Finding a better therapist or psychiatrist?

[DyingToDie123]

I have very treatment-resistant depression. Currently I have a therapist and a psychiatric NP, and neither has been particularly helpful for me, though I've only been with the therapist for a couple of months (I enjoy talking with her but she talks a lot and also spends a lot of time bombarding me with a lot of positive affirmations that don't really resonate) and I haven't made many major med changes with the NP so it's hard to say whether she's good or not. But overall things just aren't getting better, and I'm not sure if I should give either/both a chance or if I should try looking for others (esp because therapist isn't covered by insurance, ugh). Or if I should just quit therapy/psychiatry.

I've had a couple really good therapists but this one just doesn't seem great, but she seems okay, and I don't know how to find great, so I'm kinda tempted to just settle. As far as psychiatrists, my last one seemed good but she left the practice to do inpatient, which is why I found this new one. But it's always hard to tell who's actually good at psychiatry and who's just lucky/unlucky.

What do y'all think? I feel like it's not worth spending the money if it's not really helping. But I feel some obligation to at least try these things.

 

[zeecen]

Have you voiced your concerns with both of them directly? Like when your therapist does the bombardment, does she know that it's unhelpful or does she feel like she's helping? If she feels like she's helping I'd let her know what you feel would be helpful (stopping the bombardment, remaining objective, etc). If things do not improve after informing her as clearly as possible on what works for you then I would quit.

With your psychiatrist, are you hoping for med changes? Do you feel your meds are helpful? If they're not sufficiently helpful then I would talk directly with your prescriber about it. They work for you, if you feel there needs to be a change then you must advocate for yourself. I wouldn't just drop the psychiatrist because med withdrawals can be dangerous. If / when you feel you are ready to drop or switch them, you must work with the psych to taper off.

Most ppl don't graduate at the top of their class. Same rule applies for healthcare professionals. Some just aren't worth the money.

I have treatment resistant depression as well due to the way my body metabolizes medication. It is definitely possible to achieve some form of relief, but only with the guidance of a helpful team.

Hospitals may be able to provide resources on prescribers and therapists as well. There may be a team out there that works for you. Also, have you researched esketamine treatments? You may be able to self-pay for that instead. I looked into it as a possible treatment option for me and it seems to be successful with people.

 

[Pg.964]

Hi, I'm the same boat as you. I've had my psychiatrist and therapist (she's a licensed social worker not a psychologist) for 2 years now and I've got treatment resistant depression amongst other things. Unfortunately most times you do have to "shop around" for the right medical professionals, I've had other in the past whose approach and advice were wildly different (some are very unempathetic and strictly by the books). If your therapist is really nice but they're not giving feedback or starting specific therapies with you to try and alleviate your depression, I'd say it's worth a switch, especially if you're the one paying. And like the person above stated, ketamine may help, it didn't help me much and it's not permanent but that doesn't mean it can't help you! (Very expensive though) I'd recommend the intravenous method with an IV instead of the nasal spray or oral ketamine. TMS is also an option but if you don't have insurance it's also very pricey.
In my opinion, therapists should be positive but not overly so, they should understand the gravity of your situation, and should acknowledge and validate your experience as I know how hellish having this condition is. But they have to problem solve and teach you the skills to cope. Some therapies feel really stupid and pointless tbh but you gotta try everything even if won't work. I'm doing EMDR and I plan on doing dialectical behavioral therapy once my TMS is done. I wish you the very best on your recovery friend. Feel free to ask anymore questions

 

[DyingToDie123]

Have you voiced your concerns with both of them directly? Like when your therapist does the bombardment, does she know that it's unhelpful or does she feel like she's helping? If she feels like she's helping I'd let her know what you feel would be helpful (stopping the bombardment, remaining objective, etc). If things do not improve after informing her as clearly as possible on what works for you then I would quit.

Good point, I should, but I suck at advocating for myself with these things. But I'll try.

Also, have you researched esketamine treatments? You may be able to self-pay for that instead. I looked into it as a possible treatment option for me and it seems to be successful with people.

I did ketamine infusions in 2022, didn't work for me unfortunately.

 

[Argo]

What do y'all think? I feel like it's not worth spending the money if it's not really helping. But I feel some obligation to at least try these things.

I found a good one on my first try on psychologytoday's website, but I consider that very lucky. I would shop around there while keeping in mind that it is generally difficult to find a good therapist or one that matches you(even a "bad therapist" that happens to strongly mesh with you in a 1on1 dynamic, is going to be useful). I've lost my persistent desire to die at the moment but I believe talking to someone who fits well for you is helpful even in the case of planning to die-- it makes every possible outcome better as long as it's not like... a total disaster. So... just know advance that's a risk and be okay with it and walk away sooner than later if you think things are not a good fit. It helps to imagine what sort of person you'd want to talk to, that could help you. Create some mental concept of them, consider their areas of expertise etc. The more you know what you're looking for, the better your odds will be.

 

[DeadButDreaming]

What medications have you tried? I tried a few famous medications, which did nothing for me. Then I tried Venlafaxine. Initially that didn't do anything either. I saw a vast improvement after increasing the dose from 300 mg to 450 mg. Nevertheless, my OCD persisted and was severe at times. Eventually mirtazapine was added to the venlafaxine. This combination is known colloquially as 'California rocket fuel' by psychiatrists. I eventually learned I had coeliac disease too. Abstaining from gluten containing foods goes a long way in the fight against depression, anxiety, and OCD, in my case anyway.

If the medications aren't helping and your psychiatrist isn't making changes perhaps your need a new psychiatrist. It's important to give a new dose/medication a chance, however. Maybe you should ask your psych why he/she isn't trying new things.

I've never gotten much out of therapy. Perhaps others do though.

 

[DyingToDie123]

What medications have you tried? I tried a few famous medications, which did nothing for me. Then I tried Venlafaxine. Initially that didn't do anything either. I saw a vast improvement after increasing the dose from 300 mg to 450 mg. Nevertheless, my OCD persisted and was severe at times. Eventually mirtazapine was added to the venlafaxine. This combination is known colloquially as 'California rocket fuel' by psychiatrists. I eventually learned I had coeliac disease too. Abstaining from gluten containing foods goes a long way in the fight against depression, anxiety, and OCD, in my case anyway.

If the medications aren't helping and your psychiatrist isn't making changes perhaps your need a new psychiatrist. It's important to give a new dose/medication a chance, however. Maybe you should ask your psych why he/she isn't trying new things.

I've never gotten much out of therapy. Perhaps others do though.

Thanks! I've tried Celexa, Lexapro, Wellbutrin, Lithium, Cymbalta, Prozac, Abilify... I think that's it?

The thing is, I guess they do something (specifically the Cymbalta/Abilify combo), but mostly they just make me feel numb and I don't really like that. I'm not sure if all depression medications will do that for me. I have a hard time imagining a medication that's going to fix things for me, but maybe that's just me being pessimistic.

 

[StillBreathing]

I have been through a few "bad therapists". I don't think they are actually bad but it was just a horrible match. I kind of lucked out with my current one and instead of brushing off all my symptoms as depression and anxiety he has started digging to find the root cause. Major events in my childhood, teens etc that I never thought would still impact me, even tho they do. I still don't know how to solve my issues but have realized it is a process, for both me and my doctor. This is why it is so important that you have a doctor you "click" with. Mine has recently been changing the way we work during our sessions, even giving me a new psychiatrist to see if I am suffering from more than previously diagnosed.

TLDR: it's important that you and your doctor can work the problem together, finding the root cause of your problems and not just focusing on treating the overlaying symptoms. If you feel like you don't "click" with your therapist after several appointments I would say it is time to change course, either with your current or a new one.