Medication / Mental Illness

Working With a Psychiatrist

[ As is typical with medical discussions, this post is a bit longer. I’ve made headings that should help navigate it, but honestly, there’s a lot to know. I recommend fully educating yourself.]

Recently, I talked about medications. It was my goal to share all the good and all the bad. I may have scared some people away from meds, but I think it’s important to know that some benefit from them more than they’re harmed by them. I am most definitely one of those people, so I want to talk to others like me who benefit from meds. I want to talk about how to work with a psychiatrist

A psychiatrist is a medical doctor specifically trained in prescribing psychotropic medications. Sometimes, instead of a psychiatrist, one might work with a nurse practitioner with similar training. The basic things you need to know about psychiatrists

1. They are highly educated, and this is valuable to you
2. They probably see symptoms and recoveries that you don’t see
3. They are trained specifically in medications, leading to bias
4. They deal with a lot of non-compliance and have developed strategies to deal with this
5. Not all psychiatrists are equal
6. A Peer Support Specialist can help

Highly educated

So yes, they are highly educated. They have gone to med school, and specifically for prescribing psychotropic medications. They are absolute experts in meds. They likely know more than we do, at least from a medical perspective. This does not mean they know your body specifically, and please feel free to tell them what it’s doing to your body, but they do have an outside perspective that is almost assuredly useful to you. These doctors are often brilliant, and the good ones will answer your questions and value your input. I try to take full advantage of that fact with my doctor, and she appreciates it

Trained to see symptoms

Psychiatrists are highly trained to watch for every cue visible about how you’re doing. Sometimes I think I might be manic or depressed, but my doctor, with her extensive training, is looking for all those symptoms herself and maybe she thinks I’m mistaken, or maybe she sees a struggle I haven’t talked about. I’m not saying she knows me better than I know myself, but she might know the meds better than I know them. I thought I was manic last time I saw her, and she said she didn’t see the pressured speech or other symptoms that come with mania. She just saw excitement, and I’m allowed to be excited without fearing that I’m manic.

Only trained in medication

Now for some balancing negativity. Psychiatrists have kind of been trained to be a one-trick pony. They might only know medications. They work in mental health and probably learned about other things, too, but they are absolutely not trained to be therapists or teach coping skills. Mental health workers are highly specialized and teaching coping skills is simply not the psychiatrist’s  role. They may advocate a medicinal solution when perhaps more training in coping skills would be sufficient. I personally always recommend trying additional coping skills before resorting to a med increase or change. Some psychiatrists might not want to risk the damage the extra time can cause.

Highly familiar with non-compliance

Psychiatrists often deal with a high amount of non-compliance, especially if they serve people with government insurance. Many people are even court ordered to talk to a psychiatrist and have no desire to take meds in the first place. (I was once in this situation and was taken to a hospital involuntarily for violating the order and not taking my meds). Sadly, a frequent strategy to handling this is to downplay side effects, sometimes simply not mentioning them at all. At worst, a psychiatrist may just deny that a medication even can have a certain side effect. As I mentioned earlier, this led to me crashing a car when I was younger. A good psychiatrist will not do this, but as I said..

Not all are equal

Not all psychiatrists are equal. For the last decade, I’ve worked with a couple different psychiatrists, and both of them are amazing. They highly respect me, do not push meds, are honest about side effects, and try to treat my symptoms with an appropriate balance of medication and coping skills. It’s not their job to teach coping skills, but sometimes they advise me to continue my work with other professionals on that front before resorting to more medication. This is why my medications are generally at low doses, meaning I can function with fewer side effects. I personally prefer dealing with nurse practitioners, because nursing training is different from med school training. They tend to have a better “bedside manner”, and while this is probably not universally true, I found the two nurse practitioners I’ve dealt with to be more humble than doctors. I assume this is because of the style of education and the prestige of med school, but keep in mind everyone is an individual. I’m worked with humble doctors, too.

A Peer Support can help

One of the best aspects of my job as a Peer Support at a hospital was sitting in doctor appointments with patients. Sometimes talking to a doctor can be really intimidating and you might feel afraid to talk openly. Or maybe you could benefit from the perspective of someone who takes meds. There was a doctor I highly respect who advised his patient to look at the older medications because doctors know more about the potential side effects because we’ve had more time to study them. Well, yeah, but what we’ve learned is that those side effects are frequently disastrous! Don’t get me wrong, everyone should make their own decisions, but as someone who takes meds, I always prefer trying the newer stuff first because there’s been so much more development in the science of making these drugs and recent ones are less likely to do as much harm. Remember a lot of the older drugs have permanent side effects. You stop the med, but the side effect doesn’t go away. Sometimes it’s worth it, but you should know about it going in. (You may recall that I have some of these permanent side effects and in my opinion some of them were worth it. It’s a hard call to make, however

There aren’t a lot of Peer Supports in the business of sitting in with doctor appointments, but if you’re on public insurance in Michigan, it is law that you have the right to ask for someone to support you and advocate for you in doctor appointments. Why not make that person someone with a mental illness who knows what taking meds is like? If you’re on private insurance, you likely don’t need special laws to protect this sort of thing because you probably have more control of your situation. I definitely recommend looking into it.

These are the things I’ve learned after taking meds for most of my life. Despite the many drawbacks, I’m overall very thankful for my medications and the wellness they’ve helped me achieve. I’m glad to share my knowledge and experience, and as a student, I always want to learn what I can from any source.

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