I am a psychologist. I am a doctor but not a medical doctor and I provide psychotherapy, not medication. Still, I refer many patients with depression to MD psychiatrists to provide medication to help with depression. Modern anti-depressants can truly be life saving medications. While many (mistakenly, I believe) get prescriptions from their family doctor, a well trained and caring psychiatrist can ensure that you are getting the most possible benefit from your medication.

Unfortunately many patients do not make the most of their time with their psychiatrist and they are only hurting themselves. Here are some tips to make sure your psychiatrist is doing the best they can possibly do for you.

GET AN OUT OF NETWORK PSYCHIATRIST IF POSSIBLE

1) If at all possible, seek an MD who does NOT take your insurance. While this won’t be feasible for most people, the extra expense is often well worth it. While the upfront costs are high, the long term benefits can be enormous. The reason for this is that there is a national shortage of psychiatrists.  When there is more demand than supply, the provider of the service can take advantage and earn a better living with fewer hassles by opting out of insurance panels. To make up the difference, psychiatrists who remain in network must see more patients to make the same amount of money and often are more stressed and less able to devote the time and attention an optimum outcome requires.  This is not to say that there are not many fine psychiatrists who stay on insurance provider panels, but they can be harder to find

If you must see an in network insurance psychiatrist it becomes even more important to make the best use of what is usually a more limited amount of time to talk with your doctor about your symptoms and your progress.

NOT A TIME FOR SOCIALIZING

2) THIS IS NOT A SOCIAL VISIT.  You or your insurance company is paying a large amount of money for you to consult with a highly trained professional about your unique circumstances. Pleasant greetings are appropriate but you do not have to ask about your doctor’s day, his or her family or their most recent vacation.  Professionals are human. If they can get paid to chit chat as opposed to working, it can be easy to fall in to that opportunity. They also don’t want to be rude by cutting you off and saying, “but tell me if you are still crying constantly” in answer to your asking, “how is your day going.” Skip anything beyond brief greetings.

3) You are seeing a psychiatrist to help them find the right medicine in the right dose for your symptoms so familiarize yourself and concentrate on your symptoms and how they have changed (or not) since your last appointment.  BE PRECISE DESCRIBING SYMPTOMS.  When your doctor asks how are you sleeping, the correct answer is not, “pretty well”.  What’s the pattern; any trouble falling asleep, staying asleep, or waking up too early?  How many hours have you been sleeping. Keep a chart if possible. Patients tend to just remember the last couple days and an overall pattern is what is most important.

BE AWARE OF AND REMEMBER HOW YOU WERE THINKING

4) PAY ATTENTION TO YOUR THOUGHTS When you suffer from depression you tend to ruminate on the unhappy things in your life. Notice if this is improving. Do you begin dwelling on problems as soon as you are not busy doing something else? Are you able to distract yourself when you do begin to brood. Are you beginning to feel any optimism about resolving your troubles, does the future look any brighter.

ARE YOU PLAGUED WITH GUILT AND SELF-DOUBT?

5) HOW GUILTY ARE YOU? Is your self esteem still in the toilet?Are you beating yourself up for the things you do wrong? Are you doing this any less than you were at the previous visit.

REPORT EVEN FLEETING SUICIDAL THOUGHTS OR CHRONIC HOPELESSNESS

6) SUICIDAL THOUGHTS. Many people with depression would never seriously think of killing themselves. Far more common is the sense that life is a struggle, not worth living or feeling like you wouldn’t really care if you were dead even if you would not do something to bring it on. If you felt that way at the start of your treatment, are those feelings lessening or coming back if they were absent? This is critically important to discuss with your doctor.

DOES EVERYONE GET ON YOUR NERVES?

7) IRRITABILITY  Notice and report if you are becoming more or less irritable. Is your spouse or your boss driving you crazy. How is your road rage doing. Do you still yell back at the news on TV. Does everything get on your nerves? Let your doctor know if this symptom is improving.

WHAT TYPE OF FOLLOW UP DOES YOUR DOCTOR PREFER

8) FOLLOW UP Discuss with your doctor how and when you should communicate. Every office is different. Does your doctor accept emails? Does she prefer phone calls and messages through the receptionist? What about sending a fax with a question or concern. When is contact urgent? What side effects warrant a phone call or an urgent visit.

Finally, always remember that your doctor works for you. You have hired them to help you live your life better. Don’t hesitate to call in an emergency for fear of disturbing your doctor on a weekend or night. That’s what they signed up for by being a psychiatrist. Discuss in appointment what constitutes an emergency. If you don’t feel your doctor is a good fit for you, don’t worry about hurting their feelings if you go somewhere else. You’re in charge of this relationship! The goal is to relieve depression. You are most likely to achieve that if you take the most advantage of your meetings with your psychiatrist.