Reader’s Question

After a series of stressful events (family surgeries, putting a son in jail, discovering another child’s addiction to meth, the death of an employee’s child, etc.) I finally had to face the fact that I was severely depressed. I began seeing a wonderful psychiatrist who had treated me for a milder depression about 5 years prior. She prescribed Wellbutrin for my depression, and alprazolam (1.5 mg of the XR per day as 1 mg XR and 0.5 mg XR) for my anxiety. Then, six months ago, she went to work elsewhere and discontinued private practice.

Because I am eligible to be treated by Indian Health Services and our finances are stressed, I began seeing the psychiatrist there. Whereas my last doctor asked pertinent questions and LISTENED to the answers, talking to this one is an exercise in futility. No matter my symptoms or concerns, she has already had that problem in her own life — it is as if she is constantly trying to “top” my issues with her own. I’ve learned to minimize questions because she isn’t going to listen to them anyway. I would go elsewhere, but I really can’t afford to.

Over the last three months I have become even more reclusive. During the week I only leave the house to drive my daughter to school and to perform errands that can’t be delayed until Hubby can do them. I am not “afraid” to leave home, but it is easier to control my environment, and ergo, stress, by staying home.

My alcohol intake has increased as well. I have gone from drinking 3 or 4 nights a week to pretty much every night—usually 2 glasses of wine, or 3 mixed drinks. Does she know? No! She never asks!

I have asked her to increase the alprazolam to 2 mg XR — well within reasonable dosage (I’m a former RN) — and she declines. So, instead, I am hoarding my 0.5 mg tabs when possible, in an effort to accumulate enough that I can take a second dose (1 mg per am, 1 mg per pm) in an effort to resist the desire to pour myself a drink.

If I don’t leave the house, I can generally skip the 0.5 mg dose. She doesn’t know that either. I don’t notice any effects when I do take it, but I notice that without it, my thoughts become scattered and disorderly — I can’t stay on task and that merely exaggerates my anxiety. So, if I do have to be out of the house, or if I know that I need to be focused, I take both the 1 mg and 0.5 mg dose. Still, I’ve accumulated a month’s worth of the 0.5 dose, and should manage to have two months’ worth soon.

I want to stop the alcohol — I don’t need the weight gain or the health risks. However, I’m not willing to unless I have something else to soften the edges after my family comes home. Going to AA is not an option. It would require leaving the house and interacting with people, plus, having attended Al-Anon while one of my boys was in NA, I can tell you that I think the program is a load of crap. “It’s not my fault. I’m a helpless victim.” Uh, no, I am making the choice to self-medicate. I am not helpless, nor — to this point — an addict.

How do I get my doctor to listen to me rather than regaling me (generally for an hour) with what SHE did when she was depressed, anxious, broke, frustrated with family, yada yada? (When she was depressed, she went to the tanning beds. Hello? I’ve already had my first skin cancer removed. I CAN’T go tanning!)

I feel as if I can’t be truthful with her regarding my alcohol use (if she were to bother asking) because she may decide to reduce or discontinue my meds rather than supplementing/changing them to effectively manage my anxiety, and therefore my desire to do so with alcohol.

Any advice?

Our Clinical Psychologist’s Reply

Your current psychiatrist seems to have lost her clinical perspective. Self-disclosure by a therapist is typically used to make a point or facilitate movement in therapy — not to play “I Can Top That”. She is not likely to listen to you when she feels her stories are more important. For this reason, it may be necessary for you to separate your treatment program into two types of treatment. If you must continue with her for financial reasons, work on medications and medication-related symptoms in that treatment relationship. As you’ve done, focus on the physical aspects of depression and anxiety — sleep problems, tension, worry, etc.

At the same time, I’d recommend seeking a therapist or counselor. In that relationship you can discuss your personal concerns without involving the issue of medication.

A completely different option is seeking the support of a family physician who is knowledgeable about antidepressant and antianxiety medications — allowing that physician to continue your medication treatment — while continuing to see your therapist/counselor as well. You may find that a family physician may listen more than your psychiatrist in this situation. Be sure to inform your physician of your alcohol use.