Tuesday, April 14, 2009

The Hardest Thing About a Mood Disorder

What is the hardest thing about having a mood disorder? You might expect me to answer the fatigue or the weird looks I get from people when I tell them what I'm dealing with. Or maybe it would be the simple act of taking a pill every morning. The emotional implications of that are weighty enough, let alone the actual remembering. Heck, you might even guess it the few and far between yet very real suicidal hallucinations. But nope. It's not even that.

The hardest thing about having a mood disorder? Finding a psychiatrist.

All the articles and commercials and TV shows will tell you that the only responsible way to do antidepressants is through your psychiatrist. Sure you can get a prescription from your general practice doc, but he is probably so unaware of the ins and outs and complications that the odds of you getting something that actually works are pretty slim.

And then there's the self-medicating aspect. Having a psychiatrist is supposed to be keep people from doing dangerous things like going randomly cold-turkey off their meds or upping their dosage on bad days and lowering on good days. Psychiatric medicines aren't like Tylenol, people! Their effects take weeks to kick in and weeks to wear off. Psychiatrists are the dudes who are supposed to help us crazies navigate all that.

Of course, that means psychiatrists would actually have to be available.

Awhile ago my therapist recommended two psychiatrists for me. Neither of them were covered by my insurance but I thought I'd check them out. I had a few questions to ask them but I never got past the price. Intake exam: $300 dollars. Follow-up exams: $150. Out of pocket.

That sent me to my insurance website. I spent over an hour figuring out their system and how to tell who specializes in what and making a list of covered people and where they practiced. A couple weeks later I carved out the time to make the calls. After working through some bad phone numbers and crossing some dead-ends off the list, I got this lovely message:

Chirpy Robot Lady, "Press 1 if you would like to schedule a new patient exam"

(I pressed one.)

Chirpy Robot Lady, "We are not accepting new patients at this time." *click*

That's right, I got hung up on. Another hour down the drain.

I have some serious medicine questions--Husband and I are contemplating baby number four and want to talk with someone knowledgeable about the risks and medicine and other PPD issues--that I want answered and I know my OB and my family practice docs (and the internet!) can't answer them. I've spent the last couple weeks trying to drop my dosage--slowly, ever so slowly--and the results have been headaches, nausea, increased yelling (mostly at my kids), and fast-cycling, extreme emotions. That last one is usually a sign of big trouble.

I like to think I'm a pretty rational and responsibly disordered gal, but I'm beginning to feel like my hands are tied! My sister suggested figuring out if my insurance has a patient's advocate system that could help me muscle my way in to a psychiatrist. I've also heard that therapists can sometimes get you in, but I don't think my therapist is associated with anyone.

What's a girl to do? Do you guys have any ideas?


Becca Jones said...

I think insurance companies are what's wrong with medicine in America today.


I don't know what you can do about it all.

I do know that Zoloft and Lexapro are approved for pregnancy and nursing, but Zoloft makes some people worse, and Lexapro doesn't work for everyone. And then there's that sticky dosage issue....And you can't really go by last pregnancy because they're all different (some make it worse, some nearly cure it for a while).

As a person with no insurance who gets pregnancy-related anxiety (which can get pretty severe), I have struggled with this problem myself. Medicaid doesn't help--nobody takes it! You might try Boulder Mental Health--I don't think they're allowed to turn people away, and I think they might charge on a sliding scale (or maybe they just used to.)

So, indeed...what's a girl to do?

Charlotte said...

I agree. The system in this country is a travesty. When my husband was literally in a crisis, I couldn't get any psychiatrist to see him for months despite the very immediate nature of his problem. Like I said, try calling a customer service rep for your insurance. And then try community health services for your area - at the very least they might have a more updated phone list. Good luck!

Elizabeth-W said...

I'm feeling pretty good right now.
We offer a walk-in clinic two nights a week. Nights, people. It's first come, first served, but you will see either the psychiatrist or the psychiatric NP that night. Unless you want a benzo or a stimulant, you can get a prescription that night. We even take Medicaid. (I don't, but the medical people do.)
And, we have a MAJORLY strict policy that when you call you get a human.
I would look with your insurance and see if they have psychiatric nurse practitioners. They do a pretty great job, and are almost always associated with an MD. In our office, you can usually get in with a nurse in a day or two. Our psychiatrist (because she is at several locations) you might wait months for.
I think your sister is right. There may be a patient advocate/case manager. And I'm willing to bet your therapist has an MD/NP she refers to/who refers to her. I'd definitely go that route.
Did you ever look at that website I showed you, by the way?
Good luck!!

depression mood said...

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help.