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[Truean]

So I got really depressed and finally started seeing a doctor for it in Jan or Feb of this year. I'm fine with her being an M.D. and not a psychiatrist or whatever.

I told her right off the bat that I was in an odd situation at the moment financially and didn't have insurance. She agreed to make the visits $75 cash each time for about a 45 minute to 1 hour visit.

She prescribed celexa (cito phram... however you spell it), adjusted the dosage up accordingly over time etc. The whole time, I've been an incredibly appreciative patient, paid up front in full, said thank you excessively, etc. She says she likes talking to me etc. Plus the meds are like $4 a month generic, that's workable.

So far, I feel way better on the medication than I did off it. It's not 100% but I'll take it. She seemed to like the idea of adding a new medication on top of what I was already on called Welbutrin. (however you spell that). Only problem is that stuff is EXPENSIVE, even in the generic form, it's almost $100/month. I can't afford that and I told the pharmacist that straight out.

I informed my doctor that I couldn't afford the new meds and asked if I could just keep on the old meds without the addition. In a perfect world, I would do both, but unfortunately I can't make that happen. For some reason, I keep getting told by her staff that I should see a psychiatrist. The latest phone message from them is that I can keep seeing my doctor and staying on the meds FOR NOW, but that I should make an appointment with "my psychiatrist" as soon as possible....

Is it just me or am I being nudged towards the door?
I don't have a psychiatrist and I can't afford one.   
I just want to keep seeing my doctor the way things are. No, it's not perfect, but it's wayyyy better than it was before.

Am I overreacting to this? What the heck is going on here? I don't like the staff telling me "FOR NOW" and that "You need to make an appointment with your psychiatrist as soon as possible." I don't get why they are saying this, knowing I can't afford one. I really don't see how I'm any kind of a problem patient. With one exception (because I couldn't afford the meds) I do everything the doctor tells me and I am very grateful for everybody there helping me.

A.) My doctor knows it's incredibly difficult to get any kind of mental help on a budget and has told me so. She knows county services are overburdened and have a several month long wait list.
B.) My doctor knew of my limited financial means beforehand.

What the heck is this?

[LordBucket]

What the heck is this?

Dififcult to say what she's thinking. We're not hearing her side of the story. But if you wish to self medicate, that's easy to do. Citalopram is a serotonin reuptake inhibitor. If the problem is simply that your brain is reabsorbing serotonin too efficiently, thus making it unavailable to mood-altering effect, there are plenty of solutions that don't involve drugs.

Try eating more turkey and dark chocolate. Stop eating simple carbohydrates like soda, white bread and sugar. Get more sunlight and excercise.

http://www.wikihow.com/Boost-Serotonin

[Truean]

I dunno. I talked to one friend of mine whose father is an MD. She says it's because doctors are given about 2 weeks of rotation in psycho-pharmacology and aren't trained for the drugs above the standard SSRI and perhaps MAOIs.

I don't know how much truth there is in her statement [shrugs].  Any docs / med students here who might back this up at all?

[Vector]

.

[BFEL]

If all else fails you can always just ask her whats up on your next visit. You'd be surprised how often being blunt can get answers from people.

[Thief^]

Welcome to

I don't have a psychiatrist and I can't afford one.   

Welcome to America.

As to the real problem? I agree with Vector. It's probably just that she's not got the training to cure you, and is doing the responsible thing of recommending you speak to someone who does. The (cheap) meds you are currently on are clearly an improvement, but not a cure (a cure would ramp down over time, not up). Get on the waiting list for any public help you can get, even if it's woefully under-provided in the US. The sooner you're on the waiting list the sooner you're off of it!

And good luck

[ChairmanPoo]

As others have said, I think that, rather than being shown the door, she feels that your problem is going beyond a generalist's level and into the specialists territory, so she's recommending you because personal responsability.

[Truean]

Yeah I believe chairman may well be correct. The issue being that while I can't afford a new specialist, the current treatment is better than nothing. I am right between rock and hard place.... Hum, thank you for the insight. I'm glad it's not really me that's the problem.

[martinuzz]

While an MD will be perfectly okay with prescribing you certain well-established psycho-active drugs, as a short term fix, the doctor in this case is absolutely right in sending you to a psychiatrist, if only because long term treatment of mental discomfort / prolonged perscription of anti-depressants is not her field of science. Not sure how it is in your country, but here, and MD did 4 years of medical university + 2 years internship / post-doctorate, while a psychiatrist did 4 years of medical university, plus 4 years of psychology, plus 2 years of internship / post-doctorate. Not to be confused with a psychologist, which is someone who only studied psychology, and no medical science.

[Jimmy]

Yep, it's exactly as others here have said.

A general practitioner will follow a treatment protocol for managing your condition. This protocol is developed by the accepted leaders for treatment in a certain field of medicine and describes the accepted standard for managing any given medical condition on a purely routine level. By following this protocol, the GP is accepted to have followed the best practice standard and is therefore protected against lawsuits for malpractice if something goes wrong.

These protocols will generally be divided into stages such as differential diagnosis to determine the condition and treatment guidelines for both prescription and non-drug treatments. Essentially it's a one size fits all approach that doesn't rely too much on individual factors but leaves a fair bit of wiggle room for the doctor to tailor the treatment to your needs as well.

What these protocols will also include is the referral point to a qualified specialist for further examination. While you may feel good on the current treatment and feel no need to take further action, best practise will often dictate that a specialist is required to review the treatment at certain intervals (such as soon after diagnosis or medication changes and every 6 to 12 months for stable patients) usually to defer responsibility for legal liability if complications occur. Simply put, a GP isn't trained to check every aspect of your condition, whereas a specialist has the skills to look at the whole spectrum of treatment options.

The same thing would happen if you were diagnosed with a heart problem. Your GP would look at your results, consult the treatment guidelines, outline lifestyle changes such as diet and exercise, put you on heart medication and refer you to a cardiologist for further examination. If you had diabetes, you'd get the same but with diabetes medications and a referral to an endocrinologist. If it was an eye disorder, eye drops and referral to an ophthalmologist. Referral to a psychiatrist is a routine part of your treatment, and also important to make sure you're getting the best treatment possible.

Of course you as the patient have the final say in your treatment. Open and frank discussion with your doctor about your expectations and the limitations you have on your ability to pay for any referrals can help to avoid misunderstanding.

Source: I am a registered Pharmacist.