Should I give my new psychiatrist another chance?

[Jacket]

Hi all,
I posted on 17/1 the post "A few questions about starting with a psychologist". I really appreciated the replies, and am now 1½ weeks away from finally seeing my third psychologist, desperately hoping that I will have more luck. But now I have a different tricky situation, with the psychiatrist I saw. Important to note: I've never seen a psychiatrist for medication until now.

I had a one-hour session (my psychologist appointments so far have been 2-2.5 hours, because my situation is so "complex", according to them), and tried to explain everything in brief, also showing my writing on my life. During that hour, I talked about how my and/or my wife's potential infertility and how that has led to me feeling a lack of control in my life. He called my writing "obsessive", which didn't feel like a helpful comment, and also was surprised at my list of 15-ish friends I've told about my troubles. My support network means a lot to me, and I felt he was challenging me or disapproving.

He ended up saying I have "substantial depression" and prescribing me medication, saying I should start them straightaway so I could have them in mornings and so I'd be a little used to them by the time I started work four days later. I put my faith in him and took them immediately, then started to read the information about that drug on the tram.

I felt so betrayed when I saw that it has an identified risk of adversely affecting fertility. (As well as this, I had dizziness, headache, stomachache and vomiting. This was my first time ever trying an antidepressant.) I called him, and he spoke through his receptionist, saying that if I have such concerns, I should stop taking them and go back in a week's time to get something new.

Did he not know about the fertility side effect? Did he know and conceal it? Does he just want me to visit again soon so he can make more money off me seeing him? It's very expensive to see him.

For now, I booked a new appointment for this Friday, but I don't know whether to cancel it, postpone to see how I go at work without drugs and how I go with the new psychologist, go to see him and decide later whether to take his new prescription or not (I will of course be reading everything thoroughly this time), or seek a new one? I'm feeling very fragile, and already had such bad luck with two psychologists, I don't want to go through this all again because of a bad psychiatrist too. What would you do?

Thank you in advance for your advice.

[geoff]

Hi Jacket, welcome to the site once again.

All antidepressants (AD) have to list all side-effects that may occur, simply because if they don't then someone will take them to court, but it's not to say that you will have any of these effects, and if you do then after a few weeks they subside, your body gets used to them.

If they mention it may adversely affect your fertility may not happen for you and by having a blood test will give you the results later on.

Ask your psychiatrist if you can take half a tablet instead of a full or get them to prescribe you a lower dose, that maybe an option.

I think we are used to having a panadol and feel nothing except to take away the headache, AD's are different.

One suggestion is it's not a good idea to keep changing psych's because you never seem to get anywhere, and yes I would be giving the psychiatrist another chance.

Take care.

Geoff.

[BumbleBumble]

Hi Jacket,

I'm so sorry about your experience and I can't imagine what you must feel. Everything that we put in our body has a potential risk and medications are no different. The key is weighing up the risk vs benefit. Before any medication is prescribed, these should be explained allowing time for questions. If you don't feel you are receiving quality care please address this with your psychiatrist or see someone else. Depression is a treatable illness where medications are part of the picture.

 There have been a number of good studies that have demonstrated SSRIs are associated with a decrease in sperm quality (decrease fertility). You can always discuss alternative medications with your psychiatrist. 

Take care

[geoff]

Hi Jacket, one problem which this particular AD might cause is some sort of dysfunction and can decrease your libido.

If this is what you are worried about and have experienced then it certainly needs to be discussed with the psychiatrist.

Take care.

Geoff.

[Nurse_Jenn]

Hi Jacket,

Great to see you reaching out on the forum. Your situation sounds tricky and I am really glad you have a lot of support to talk about your situation.

As far as offering specific medication advise, it is not something I can do without doing a full assessment. What I can offer you is some advise on how to better work with your psychiatrist. Tim is right in saying that many medications have a long list of side effects, some are more significant than others depending on the number of incidents of the side effects during clinical trials. It does not mean you will get the side effect. If you look at the side effect list of something as common as Panadol, it is quite long as well.

I would utilize your next psychiatry appointment to discuss side effects. Not all Doctors practice in a way that gives their patients all the information. Quite frankly, many patients not want to know. But as you do, I would request an appointment to discuss the specifics of the medication and risks. Another option would be to make an appointment with a pharmacist. Some Chemists have a service where pharmacists are able to complete a medication review going through the finer details of medications, side effects and risks.

In any case, getting the full picture of the medication you have been prescribed is very important particularly if you are trying to conceive a child.

As far as staying with your current psychiatrist, this is up to you. Feeling trust in your health care providers is important and sometimes these relationships take time to develop. It is hard to tell whether you should stay or go and I believe you will know as time goes on. Their level of response to your queries regarding medication may help your decision.

Keep on using the forum for support as I know there are a lot of people going though difficulty finding the right treatment and provider. Sometimes it helps to know you are not alone.

Wishing you the best possible outcome,

Nurse Jenn

[therising]

Hi Jacket

Sorry to hear your past experiences haven't been so great. Like with meds, mental health professionals can become a bit of a hit and miss experience.

I believe we're a little conditioned when it comes to dealing with professionals or specialists. When I say 'conditioned' I mean, as kids, we'd walk into the GP's office with Mum or Dad (who'd describe our symptoms) and wait for the doctor to give us the best guidance he/she could. How often did our parent/s dictate their expectations to the doctor, in regard to our recovery? Off we went, to follow instructions typically without question. So, you can sort of see how future visits to professionals can involve a bit of conditioning, based on past experience.

Imagine walking into the psychologist's/psychiatrist's office and you hear them say 'What are your expectations of me and our sessions?' Wow! Some will actually say this but I imagine they are few and far between. What if you walked in with a set of expectations?

• I expect to leave each session with a sense of progress (even if it is tiny or comes in the form of a constructive idea to contemplate between sessions)
• I expect to have infertility issues taken into account when being prescribed medication
• I expect not to be judged/ridiculed, unless it's the sort of judgement that is productive and leads to progress

Imagine saying 'Can you meet these expectations? If not, let's just go our separate ways now and not waste each other's time'. Yes, perhaps a little aggressive yet something we're perfectly entitled to say.

Jacket, I try my best to be a realist so, realistically, I couldn't see myself saying this (as I'm not all that confident). I could see myself saying 'Based on negative past experiences with therapy, I've written down the 3 most important things I want from my sessions with you and I'd like to discuss them before we start'. I believe a good relationship will involve both the client and the therapist seeing each other as guides through the process of evolution.

There will be side-effects with a lot of different meds because they're basically designed to change our chemistry (something our body may take a little while to adapt to) although I believe that when someone is prescribing medication, they should be aware of how it may interfere with any preexisting conditions - a couple's infertility issues included.

Consider your expectations Jacket. A good therapist will be open to discussing them with you.

Take care and all the best

[memorytrap]

Hey mate,

Back your own judgment, it's your body. I was put on an SSRI about 15 years ago and I experienced similar symptoms. I was told that my body would get used to it eventually and that not everyone will experience the same side effects, but after taking it for 18 months I developed serious detrimental physical conditions and I had to discontinue it. 15 years later, the side-effects it triggered in my body are still with me and I live in constant pain. The worst thing that can happen is not being listened to. If you're uncomfortable, don't force yourself to feel the need to adapt. The most important things you need to feel with a therapist are comfort, acceptance and progression.

[Jacket]

Hi all,
Thank you again for your warm support.

I've decided to give him one more chance, but to try to be firm in the ways that I was disappointed with the last session. I'll write the reasons down just in case I don't have the confidence to say them. I feel I might have the confidence to say them, but he may shoot me down immediately after doing so. If he does, I'm out.

I'll be making sure that sperm shape, libido, etc. are not affected by whatever I take. I know that I won't necessarily get any side effects listed, as Nurse Jenn said, but if I can avoid them, I will.

Today I went back to work and after speaking to a couple of friends there, I feel better. I'm hoping I won't need drugs at all and can just rely on psychology. However, I do feel that maybe to an extent I'm making excuses for myself to try to get out of medicines completely and just rely on psychology. That would be ideal.

Anyway, one more chance to speak to him, then I'll decide whether to go ahead with the medication he prescribes or not.

Thanks again.

[Jacket]

Hi all. I just thought I should give a quick update. Do people like updates and conclusions? Or do they just want the forums to be questions and answers? Anyway, here we go. Mods can delete it if they want.

I finally went to see the psychiatrist. I drove 45 minutes each way, and found out beforehand that it was only a 15 minute appointment, so I was already feeling bad about it.

I went in, and was quite visibly upset as I told him the three problems I had with our session last time. During this, he just listened with his hands folded in front of his mouth, and he was quite intimidating, but somehow I was able to be honest about the ways I felt judged and that his duty of care was lacking.

After I was done, he told me he didn't know about the fertility side effects, despite having prescribed this to hundreds of people, and that since last week, he did further research and found that all antidepressants have some kind of side effect like that. But he saw that I was in a bad way, so I should still have something because I was clearly distressed because of my work starting this week.

I told him that work was okay, that my concerns about it had slowly started to dissipate, though it was still tough every day. But I haven't given up on having a child, so I really don't want something that can affect me like that. By this time I'd calmed down a bit, so maybe it was evident that my present anxiety was more about seeing him, who I didn't trust. He then said that in that case, while I'm trying to have children, I shouldn't try to have anything, and there's no reason to see him since I was mainly going to him for medicine (but he's happy to see me if I want). I started thinking, "Will he apologise? Do I deserve an apology? I hope he apologises. I hate this" Finally, he apologised for causing me offence because of his comments, and we parted without a follow-up appointment booked.

I'm somewhat relieved as I never really wanted antidepressants, especially if all of them affect fertility, and I couldn't feel good about taking them at all. But on the other hand, one avenue to get better (medicine) is closed to me, and now I have to try to face this through the new psychologist I start with next week, my friends, and my own resilience. It's going to be so tough, but I have some small hope that most days will be better than the last. Thanks again for your support on this forum.

[White_Rose]

Hello Jacket

I am sorry to learn of the difficulties you have had with the psychiatrist. It is disappointing when we find the person who is supposed to care does a bad job. The first psychiatrist I saw gave me 45 minutes, was never on time because he arrived at least 20 minutes after the start of the first appointment every time. It was horrible because it affected the time I got to work and the explanations I had to give. No matter how many times I explained the situation he never changed his ways. He was sarcastic because according to him I was sarcastic though he never talked about it with me. After the start of one session he got really angry with me and stormed out of the room, coming back a few minutes later to tell me off again. I was terrified and I know that sounds unlikely but it really was horrible. He stormed off again but by that time I was in such a tizz I could not even stand up let alone leave. He came back again and swore at me using words I would think no psych or any professional person would use. I simply would not go to another psychiatrist until my wonderful GP persuaded me to try the psychiatrist I now see. Chalk and cheese. She is lovely and after nearly three years I have come to trust her.

Sorry to make this such a drama. The reality is that some doctors of whatever persuasion do not know how to treat people. This doesn't mean they will never disagree with a patient and sometimes may not explain matters in a way you understand. They and we are human. I think they need to recognise their patient is unwell and it's up to them to remain calm.

Knowing the side effects of medication I think is reasonable but I had an occasion when a doctor (other specialist) who did not know the potential mismatch between his medication and an antidepressant. It was bad.

I've used most of this post to moan about me when what I wanted to say is that all doctors are not alike. In your case he should have discussed the length of appointment time and the reason he was seeing you to make sure you both knew the scope. I know it will be a hard ask but can you ask your GP for a referral to another psychiatrist? It's my experience that if you are very unwell a psychiatrist is a better option and one that will affect your wallet less than a psychologist. Quite often you can see both. Tell your GP you would like therapy from the psychiatrist as I think it will help re medication.

I would love to hear from you again. I will not talk about myself.

Mary