, and not be fobbed off with medication that is not right for you or accept poor treatment from the GP.

I'm sorry that your GP didn't listen. Could you ask to see someone else for your next appointment? Are there any nurse practitioners at your surgery (nurses who have had extra training to act in similar capacity to GPs and can prescribe) The last practice I was at had one with a background in mental health who was fantastic, surgery website might tell you what background and interests the Drs and nurses have which could be helpful when choosing who to see.

Thank you all :-)

FrameyMcFrame - Thank you! That's a very useful thread - and I've come across plenty of others when I've been researching this evening. It does seem to be a huge gamble whether it works at all, and even when it does, the early adjustment sounds appalling. Add to that it sounds like it doesn't even tackle some of the issues I have and may even make them worse (plus my relationship is already in trouble due to my libido) I think I'm going to give it a miss. I can't gamble with all that, I can't risk being worse off than I am already. That's £8.40 wasted, oh well.

secrethideaway - yep, that sounds about right :-( I'm sorry you've had to go through all this. I had a fairly easy time getting an ASD diagnosis for my then four year old son because he was basically trashing the school, but I'm in the process of trying to get an ASD diagnosis for my oldest daughter (10) who is very, very much like me. She is extremely well behaved outside the home, so nobody ever has concerns. The experience is like day and night. She masks so well in front of others so nobody believes me and I KNOW they think I am being paranoid, but her meltdowns and obsessions at home it is another child. We've talked about it (she's very mature for her age) and she can totally identify with the "symptoms" of ASD and she knows she is two people depending on where she is. And that is how I am too. I keep it all together but when I am "safe" I can explode. Not violently, but shouting, running away, burning bridges.. depends on the scenario and my current mindset.

At work today my manager was talking to me about something technical that I was having trouble understanding due to my constant brain fog at the moment, and all I could think about was how I couldn't quite control my breathing, my heart was racing and I was thinking what was I doing there and seeing patterns with the words on the screen(!) - yet externally I just looked completely normal I am sure, making all the right acknowledging sounds.

And my brain does not stop running at times, just endlessly talking to itself and I swear I can hear things that aren't there sometimes. I can get obsessed with things to the detriment of my health and personal care and sometimes even safety. Not to mention my phases of extremely impulsive behaviour which I am sure aren't typical even if in some cases they've opened new doors in my life for the better. If my GP thinks any of this is "normal" then I fear for the future of the human race, frankly. And I don't think citalopram is going to fix any of that.

The local paed at least (after I managed to get a referral from a decent GP) listened to me and said there was enough evidence there for her to go through the ADOS assessment, which is at least a year wait. But it was such a relief for somebody to actually acknowledge I might be right, and not just say "don't be silly" for a change.

The trouble is, I find it very easy to advocate for my children, but I am no good at doing it for myself. I feel like a fraud, an imposter, and don't want to waste anyone's time. And as you have experienced, you have to jump through so much to get to the right person and for somebody with massive anxiety problems, it's a bit of an ask..!!

AnxiousCarer - I would like to see somebody else but I am scared of the whole "why are you seeing somebody else?" and of offending the other GP. You are right about nurse practitioners - I've seen some very good ones over the years. This doctor in theory should have been good on paper but she wasn't in practice.

I'm seriously considering trying to get a private ASD diagnosis despite the cost. Because then it might open doors to me in terms of getting the proper NHS treatment - people won't just dismiss me and more importantly I'll have the confidence of a diagnosis.

I have diagnoses of ASD and bipolar disorder.

I wouldn't presume to give medical advice at all, but what I would do is take those things one by one.

The citalopram might help with the depression and anxiety.

Because ASD can affect the treatment you need for other disorders, and because ASD can sometimes look like bipolar disorder, I'd personally go with trying to get an ASD assessment first. They're supposed to have a framework in place for providing this in all parts of the country - in theory.

Print out and fill in a screening test call the AQ10, make a list of the symptoms that you feel suggest you have ASD, and say that that, in combination with your strong family connection with someone with ASD, you would like an assessment.

I think that treating the anxiety and depression in the short term is also important. You're on medication, so give that a chance, and see if you can refer yourself or get the GP to refer you to your local IAPT service. Once you've done therapy through that, if you're offered it, it might be worth asking for a referral to secondary mental health services, but it's very unlikely you'll get that.

GPs don't get offended if you see another GP.

All the above is assuming NHS. I think you should also look carefully at what services your private insurance will provide, and for how long (some of them cover short treatment, but won't provide long-term care). Make sure you know what services are available and where and to whom in the local area you are entitled to go. Find out if you can refer yourself to these services or if you need your GP to refer you, and if so, tell the GP you have private health insurance and where you'd like them to refer you to.

This is what is do if I had my time again (and hadn't gone the slightly more complicated route if going a bit mad every so often and being put in hospital).

Thank you :-)

I'm seriously reluctant to try the citalopram unless I'm sure it's the right thing to do - and by that I mean by somebody more qualified than spending a few minutes with me minimising my issues. I'm not prepared to risk it. Yesterday I burst into tears at school after having a panic attack and meltdown over not being able to get a parents evening appointment for my son (despite getting there early - seems plenty got there even earlier) and ended up crying on his teacher. Go me. The thought of being even worse than that yesterday if I'd taken that pill fills me with horror.

I'm glad you think I should address the ASD first - that is what I am thinking too because it changes so much. I think I have about 35 on the test if it's the one I think it is? (Baron Cohen one?) and the list of symptoms for women fit me like a glove. I have an uncle diagnosed, my son is diagnosed, my oldest daughter is being assessed and even my mum scored about 30 on that test and she is somebody who minimises every potential health issue going - she was really surprised. I'm 99% sure my aunt and sister have it too.

Thank you so much for the advice on what to ask for. I did have referral for CBT last year which was over the phone, and I ended up getting so anxious over having to receive phone calls (I hate phone calls!) that I ended up masking most of my responses so I could get discharged. Although to be fair at the time I did feel good - it was one of the more "up" phases, and I genuinely thought I didn't need more help at that time. The GP said because I scored highly she was surprised I had relapsed(!)

I don't think insurance would cover an ASD diagnosis, but it might cover seeing somebody for mental health. I need to ring them and ask, but, as I hate phone calls.. yeah. In terms of diagnosis it may have to be out of pocket, but fortunately we can hopefully afford to do that even if it means putting it on the credit card. It has to be worth it. I do know of an excellent doctor locally who diagnoses it in adult women, so there is that.

I think the best bet is for me to find who I want to be referred to and ask the GP. My mistake was going in not being sure what I wanted.

So sorry you've had to go through such a bloody hard time :-(

Hi!

I think the questionnaire you've filled in is the AQ50. The AQ10 is just a shortened version of that that GPs often seem to use for screening to decide whether to refer - it's only ten questions, so a very blunt implement, but it means they can read all the questions as well as see the score at the end.

ASD diagnosis through the NHS can take a very, very long time, as you obviously know given your family's experience so I think you need some kind of help with the depression and anxiety in the meantime. I guess you're right that it's possible your insurance will cover that, if not the ASD assessment. Also if at any point you believe that you could be having a high episode, or someone who knows you notices you're acting out of character like you might be high, then those can really cause problems and should take priority at that point IMO.

Could you communicate by email, get someone else phone, or arm yourself with whatever information you have from documentation and/or their website and jot yourself down a list of items to be dealt with in the call?

For therapy, I think it's worth suggesting, if you can, that you find phone calls/group work/whatever difficult and you suspect you have ASD which might mean you need individual therapy (I'm on the waiting list for CBT right now! I told them my diagnosis and I'm going to have 6 weeks of individual therapy). If you do get referred for ASD assessment, you can say you're awaiting assessment. I'm really sorry the therapy didn't help last time :(

That parents' evening sounds awful, must've been so horrible for you And badly organised; it shouldn't have been a rush to get tickets before they sell out, like a festival or something!

I just started on escitalopram yesterday Maybe I'll let you know how it goes!

There's a thread over on the Mumsnetters with SN board for adult women who have or think they might have ASD, dunno if you've seen it? I'll go and get the link in a minute.

This one! I'm on there under a different username. If you haven't read or posted on it before, we're really friendly and welcoming, I promise

Thank you! :-) Ah, I'd not come across the AQ10.. I wonder how I would score on that? Although I am sorely tempted just to say to hell with it and go for the private diagnosis with no wait. Everything said about this doctor is positive, and she sounds very professional. I only know about her when we were wondering if we'd have to wait years to get our son diagnosed so I was looking into alternatives, but as it happened because he was so violent and was so obvious, he was sorted straight away.

I may see if I can get my husband to ring and ask - he is good like that! Sometimes I think he's probably enabling my phone anxiety but on the other hand I seriously struggle. I can't even process what people are saying at drive-thrus (my husband can, so it is just me) which is partly why I struggle on the phone. It takes me longer to work out what they're saying and I get afraid in case I've misunderstood and it becomes a feedback loop. I need to see faces with words! My hearing is perfect though, too perfect.. I can hear everything (phone chargers, TVs etc) that others can't, so it's not that!

Individual therapy in person would be ideal. I had it before many years ago (after I quit work to be a SAHM and a traumatic previous year including losing my dad and nearly my baby) and found it really helped, and it got me back on track.

You're absolutely right that somebody should try and be aware when I'm "high". Trouble is, I'm convinced it's totally okay (of course, that's kind of the way it works!) and I don't take kindly to being told what to do. My son has PDA (diagnosed privately) and I know I have PDA traits so it's clear where he got it from. So whoever it is looking out for me (DH, presumably!) will not have a nice job :-(

Good luck with the escitalopram! The first few weeks of any drug sound awful, but I hope it works for you. Good luck with the therapy too!

And thank you for the link - I think I have seen it before when I realised I was almost certainly autistic last year (when investigating my son!) and it was very reassuring. I never posted but it was nice just to have it there and lurk on it and feel like there were others like me out there :-)

Hmm, just looked at the AQ10 - it's very geared at males. I'm fairly good in reading people because I've worked so hard at learning how, like many women on the spectrum in order to get by in life. And there's a lot of questions on that!

Still scored 6-7 though - all the non-reading-people-related ones I scored for, obviously! The cut off is 6 so I guess they would take me seriously.

My DP does a lot of stuff like that for me, too - he's started, though, in the nicest possible way, doing less and less of those kinds of things for me unless I make it clear I really need it, which is good I suppose (though doesn't feel like it at the time )

I'm terrible at distinguishing what people are saying when I can't see their lips. I've had my hearing tested and it's fine, and like you, I pick up things other people don't hear, but I think the differences are in my brain rather than my ears IYSWIM? I was tested for deafness as a child because I reacted so little to being spoken to but it seems I was just rude

I hope whatever you decide, you can get some answers and some solutions.

Thank you! Sorry for the delay in reply, I was away for the weekend!

Yes, I try and force myself a lot of the time (I've had to lately for various things, including interviewing nannies which was horrendous over the phone) but it never gets easier, alas. I still get all flustered! As you say, it's a brain processing issue, not a hearing issue.

I'm going to try and see if I can get a private diagnosis I think, and will see what happens. I've still got an appointment next week with the doctor who didn't really listen, not quite sure what I'm going to do with that as I should go to tell her I'm not taking the pills and why, or it would probably flag something if I cancelled it!

Need never apologise Post, don't post, reply, reply after a long time, don't reply - it's fine, it's a message board :)

I don't think cancelling it will make them think anything in particular. But maybe it would help to talk through why you decided not to take them?

Just thought I'd give a quick update. I went back to the GP, told her I didn't want to take the Citalopram because I didn't feel it was necessarily the right drug. I said I wanted a more thorough assessment before taking anything as I wasn't prepared to end up stuck with something inappropriate which could end up making my life even worse.

I told her that I wanted to get a diagnosis of autism so that I could get the appropriate mental health help in the future. She seemed to relent at this point, and referred me to the local "single point of access" mental health unit. They called me yesterday for triage, and I'm due to go in for an initial hour long assessment for ASD in a few weeks. So that's progress!

Several weeks ago I tried emailing the local highly recommended private ASD diagnosis doctor and they never even replied :-/ I'll see what the NHS can do before trying again.. I strongly suspect a waiting list of upwards of a year if the initial assessment thinks there is something worth investigating.