Argumentative psychiatrists
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Argumentative psychiatrists, and treatment options

Q: I have been stable for about 8 mos. now & when the seasonal dips started for me, my clinical psychologist (psychopharmacologist as well) suggested I look into 5HTP as a safer alternative to anti-depressents, so I did. I'm experiencing fantastic success on 200 mg nightly. My psychiatrist, however, is pushing me to try Lamictal & is angry with me for trying the 5HTP. I'm on 600 mg of Neurontin in the morning and again in the afternoon, and 400 mg of tegretol in the evenings. I've shared my apprehensions re: the drug to no avail. Here's my question. Is it common for a psychiatrist to become argumentative with a patient, and to push a particular drug therapy, and, is it acceptable for me to "shop around" for a new psychiatrist now that I'm stable? My diagnosis is less than 2 years old. My thanks in advance.

Dear Carol --
First of all, congratulations on finding something that leads to stability.  Second, I wish you and I could both hear the laugh that goes up when other readers on this site see your question about "argumentative" psychiatrists!  I fear that my profession, like other doctors in medicine, is quite likely to get fussy when a patient doesn't "follow directions".  Medicine even has a term for it, you know: "non-compliance", which rather sums up the treatment stance, don't you think?

However, now that I've dissed my colleagues, I should point out that almost all of them will actually be trying to help you.  If you do something they think could harm you, while they're trying to help, then yes, sometimes you'll see a reaction.  The idea that you and they are supposed to collaborate, as opposed to having you simply follow their directions, hasn't really caught on yet, shall we say.  It will.  Meanwhile, shopping is ok.  Here are some guidelines on that.  However, before you bail, you might go back to Psychiatrist A and say "look, here's how I want to work with a doc'.  If I hear of something, I'll talk about it with you first.  But I don't want to simply be told what to do, no questions asked.  If I propose an option, I want it taken seriously, and to have you help me evaluate the risks/benefits ratio of that treatment relative to my other options.  Can you work with me like that?  I didn't like how you treated me last time."  If you like what happens thereafter, stick with him.  If not, shop.

Meanwhile, here some thoughts on your regimen so far.  Seasonal dips: consider light therapy (light box or dawn simulator).  Tegretol 400: not a very big dose, and your only mood stabilizer (Neurontin doesn't count: not a reliable mood stabilizer for most folks; could be for you, but statistically risky).  5HTP: completely untested, and basically an antidepressant approach -- which is risky in bipolar disorder.  Maybe you have pretty big "seasonal affective disorder" component that is responding to the serotonin.

So overall, what you're on is a little dicey as regards long-term stability, and a little uncertain.  If it keeps working, great.  Be on the lookout for subtle cycling, like even PMS level stuff.  And you know, on the whole I think I might rather more agree with your psychiatrist's recommendations as far as the next thing to do -- perhaps just not with how he did it.

Dr. Phelps

Published November, 2000

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