These last few weeks, I’ve been feeling prematurely aged, because I’ve been having lots of interactions with doctors, trying to figure out which of my various meds – if any – might be contributing to a weird resurgence of my depression, coming at a time when, outside circumstances considered, I should be feeling pretty cheery.
If you think the usual talk therapy-medication management model of split care that characterizes much of psychological treatment these days is bad, well, get a load of this.
These are the docs I’ve been seeing – and these are only the ones involved in this particular little dilemma involving my recent depression: the psychiatrist who prescribes my psych meds, the therapist I see for psychotherapy, the neurologist I see for migraines, and another doc who prescribes birth control.
For a young person who takes psychiatric meds, this is actually not a crazy list, especially since migraines are a common problem in people with anxiety and depression and plenty of young women are on birth control.
The problem? When it comes to sussing out which drug might be causing a particular side effect – in this case, the blues – none of these docs seems to feel comfortable making a grand pronouncement. There’s no chief justice/Grand Poobhah for medications.
Each of my doctors is willing to offer an opinion on in his or her area of expertise and say whether the drug he or she is prescribing might be contributing to my gloominess (or, in the case of antidepressants, failing to get rid of it).
But what I want is someone who can look at all the factors and make a global pronouncement – someone who can say, “Well, you’re bursting into tears a lot lately, and that’s not the kind of depressive symptoms this migraine medication causes, and it’s also not really characteristic of your previous depressions, based on my notes. But it can be a side effect of this particular kind of new birth control.”
And no, I don’t want to have to do this myself, without any actual medical backup.
I can’t get my doctors to do this. They keep hedging and saying that I should make sure to check in with the other docs in case the other drugs might be involved. My therapist is actually the best at proffering firm opinions on the subject (she thinks it’s the birth control). But then she remembers that she needs to tell me to ask the M.D.s
It’s like a merry-go-round of medication side effects and passing the buck. I suppose older people, who take lots of medications, must get this all the time. In my case, it feels like a glimpse of what’s to come. A frustrating glimpse that I could do without.
Perhaps I’m just unlucky, but I’d be willing to bet I’m not the only one who’s experienced this kind of alarmingly fractured care when it comes to mood symptoms.
In theory, one’s GP should be able to weave together all the information from the various specialists. But GPs are busy, and getting an appointment in a pinch is difficult. And they may be uncomfortable overruling specialists.
I’d be curious to hear if other people have had similar experiences where doctors, or perhaps a doctor prescribing meds and a therapist providing therapy, seemed too cautious about stepping on each other’s toes.
I know one of the young women I profiled in my book, Dosed, has blogged about this topic. Hers was a considerably more life or death situation, but her frustration was similar.
Please feel free to share your experiences – or just to weigh in about whether you think split care is likely to leave patients in the lurch when they’re looking for firm answers about medication.