What it was like to see a psychiatrist

Part of an ongoing series about life with complex post-traumatic stress disorder

I was brought up to believe that psychiatrists were crazy people obsessed with brains, who needed to study them to find out what was wrong with themselves. They were really villainized in my household, probably because my parents kept getting referred to them and were afraid of what they’d be told (oh dysfunctional home lives…but enough about that!)

So, I was pretty freaked out when while recovering from a concussion, I was finally referred to go see a psychiatrist. I thought that they might try to give me medicine that would make me not feel like myself. But, I knew that I was having a lot of trouble focusing, and was struggling with depression and anxiety along with my PTSD/CPTSD, which is not uncommon after head injuries. So, I talked to a few friends who I knew took antidepressants to see what their experiences had been like. They emphatically recommended working with a psychiatrist, and so I went.

First, I had to see who was in network. I also got a referral from the clinic that had suggested it could be helpful to see one, which is necessary in the US if you have an HMO plan (I have PPO, in which they are only sometimes required). Psychiatrists have to go through many years of medical school and are even more expensive than other doctors, so in network care is important (in network = someone your insurance plan is contracted with). Not everyone wants to go through that much extra training, so there are not enough of them in the US. This means there can be very long wait times, so I expected to call 10–20 people to get in within a month (if you’ve even remotely thinking of going, book right away, then take a while to think about it). I called my insurance and looked online to get a list of everyone in network in the area, then found some that looked like specialized roughly in what I was looking for within a reasonable distance of where I live. I also kept my referral at the hospital system my PCP was in, in case I wanted a second opinion. It’d be expensive to do one appt out of network, but it would only be for a consultation.

I left messages explaining I was being referred by the local concussion clinic, and a brief overview of symptoms, and then one of the doctors gave me a call back. She asked me several questions for about twenty minutes, and I learned more about her practice. We decided right away that in my case, due to family history, it would be very useful to get some genetic testing done prior to prescribing anything. I made an appointment to have a cheek swab test completed, then came back in a week for interpretation.

I also completed an intake call with the hospital’s system in parallel in which a social worker asked me questions for about 45 minutes about my symptoms, family history, and any prior diagnoses.

So, appointment time rolled around. My new psychiatrist sent me six or seven online forms to fill out, including multiple questionnaires about my attention, emotions, health history, and family history. I worked on them in advance in an online portal. She was friendly in person, and wore dressy casual clothes, not a white coat. Her office was small and warm with couches, fashionable throw pillows, in a nearby small town. It didn’t say what type of doctor she was on the door, so it felt discreet. Right away, I was clear with her that I’d never taken any form of psychiatric medication before, and that I didn’t really understand how the process worked.

We reviewed the results of the genetic report, and talked about the implications (in terms of potential responsiveness and also metabolism) of various medication options that can assist with anxiety, flashbacks, depression, and PTSD. She explained that most medications affect one or two of the three main neurotransmitters, dopamine, serotonin, and norepinephrine, and discussed which might be most effective in my case. We narrowed down the options to a few, ran out of time, and then I came back the next week. By then, she’d had a chance to read the multitude intake forms I’d completed. She asked for updates on symptoms, then introduced two medications that she thought may be helpful for me (I’ll write a second article about my experiences with them after I’ve been on each for a long period of time). We talked about why those medications might be helpful, how to take each of them, what side effects to watch out for, and how to contact her with any questions. She also provided a book on DBT (dialectical behavioral therapy), ensured I was in regular therapy, and suggested I in particular work with my counselor on certain skills.

Two weeks later, I came back. She’d had to do some insurance reviews, and I had experienced some side effects, which is common when beginning new mood medications., so we’d been in contact over email in interim. We had a shorter, twenty minute appointment where she updated my instructions for one of the medications, and agreed to follow up on the other in three weeks. In the meantime, I had to try increasing the dose of the first one.

A few weeks later, I went to see the hospital system doc for a second opinion. This doctor was jovial with a small white beard, and seemed like someone you’d expect to find at an opera party. He wore a green wool sweater and dark slacks. He was an expert on depression and bipolar disorder, both of which run in my family, and it was fascinating to hear his advice. He listened to me and asked me questions for a full 60–90min, told me the medicines the first doc prescribed were very clever as a fit for my hereditary and symptom profile, and recommended a few other courses of action that she had not thought of (including getting an MRI in case of future head injury, and some future medication options to protect my brain). It was reassuring in my case to see someone who could also see my full chart in the hospital system, and provided more information related to head injury. I was nervous about getting a second opinion, but really believe that especially with psychiatry, it is never a bad idea. Any doctor who is secure in themselves and wants the best for you, will not mind doing a secondary consult.

So, was it what I expected? No, definitely not! And even better, the medicines I started taking have not changed my personality. They helped me focus, calm down, not get so stuck in flashbacks, and helped me be a clearer in my concussion recovery. I was so terrified to try them, but I think that I probably should have been in a psychiatrist’s office ten years ago. If you experience anxiety, depression, or PTSD, there are many levers you can pull to improve your quality of life — dietary changes, exercise, trauma sensitive yoga, support animals, medication — but please don’t discount medicine or at least a consult with a psychiatrist. Psychiatry turned out to be one of the safe spaces I’ve found where I am treated like the symptoms I have aren’t me being weird or deficient, but results of real changes in the structure of my brain — the way my receptors process different neurotransmitters, and the regulation of my nervous and limbic systems. And, guess what? There are real medicines that can help my mind out when something is a little off.

I think that visiting the psychiatrist helped me realize for the first time that my brain is a part of my body, and it deserves visits to the doctor like any other body part. I’m glad I went, and hope you feel less afraid to go to the psychiatrist whenever you need it, too.