Shrink-Shopping? Here are some ideas to consider.

By Dr GaryCA Latest Activity January 22, 2011 at 8:51 pm Views 5,423 Replies 20 Likes 7

Dr GaryTherapist

It seems that I am always running into friends on Depression Connect who are making decisions about what type of treatment they should be seeking and what kind of mental health professional they should be working with.

As I always say, when the going gets tough, the tough go shopping. Shrink shopping, that is.

First, you may want to consider both medication and psychotherapy. Generally, these are delivered by two different professionals.

Some patients take an anti-depressant and also work with a therapist. Others work only with a therapist.

You might want to begin with talk therapy, and see if your therapist recommends that you also consider medication. If you have health insurance, you would probably want to begin by calling your insurance provider and asking for a behavioral health referral. Some companies have a Website that you can go to and look at the names and descriptions of therapists in their plan, or you may need to call and get a few names. These individuals may be trained in counseling, social work, or clinical psychology.

From here, I would recommend calling the therapists they recommend, or the names you find on the insurance company behavioral health website, and asking to make an initial appointment. You might get a feel for the therapist on the phone, but it’s a good idea to make an appointment and meet together.

If you know anyone who is in therapy, you might also ask for a recommendation. You can then check with that person, or with your insurance provider, to see if that person is in your plan. Of course, if money is no object, so much the better.

Also, here is a link to a directory of therapists:

http://therapists.psychologytoday.com/rms/

If you don't have insurance, your community mental health department or department of social services will also have low or no cost treatment available, though you will have fewer options as to whom you see and there may be some wait time before you can get in. Don't give up.
I know this sounds a little complicated, but the starting place, for better or worse, is what you can afford, and the coverage that you have (or don't) have.

Chemistry is unpredictable. Get a feel for how the therapist works, if you feel comfortable talking with them, if they seem to be listening to you, if they have a personal style that meshes with yours, what kinds of goals they usually recommend for a patient with issues similar to yours, how they would envision you working together going forward, and how available they are in terms of scheduling flexibility.

If you go the medication route, you would work with a physician, that is, an MD. Your regular doctor may be able to prescribe an anti-depressant if you are not already being prescribed one. Ideally, working with a psychiatrist, or a psychopharmacologist, a professional who specializes in prescribing drugs for psychological issues, is recommended. But patients have success with either route, and insurance companies sometimes encourage patients to at least first talk to their regular doctor, or even insist upon it. Your insurance company/behavioral health provider may also recommend a nurse practitioner who is also qualified to prescribe medications.

Again, your therapist might recommend that you consider medication. If you do decide to go this route, or if you need to, I would still recommend working with a therapist to help you with day to day coping strategies going forward, in tandem with your medication.

Support groups can also be helpful. The Website, www.nami.org, lists many support groups all over the US. Local hospitals or community mental health departments, may also sponsor support groups for individuals experiencing depression. Supports are a great way to share experiences as receive emotional support.

A few words of caution: If you are feeling really overwhelmed by your depression, to the point that you are having difficulty functioning in any way, then I would recommend getting medical attention immediately, through your regular doctor or through your behavioral health provider's recommendation. Don't wait.

Also, keep in mind that if you see a therapist, you will be evaluated for depression during your initial session, and medication may be recommended at that point as well.

Depression is treatable! Don’t go through it alone!

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Replies (20 replies)

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  • MJDallas
    MJDallas August 23, 2015 at 12:30 pm   

    I am on several medications (Lithium, Trazodone, Seroquel, Venlafaxine, Atorvastatin, Levothyroxine, Metformin, Fenofibrate). I went online earlier and printed off several support group meetings and I intend to start attending some (MHA, NAMI, DBSA). I don't understand why/how my depression gets so bad when I'm taking several meds. I haven't been to church in about a year because of anxiety. I think I told you I've been diagnosed with Bipolar I, severe MDD and anxiety. Thank you so much for the web site. I'll look it up today. I know therapy would help me.

  • Dr GaryCA August 27, 2015 at 6:13 pm   

    HI MJ< so glad to hear this was helpful. I am happy to hear you are going to find a therapist. Excellent! Thanks for letting me know.

  • MJDallas
    MJDallas August 27, 2015 at 8:40 pm   

    MJDallas 8:38 pm 0 Likes
    I like this Report as inappropriate my doc is leaving the clinic. now I have no one to prescribe and refill for me. they won't let me move to another dr. at the clinic, says they're going to close the clinic. I told the girl that I don't appreciate being stuck in the lurch!!! They didn't even recommend someone else. I am panicking. Have been on phone and computer all day. Most are too expensive, one has no appts. open until Dec 9. My anxiety is through the roof. Why do they make it so difficult for mental health patients. I'm going to bed and start searching again tomorrow.

  • Dr GaryCA September 4, 2015 at 8:48 pm   

    MJ, I am so sorry to hear this. Just so sad that they didn't make a better referral for you. I am hoping you can get connected with someone soon.

  • plb1257
    plb1257 January 30, 2011 at 5:27 pm   

    I went to a grief counselor 11 years ago because I was so depressed when my mom passed away (plus, I have issues with my dad). I was so depressed that I was referred to a psychiatrist who started me on medication (Paxil) and I had so many side effects that he has just piled on one thing after another. I think that it is worse than dealing with the depression. However, he now has me addicted to so many things that I can't get off of them (I am on Effexor, Geodon, Lamictal & Ambien. I was on Klonipin also but I overdosed on it on Jan. 13th and was put in the Acute Ward of the psychiatric hospital. He tried to taper me off of the Effexor and switch me to Cymbalta but the nightmares were so, so horrible you can't even imagine so I am back on it. I googled Effexor withdrawal last night and there were so many hits it made me just sick. So many of these meds have led people to commit suicide — it is just terrible. Not in my lifetime, but sometime in the future, they will look back at this as we do looking back at the use of patent medicines and putting cocaine in the coca-cola. I think I am going to look for another doctor. I am so discouraged and I want my life back…

  • Dr GaryCA January 30, 2011 at 10:28 pm   

    Hi, sounds like you have really been through a lot with medications. Each person has their own unque biochemical make-up, and this can present a lot of challenges to doctors and patients. I can understand why you would feel discouraged. But I would encourage you to stay connected with a psychatrist, whether or not you decide to move to another practitioner, be honest about how you are feeling, share what you are learning, and ask questions. There are a lot of medications, and combinations of medications, available. I hope you find the best regimen soon!

  • DeaneRenata
    DeaneRenata January 10, 2013 at 10:27 am   
    Edited January 10, 2013 at 10:34 am by DeaneRenata

    Are you saying that because of our genetic makeup not all medications will work for us, we have to find out which ones that do? My doctor put me on a hormone pill that did stop my cramps and premenstrual syndrome (I'm a girl), but at the same time it made me feel very not-like-myself on the inside, and for that reason I wanted to stop taking it. I remember wanting to feel normal, but it was almost like my medications were changing me. Someone told me that medications can change people, and for that reason he does not believe in taking any at all, whatsoever. Is he right? Do medications (like hormone pills), change people?

  • DeaneRenata
    DeaneRenata January 10, 2013 at 10:32 am   
    Edited January 10, 2013 at 10:33 am by DeaneRenata

    Back then my cramps were very, very bad and I would complain to my mother about them which was how, through my doctor, I learned about this hormone pill and they prescribed it to me and I started taking it, but then I ran across some man who told me he did not believe in taking pills at all because he told me that medications can change people. I don't know if that is true, is that true?

  • DeaneRenata
    DeaneRenata January 10, 2013 at 10:34 am   
    Edited January 10, 2013 at 10:34 am by DeaneRenata

    So if I don't take the medications that my doctors prescribed for me then what do I take? Herbs? Homeopathy? Naturopathy? Something else other than traditional medicine?

  • DeaneRenata
    DeaneRenata January 10, 2013 at 10:36 am   
    Edited January 10, 2013 at 10:37 am by DeaneRenata

    What I was saying is that the man I met was trying to make it sound like medications were more the problem than the solution, and that people sometimes died from them.

  • alfie123
    alfie123 January 22, 2011 at 9:38 pm   

    I have seen numerous therapist through out my life and have had mostly bad experiences. One of my therapists used to fall asleep during my appointments!! Another cut my appointments short but still charged me the full price. I am very weary of finding a new therapist. How can I get over this?

  • alfie123
    alfie123 January 22, 2011 at 9:43 pm   

    I also can't find a therapist close to my town on the website you suggested :(

  • MJDallas
    MJDallas September 5, 2015 at 9:37 am   

    alfie123 - that's the cutest dog!

  • Dr GaryCA January 23, 2011 at 7:20 pm   

    I am sorry to hear that you have had such bad experences with therapists. Like other professions, there are really good therapists and there are those who are not so great, at best. We have high expectations for people who hang out shingles and say that they can help other people, but the reality can be very different. But is a trial and error process, just like other professional relationships. I would encourage you try to keep an open mind, even though you have been disappointed, and give it another try. You might want to begin the conversation with your hopes as well as your expectations — e.g. stay awake and be ethical — and take it from there.

    You might want to do an Internet on counselors or therapists in your home town and see what comes up.

    I hope you have a better experience next time around. Keep me posted, please!

  • tSquare
    tSquare January 22, 2011 at 9:38 pm   
    Edited January 23, 2011 at 5:16 pm by tSquare

    Scrinkle.. squeek.. scrunkle…scrunch… Oh… my bad.. At first glance I read 'shrink wrapping' dang… got all enthused about a new treatment. GRIN !!! Sorry, couldn't resist, Dr. G.

    Great 'how to' write-up on finding and starting on a treatment process. The one thing I might like to add to your list is that these days, at least in some areas, getting in to see a new therapist or doctor is often a long wait, or not possible on your first choices. So I would reccomend listing a few practitioners from people's searches and inquiries (besides that of going to their own current Gen. physician). For a lot of doctors, and therapists are full up, have waiting lists even.

    Here is the digital Kleenex, Dr. G,
    Prrrrrr =^,,^=

  • Dr GaryCA January 23, 2011 at 7:25 pm   

    Hi tSquare,

    Achooo! There, that's better.

    You are very funny. I could go on to make another pun about shirnk rap.

    You are right about the waiting list. Patients/clients come and go, but if everybody is coming and staying, at least temporarily, then it can be difficult to find someone to work with at first. And if you are using managed care, you may discover that some therapists take only a limited number of managed care clients. So it can take some time. As you said, it's a good idea to come up with a list and then start going through it.

    Thanks for checking in. Great to run into you, as always.

    Gary

  • Juliana Morrow
    Juliana Morrow January 22, 2011 at 9:15 pm   

    Love the title, can borrow it? :-)

  • Dr GaryCA January 22, 2011 at 9:18 pm   

    It's all yours!!! Sharing is caring!

  • MJDallas
    MJDallas August 27, 2015 at 6:32 pm   

    haven't found a therapist who doesn't want every red cent I have. I am searching many resources. living on Clonazepam

  • MJDallas
    MJDallas August 27, 2015 at 8:38 pm   

    my doc is leaving the clinic. now I have no one to prescribe and refill for me. they won't let me move to another dr. at the clinic, says they're going to close the clinic. I told the girl that I don't appreciate being stuck in the lurch!!! They didn't even recommend someone else. I am panicking. Have been on phone and computer all day. Most are too expensive, one has no appts. open until Dec 9. My anxiety is through the roof. Why do they make it so difficult for mental health patients. I'm going to bed and start searching again tomorrow.

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