Tough Med Management Appointment w/ Psychiatrist - Is it Her or Me?

[annalawny]

Hi, all - I've been absent from the boards for a while, but now I've been dealing w/ my 'new' meds for a few months.  I'm on Citalopram (10 mg) and Valium (2 mg daily, 3 if I need the extra at night), in addition to BP meds (atenolol and lisinopril, and a baby aspirin.).  I've been seeing a psychiatrist now for about 7 months, and because I'm pretty sensitive to the meds, she has been very good about taking things slow.  I supposedly have OCD and dysthymia, and I know that the usual dosage for folks w/ OCD is 40 mg. of citalopram - however, I'm not adverse to going slow and getting used to it so that's not my issue.

I haven't been to a psychiatrist before, or taken meds for these issues,although I do have a therapist.  I have been with my therapist for years, and feel comfortable about saying whatever I want to.  Further, the citalopram may be making me more wired or 'unedited.'  Or more to the point, the lack of citalopram.  Not sure.  I've had a pretty frustrating August, with a lot of work and life stresses, and this culminated in my having a significant OCD 'episode.'  When I went to the psychiatrist, I told her I wanted to 'jump out a window.'   Of course, I harbor no such desires for real - but she got pretty exercised about it, saying that she didn't think I really wanted to do that either, and what if she was wrong, and there were questions and an investigation, and so on... she left unsaid the punchline - that she might have to 'act,' if I said such things at all (CYA, perhaps?).  So ok - noted - don't say stuff like that to your psychiatrist.

My appointment went downhill from there, as she seemed pretty frustrated with my inability to control my OCD. I could see that she was having some sort of a bad day that had nothing to do with me, but when I left there, she was telling me that I 'am not helpless in this.'  By this time, I felt pretty helpless - all I could think of was running... I was hugging myself, involuntarily.  I like this person - she is usually really nice and I think she's a good doctor - but I don't know what was up with that - Not sure where to go with this / what to do - talked w/ my therapist, and she thinks I need to discuss it.  I know that, but it's hard to do.  Do I initiate the conversation or wait for her to do so?  This is all still pretty new to me - but I keep feeling like... Helloooo... I have O. C. D.  Obsessive COMPULSIVE disorder - which seems to indicate some degree of helplessness, in itself.  Am I crazy?  Is she?  Should I chalk this up to just a bad day and see how things go?  And if anyone has any ideas about how to deal w/ this at the appointment, I'm all eyes.  Thanks -

[lynn57]

Your dose of citalopram is very low.  You may need an increase in your dosage to get the help you need from it.  I take 60 mgs.  That's a pretty high dose.  I can't believe the difference between 40 mgs and 60mgs.  It really kicked in and did it's job.  We are all different and require some tweaking when it comes to SSRI's.  I'm sure your doctor was just having a bad day.  She is there for you to talk with about things bothering you.  I would discuss the way you felt at this last appt.

[mammo]

They take comments such as "jumping out a window" very seriously because even though you didn't mean it....many do. They have to determine who really means it as a comment like this is a big red flag to them. I think you were trying to describe a feeling and not something you wanted to do. Citolopram is good in treating OCD as are most antidepressants along with CBT (Tofranil & Elavil do not help). Give the meds time to do their job, and stay the course....I feel you're headed in the right direction.  I think I would clarify with her that you didn't mean this literally and let it go.  I think she feels if you meant this literally it would reflect badly on her, and she may feel as if she failed you. She obviously understood how you meant it but it really concerned her. Don't dwell on this, keep moving forward.  You say she is normally very nice, and until now you have been comfortable with her so once you clarify exactly what you meant, it should put her at ease and things return to normal. I think she was very concerned for you and it came across as anger on her part.
Don't beat yourself up over this, we often don't know what will put our doctor in a tailspin.  Chalk it up as a learning experience and keep moving forward, you did nothing wrong. Hope this helps and best wishes.

[nexus788]

I'm surprised the psychiatrist has prescribed you citalopram because it's only used to treat ocd off label.

I hope everything works out for you!

I have my first appointment with a psychiatrist next week. God knows what they're going to put me on :(