Originally sent by email to a small group of individuals, Jessie agreed to let this be posted so “this information, which I have worked so hard to discover, over time, might … be available to the people who need it …”

I had to sit on this a while before I figured out what I could add that was helpful. I realized that for me, a psychiatrist is pretty much just someone with the right set of initials after their name. To me, it’s much more important to investigate the office setup, workflow, and resources than to pick someone with whom you have terrific rapport.

Things to consider:

• Are they covered by your insurance?
• What is the standard turnaround for medication refill requests?
• How many days a week are they in their office to take calls, and what type of availability do they have for follow-up appointments?
• Do they have any support staff? How responsive will they be to an urgent request for paperwork or records? Is there someone in the office who knows how to use a fax machine? How long will it take them to coordinate a prior authorization request with your insurance company if the new year turns over and one of your expensive, tier 4 psych meds is now not covered for a stupid reason, you only have 1 day of medication left, and the med has a terrible associated discontinuation syndrome?
• Do you expect to be receiving any controlled substances? If so, will you be required to go to the office once a month for an in-person visit to have your prescription renewed? Maybe you don’t have to see the doc, but have to pick up the Rx during regular business hours on a weekday? Maybe they will write for 3 months at a time? If you have ADHD or if you are taking benzos, these are good things to ask. Also, do they have a controlled substances policy that requires random u-tox screens?
• If you have substance abuse issues (i.e. alcoholism) will they still be willing to prescribe psych meds?
• If your provider is away, and you need an Rx NOW, is there another provider who would be willing to write for them?

And here are some tips:

• For non-controlled substances, most insurance policies will allow you to refill before your 30-day supply is used up. In the past, my insurance plans have allowed a refill on the 25th day of the prescription. If you consistently fill a little early, you can save the extras, and then you won’t be totally fucked if you forget to refill or can’t get ahold of anyone in the office and you run out of meds.
• Understand the discontinuation risks for your individual meds. Some antidepressants are worse than others (ranging from mild irritation to “brain zaps” to rapid regression to an internal state that is way worse than where you were before you started the med.) Benzodiazepine withdrawal is notoriously difficult. Psychostimulant withdrawal can cause depression and insane fatigue. It pays to know yourself, pay attention, and be careful.
• Please educate yourself about the meds. Understand where your dose falls in the range of therapeutic doses. You may require a higher dose based on weight or brain chemistry. Other meds (sometimes seemingly unrelated) may require an adjustment, up or down. It is very, very important to understand if you are taking a HIGH dose, and why.
• When you pick up your meds from the pharmacy, read the bottle before you leave: Right med? Dose? How many refills left? If there are none left, tell the pharmacy right then to submit a refill request to your doctor. If anything looks weird or you don’t understand, ask a pharmacist to explain.
• Be willing to give a med a thorough try. It usually takes more than two weeks for a med to take effect and settle into your brain in a way that feels normal. Expect to feel weird for the first couple weeks. The side effects will usually subside. If they don’t, and you feel more anxious, or can’t eat as much, or you have disturbed sleep, or feel off in any way, discuss with your doc. It’s completely possible this med is not for you. It is really worth it to keep trying others, and to not give up too soon. Psych meds are like birth control: everyone reacts differently, has their favorites, their own terrifying anecdotes that may not be applicable to you.
• I recommend being in psychotherapy when you embark on your med journey. Depending on your diagnoses and life experience, psych meds can be EXTREMELY EXISTENTIALLY DISORIENTING, and it is important to have someone to talk to about what’s going on. Supportive friends who are ok talking about these things are also awesome.
• If you decide, after some time with meds, that you now feel great and would like to stop taking them, please discuss with someone first. Just… please.
• Consider, before you establish care with a psychiatrist, whether you will lie about any substance use/abuse history you have. Both lying and telling the truth can have serious consequences. It depends on your treatment goals, how well you know/trust yourself, your medical history, and… a million other things, I guess. (I favor a circumspect, utilitarian relationship with my psychiatrist, and a soul-bared relationship with my therapist.)

Good look on your brain journeys, yous…

<3

Jessie