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A little unsure about my first therpist visit in years

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Posted 1/30/2007 4:45 PM (GMT 0)
just wanted to quickly share my experience and get some opinions. i finally made an appt and went to a therpaist yesterday. he is well qualified (former Rhodes Scholar, degree from Harvard and was a lecturer at Harvard, etc., etc.). he ahd sent me a packet of info about a week before. it was about 8 pages long and essentially asked tons of questions about how i have felt the past 12 months and to circle 1, 2 or 3 based upon severity. it covered everything from anxiety to abuse to medications to alcohol intake and family medical history. when i went into his office he took the form and literally looked at each page for about 3 seconds, flipping back and forth a few times. then he says, 'ok, from a brain standpoint you've got mild to moderate depression, mild OCD, mild ADD and moderate to severe anxiety. you also have some post-traumatic stree. these are all genetic except for the PTS." he then explained how his field now believes the brain functions and how all these areas interat with bio-feedback loops and that you need to treat all these things at once because treating one thing will only allow you to go so far before the others bring you down. he immediately said he was going to prescribe me 4 medications, 3 of which i would take daily. he recommended a book to read on OCD and told me to go to the state's best PST person for a consult. he then asked if i had kids and if i was planning on any more because all these things have a 50/50 chance fo showing up in children and he tells people not too have too many if they can avoid it because having, say, 6 kids means at least 3 will have all these issues and it's a lot to handle. he then basically asked if i had any questions or concerns. we talked for a while and then he made an appt. to see me again in one month.

now, my problem is that he really didn't ask me any questions. i had to interject and say things like the fact that OCD really wasn't my main issue right now, and going into detail about how my main problems were with depersonalization and derealization and lots of visual issues (visual snow, trails, etc.). if i hadn't brought some of these things up he probably wouldn't have asked me anything (besides a few initial questions about my age, marital status, etc.). i also was concerned that he said to stop zoloft and start taking 3 medications regularly and with no follow-up for a whole month. and the thing he said about kids, after i told him i had a 7-month old, seemed awefully callous and evidence of a poor bedside manner.

i did like that he said this is something that with the right meds and therpay you can get under control and sort of reset your brain to the point where you can even work on getting off the meds completely. and the fact he said my visual symptoms were purely anxiety-related and not due to the drugs. the drug experience i had as a 15-year old probably was just fueld on the fire of all the changes i was going through as an adolescent.

but again, this whole appt was about 30 minutes long. it's been a while since i saw a therapist (many years) but i would think that the first one or even two sessions should be just getting to know the patient and maybe not even talking about the main problems that bring them there. then, even if there is a clear diagnosis i would think there should still be plenty of discussion and back and forth. i can see his method may be to first prescribe these common meds and then tweak them as time goes along as he figures out which are the main problems a specific person is having. but i still don't see how he could honestly spend 5 minutes looking at a form and prescribing 4 medications and then sending me away for a month.

does this seem strange to anyone else? i am definitely going to get a second opinion from another therapist. just wondering what people's impressions are.

thanks. sorry for the long-windedness.

Posted 1/30/2007 5:06 PM (GMT 0)
wow. sounds like it was kinda one sided to me. My brother went to 3 therapist to only give up on them. He had one that would never ask him a question and just tell him to talk about himself and tell him he doesnt need meds and if anyone in history ever needed meds it is my brother!!!!!!!!!!!!!!!!!!
But I do find that kinda odd that he would switch you over to 3 daily meds like that. I dont really know what to tell you but you could try another doc and see if they say the same thing?
Good luck!
Posted 1/30/2007 5:28 PM (GMT 0)
thanks. i agree. for what it's worth, he prescribed attivan, adderall, celexa and busparone.
Posted 1/30/2007 6:43 PM (GMT 0)
wow weee!!! that does seem like alot of meds. I dont really know that much about those meds so I really cant say one way or another but it just seems like alot to me. I really wish you the best!
Posted 1/30/2007 9:43 PM (GMT 0)
That seems like a harsh load of meds for your conditions. Writing your responses down and circling a number is a great way for Dr's/Therp. to BEGIN to evaluate you and try to see a pattern. It means virtually nothing if they don't sit down with the person and get feedback on WHY they circled what they did etc. I don't think that he's so good he can look at a paper and diagnose you in 5 seconds. I have never meet anyone that good, ever. It is true that a lot of anxiety related conditions are genetic. It is not a known factual number though. He can't not give you a def. 3 out of 6. The study is hard to exactly pinpoint because ppl argue genetics over enviroment, which essentially you can not have one and not the other (hope that makes sense to you) Have an anxiety disorder should be thought about when having children just like high blood pressure or anemia, it is NOT a type of disorder where DR's will tell you its not a good idea to have children. It is true that you should treat all the disorders you have though. My anti-anxiety meds do nothing for the OCD etc. If your going to take them, you might as well clear up all the things troubling you. Their are medicines that treat all of the things you just mentioned with one pill. Ask him why he things you should take each indiv. med and for how long. Sorry my post is so long but something wasn't quite right with that visit.
Posted 1/31/2007 12:16 AM (GMT 0)
I don't normally like to comment on other people's psychiatrists, but I think you need another doctor FAST. Anyone who pretends to diagnose patients with a questionnaire in 30 minutes and then proceeds to hand out BuSpar, Adderall, Celexa and Ativan is a joke. Did he explain to you the justification for all of those meds (which all have substantial side effects and possible interactions with each other). Did he suggest psychotherapy as well?

I also take very strong exception to his "biological determinism" that you will pass this on to any children, which has never been proven with any disorder with the exceptions of bipolar disease and schizophrenia.

I would not take any of those drugs without getting a second opinion.
Posted 1/31/2007 1:05 AM (GMT 0)
thanks everyone for your advice. the more i think about, and the more responses i could, the more i realize how odd the whole experience was. i have set up an appt with another therapist in early february, so we will see how that goes. if i decide to stick with the new person maybe i'll mention the experience i had with this other guy and see what they think.
Posted 1/31/2007 1:07 AM (GMT 0)
oh, and he sort of explained the reasons for the meds (though i already knew). as for the psychotherapy, i think it was implied when he mentioned that after a couple years they try and wean you off the drugs if you've been doing well for a period of time. but he should have been more clear than he was about all of this.
Posted 1/31/2007 2:45 AM (GMT 0)
Right....but he has no problem prescribing four very potent psychiatric drugs when he just met you and reviewed your response to a questionnaire in a span of 30 minutes. Your suffering from "mild to moderate" symptoms of this label and that label, but somehow heroic combinations are the automatic solution. No time spent assessing the patient or their current psychosocial situation.

I'm very glad you are seeking another opinion on this. Psychopharmacology has its place, but it is never routine.
Posted 1/31/2007 4:09 AM (GMT 0)
I'm really glad you are getting a second opinion..this psych sounds a little bit full of himself.  You can find out a little bit about a person from a questionnare but it is imperative you speak to the person and find out about stress/events that are going on in their life.  Those meds are pretty full on for a first visit as well.  I had a psych who put me on way too high a dose of xanax when I was a teenager and I suffered for a long time as a consequence.  Please take care with this guy.
Posted 1/31/2007 12:28 PM (GMT 0)
Sounds like you found a text book geek...none of us fit into neat and tidy molds...I think the second opinion is a great idea...I belive the surveys are semi standard for evealuation purposes BUT...they should not be the only thing they address...Seems like a med pusher who has set meds he prescribes...Let us know how the second opinion is...Also sounds like you are working with a psychiatrist...perhaps you should also try out a psychologist...alot work with psychiatrists for the med end but the seem to mostly have a better handle on the mental then medical...
Posted 1/31/2007 2:50 PM (GMT 0)
yes, he definitely seemed like a textbook/research scientist type with little bedside manner or interest in the humanity of the situation. much too one-sided. i also found out that most of his work seems to be coaching big corporate CEOs. upon reflection i am actually surprised i didn't knock him out when, after telling him i had a 7-month old at home, he went into that business about not having too many kids.

anyway, looking forward to the next person. i know that when it comes to therapists it can be a very personal choice and you have to find someone you feel you can trust and who makes you actually feel better most of the time and not worse. if in fact this other guy was correct in his diagnosis and medication suggestions then there is no reason i can't get the same info from someone else but with a little more compassion mixed in. though i am pretty sure the next person won't be prescribing 4 medications all at once. but we'll see. for now i will stick with the zoloft since i've been doing a bit better lately (though i think that's more my own doing). i'm not sure if this first guy was technically a psychologist or psychiatrist or therpist or LCSW or what (still kind of confused by all that). but i am hoping this next place i am going will use one person for the therapy and another for the medication and they will consult one another. sounds like the right combination.

by the way (i should probably start a new thread for this), i stumbled upon a website by a 25 year-old kid from Ireland who battled Depersonalization and Derealization for about a year and kept track of everything that happened to him. He now reports he is symptom free and just wrote a huge guide about how he got through it and what he learned. I checked it out and he's the first person that really describes everything I have gone through to a 'T'. He has some very positive things to say and some very profound insights. The biggest thing was how he describes DP/DR as something your mind does in reaction to trauma and while most people experience it during the trauma and maybe for a short while afterwards, for some people it lingers for a very long time. This is because it becomes a habit of thought, a habit that is reversible. But while you are suffering from these feelings, since there is no longer an immediate and obvious threat, life itself and everything in it becomes the focus of the fear because your brain needs there to be something to focus on. He discusses everything from anxiety and depression and things that seem to help and hurt the situation, a strategy to get out of the rut, and all kinds of other stuff. He admits he is no doctor and this is all his personal experience. But I found it very helpful and interesting. If anyone is interested in the site please let me know and I can provide the URL.
Posted 1/31/2007 5:17 PM (GMT 0)
Depersonalization and derealization are labels which may or may not mean anything. They are simply symptoms of general anxiety and can be found in nearly every diagnosis in the DSM-IV. Experienced psychiatrists know DSM diagnosis is for the insurance companies and are a lot less important in finding clinical solutions to a variety of problems.

No one knows if there is a genetic component to anxiety, depression or OCD....it has never been proven nor does it particularly matter from a practical standpoint. None of the drugs are a cure and they do not "correct" anything in the brain...they are simply neurotransmitter inhibitors, antagonists or agnoists that relief symptoms and allow people to focus on things like CBT or psychotherapy.

What is important is to find someone who is on your wavelength and that you feel comfortable working with. Psychiatry is more art than science.
Posted 1/31/2007 8:29 PM (GMT 0)
geebs -

you seem to have a lot of info about these conditions. it's interesting to know the genetic link has not been proven as fact. doctors often like to present many things as facts when in actuality they are not. it's just easier for them i guess than it is to explain the reality of the situation. just like the theory of evolution. most people consider it a fact, yet in reality it is still technically a theory. it's hard to argue with the seemingly overwhelming anecdotal evidence though that these things are genetically related, even if they haven't pinpointed any specific genes.

as for the ability to 'reset' the brain, i guess the idea is that the brain, even when you're older, still has a certain flexibility and if through drugs and CBT you are able to change it's biological activity there is a chance it may 'set' and stay that way, even if you discontinue the meds. there are also studies coming out related to post-traumatic stress disorder showing patients who have, through various methods, 'reset' their brain and basically wiped out the traumatic events and the lingering effects it had on their mental health. i like these ideas, though the reality may be less hopeful. there's plenty of other contrary evidence that discontinuing meds and therapy will result in a slip back to how things were. makes me think of braces. if a kid gets braces and his teeth are adjusted, there is still a chance they will go back to the way they were if retainers are not worn for a long time afterwards.

in sum, i guess the science and study of these mental health conditions have come a long way in the last few decades but it's still in its infancy and there are many many uncertainties that remain. but i don't think anyone can argue that the future is anything but hopeful for sufferers of these conditions.
Posted 1/31/2007 8:40 PM (GMT 0)
I think science always has to start somewhere and the biological theories of mental illness are constructive in designing safer, quicker-acting, more effective medications to treat overwhelming symptoms that can destroy people's lives.

I also think the studies on the brain and its mechanisms are important to further our knowledge and study things, but ultimately there is no magic pill or combination of pills that cures the human condition. I would be the first to raise my hand and say medication has changed my life and helped me, but I also have done a lot of hard work to change myself too. No pill can accomplish that!

It's all good, but I don't like doctors who automatically shove pills down your throat to further their own personal theories with no basis in reality.
Posted 1/31/2007 9:50 PM (GMT 0)
very true. i also think that there is a fine line between a mental health disorder and a personality trait or characteristic. this doctor, and i am sure plenty of others, like to make people feel that any feelings or emotions above or below a very specific baseline is something needing treatment. in fact i got the feeling this guy was treating me like a real head case and that pretty much everyone on the planet except him was an emotional mess. i don't know how someone can view life so black and white and uninteresting. i would guess he is in the small camp of people that think 'normal' is an actual state of mind, that he is one of the rare people who is in fact normal, and that everyone else should strive to attain normalcy, though most of us will never be so fortunate. i'm probably being a little harsh and presumptious, but i don't think i am too far off.

well, i continue to push forward. and i will also continue to educate myself on forums like these and with books and other materials. i think we all have an obligation to ourselves to be as knowledgeable as possible. i always try to remember how things were before the internet. scary. it's also scary to think of all the poor people who dealt with these issues before there were any truly effective medications and therapies that didn't leave you half unconscious.
Posted 2/1/2007 12:18 AM (GMT 0)
In my experience, there are all kinds of psychiatrists out there and some are pill pushers who don't listen to their patients. I do not believe in that type of doctor because the more medication you are on, the less motivated you are to make changes in your life that are feeding the illness.

Certainly, there is a place for psychopharmacologists who are dealing with people suffering from severe forms of illness that has not responded to conventional treatment and can no longer function, but that doesn't sound like you. So why is he suggesting all these exotic combos? And in 30 minutes with no questions asked?!?

It's very upsetting to see that, which is why we need to educate ourselves and ask questions. It's too easy to become overmedicated and have tons of side effects with no real change in your life.
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