What will happen the first time I see a psychiatrist?

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I finally got to see a counselor and she told me that I need to go back on medication because of my anxiety (and she mentioned something about depression somewhere) and because I can't sleep well. I told her that in the past I had been diagnosed with ADHD and Asperger's. She doesn't really think I need Adderall again (good because I hated it), but I guess that's more what psychiatrists do. Anyway..what will happen when I see one? What will they ask me and what do you think I will be put on? I used to take Adderall and Geodon also before. Are there any meds I should try to avoid in particular? Or any experiences with medication for anxiety/depression? Ahh the appointment is a month and a half away...that's a long time to try to function.

dont do drugs drugs are bad. perscription drug atleast.

Usually a (good) shrink will sit you down and ask you about your past.
They might ask you what you think is true and untrue about your diagnoses, in regards to 'the norms' for those diagnoses.
They will ask you about drugs (legal and illegal) and what effects they had on you.
They will ask you if you have had thoughts or experiences of hurting yourself or others.
If you've ever been institutionalized, seen other shrinks, or had trouble with the police.
They should not make a diagnosis on your first visit, unless your condition is WAY obvious.

They will ask you what drugs you are on now: Those drugs may affect your personality and cause misdiagnosis or interfere with diagnosis if the shrink doesn't know you are on them, so be honest and tell all. Even if it's illegals.

Yeah, that's kind of the key part. Some psychiatrists are good, and some aren't, and that's just the fact of the matter. I'm not sure what health care system you are in, but as a patient and as a human being, you have a right to a second opinion, and I think a third or fourth opinion if need be.

So, yeah, pour your heart out, which might kind of be your inclination anyway (and maybe just be a little guarded and a little observant whether the psychiatrist tries to listen respectfully) but then primarily in the week or two following the appointment, kind of mull over, well, did the doctor seem to listen to me, seem to respect me, seem to treat me as a valued person who has real input, it's your life afterall. And really trust your gut feelings on this as much as anything else.

Look at age 16, you've been in school long enough to know that some teachers are good and some just aren't. And a lot are in the middle, and you can work with in the middle. But if the doctor's just not good, that's something you really can't work with. In particular, if a medication didn't work the first time, there's not really much of a reason to try it again, particularly since there are a number of good medications for anxiety and a number of good medications for depression. And part of good medicine is trying a medicine that would seem to be promising, a good bet as it were, and then taking a good honest look at how it actually works here in the messy world, and if it's not working too well, by all means, let's try another medication. (I understand with some anti-depressants that if a person abruptly stops, serotonin levels can drop and the person can find himself or herself even more depressed. All the more reason to have a doctor you can halfway talk with.)

I always thought it was a horrible idea. Shrinks are required by law to turn in to the police any patients who are in danger of harming themselves or others. Abusing drugs is a form of harming oneself, so you get my point. Somehow, I have a vision of a shrink calling security to restrain me while he/she dials 911 (or 112 for those of you in Europe) the second I admit to using drugs. Heck, I've seen escorts in the past, and I would never admit that to a shrink unless he/she was waterboarding me. The risk of being reported to the police is just too great. If you must see a shrink and you use illegal drugs, get treatment for the addition first, wait at least a month for them to get flushed out of your system, then see a shrink. It'll be much more difficult for a shrink to turn you in if you tell them you've been clean for months, as opposed to using drugs now.

In some cases, talking to your religious leader might be a better option (that is, for issues not related to medications). Their job prevents them from turning you in to the police even if you tell them you committed a serious crime. (That's only if already committed, not if planning to commit.) They may encourage you to turn yourself in, even tell you it'll help God forgive you, but not report you themselves. In the end, you may get some words of encouragement and/or a recommendation of a good treatment program.

I've read about eight medical school biographies, beginning with when I was thinking about medical school. In one a young intern was intaking a patient. The patient was very honest about previous drug use, and the intern, as a diligent young doctor, wrote the details in the paper chart. But then when she went to the doctor's room to get a couple of hours sleep (interns and residents used to have these marathon shifts of 36 hours, yeah really, all day one day, on call all night, and all day the next day; now, in many places, it's limited to 24 hours). Okay, so she's finally laying down for a couple of hours sleep, and you know how when you're finally away from the immediate rush of sensory input and the more important things of what has happened sometimes bubble to the surface---And it occurs to her, gosh, I've included a lot of details, and it might come back to really dog the patient, insurance, all that, maybe even employment. So, this young doctor thinks it's important enough that she gets up, goes to where the chart is, and scratches out the details she put in, really inks it out so it can't be read at all, and instead writes "some polydrug abuse."

So that's a doctor you can work with, a doctor who has your best interests at heart.

'Yes, some drug use. And I would ask that you just put in the chart, "some drug abuse," something very straightforward like that. I'm willing to tell you more. In fact, it would kind of be good for me to get some of it off my chest. But I'd ask you not to put into any chart the details of what I share with you. Is that acceptable?'

And almost the formal question at the end 'Is that acceptable?', in this case I think it plays well. I think you almost need the formal question.

So, there you go. You see how the doctor responds. Some doctors, and some people in general, are by the book, and some people aren't. Some people buy the addiction model hook, line, and sinker, some don't. (I tend to favor more of a 'controlled drinking' approach myself, and I know that's controversial. Or, I think that should be on the table as one of the possible methods, and a person might try that first and try that early, and if it doesn't work then start thinking about abstinence. And it kind of needs to be on the table, and a person probably needs a sense of humor about the whole thing in order to artfully sidestep the "don't think of a white bear" effect.)

So, anyway, we come to the not very remarkable conclusion that you want a doctor you can halfway talk with.

Last edited by AardvarkGoodSwimmer on 03 Sep 2010, 4:32 pm, edited 2 times in total.

she gonna lock u up

What's likely for a psychiatrist dealing with someone who has AS, anxiety, and insomnia would be that they'd put you on an SSRI. These are antidepressants that can also be useful for anxiety, and as far as psych drugs go, are not too "serious" (i.e., not too risky and without a high rate of severe side effects). The doctor may also give you some kind of a sedative for sleep; amitryptiline is usually one of the first things tried, or else one of the antihistamines used for allergies, for the drowsiness side-effect.

They'll probably ask about your symptoms. They will probably do a quick depression screening (the questions are straightforward; things like, "How is your mood?" and "Has your appetite changed recently?").

Most psychiatrists will take input from you. If, for example, they prescribe a drug that you don't want to try, or if you want to start at a low dose (I highly recommend you do, if you have a history of drug sensitivity at all), then you can generally get them to try something else. Psychiatrists, after all, are only human and cannot go home with you and force you to take the medication they prescribe; so if you have a different idea, and they think that it is an equivalent or nearly as good solution to try, then they will generally go along with it.

lmao

That's the better ones. A fair number of psychiatrists are "be righters." That is, they are more concerned about being right about some little pet theory than they are about your life going well.

And when you run across a doctor like this, you just want to graciously back off and graciously go to the side. And find another doctor who respects you as a patient and as a human being. Yeah, find one of the doctors like Callista is talking about.

That's the other thing, that the first visit may be a bit of a let down. And it might be more like the third or fourth visit before you get to the substantial personal issues you want to talk about (if you wish to take that approach).

Mine just kept asking me about suicide. "Why are you suicidal? Have you attempted recently? No? Why not?" It's like SHUT UP. It seemed like she wanted me to commit suicide so she can deal with other patients. This same woman also freaked out when my brother wanted to quit his anti-depressants. His depression was based around the morons at high school. He graduated, so his stressors were gone. She told him that he NEEDS anti-depressants and that he would most likely never be able to go without them. He's been off them for 4 years.

I've been to three different psychiatrists, and none of them bothered to ask many questions. I wonder why this is? Two of the three have good reputations.