How should I manage my medication until I can get in to see a new doctor?

[ltriach2]

I've been seeing a psychiatrist for over a year now and am on some medication that has helped me a lot with managing my depression, anxiety, and PTSD. Since I started seeing her, there's been some things about her that have rubbed me the wrong way and I was able to kind of overlook them, but they’ve gradually gotten to where I can’t do that anymore. She's not a bad doctor or person, but she tends to make her priorities more important than my priorities when it comes to treatment and even when I come in with good news to report she'll bring it back to me not doing "enough" in the areas she thinks I should and dismissing the areas I've done well in – even if the areas I’ve done well in are the areas I feel I’ve needed to put the most work into, and even if the areas she wants me to prioritize (mostly the social stuff, like making friends) are areas I’ve also majorly improved in. It seems like anytime I try to convey this to her, it's like I'm raising a red flag that says I'm just trying to avoid making an effort. I've really tried to step back and consider whether she's making a good point, but it just seems like she's measuring my accomplishments using someone else's ruler and not mine. Again it doesn't make her a bad person and I do think she cares about me as a patient, but at a certain point it's just excessive and unpleasant and doesn't create a positive or healthy environment. Obviously it's fine to offer constructive criticism to a patient but hers stopped being constructive a while ago and I'm tired of walking out of her office feeling like I've failed because I didn't live up to what she wanted when I know I work really hard to manage my mental illness. I'm grateful that she helped me find the right medication, but I really don't owe her anything and I can't keep feeling like every time I go to the doctor I'm going to need to justify all of my choices, even the ones I'm content with. This isn’t good for my mental health.

So after my last appointment on Monday, I decided it was best to call and make an appointment with a different office. Since I'm a new patient and the new psychiatrist's office seems to be pretty in demand, the appointment isn't until July 13th. They put me on a cancellation list in case an earlier appointment becomes available but I don't want to rely too heavily on that possibility. The issue I'm having is that my current psychiatrist only gave me a prescription refill that will cover me for two months and I'm supposed to go back on May 24th for another appointment. Obviously, it'd be bad to run out of medication and not be able to take it from May-July - especially since one of the medications is Effexor which is known to have withdrawal effects. Does anyone have advice for how I can get my prescription while waiting for the July 13th appointment, without having to keep my May 24th appointment with the current psychiatrist? I can go back if I really, really have to but I just am hoping for an alternative because the last appointment was the worst one yet and has left me stressed and upset for literally days after. I just don’t see the point in giving this doctor any more of my time or money when it's actually become bad for my mental health rather than helpful. Would seeing a general practice doctor be a good option? Could I call the future psychiatrist and explain the situation to see if they'd have any suggestions? I obviously hesitate to call the current psychiatrist to explain the situation since of course I'm not sure she'd be willing to call the refill into the pharmacy in order to help me avoid seeing her; the current psychiatrist is in a neighboring city and the new one is much closer to home, so that's always a reason I could give if needed but doesn't quite cover why I couldn't just come in for one more appointment when I've been making the relatively short drive for over a year now. I know this is a couple months away, but don't want to wait until the last minute to get it sorted. Any advice is appreciated!

[Paxiled]

Don't let the prescription lapse.  This can be a very hard drug to stop taking, so you want to make sure any psychiatrist you see has respect for this -- many don't care much about withdrawal.  Primary care physicians are particularly bad at this generally.  It's an art form and requires a very caring and involved psychiatrist to properly manage medication.  To my uninvolved ears it sounds like you have a good psychiatrist -- she wants you to get better, not just medicate yourself forever.  Are you in therapy?  It sounds like she's doing some therapy on you, whereas most psychiatrists will just ask you how you're doing on your med and say ta ta.  Here's the thing about therapy -- it puts pressure on you if you have a good therapist.  Doesn't mean it will work, but for it to work you have to work and a good therapist pushes you.  A bad one just sees you every week and collects your money while nothing changes because the nature of mental illness is to avoid doing anything about the problem in a way that solves it.  I've done terribly with therapy, and so I'm not suggesting it's a panacea, but when it does work you're cured whereas drugs just tamp down the symptoms.  All that being said, for your stress level, I'd keep the appointment and not run out of the med and not try an end-around to avoid seeing this person one more time.  That way you'll have continuity with your medication absent the stress of trying to get someone else to prescribe it until you find a new psychiatrist you'll like, as you have no idea at this time if the the new one will be any good or a tool.  They are not created equal.  

[ltriach2]

Thanks for the advice! I do think you're right about just going to see her one last time instead of trying to go around it. After the last appointment, I was really unhappy so the thought of not going back seemed worth the hassle - but stepping back it probably isn't, even if I'm not her biggest fan at the moment.

I do see a therapist and 100% agree with you about medication not being a cure-all and needing a therapist who pushes you. Medication is a supplement to therapy rather than the other way around, and the main benefit of the medication for me is it makes it easier to implement the tools I've gained in therapy by taking away some of the "noise" in my head. At first I really appreciated my psychiatrist's approach in the sense that, as you said, she is a much more involved psychiatrist than many can be. I saw a psychiatrist before moving out of state who was similar to her in that way so it was good to find one when I moved who was interested to know about more than just the symptoms and side effects. But it's just become a situation where every time I go see her it's negative, negative, negative. I don't doubt her approach works for some people and again, I don't think she's a bad person/doctor, but that doesn't work for me at all. Part of the reason my therapist's "pushing" has worked and helped me to get so much better and keep moving forward is because it's done in such a positive way, even when she's saying something I don't want to hear (but need to). My former psychiatrist was the same way - he pushed me to do better and had no problem calling me out when I was finding ways to stall my recovery, but he always did it in a way that made me feel encouraged. I think a big part of this is acknowledging that I have done a lot of work to this point - when I start to feel hopeless and stop trying, it's usually because I feel that it's all just pointless because I try really hard and don't get anywhere, and usually what gets me moving again is the reminder that "this is where you were, this is where you are, and there has been an improvement even if you feel stuck right now,  and the only way to get unstuck is to keep pushing through this or that even if it's scary". The current psychiatrist I feel is more of a "this is where you are, this is where I want you to be, you should be there by now, why aren't you trying harder to get there?" which just...isn't effective for where I am at this point in my life because I know I have dedicated a lot of time and energy into getting better and stepping out of my comfort zone and it adds nothing positive to my life to have someone who only sees me every few months and only gets the cliffnotes version of my recovery take this really negative mindset towards my recovery. I really don't benefit from it at all and it has actually just become detrimental for the reason stated above - a big mental block for me is that I tend to beat myself up by saying it's pointless to keep going because it's never going to be enough. And stepping back I think one of the main reasons it's become difficult to overlook the way she often makes me feel is because I /have/ gotten so much better about recognizing my achievements and pushing through self-doubt. The therapist I see every other week has helped me so much with that and I feel like even if I stopped the medication tomorrow, I'd be okay because of the tools she's given me (though as I said, the medication does help a lot,  but it's definitely not everything or the main part of my recovery). And another thing I'll mention is that my therapist doesn't seem to see the same types of issues as my psychiatrist does - we seem to be more on the same page about what I need to focus on and when she pushes me on things, it's easier to take because even if it's hard to hear I know she's doing it in my best interests and after listening to how I've been feeling and the steps I've been taking. I don't really feel my psychiatrist has a good enough picture of my life or what my goals are to make the judgments she often makes, given how the questions she asks are often pretty limited overall (it's a pretty short meeting).

Anyway, sorry if this answer got more detailed than you were looking for haha But I just wanted to clarify a little more what my complaint is with her as a doctor, because it's really not about her pushing or saying things I don't want to hear but just the overall negative approach she brings to our sessions that I don't respond to. As I mentioned, it's not uncommon for me to leave her office embarrassed or upset - that's not the result of constructive feedback in my opinion. When I left my former psychiatrist's office and when I leave my therapist's office after they've told me some truths I've been avoiding, it's usually a feeling of having a lot to think about and maybe a heaviness/"oh god I don't want to do this" feeling but still a sense that things are headed in a positive direction if I can get past this point.

You're right that mental illness can make you very good at avoiding things that are unpleasant - it feels so much safer that way - and that the point of getting treatment isn't to find someone who enables you to stand still. But I just need a more positive, gentler approach or it ends up going the other way and I feel like "oh yeah, it actually is a lot better to stay where I am and just steer clear of this feeling rather than open up to get help", which is how she's started to make me feel and that would be dangerous if she were the only person I was seeing for treatment and I didn't have a therapist who helped me learn to get past that feeling. Funnily enough, I think your post is actually a good example of what I mean because I was letting myself get so keen to avoid this person who I've managed to survive seeing for over a year, but reading your post helped me kind of step back and ask myself if I was really going to risk disrupting my treatment and having to jump through hoops with multiple doctors rather than doing something that objectively isn't so bad and makes the most sense. It wasn't pleasant to have to make that realization, but your post was helpful in not tearing me down or saying I was silly for doing this or that, but just offering a different perspective that helped me see past what my head was telling me ("avoid, avoid, avoid!!" haha). So thanks and I hope this has kind of cleared up what I was describing about my current doctor - her approach would be fine for some, but just causes me extra stress and grief.  I'm feeling positive about the new psychiatrist as she has a good reputation and I know someone who has had a good experience with her - so fingers crossed it will all work out! I appreciate your feedback and will keep it in mind moving forward. I hope that if you ever decide to try therapy again you have a better experience; it can definitely be tricky to find a good fit but when you do it's nice to have someone you know is rooting for you and who you can share your successes (and failures) with. Good luck with your recovery!