First visit with a psychiatrist

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I have met with a psychologist (to verify my self diagnosed AS), but not a psychiatrist. The psychologist noted that she felt I had dysthymia (chronic depression). I had never considered that because, as I look back now, I can't think of a time when I didn't feel as I do. I've been thinking about it since and have decided to meet with a psychiatrist if there is a chance that I can be made to feel different...happy.

Anyways, as I've said, I have never met with a psychiatrist before. Can anyone give me an idea on what to expect? I am honestly hoping to be put on some kind of anti depressant right away to see if that would help (I don't see therapy as a viable option for me). What are your experiences?

Straight up, some psychiatrists are good, others not so good. You want to ping-pong the conversation back and forth. Disclose in medium steps and see how it goes. Also, in the couple of days following the visit, see how you feel about the whole thing.

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A family practitioner or an internist can prescribe Zoloft or any other anti-depressant. You are not 'stuck' with a psychiatrist. As I understand it, people's biochem is different and what works well for one person might hardly work at all for another person. So, you need a doctor who's willing to stay loosey-goosey, try something, see how it works, try something else. The last thing you need is someone who's a dogmatist or who looses their patience when the third thing doesn't work. It might be the seventh thing that works and that is perfectly okay! In addition, you want to be somewhat careful coming off anti-depressants (again, so valuable to have a doctor you can halfway talk with). And, some people have had success with nutritional supplements, and again, this, too, is highly variable and what is an absolute godsend for one person might not do much of anything for another.

The psychiatrist probably will want to try you on some medication. Just be aware that not all medications will work, and some may even make you feel worse, so there will probably be some trial and error involved. Be aware of how the medication affects you. If you report negative effects and the doctor tries to pressure you into staying on a drug, then it might be a sign to look for someone else. Also, some people with AS are very sensitive to medications, so you might ask about starting at a lower dose than would normally be prescribed.

Also, please note that the best outcomes for depressive patients result from a combination of drug and talk therapy - not only does the biochemistry need to be rebalanced, but some of the habits of thought ingrained over years of being depressed need to be redirected.

I am not opposed to talk therapy, I just have difficulty seeing its benefit for me. I don't seem to be overwhelmed by negative thoughts or feelings, I just have never really felt happy. It is almost anhedonic, except that I do have moments of joy, but they are ephemeral. I am basically apathetic toward everything. I have no ambition to do anything or go anywhere because nothing I have tried brings me any measurable happiness. I can think of nothing in my life that would cause me to feel this way, there was nothing particulary unhappy in my life. All that makes sense to me is a biochemical inbalance.

That's what I mean by a "be righter." It is more important to such a doctor to "be right" than it is for your life to go well. Amazing once you think about it, isn't it?

Okay, and there are gray areas. And those are sometimes hard to handle. So the doctor's not terrible. He or she's just not a great listener. Here's where you can use the method, well, in football terms, you're putting the doctor on the bench. You're not firing him or her. You're just going with another starting quarterback as it were. And as a patient, you have every right to get a second opinion.

Just remember, sometimes you have to try a series of anti-depressants to find one that works. And that's okay, for when you find that one, you'll be happy you had the patience to do this.

I'm not a great fan of talk therapy either. Sometimes it even seems to have a religious component in that I must 'confess' and agree with the label. No, I don't need to agree with your label. I can just let it be. And I'd rather had a more straightforward approach, I roll with the good points I have going on in my life right now, and I matter-of-factly address any deficiencies. And I'm not going to focus on the deficiencies. I'm going to focus on the positives and build from there.

And, maybe be a little open to dietary supplements, not as a replacement to medication, but as an adjunct. Although as I understand it, this only works for a minority of persons suffering from depression.

It took about twenty years before they finally got my diagnoses right... You have to be absolutely honest with the psychiatrist, or you can go down a lot of wrong alleys before you get the help you need. My condition left me extremely paranoid, which is why I was dishonest with doctors... I didn't want to give them an excuse to "get me." But in fact all they wanted to do was help, and when I finally couldn't take it anymore things actually got better. So, be honest, and you won't have to wait twenty years for the right meds... that's my advice anyway.

This sounds a lot like my perspective. I have no reason to not be honest about any issues I may have...I am there seeking their help.

But I'm going to take it in medium steps and let the psychiatrist demonstrate himself or herself as a reasonable individual.

And crucially, I'm going to see how I feel about it in the days and weeks following. Did the psychiatrist respect me as human being? Did the he or she easily and readily accept that we don't necessarily need to agree about everything.

(Remember, some 'helping professionals' are huge egoists and mainly just want to listen to themselves pontificate.)

Very true, I will take carefully measured steps until I know more about him. Thank you for your input.

Just left my first visit, seemed very basic. He asked why I was there (depression), then just went into patient history questions (lot of these). Then for some reason he felt the need to go into a spiel of the anthropological and genetic roots of depression (didn't particularly care, but whatever ). Then he started explaining anti depressants (and THEIR history ) And then he wrote me a Rx and a lab order for a thyroid panel and vitamin D levels (rule out other possible factors) and sent me on my way. Hope it works!