You get what you pay for at the Pdoc’s

Went to see the pdoc nurse practitioner to get my Adderall refilled yesterday. When you go in for a meds checkup with the nurse, they have you fill out this checklisty form in the waiting room where they try to concise a DSM diagnosis into one-word categories–”mood,” “sleep,” “appetite,” “interest,” “anxiety,” etc.–with 1 to 10 (bad to good) rankings.

I’m thinking, okay, this is subjective, and surely she’ll ask me questions and we can discuss it if she has concerns. Because, y’know, that’s what a doctor would do. So I fill it out based on how I’ve been sleeping and stressing this last week, giving “sleep” a “3″ since my circadian cycles have been wonky, and mood a “3″ as well because I’ve been juggling too many hamsters. And I also put down a “4″ for appetite because, well, I’m taking an amphetamine, and it’s an appetite-suppressant. (Which, by the way, is an excellent way to lose weight.)

When I go in, she informs me that “I’m not doing good,” which I thought was a wee bit presumptuous since she’s exchanged all of two, maybe three sentences with me. And she pushes hard for me to get back on an antidepressant. I ask her what she’s basing her assessment on, and she says the 3 I gave “mood.”

Okay, so nurse lady doesn’t subscribe to my “it’s subjective” interpretation and doesn’t realize that that 3 is a 3 for me across the board, and that my board has never been profoundly depressed or psychotic. I try to explain this to her and that I didn’t think “mood” was an effective descriptor for everything that encompasses a person’s mental state, and I’m not suicidal or homicidal, and I’m really not all that depressed either; I’m mostly cranky and stressed.

Her response? “You keep going like this and you’ll end up in the hospital.”

WTF? First of all, I was diagnosed with mild depression–not a hospitalization caliber ailment–and I feel tons better now than I did when I was diagnosed years ago. Second, how can she find it in the least bit appropriate to tell anyone, especially someone who may be feeling emotionally frail, that if they “keep going like this you’ll end up in the hospital” based solely upon a 1 to 10 scale of a one-word descriptor? This woman hasn’t spent fifteen minutes talking to me in the three months she’s been aware of my existence!

I tell her, “No, I really won’t.” And explain to her how hard it was to get off the Effexor and that I would rather not go back on an antidepressant.

She continues to push and suggests I try Celexa which is a “more pure” SSRI than Prozac and isn’t an SNRI.

I try to point out that it wouldn’t take effect for six or so weeks in any case (by which time I fully expect to have selected the hamsters I want to keep in the air, and to have volleyed the rest of them over the fence), and she interrupts me and says “two weeks.”

Huh. Okay, my grad. school Psychopharmacology class was a loooong time ago. Maybe they’ve made strides in the antidepressant field. Might be worth trying.

As I make speculative noises, she rattles on how I should “take this at night before bed.” Since I took the Prozac in the AM, and I don’t want to take something that will make me tired because that’s the whole reason I’m on the Adderall–fighting the fatigue and all–I ask her “so this will make me sleepy?” And she says “no, you just take it before bedtime and when you wake up you’ll feel better.”

Do you get that she was talking to and treating me like a refugee from the short school bus?

Yeah. By this time I’m annoyed, upset, indignant, and doubting myself. Maybe I should go back on an antidepressant. After all, I was dwelling upon it before, and I’m going through a lot right now. But mainly, I just want to get my stupid Adderall refill and leave. So I give her the go ahead on the Celexa.

She enters prescriptions for both meds into the computer and off I go to the pharmacy. But Adderall is a controlled med and requires a hard-copy script, which nurse-lady should have known. I’m forced to go back and wait 45 minutes to get a stupid piece of paper, ensuring that I get caught in rush hour traffic, making an already upset-Eugie extremely unhappy.

After languishing for over an hour in Atlanta’s lovely traffic, I got home and looked up Celexa online. Length of time until effective: 6-8 weeks. May cause drowsiness.

In addition to bullying and coercing me, she lied to me.

I’m obviously sympathetic to the mental health profession, having that MA in Psychology and all, but I’m feeling pretty mistreated by it right now. And I have to wonder, how exactly is the sort of conduct she displayed going to be of benefit to anyone’s mental state?

Because I have indeed been stressed to my eyeballs, I took the Celexa last night. When I woke up this morning, I was groggy and light-headed. And I feel a headache coming on. Oh yeah, so helpful.

Now I’m debating whether it’s worth staying on it, because I was, after all, contemplating going back on an antidepressant, or if I should just pitch the stupid pills out the window.

I’m trying to base my decision not on my experience in getting them, but my overall mental state.

Right now, the window’s looking pretty enticing.

Feh. And she wants to see me back in six weeks. I’d say “no way in hell” except my alternative is to follow-up with a doctor to get my Adderall refilled, which has a co-pay. Seeing her, at least, is free.

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15 Responses to You get what you pay for at the Pdoc’s

  1. Yikes. She was a real Nurse Cratchett. I think you should follow your own instincts on this one.

  2. ellameena says:

    Yeah, it sounds like you have more knowledge of psychology than the nurse. It might be a good idea to try a different antidepressant, but you cannot judge the results after two weeks. There is research on a new EEG type brain test that could evaluate an antidepressant after two weeks, which I think is pretty exciting, but it’s not on the market yet. I think waiting six weeks for your external issues to resolve before trying to treat depression seems sensible. You don’t sound like someone on the way to hospitalization.

  3. harmonyfb says:

    If it were me? I’d flush the Celexa, and find a doctor who didn’t lie to me and patronize me.

    But first, I’d make the follow-up appointment and hold it up for her to see and ask her when she decided it was ok to lie to her patients in the name of coercing them into unwanted medications. Then I’d ask her for my records.

  4. nmsunbear says:

    Is there any possibility of switching to a different nurse practitioner?

  5. raecarson says:

    Oh, Eugie, I’m so pissed off on your behalf that I almost have no words.

    Almost. Go with your gut on this one. If you don’t think you need an anti-depressant, then don’t take them. You can always try them later.

  6. I have a huge problem with this RN, practitioner or not, foisting medications upon you with such a tiny bit of time spent, far out of sync with the massive assumptions she made. If at all possible, go to your doc. Why take a drug that causes so much anxiety, has disturbing side effects and is for a condition that is only mild and may be uplifted by chucking some hamsters out the window with the pills?
    Be well, sister!

  7. klingonguy says:

    Sadly, you’re in a no win situation here. You can’t call the NP on being a lliar because she’ll most likely either a) view the accusation as just another symptom, and/or b) deny having made the statement about the 2 week onset.

    Neuropharmacology has made great strides in recent years, but individual differences makes so much of it such a crap shoot that it’s hard to remember just how bad it used to be. And even with the most conscientious of healthcare providers, the insurance companies have made things so tight that it’s no surprise if they drift into the path of least resistance (and quickest turn around) offered by a quick-fix drug approach to care. I see this everyday.

  8. j_hotlanta says:

    This sounds like yet another gotcha in “effective form filling out in the US legal system”. Probably somewhere there’s a guideline that says a “3″ is “serious” depression and since you self-documented it the NP’s subjective appraisal doesn’t carry much weight. Should you go off on a hamster-killing spree, it would be her ass if she let you slide out without some kind of mood-altering substance. She’s now covered that ass so she’s happy (whether you are or not).

    You know the symptoms of chronic depression; if your 3 was “a couple of stressful days” then I don’t think you have it.

  9. blzblack says:

    If it’s mild, why not something cheap like St. John’s? Mine can get overwhelming, but it’s helped me.

  10. gardenwaltz says:

    you know, at my daughter’s pediatrician’s office they always hand me a laminated form with a dry erase pen. i resented it strongly when she was smaller and it was hard to juggle in order to avoid getting marker on her. i’ve learned to be very careful about what i put on that form, but i think i will avoid it completely in the future.

    in my opinion, you’ve been given a prescription drug without a diagnosis. honestly, i’d call back and complain. NP’s do not generally have their own practice and there has to be someone there who will actually talk to you.

  11. fahkingnut says:

    I’m not too hot on her attitude either, but some of her actions were in line.

    Both anxiety and irratability tend to increase in bi-polars and some depressives, so her statement of you heading to the hospital may have been overkill for you, but in-line with the diagnosis for most of what she’s delt with.

    Many of the meds give the 6-8 weeks info, but it only takes 2 weeks for theraputic levels to be reached and released from the liver. The 2 weeks is when you should start seeing a change even with the bigger and older meds like Depakote. I’ve never been on Celexa, that I remember, but I have been on most of them. Maybe even taking the dosage at like 8 PM will help stave off the morning grogginess problem. Any reasonable doctor will allow for time shifts to avoid side effects.

    I’d be reluctant to go on another anti-depresant given this visit. You know your source of stress and you know how to deal with it. Should you take the Celexa? I don’t know. Tough call for me, an outsider.

    Just be well regardless of what you do.

    Love & Hugs,
    FahKingNut

  12. leahbobet says:

    I…well. I would find out who the hell her boss is and repeat this story. Lying, even for good intentions, is not acceptable in health care.

  13. keesa_renee says:

    I vote for the window…and my personal suggestion would be to send pdoc over the fence with the hamsters. (Is she the one you usually go to?!)

    :huggles: Hope you feel better soon!

  14. kafkonia says:

    Celexa’s what they prescribed to me (although I’m now on the generic equivalent, apocitalopram, I think?) I didn’t have too much of a problem with drowsiness, but then, depression was making it hard for me to sleep, so that may have something to do with it.

    It certainly helped me out, but that’s no excuse for the way you were treated. *hugs*

  15. whitecrow0 says:

    Totally wouldn’t go back to that nurse. Wrongwrongwrong. :{

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