Thoughts Before Meeting My New Psychiatrist

Illustration of a doctor speaking with a patient
Image by Elf-Moondance from Pixabay

I need to pull my thoughts together in preparation for my first appointment with my new psychiatrist today, and I thought I might as well do it here.

Medication refills

The discharge prescription from the hospital was for weekly refills. I want to get more medication than this at a time, and here’s my concern. When I have meds, I take them. When the difficulty of getting them outweighs the resources I have available, I either start rationing them or I stop taking them. That’s been a big issue over the last year.

I get that there’s a concern that I might overdose if I had a larger quantity on hand, but here’s the thing. The meds I’m on wouldn’t kill me; they’d just make me barf a lot. If I wanted meds to overdose on, I’d ask to be switched to a tricyclic antidepressant (TCAs tend to be more effective than many other antidepressants, but they can cause a cardiac arrhythmia). But every time that’s been suggested, including during my recent hospitalization, I’ve said no, that’s not safe for me to have at home, because the chance of me overdosing on it at some point is a risk that’s not worth taking. That’s not the decision-making process of someone who’s intent on stocking up on meds for the purpose of suicide.

Dexedrine

I stopped taking Dexedrine last year because I didn’t have a prescriber. It helps somewhat with my mood and concentration, but mostly it helps with the psychomotor retardation (slowing of movement & thinking). I’ve never felt any effect from it right after taking it, and certainly no “high” of any kind, but I have noticed that after 3-4 days either on it or off it, there’s a change in how slow my movement is. I didn’t ask to restart it in hospital because I see it as being symptom-targeted rather than important for the illness process overall, and I wanted to see how much of a change that ECT made in how slow I was. It helped somewhat, but the psychomotor stuff has gotten worse since I was discharged.

Given that it’s hard to get out and do things like go to the pharmacy when I’m super slow, I’d like to go back on the Dexedrine. The highest dose I’ve been on is 15mg twice a day, and 15mg once a day seems to be the minimum dose where I start to notice a real benefit from it.

Appetite

My appetite has gotten worse since getting out of hospital, which is somewhat concerning, as it’s usually not an issue when I’m well-medicated. I’d like to bump up my mirtazapine from 30 to 45mg a day and see if that helps. I’ve tried taking 45mg in the past, and it disrupted my sleep (at lower doses, the antihistamine effects of the antidepressant mirtazapine make it quite sedating, but at high dose, it has stronger effects on norepinephrine, making it less sedating). However, at that time I was only on 300mg of quetiapine (antipsychotic) rather than the 600mg I’m on now. I’ve been taking 45mg for the last four nights and my sleep has been fine.


I don’t know if the psychiatrist is going to be open to doing anything with my meds on the first visit, but I want to go in conveying that I am the one in charge of my treatment. The psychiatrist may not like that, but it’s my brain and my body, so it’s gotta be me in the driver’s seat. As for increasing the dose of mirtazapine myself, she might as well get used to the fact that I’m very proactive in managing my own med regimen, and if changes need to be made, I’m not going to wait around for a doctor to make them. Wish me luck!

84 thoughts on “Thoughts Before Meeting My New Psychiatrist”

  1. Good luck!!! Hopefully your doctor is receptive and respectful of you and your being in charge of your own care. It’s important to have an active role in your care and I’m glad you do and will advocate for yourself!
    I think it’s definitely a large barrier to only have one weeks worth of medicine at a time. It would definitely hinder the process, not help it. Hopefully you get the changes you need!

  2. I don’t really believe in luck as it were, but I do believe in you Ashley, and I am impressed of how well you know your stuff when it comes to this sort of thing.

    I didn’t have a clue when I went to my psychiatrist.
    I didn’t know what I needed or what would be best.

    But knowing what you need and what you would like, is great. You are and should be in control of what you do or don’t put in your body.

    I hope it goes well ❤

  3. A good psychiatrist will be happy to work with you with your meds. I’m so reticent to bring things like these up (please, perform, perfect), but every time I do, my psych tells me he’s proud and how vital it is that the patients get to have a say in how we’re medicated. You sound knowledgeable and reasonable, so let the discussions commence. I hope it goes well 💝

  4. Good luck! I feel some doctors can be defensive if a patient goes in with a clear idea of what they want to do, even if they know their stuff, as you do. I hope they don’t try to establish a “I’m the doctor, you’re the patient, I speak and you do as you’re told” scenario.

  5. Best of luck! 🍀 When I started seeing my current psychiatrist, he was totally on board with my medication recommendations, including the Xanax, which is the best anti-anxiety that I’ve found personally. I’ve been (and off) Xanax for about eight or ten years now, and I haven’t gotten addicted. He monitors it very well and I’m comfortable with him doing that. He takes an active part in decision making and is informative of what the risk/benefit ratio is, and the impact on my other co-morbidities (diabetes, arthritis, chronic pain). I think your goal to claim your own care vis a vis medications is certainly logical. Take care!

  6. Does your pharmacy deliver? Mine does although I don’t use it. That could solve a big problem. I hope you like your new psychiatrist. I hope you will tell us how it goes 😊 💕

  7. Good luck! I can imagine it’s a tough process, with the new person, and with the meds. I’ve always had a firm ‘no’ attitude towards meds. The only exception, ever, was half a dose of 15 mg Mirtazapine for maybe ten days total during a time when I simply couldn’t sleep for days and days in a row. It made me feel very trippy, and all sensory inputs seemed to be activated at all times. I found it horrible. Stopped taking and never looked back.

      1. I found out fairly recently that I belong to the highly sensitive person crew. Sensitive to overwhelm, fear, impulses, certain foods, and apparently it also includes meds side effects.

          1. Snakes, spiders, and every other creepy crawler in the book are fine. But pretty high anxiety about many other things. Although lately I’ve been quite in control of my GAD…

      1. I wonder if dexadrine is more tightly controlled than some meds not considered to be habit-forming. I think it’s the kind that one would only feel a “high” effect if one were to abuse it; like say, take six at a time. I’m thinking it’s an amphetamine (or in that class) but not sure how it relates to other controlled substances.

  8. I agree with my entire being in the last paragraph of this post. When we are not allowed to be in charge, and when providers refuse to listen, then it is time to find a new provider. My psychiatrist bumped my Buspirone from 20 mg/day to to 60 mg/day and it caused panic attacks and heart palpitations and “syncopated episodes”. I didn’t wait the two months it would take to see him again to reduce the dose on my own; and when I did see him, he was unconvinced of what I was telling him. But I stood my ground, and told him I would not take more than 20mg/day ever again. I too take mirtazapine to combat night terrors and induce sleep, but do think it is somewhat responsible for the night time binge-eating that occurs after taking it. I wish you the best of luck, my beautiful friend. You deserve proper care!

  9. I think your plan is well thought out.
    It is important to let the doctor know that while they have the expertise with medication (Not that you don’t) BUT
    YOU ARE THE EXPERT AS FAR AS YOUR BODY GOES.

    1. You know how they make you feel. What works, what makes it worse… A doctor cannot get inside of your body, SO they must LISTEN to you.
      Honestly, if you really don’t want to live any longer, then a prescription is NEVER going to change that… so making your life better should be the priority.
      The Doctor Needs to care about
      your QUALITY OF LIFE.
      QUALITY makes the desire to live stronger than the desire to not to.

            1. Keep with it. I have been through a lot of shitty hospitals. I have been through hundreds of shitty doctors. But Fuck him and you move down the list.

  10. I’m glad you want to be the one in charge of your treatment and not take the back seat on it. I hope the psychiatrist sees how much you know about the treatment and your body and is happy to take your suggestions. Best of luck!

  11. Johnzelle Anderson

    Yes! You are in charge of your treatment! Please post a follow up to let us know how it went.

  12. Glad you are able to prepare so well for your first meeting. I hope the psychiatrist pays attention and values your insights into your meds and their effects. I wish you well, and as always, pray for you x

  13. Good luck! 🙂 I hope your psychiatrist will be flexible and cooperative enough and understand that it’s indeed your brain and your body and that it’s you who needs to be in charge of your treatment. 🙂

  14. I hope you had a nice visit. Weekly refills? Ugh. Sounds exhausting or something like that. Yeah, if I wanted to overdose, I could get OTC meds that would do the job. xoxo

  15. Good luck! I hope you get a great psychiatrist. I really appreciate Dr G (who I’m going to lose, because she’s going on maternity leave) being collaborative, respectful, and not at all threatened by well-informed patients.

  16. I hope this new doc takes good care of you, Ashley! Listening is probably the most underrated aspect of healthcare that providers really struggle with. I hope she is able to listen to you and collaborate with you vs trying to be an expert. That always turns me off from new providers :/

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