Anyone seen a psychiatrist ?

[LostThePlotEncore]

I’ve been seeing a therapist for almost a year. She has told me that she cannot officially diagnose but believes I have clinical depression and have had for a long time. I have been on antidepressants most of my adult life, at least 25 years. I’ve tried Citalopram. sertraline and I am now on Venfalaxine (sp?) and I’m no different. I have short periods when I’m reasonably ok but I’m just numb to everything now. She thinks I need to see a psychiatrist to get some support with more specialised medication. Assume a GP cannot do this? Has anyone else been in a similar position and can share their experience please?

Mine was done in the military but we sat for a good hour/90 mins and he asked all sorts of questions. Some were on a scale of 1 to 10, when did i last cry, feel safe, do i have nightmares etc etc he Recorded it..... I got my diagnosis 6 weeks later and then we started medicating and Emdr therapy. He didnt just diagnose after 1 session.

Less then an hour chat on the phone (nhs) she had made her mind up before I'd opened my mouth.

My psychiatrist isn’t a big one for diagnoses, especially personality disorders, not least as there are so many overlaps between different conditions. Sometimes I meet the diagnostic criteria for something, sometimes I don’t. It doesn’t really change how he treats me particularly. The medication treats the symptoms and the therapy-style work we do treats the causes.

When the GP prescribed the antidepressants, did they not give you a diagnosis? Normally I'd have expected you to have had a diagnosis at that point. If not clinical depression, then OCD or generalised anxiety disorder. As they are still prescribing I'd suggest going back to them for a chat first. Also worth checking with them if they would be willing to undertake shared care with a private psychiatrist. If not, you will have to keep paying for private prescriptions and seeing the private psychiatrist to access whatever medicine they put you on (obviously whether that matters is dependent on your personal finances).

Any possibility you might have ADHD? You mention bipolar. It overlaps with ADHD.

It's common for ADHD to be misdiagnosed as depression. I

Try the ASRS screener questionnaire.

Can never get a face to face now with a GP. A few years ago, well about 15, a GP said he suspected generalised anxiety disorder but I don’t think he really knew.

How on earth did any of you get to see a psychiatrist? And if privately, what did it cost?

I've suffered with depression for about 24 years, actually probably longer but not diagnosed, on and off but mainly on, not always medicated. I've tried at least five antidepressants. I briefly had a call with a psychiatrist during the pandemic, who basically asked what I thought was wrong. I was diagnosed with traits of bpd and ocd. I don't feel it was a proper diagnosis. I've now requested they look into adhd, as I have problems that point towards it. There is a very long waiting list, three years I think.

I'm frustrated that I've been taking medication for so many years when a psychiatrist could have diagnosed correctly in the first place.

Not personally, but I've supported someone who has and attended appointments with them. They may be able to offer you other options for treatment. Have you heard of TMS, for example? If you aren't making progress other ways, it might be worth it for you to see what they have to suggest.

A tangent but I think you have a good therapist to recommend further investigation and to be clear on what the limits are of what they can do.

I was referred to an NHS psychiatrist by my NHS clinical psychologist but that was 30 years ago so the threshold for seeing those professionals on the NHS might be higher these days.

I refuse to deal with the NHS now after being sectioned and medicated against my will.

My private psychiatrist charges £170 per appointment but it is covered by my private medical insurance.

How on earth did any of you get to see a psychiatrist?

Referred to MHAS by my GP. It's what they typically do if you have persistent poor mental health that doesn't respond to the limited medications that GP's can prescribe, or if you describe symptoms which can't be attributed to typical depression or anxiety.

You still need assessed at the other end before you'll see the shrink, but in my experience it's rare they'll conclude straight away that there is nothing they can offer you before you've been assessed by a psychiatrist.

Yes I see one roughly every 4-6 months. I have GAD and Bipolar. Nothing scary about seeing one, I look forward to my reviews with her.

I think that you are over-estimating the significance of seeing a psychiatrist, @LostThePlotEncore . Psychiatrists' expertise is really in medication, and it is unlikely that they would bring a whole new diagnosis to the table.

If you are already being prescribed anti-depressants, presumably these have been prescribed by a GP? Since you have tried several and felt no clear benefit it would be quite common and reasonable for the GP to refer you to a psychiatrist with a view to tweaking the medication. Or they could just write a letter requesting a psychiatrist to review your notes and suggest which AD might be a better fit for you (if any).

Ask your GP if they can do this. I've been through similar a few times - most recently it was just an exchange of letters.

The only difficulty is that these days GPs have various protocols that sometimes seem to require them to refer you to an intermediate person who will look into a range of options (such as online CBT etc) before they will make a referral. That can seem like a pointless diversion, esp if you have already had private therapy.

Yes in my 20s.Ive had generalized anxiety agoraphobia anorexia seasonal affective disorder.
In my late 50s I discovered I had ADHD and awaiting ASD assessment.
Anti depressants don't work on autistic traits is my understanding from what I've read online.

I saw one on the NHS. I didn’t find her very helpful, she fixated on my self- harm and asked lots of leading questions before she diagnosed me with EUPD (previously known as borderline personality disorder). I feel she had decided that was the issue before I even walked in and I really didn’t feel the diagnosis fit and neither did anybody I shared it with. A year or so later I was diagnosed with autism and ADHD (not by her!) which she’d completely missed and made far more sense than the EUPD diagnosis, which I then had to fight to get removed. I wouldn’t see an NHS psychiatrist again by choice.

I have seen many psychiatrists the first when I was 18 and still see one now 20 years later.

They go through your history and symptoms and then discuss treatment plans potentially discussing possible diagnoses but not necessarily

I started with a depression and atypical anorexia diagnosis then generalised anxiety was added at 18. At this point I was seeing 2 psychiatrists one weekly for my depression and anxiety and a second psychiatrist and a psychiatric nurse for the eating disorder.

At 21 I was referred again to a psychiatrist this time for a manic/psychotic episode but wasn't diagnosed with bipolar but they did treat me with antipsychotics to manage the mood .

At 23 my GP treated me for depression but the antidepressants sent me manic and I was referred to another psychiatrist who said he had a couple diagnoses in his mind, one of which was bipolar but he wanted to see how my mood changed over time and how it responded to medication. I was given a care coordinator now too. After 6 months I had a "probable bipolar" diagnosis and after 3 years it was changed to bipolar 1.

It might seem scary to get a diagnosis but for me that scary diagnosis made my life less scary. It gave me a treatment plan that was effective and it gave me the language to describe what I was experiencing.

A lot of autistic people have anxiety and/or depression, and the anti-depressants can help with that.

They transformed the anxiety of my Audhd dd

I saw a psychiatrist through the perinatal mental health team at the beginning of this year, I was diagnosed with OCD, phobic anxiety and agoraphobia. Trialled quite a few antidepressants and am now titrating onto escitalopram, if this doesn’t work then back to the drawing board for a “combination approach” whatever that may mean. It was definitely worth seeing the psychiatrist though for the initial diagnosis etc

I was very depressed for most of my adult life. All of it came from suppressing my emotions which I learned to do in early childhood. Dealing with my emotional issues and developing emotional regulation skills and actually being able to sit with my emotions changed everything.

Some people’s depression is down to what I call shit life syndrome. In other words it is an appropriate response to environmental issues.

I don’t think psychiatrists are particularly good at dealing with emotional issues obviously they are dealing with issues biochemically rather than the underlying emotional issues. An excellent psychologist is worth their weight in gold. Personally I had to go through some metaphorical toads to find my handsome Prince of a psychotherapist but it has changed my life.

My psychiatrist has been amazing to me despite me being a pain in the arse and refusing to take the medication he recommends most of the time. I’m pretty sure I wouldn’t still be here if it wasn’t for his support over the last few years.

Many years ago I saw a private psychiatrist who was lovely but the meds she prescribed I don't think suited me.
During covid I had a phone appointment with one on NHS who clarified my diagnoses and put me on meds that a GP can't prescribe, and got me back on my feet. It was only a one-off by phone and I'd have appreciated more in-depth consultations... but he hit the nail on the head then so to speak. It's worthwhile. GPs are very limited in what they can prescribe. I'd see a private one if I could afford it, but I can't.