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Need advice about psychiatrist appointment

HLon99

HLon99

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Apr 15, 2020
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Dear Forum,

As you may already know I have bipolar disorder and I am currently taking Aripiprazole (Abilify) and Lamotrigine. These medications, up until recently have been working very well for me with minimum side effects. However, recently I was also been treated for ADHD by a different psychiatrist. Since then, I have found that the Aripiprazole that I am taking is causing an interaction with my ADHD meds. So I have been considering making a switch to Quetiapine.

Today, I finally got the chance to speak to my psychiatrist about it. Initially, she suggested that I take the antipsychotic out of the equation completely, but I countered with the fact that antipsychotic helps to prevent the mania, so removing it would be a risk destabilising my mental health. She agreed. She then suggested that to switch to Quetiapine (Seroquel), but she wanted me to be on a VERY low dose (25mg). Quetiapine is only really effective at preventing mania at doses of 300mg+, anything below and it works practically as a sleeping pill only. I told her this, and she seemed to get very frustrated with me, asking me why am I so desperate to be on such a high dose etc. After a lot of backwards and forwards, she agreed to a middle ground of 100mg, even though I doubt that this will work for me. She also said to call her if things don't work out and then we will be able to review in 6 weeks.

I fear that in the heat of the moment, I may have overplayed my hand. I know that only a fool argues with his doctor, but I honestly believe that I was in the right. She's been a good doctor to me, definitely better than 80% of the shrinks out there, but it does sometimes feel like we fundamentally disagree on a lot of key issues and this causes friction between us. I used to have an amazing psychiatrist with whom we got along perfectly, he could really speak my language. Unfortunately, he retired. Since being with her, it has become somewhat of an uphill struggle, I kept insisting that she gives me 300mg and even though we settled on a middle ground, I could hear the frustration in her voice. I fear that I may have alienated her now and she might even ditch me as her patient.

Anyone have any advice on speaking with psychiatrist?
 
S

squizofrenia123

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Sorry, I'm no help but do know that the only medication that works for me is an antipsychotic. I take aripiprazole and am szaffective- bp type 2. I took a variety of medications before but the only med I really need to avoid psychosis is abilify. I don't take a mood stabilizer anymore because all it did was cause me more side effects. I rarely get severely depressed these days but mostly have voices which come and go. I do exhibit some signs of hypomania at times though but can deal with them. I used to be hypersexual but with age, this symptom has been decreasing some what. So, all I need to deal with now are my voices. So, in essence, less is more for me. I would tell your psychdoc how you feel since you are taking the meds not your doc. Also, you may have to play around with your meds, meaning fine-tuning them until you find the right combo. Patience is key here. I found out that the only med I needed was my antipsychotic med after taking a lot of meds for about ten years. Sometimes, your illness mellows out with age too. So, please be patient. Keeping a journal about your daily symptoms might help too which you can show to your psychdoc. I hope this helps. Best wishes!
 
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Nukelavee

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I take Rexulti as, I guess, a mood stabilizer. Small dose, .25 mg a day, and I find it to be very effective. Looking it up, it seems to be similar to Abilify.

300mg sounds like a huge dose to me.
I fear that in the heat of the moment, I may have overplayed my hand. I know that only a fool argues with his doctor, but I honestly believe that I was in the right.
Maybe, depending on their character.

Personally, I have no problem disagreeing with my doctors, or sticking to my point or choice about my treatment. And I don't think anybody else should fear making their doctor angry by disagreeing on what treatment you prefer.

Doctors aren't infallible, and I feel a truly good doctor takes into account their patient's wishes and insights.
 
manicmonday

manicmonday

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I wouldn't worry about it. My psychiatrist said he'd rather give me a pill I'm happy to take than one I end up not taking in protest and she's probably of the same mind as she agreed to give you 100mg. If you're monitoring for the prodromal signs of mania and find you need the higher dose then they should be able to increase it for you quite quickly.
 
HLon99

HLon99

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I wouldn't worry about it. My psychiatrist said he'd rather give me a pill I'm happy to take than one I end up not taking in protest and she's probably of the same mind as she agreed to give you 100mg. If you're monitoring for the prodromal signs of mania and find you need the higher dose then they should be able to increase it for you quite quickly.
My psychiatrist isn't like that, she's very conservative when it comes to medication. It took me a solid 15mins to convince her of all the reasons why I should be put on 300mg and only after I mentioned my past psychotic symptoms did she budge ever slightly and agree to 100, which is just a third of the proven minimum effective dose for bipolar.

Even then, I fear that I may have overplayed my hand by back-talking her, tightening the screws on our already strained relationship.
 
O

On Fire

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My psychiatrist isn't like that, she's very conservative when it comes to medication. It took me a solid 15mins to convince her of all the reasons why I should be put on 300mg and only after I mentioned my past psychotic symptoms did she budge ever slightly and agree to 100, which is just a third of the proven minimum effective dose for bipolar.

Even then, I fear that I may have overplayed my hand by back-talking her, tightening the screws on our already strained relationship.
I have previously been advised by my GP that this is the NHS, not a private health care system, and trying to self prescribe or even doctor shop (which I am not accusing you of, but my GP once told me off for) does not work in the UK system.
 
N

Nukelavee

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Even then, I fear that I may have overplayed my hand by back-talking her,
you may have, but I honestly feel you did nothing wrong. First, you are both adults, there has to be mutual respect for each other simply for that reason. She's not a parent or guardian, you are equals. Yes, she knows her field better than you, but you know you vastly better than she does. And, you are smart, just like her.

I'm not saying you should pick fights, but I don't think you should be in a position where you fear your effect on her mood.

I can totally understand your feelings about this, but I feel you are maybe overestimating or assuming a negative outcome where it may not exist.
 
N

Nukelavee

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I have previously been advised by my GP that this is the NHS, not a private health care system, and trying to self prescribe or even doctor shop (which I am not accusing you of, but my GP once told me off for) does not work in the UK system.
I feel like we have more choice in the matter under our system (in Canada), although that might just be my experience. Personally, I feel like it's not unlikely your doctor said that simply to maintain a form of control.

If a doctor told me I get no input or choice in my treatment, I'd walk out, and get another referral.
 
O

On Fire

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I find it so difficult to get along with NHS psychiatrists. They always get me wrong, even though what I have is a relatively common combination - autism and schizophrenia.
 
O

On Fire

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@HLon99 I think you will miss Aripiprazole. It is the best medication I have come across, and is now all I take.
 
O

On Fire

Guest
The NHS is like a national religion in the UK, it is just such a shame how bad metal health care frequently is. Even when I have had the care and had resources spent on me, I always find it lacking. These days I am discharged to my GP and there is a mental health care practitioner attached to the GP practice - it is the best care I have had. So sometimes less is more, but I think I am somewhat unusual, so your millage may vary.
 
HLon99

HLon99

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@HLon99 I think you will miss Aripiprazole. It is the best medication I have come across, and is now all I take.
I know you are very pro aripiprazole but don't be so dramatic. Its not exactly an ex-girlfriend, I can always go back to it if it doesn't work out 😂
 
O

On Fire

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I know you are very pro aripiprazole but don't be so dramatic. Its not exactly an ex-girlfriend, I can always go back to it if it doesn't work out 😂
Haha. I do tend to rabble on, definitely.
 
K

keith74

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Sorry to hear of your struggles with your doctor. It is common for doctors to start you on a low does and slowly increase your dose if you don't show any adverse effects. But 25mg is really low and basically just good for some anxiety and to help you sleep. 100mg is considered a standard low dose to get you started (my wife got started on 100mg when she was on it). Maybe show her the below link which mentions 400mg is standard to treat mania:
https://www.moodtreatmentcenter.com/quetiapine.pdf (page 2)
 
N

Nukelavee

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100mg is considered a standard low dose to get you started (my wife got started on 100mg when she was on it).
Btw - how is your wife doing, and, how are you doing this week? Things going ok?
 
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