The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
-
Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
-
Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
-
Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
-
Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
No email address required.
Notes -
How does one go about finding a "Dr. House" kind of specialist for very treatment-resistant conditions? Specifically, a psychiatrist. Money is no object.
I'm having a four-month-long episode of severe anxiety and panic as a result of getting off of an SSRI I had been on for 25 years. I was totally fine before getting off of it. Getting back on the medication has not gotten me back to my prior normal. My psychiatrist has tried many different adjunctive medications and either nothing resolves it or I get intolerable side effects. My psychiatrist today described my prognosis as, quote, "poor", on account of repeated medication failures.
My ideal vision is a team of multiple experienced psychiatrists, ideally who specialize in anxiety, who can spend a few hours reading about my case and consulting with each other about what might be going on and what might help. I just have no idea how to find such a thing. I'd also be happy to see a single psychiatrist if only I had some way of knowing whether they're especially brilliant or perhaps specialized.
Any advice - even wild speculation - about how to find the care I need would be appreciated. I'm pretty desperate.
Look up medical concierge services, find out who’s best if money is no concern. You pay them, they find the specialists.
More options
Context Copy link
I mean, you could always go to Scott? (Or put yourself on his waiting list)
More options
Context Copy link
Dr. House doesn't really exist, the equivalent in real life is something like a specialty tumor board at a premier research institution, which is a group of knowledgeable specialists "discussing" the specific approach to a known problem (and rarely trying to figure out what the problem is or arguing over what it is).
Your situation is different in that you know what the problem is, and it's a basic diagnosis, but you can't seem to get it treated. It's not unreasonable to be like "okay what's up we need more options, more heroic measures."
However, my suspicion is that you need to go back to basics.
Basically - you need therapy. Medication may not help in the way you want it to help.
This doesn't mean you should give up on medications, you can always try more/different SSRIs etc. to find something that hits for you, but at a basic level you have to keep in mind that some things are more responsive to medication than others and this includes in psychiatry.
The classic example non-psychiatric example is insomnia (well some consider this psych). We have meds. We have a lot of meds. We have really expensive meds. We have really dangerous meds you should never use but people demand anyway and have really bad outcomes. What works for insomnia? Behavioral modification and therapy. Works (maybe an exaggeration, maybe not, I'd have to review the data) orders of magnitude better than meds.
In psych - for people with certain types of depression (terminal cancer? live in an active war zone and your family all got blown up?) medications aren't going to work for a lot of people. Therapy is generally going to do more.
Back to anxiety.
Anxiety often requires higher doses of medications (sometimes to the point where the side effects outweigh the value), but best practice is essentially to have medications lighten the load enough for therapy to be useful and helpful.
You don't need a genius psychiatrist, you need an excellent therapist (can be a psychiatrist), which is not the same thing and is something you can absolutely pay for if you wish in most metro areas (and a cheap, serviceable therapist may do). It is possible that a slightly more clever psychiatrist would throw something on that would solve the problem but that should be a secondary goal.
Now I don't know what your relationship with therapy is but you might be skeptical about it and might be asking why that would suddenly be a thing you would need now later in life after medication worked for so long. Additionally, if you are posting here you are probably intelligent, high resource, and rational - and thinking because of all that therapy shouldn't be needed. Unfortunately that's not how this work.
For example: a lot of anxiety related behaviors and experiences are basically just good old Pavlov fucking with your nervous system. Don't matter if you are mucho smart, if the bell goes off you'll salivate.
I wonder if a process like that happened here - you went off the med and expected something to happen or something happened, you felt like the safety net was gone, you had experiences, they rapidly reinforced themselves now you are in an anxiety spiral..... one you'll be able to get out of with time and space maybe, but faster and more effectively with some skills training, CBT, whatever - all with medication as a supportive factor. The meds are often a crutch, and therapy skills can be more definitive treatment (one of the reasons why you may want to avoid meds for anxiety).
Keep in mind that other conditions often work very differently.
It may also be reasonable to see your PCP to rule out any medical problems (not that they are likely) and assuage any health anxiety.
More options
Context Copy link
I'm not sure how to get a group of specialists, but as a backup, go on Reddit or Twitter some other forum and post a bounty for whomever gives you the best advice.
More options
Context Copy link
More options
Context Copy link