might have to see a psychiatrist

[polo48]

Hi, I'm new here and have been suffering from bipolar for nearly half a year now, although I see my doctor every month and have been having counciling, although it helps sometimes but I feel that it's not enough and that I sometimes feel worse after some of the session that I have been to.
The medication that I'm taking "DOSULEPIN" helps sometimes although I'm now on the max doses, when I last saw my doctor she exsplained that it things don't improve with the medication and councilling sessions then she would refer me to see a psychiatrist, this has played on my mind alot since she mentioned it and although she exsplained abit about what they do but I would like advise from others who have either seen/seeing one of what excactly happens, as I'm really worried that I may not be able to go there, as I find meeting new people and being in social enviroment very difficult to cope with.
all advise would be most greatful thank you
polo

[monkeyc]

You should have seen one before now.  A GP or family doctor is not equipped to make a proper diagnosis for bipolar or any mental illness.

Dosulepin is a trciylic anti depressant - you really should not be on an AD and esp a tricyclic without a mood stabiliser -these drugs can cause mania in bipolar's very easily.  Its also a very low effectiveness AD given to patients because its considered 'gentle' apparently (scary thought that).

Counselling is a vital plank of managing the illness but it cannot take the place of real medications and treatment - a psychiatrist is the person trained to treat mentall illness, they have 6 or more years additional education above a  GP (depending on country) and know the illness'es they treat.

Its kind of hard to know what else to say, you do not say much about your symptoms t all here so its not easy to make a judgement but I can only reccomend a psychiatrist - regular doctors are not trained in this and the fact that yours seems to think that you can treat bipolar with a Anti Depressant and counselling alone seems to confirm that to me.

[polo48]

thank you, for your reply, with the mood swings that I get and also the thought of commiting suicide plus yes! I have harmed myself on my accasions that I've been at my lowest and other times that the drugs are not helping as much.
thanks again

[monkeyc]

The drugs you are on would not help at all.

Yes you need to see a psychiatrist.  Sooner rather than later.  

[bernie40]

Hi polo48, who gave you the diagnosis of BP?  A Dr (GP) is not qualified to give that diagnosis.  They may consider it a possibility but if so then you should have been referred immediately to a psychiatrist, especially as in this country you are looking at a wait of at least 12 weeks before you get the appointment through.

If you do have BP then monkeyc is correct in advising you that an AD is not the answer and could in fact make matters worse.  It doesn't always make things worse I have to point out, some people do manage with an AD but usually alongside a mood stabilizer.

Don't fear seeing a psychiatrist, there is no shame and they are, on the whole, very good people.  At least you will then get a correct diagnosis and the correct treatment.  You can discuss any worries regarding potential medications or treatments with your psychiatrist as you remain in control alongside your psych.

All the best.

[bernie40]

Sorry - I don't want to mislead you I should have said that as long as an AD is taken alongside a mood stabilizer then some people do well on them.

:-)

[ILADVOCATE]

Well it depends on which antidepressent. As for anti-depressents Wellbutrin is the least likely to enduce mania when given for treatment refractory depression alongside a mood stabilizer. However, an anti-depressent should never be give alone in bipolar. I've seen that happen over and over with bipolar because a person speaks about their suicidal ideations but doesn't realize the days they feel "really good" are mania and don't bother to detail them. A psychiatrist after enough visits would likely spot that themselves, but it must be talked about regardless, but a general physician is not trained in spotting symptoms of a psychiatric disability. I do have a relative who is a doctor who prescribes psychiatric medication but its basically a charitable effort because the people can not afford a psychiatrist. Then again he is following up on the diagnosis they got from a psychiatrist. My general physician will not adjust my psychiatric medications except to authorize tests that are needed (bloodtests, the EEG for Geodon, etc.). And yes of course talk therapy is needed as well, especially in bipolar as the complex interplay of controlling emotions can not come from medication alone.

[monkeyc]

Yes but Wellbutrin on its own will induce mania at much the same rate as SSRI drugs can.

Its that corresponding therapy thing.

Look I am one of the most outspoken people here about over prescribing of AD's and he inability of GP's and family docs to treat mentally ill patients but the reality is that its true - there are the are ones who do know what they are doing; I used to have a good one before he retired; but they are outweighed by the majority.

A GP in Australia does 4 to 6 years of study depending on course (grad or post grad for example) and then goes into practice - a Psychiatrist does another 4-6 years on top of tha.  An average GP consult time in this country is given as a short appointment less than 15 mins - in reality in most medical centers here its about 7.5 minutes for a consult (and charged at $50-70 depending on day, time and location with a $30 rebate).

Now I don't know about you but can you tell me that 7-8 minutes is enough to discuss the nuances of a psychiatric drug with someone who has likely never prescribed it before and is reading it from their copy of MIMS?  Its not.  And thats assuming they are switched on enough to ask about other drugs which they generally are not and there is a waiting room full of patients to be billed.. umm treated.

Thats why GP's hand out Anti Depressants - Prozac is common, its seen as 'safe' and if the person is depressed then why not - they ask the 10 questions and bung over the script and serve the next customer.

I do not think I am exaaggerating when saying that this is the case world wide no?  First line medical treatment is a bums on seats money making affair now.  Anything else needs specialists.

[ILADVOCATE]

I'd really need more information on that although coming from you I know its accurate because I know people with bipolar with treatment refractory depression. The person I knew was taking Pristiq as an adjunct anti-depressent (in addition to a mood stabilizer at full dose) and it was making them wildly manic. I suggested they speak to their psychiatrist about Wellbutrin. I believe they are doing better now on it and I tended to believe that psychiatrist felt that Wellbutrin was less likely to induce mania although of course it can happen.
  I would tend to believe that a working mood stabilizer should control both mania and depression. Lithium, despite a difficult side effect profile for some people is equally effective on both. As for other mood stabilizers, it depends. Some are more effective on depression and some on mania. None are quite as effective as Lithium but then again its the only medication developed as a mood stabilizer first. I always felt that with bipolar if an adjunct is warranted its best that it be another mood stabilizer (I've been on multiple mood stabilizers at times) but from what you've suggested sometimes an adjunct anti-depressent is neccessary. Is that due to the specific form of bipolar where depression is more prevelant?

[dippy1]

All this talk of theory could scare a person away from the psychiatric department chaps! No two people are ever quite the same in their response to different treatments. Most doctors begin with the most commonly effective (and cost efficient, safe, licensed) option and take it from there. Sometimes dealing with mental health or any other illness can be as much of an art as a science...wish there was a "one size fits all" solution, but I think we all agree polo48 should seek a professional assessment and oppinion about his treatment. :-)

[ILADVOCATE]

I agree but things are complex sometimes. Its essential that a person with bipolar talk with their psychiatrist about their manic episodes or they can get misdiagnosed with depression. And that a psychiatrist's knowledge is greater than that of a general practitioner. Its important to have knowledge about what's going on but not self diagnose. I already explained in posts what happenned when I explained I had ocd and got treated for it when in actuality I have schizoaffective because Anafranil is an anti-depressent and it set off mania. The only psychiatrist who understood was an older psychiatrist who didn't have a very good professional approach but the poems that I showed him that I thought were "cool" he said were "psychotic" and as it turns out he was right. I did have obsessive thoughts but as another psychiatrist explained they were masking psychotic thoughts. I should have just explained exactly what was going on.
  And the other issue is there are medications not used in the U.S. Sometimes they just have different names. But sometimes they are not in clinical practice here including multiple anti-depressents and at least two atypcial antipsychotics. And the benefits system and health care system is different. Clearly psychiatrists work under a series of set guidelines and that's fine and there's no need to second guess them but remember if I say a medication is FDA approved, it may not be outside the United States and if I say its within the standards of the American Psychiatric Association things might operate differently in the U.K. I agree overall but I was making a side note to your comment.

[monkeyc]

Lithium is effective in both phases and so are some others but AD drugs are not effective on Mania - you can easily have an MS without an AD in fact its reccomended based on most of the stuff you can read for maintenance phases.

Adjunct AD drugs are used where depression is not managed by the Mood Stabiliser or is more severe - particularly where unipolar or major depression factors are playing a role as opposed to bipolar depression.

No 2 people are ever the same is a good way of putting it BUT a GP should be able to read guidelines on bipolar treatment and drugs well enough to avoid prescription risks.  However I have seen so many cases which show this is not true - i personally knew 2 people no longer with us dead from suicide on Prozac who never ever should have had the damn drug had the GP asked a few basic questions of them - but thats hard to do in 7.5 minutes now isnt it.

[LeftCoastChick]

I agree, let's reign this is. Please take this private.  I would be freaked out by all the statistics and studies, when all I want is some support.

It's great Polo that you are reaching out, there is no shame in doing so. Brains are complex and delicate organs and we sure take the brain for granted. It couldn't hurt to go. The Dr. should run some tests to rule things out, as well I suggest you see your GP as well.

[dippy1]

I was rather freaked initially when my GP refered me to apsychiatrist. It was out of my normal field of experience and symbolised all sorts in my head, it felt like a failure to have become so ill that I needed to see a psychiatrist and whilst I couldn't argue it wasn't the right thing I struggled with the whole "label" thing.
The initial consult is actually far less scarey than you might imagine. The length of the consult is much more than the ten minutes with a GP and the consultant will ask you questions about your history, medical and mental health, about your social situation and about you symptoms. There'll be the obvious questions about suicidal thoughts and plans and he'll want to know what meds you've had and what effects they've had on you. There may not be a diagnosis confirmed at the first consult; sometimes these things take time. It's likely that they will add or change your medication and review you soon; initially I saw my consultant weekly (but I was bad and he came close to admitting me to hospital) I was very nervous about the first appointment but relieved I'd found a good doctor afterwards, it's all about prejudgement and fear of labelling I think. A good friend said philosophically to me while I was waiting for my first appointment that I had to just "take the ride"..I did and it was helpful and necessary and not as threatening as I had expected.
If you broke a bone you wouldn't hesitate to see an orthopoedic  consultant if it were suggested. Your mental health is far more important than a broken bone, so "take the ride" my friend.
There is a lot of support on this site, please keep posting.

[bernie40]

Its easy for us all to get carried away when discussing BP, medications and Drs -v- psychiatrists.  I am guilty of it myself at times.

Its important that we try and focus on the original posters query which in this instance was regarding feeling anxious about meeting a psychiatrist for the first time.

Although gaining as much knowledge as we can about the effects of anti-depressants, mood stabilizers, anti-psychotics etc etc is important, we sometimes throw all this at someone before they are ready to hear it.

polo needs to get through the first psychiatric appointment before even beginning to try and work through the quagmire of different medications.

I apologise polo if we have bombarded you a little here.  Good luck with your psychiatric appointment and as dippy1 has said "take the ride", it certainly won't cause you any harm :-)

[polo48]

Thank you for all the advise, it's much appriciated, I'm going to doctors tomorrow so we'll see what she's got to say Wish me luck!!! keep you all informed, can't really talk much today as I'm very mixed with emotions, so just wanted to say thanks.

[cowgirlnerd]

We have all been where you are today and even though the psychiatrist can bring feelings of fear and what comes from the treatments, it can save your life.  We know how the thoughts of what they might ask, what should I tell, should I tell it all, will they put me in the hospital?  Trust me, we have all had them - the most important thing is to not think anything you say or think as abnormal.....my friend monkeyc taught me that some when I got here on the forum...  There is no "normal" so just get that out of your head now.  You have your own issues and you will find that we all have similar issues based on our disorder, so we can help each other through it, along with your new medical/psychiatric team, and find OUR "normal".  

Just know that you aren't alone, and if you have any questions, please ask - don't be afraid.  AND, please let everyone know how it went - it's good to let it out.  It's not curiosity on our part - we care.

Hugs.
Racheal

[dippy1]

Good luck for tomorrow. I'll be thinking of you. Try not to worry..this is the beginning of recovery/getting better. Be as honest as possible with her and with yourself. If you're nervous it's ok to say so, she'll be used to that. It might help to make a list before you go of things you really want to cover/talk about/mention. Old advice I know but still true.
Let us know how things have gone when you're ready o share, best wishes, Kx