Do i go to a doctor or a psychiatrist?

LegacyUser

Well I'm new to this so I hope its okay to ask. Ive suffered depression for a very long time and was diagnosed with clinical depression 11yrs ago, I was put on meds then and going to a therapist for a year and a counsellor for another until I got a new counsellor who made me doubted I had depression so I ended up boycotting her. I haven't seen anyone since then as over the years I tried dealing with it in my own way which worked but now I'm starting to struggle. Ive had a very bad start to the year with a loss in the family and my anxiety is starting to take a toll as I worry for one of my sisters the most as she is going through a very rough time. I'm a bit of a social introvert which means my family means everything to me and I find it hard to talk to others including them as I don't want to bother them when they have their own battles to fight. This depression and anxiety is really doing my head in and I find it increasingly hard to get through each day. Some days I find myself breathing hard from anxiety or I start to tear up from depression in my shift and id have to run to somewhere were I'm out of view and try to get myself together, I find it hard to even get up for morning shifts too and my sleeping pattern isn't great either. I have tried tiring myself out with exercise and reading but it doesn't work sometimes. So should i maybe go to a doctor and get anti-depressants or should I go to a psychiatrist instead? any advice would be helpful.

Maximus Alexander

Go to a good GP and make sure they know your history. The GP should be your first port of call; they will decide if medication is a good option for you and may also refer you to other professionals for treatment. The important thing is that this can be treated and you don't need to carry on living with this illness controlling your life.

Start with the GP: they are the medical professional who can advise you on treatment, and if that includes a counselling or psychotherapy, then they will be able to provide you with recommendations too.

LegacyUser

Thanks I think I will, just wasn't sure which way was better, its great to have someones opinion on these things thanks so much.

Vital Transformation

Your GP can refer you on to a consultant psychiatrist if he/she feels you need a specialist opinion. I think that's the process, not sure if you can go directly to a psychiatrist. A psychiatrist is also a doctor by the way, just one with further training in the field of mental health.

pilly

Go to see your GP first but don't give up on the idea of counselling either. There are good and bad counsellors out there so not everyone will suit but if you get the right one it can be a huge help.

Airyfairy12

Why did you boycott the councillor who made you question your depression? I'm just wondering because to me that sounds a little bit like youre only interested in being told what you want to hear rather than being open to looking at other diagnoses which could be helpful for you.

From personal experience with councillors I understand how frustrating it can be when you don't connect with them, they don't 'get' you or theyre unhelpful but try to remain open to their suggestions, did she explain why she thought you might not have clinical depression? It's been a long time since your initial diagnosis, sometimes when we're diagnosed with something it can stick with us, once labeled we can almost become the illness, preventing treatment from being effective, this is why lots of mental health workers don't openly diagnose patients as it can do more harm than good.

Have any of the councillors offered CBT, DBT, mindfulness or other treatments? It might be worth asking about them if you havnt tried them before.

Try to find a good GP who is empathetic and understanding, you don't need someone uncaring to fob you off with a prescription for meds so id ask around for recommendations. My original family doctor was a horrible man, very insensitive and clearly didnt give a toss about his patients. I recently changed doctor for the first time ever and im kicking myself for not doing it sooner, she's fantastic. The professionals you go to for help make a big difference so choose carefully, if the doctors not helpful then get a new one.

I would try not to focus so much on the illness itself but rather healing from it. People do overcome mental health problems and youre not any different.

MrMorooka

People dismiss how hard it is to 'just go to the GP'. Lots of people don't have a GP, I don't. I would have to go and research and find one and take a day off work to visit, and so on. Then if they're not good, then what? Go find another one and repeat until you meet a doctor you like? It's a hell of a lot of effort for a depressed person to make- unrealistic. Or if you live at home and haven't been to a doctor in years, how do you explain why you're visiting the family GP or whatever to the family you're living with? That's pressure too.

Maximus Alexander

MrMorooka wrote: »

People dismiss how hard it is to 'just go to the GP'. Lots of people don't have a GP, I don't. I would have to go and research and find one and take a day off work to visit, and so on. Then if they're not good, then what? Go find another one and repeat until you meet a doctor you like? It's a hell of a lot of effort for a depressed person to make- unrealistic. Or if you live at home and haven't been to a doctor in years, how do you explain why you're visiting the family GP or whatever to the family you're living with? That's pressure too.

I don't dismiss it at all. It's hard, but it needs to be done.

I had a serious depressive episode myself in January and though I've suffered with depression throughout my life, I'd never sought treatment before. This time it was bad enough that I had no choice.

I didn't have a GP, but I found one. In my case I spoke to a friend who had recently been treated for depression and anxiety and they gave me a recommendation. I was in such a state that I couldn't even call the GP myself to make an appointment, but fortunately my OH did this for me.

Three weeks on and I feel back in the full of my health; it was the best thing I ever did. I couldn't have even imagined ever feeling this normal again at the time, let alone so soon.

If you can't bring yourself to take action yourself, and I can totally understand how that feels, then talk to a family member or a close friend. You don't have to tell the world, but pick the person you most trust and confide in them. Ask them to help you. They will! It's an illness and there's nothing to be ashamed of, and it doesn't have the same stigma attached to it that it once did.

The alternative is to live in suffering for an indeterminate amount of time which is surely a much worse fate. So please, talk to someone, see a doctor. Look after yourself.

Airyfairy12

MrMorooka wrote: »

People dismiss how hard it is to 'just go to the GP'. Lots of people don't have a GP, I don't. I would have to go and research and find one and take a day off work to visit, and so on. Then if they're not good, then what? Go find another one and repeat until you meet a doctor you like? It's a hell of a lot of effort for a depressed person to make- unrealistic. Or if you live at home and haven't been to a doctor in years, how do you explain why you're visiting the family GP or whatever to the family you're living with? That's pressure too.

Why would you have to explain to your family that you went to the GP? The doctors not going to tell them, its confidential. Most people just take an hour or so off work to fit their appointment, you'd be in the doctors office for 20 minutes, why would that require an entire day off work? No employer would have a problem with taking the morning off or an extra 40 minutes at lunch. Every town and village in the country has a GP, you ring and ask for an appointment.

MrMorooka

Maximus Alexander wrote: »

I spoke to a friend who had recently been treated for depression and anxiety and they gave me a recommendation....fortunately my OH did this for me....then talk to a family member or a close friend.

Oh, how nice and fortunate for you to have a friend. And an OH. No offense, you have no idea what I'm talking about. I'm talking about young men with nothing, who are wasting their lives playing video games, eating like ****, drinking, with zero social lives. There are thousands of these people and they're completely invisible. Sometimes you see them post on forums like this and nobody notices. You won't see them out and about anywhere. Invisible. Statistics.

You are so, so far above a lot of depressed people like this, just because you have an OH(being in a relationship is like going to Mars for so many people) and friends and you don't even realise it. When people like you give advice to people like I'm talking about, it bounces off, it is so unrelateable it just means nothing to them.

As a thought exercise, if you had had this depressive episode you mention and you didn't have your OH to make the appointment for you, what would have happened? Would you have just gotten worse, and ended up as a statistic? Because this is the reality. You were lucky enough to have other people do a huge amount of the work for you, to find a good doctor, to make you visit them. When you're depressed, doing something like that can feel almost impossible, doubly so when you have no support in it, no one who will notice if you don't go for that appointment, no one to help.

weirdspider

Suilegorm wrote: »

Well I'm new to this so I hope its okay to ask. Ive suffered depression for a very long time and was diagnosed with clinical depression 11yrs ago, I was put on meds then and going to a therapist for a year and a counsellor for another until I got a new counsellor who made me doubted I had depression so I ended up boycotting her. I haven't seen anyone since then as over the years I tried dealing with it in my own way which worked but now I'm starting to struggle. Ive had a very bad start to the year with a loss in the family and my anxiety is starting to take a toll as I worry for one of my sisters the most as she is going through a very rough time. I'm a bit of a social introvert which means my family means everything to me and I find it hard to talk to others including them as I don't want to bother them when they have their own battles to fight. This depression and anxiety is really doing my head in and I find it increasingly hard to get through each day. Some days I find myself breathing hard from anxiety or I start to tear up from depression in my shift and id have to run to somewhere were I'm out of view and try to get myself together, I find it hard to even get up for morning shifts too and my sleeping pattern isn't great either. I have tried tiring myself out with exercise and reading but it doesn't work sometimes. So should i maybe go to a doctor and get anti-depressants or should I go to a psychiatrist instead? any advice would be helpful.

If you have access to a psychiatrist I'd definitely say an appointment is worthwhile, given that they are specialists in the area of depression.
My experience, and from what others have told me, is that most GPs tend to listen for a few minutes and off you go with an antidepressant. Psychiatrists will be more likely to provide individualised treatment to suit you best.

If you have a medical card its likely you'd be put on a waiting list and if you are paying privately to see a psychiatrist the cost tends to be high. So it may be a case that the GP is your only option, which is better than receiving no treatment at all.

People slate anti-depressants all the time, and claim that depression can be resolved by making changes in your life. But they don't understand that the neurotransmitters in your brain giving you motivation to make those changes are lacking. Disrupted sleeping, tearfulness, difficulty getting out of bed; you do not sound well. Please do not attempt to continue "dealing with it" in your own way. Hope you get the help you need.

MrMorooka

That's actually a question I have. If you go into your doctor and say "I'm depressed", when do you actually get treated? Do you go into a waiting list to see a specialist and stay there for months/years in the HSE hell? Does the doctor just give you a prescription for something then and there? How much does all this cost?

weirdspider

MrMorooka wrote: »

That's actually a question I have. If you go into your doctor and say "I'm depressed", when do you actually get treated? Do you go into a waiting list to see a specialist and stay there for months/years in the HSE hell? Does the doctor just give you a prescription for something then and there? How much does all this cost?

It depends on the type of depression being treated.
The doctor will ask a few questions to evaluate your mental state, if you have mild, moderate or severe depression. (There are various scales out there to measure this, such as the Beck Depression Inventory Scale for example.)
Not all doctors ask enough questions however and thats where the issue lies with regards to treating people with antidepressants who may not necessarily need them.
He/she will determine whether or not counselling or CBT alone may be sufficient (and usually is in the case of mild depression), in which case you will be referred to a counselling service via the HSE. The waiting lists for this are a bit shocking. (I got referred, got told in August that I wouldn't be seen until January). You could of course go down the private route with regards to CBT/counselling but it tends to be very expensive and unfortunately not usually an option for medical card holders.
They usually prescribe first line treatment, so one of the SSRIs which are known to be safe and effective in most patients (escitalopram, sertraline, citalopram, paroxetine, fluoxetine, fluvoxamine; nowadays its mainly escitalopram and sertraline).
Referral to a psychiatrist usually occurs where the patient appears to be suffering from severe depression or manic depression.

Regarding cost, the cheapest option is by far treatment with an antidepressant and therefore it is most popular amongst GPs. For example, a cost of psychological treatment for anxiety or depression in Ireland is estimated to be around 874e per person. (source: clinical focus, the price our mental health).
The total ingredient cost of the most commonly prescribed antidepressant in Ireland - escitalopram or Lexapro - equaled 12.5 million euro for 435,927 prescriptions (from Nov '09 to Oct '10). This works out at an average cost of around 2 euro per prescription of escitalopram/Lexapro. (source: NMIC bulletin; pharmacotherapy of depression in adults).

So to answer your question; yes, most of the time the doctor sends you off with a prescription for an antidepressant.

Big Bag of Chips

MrMorooka, if you're sick you have to go to a doctor. It really is that simple. Same was as if you're hungry you have to go buy food and eat. Or if you want money you have to work, or sign on and collect it in the post office! Nobody is going to come and take you (not you specifically) by the hand and bring you. Sometimes people have to take responsibility for themselves. Nobody is claiming it is easy, but the OP came asking a question and was given an answer. It would seem they don't have an issue with going to a GP, they just weren't sure about where to go. So your point about it "not being as easy" as that isn't relevant to the OP, as they seem fairly ok with that.

Yea, it is a sad fact that some people are desperately lonely and 'invisible' but luckily now a lot of places have websites and can offer online support and advice. It might be enough to tide someone over, or to give them the nudge to approach a GP. Unfortunately, when we reach adulthood our lives are our responsibility. Some people are lucky to have family around them who will keep an eye on them. But even concerned family and friends can't bring someone somewhere against their will. It still has to come from themselves.

MrMorooka

weirdspider wrote: »

It depends on the type of depression being treated.
The doctor will ask a few questions to evaluate your mental state, if you have mild, moderate or severe depression. (There are various scales out there to measure this, such as the Beck Depression Inventory Scale for example.)
Not all doctors ask enough questions however and thats where the issue lies with regards to treating people with antidepressants who may not necessarily need them.
He/she will determine whether or not counselling or CBT alone may be sufficient (and usually is in the case of mild depression), in which case you will be referred to a counselling service via the HSE. The waiting lists for this are a bit shocking. (I got referred, got told in August that I wouldn't be seen until January). You could of course go down the private route with regards to CBT/counselling but it tends to be very expensive and unfortunately not usually an option for medical card holders.
They usually prescribe first line treatment, so one of the SSRIs which are known to be safe and effective in most patients (escitalopram, sertraline, citalopram, paroxetine, fluoxetine, fluvoxamine; nowadays its mainly escitalopram and sertraline).
Referral to a psychiatrist usually occurs where the patient appears to be suffering from severe depression or manic depression.

Regarding cost, the cheapest option is by far treatment with an antidepressant and therefore it is most popular amongst GPs. For example, a cost of psychological treatment for anxiety or depression in Ireland is estimated to be around 874e per person. (source: clinical focus, the price our mental health).
The total ingredient cost of the most commonly prescribed antidepressant in Ireland - escitalopram or Lexapro - equaled 12.5 million euro for 435,927 prescriptions (from Nov '09 to Oct '10). This works out at an average cost of around 2 euro per prescription of escitalopram/Lexapro. (source: NMIC bulletin; pharmacotherapy of depression in adults).

So to answer your question; yes, most of the time the doctor sends you off with a prescription for an antidepressant.

This is a fantastic post, thank you.