How Often Is Enough To See Your Doctor?

My 28-year old daughter has recently been diagnosed as bipolar.  She actually only had one episode of hypomania but that was what put her in the psych ward for a month.  She had been seriously depressed before that for 6 months.  Right now, again, she is in a state of depression.  I’m wondering if she is seeing her psychiatrist often enough?  She’s been out of the hospital for just over 4 months and has only seen one doctor once then switched to one closer to home and has seen him twice. (The last time being the middle of July.) Do they leave it up to the patient, if so, should she be going on her own more regularly?

 

I would like to commend you on being so in tune with your daughter and being so supportive and apprised of the care she is receiving and how she is managing and handling her bipolar disorder.  There are many people, not just the Ask A Bipolar community, but out in the general population who do not have the type of support and attentiveness that you are able to give to your daughter in helping her get through this and get stabilized.  She is very lucky to have you.

That said, I can relate a little bit to your daughters situation.  My symptoms were primarily deep depression and it was a substance abuse induced hypomanic episode that landed me in the hospital.  Bipolar disorder is a disorder which goes in cycles.  After being manic or hypomanic, the next phase will be the crash, or severe depression.  The frequency of the cycles, how much time between the mania/hypomania and depression, and how long each cycle lasts is something that is completely individual in nature.  Everyone’s body chemistry is different, so there is no exact equation on how long or how often someone will cycle.  So, your daughters depression MAY not necessarily need more doctor’s attention, but should not be taken off the table as an option though.

As it pertains to doctors visits, a lot depends on the type of doctor your daughter is seeing.  Is she seeing a psychiatrist (we refer to them as Pdocs) who only prescribes her medications?  Pdoc appointments tend to be generally short in nature because their goal is to just check to see how the meds are working and make any adjustments if necessary.  Is she seeing a therapist?  A therapist is there primarily to talk through your daughter’s issues and help her sort out all the things going on inside her head.  Those visits usually last a lot longer, up to about an hour in length.  There are also doctors who are psychotherapists.  I actually see a psychotherapist and love it.  A psychotherapist is a doctor who is a psychiatrist and a therapist, so he/she will keep track of your medications while also doing a therapy session.  I prefer a psychotherapist because it’s what I call my “one stop shopping spot” since he has all of my records and knows first hand the effects of the medications combined with my therapy.

It is completely up to each individual which type of doctor you choose, but that can also affect the frequency in which you see them.  If your medications seem to be working properly, you may not have to see your Pdoc every month, but every other month, or every 6 weeks or so.  If there seem to be some really bad side effects or the medication does not appear to be working at all, then more frequent visits are probably necessary.  As far as the therapist, its always encouraged to see your therapist as often as you can and work through as much as you can with a professional.  However, sometimes, and I say this because this is my own personal experience right now, a doctor will determine that a lot of the mood or depression is due to situational factors that can not be fixed or changed at the current moment and the cycle of depression has to unfortunately ride itself out or run its course.  (I know that really isn’t encouraging to hear, but sometimes it does happen.)

Remember, bipolar disorder is a biological illness.  It is an imbalance of chemicals in the brain and so it affects everyone differently.  Sometimes the reasons we are in our depressions or  our hypomanic/manic states can not be explained.  Most of the time they can and we can pinpoint a trigger, or we can see our doctor more and that may help, but not always.

My suggestion regarding your daughter’s doctors visits (after this long winded background lol) is to:

  1. Determine what type of doctor she is seeing.
    1. If its a Pdoc, she doesn’t necessarily need to go as often as she would her therapist.
    2. If its a therapist, or psychotherapist, they will be able to recommend to her if she needs to see her Pdoc more often regarding adjustment of meds.
    3. Talk to your daughter and see how often her doctors have advised that they want to see her.  If you are concerned it may not be enough, then encourage her to make an appointment with her therapist for sooner.  If the therapist she is seeing can’t see her often enough because of scheduling conflicts or the therapist is too busy, you may have to look into finding another therapist that has more availability.
  2. Talk to you daughter.  Since she is over 18, her health care is completely up to her and since she has been discharged from the hospital, there are no laws that can require her to see a doctor at a certain frequency (at least to my knowledge).  Now, when I say talk, I am basically referring to just inquiring if she thinks that going to see the doctor might help her a little bit right now since you notice she is struggling.  Not everyone feels comfortable talking about whats going on inside our heads with our parents because a lot of times it can be scary for them.  So, don’t necessarily try to talk to her about WHAT she is feeling or those types of details, but try to get into a discussion about how you could help her feel better and if another doctor session is in order.  Check with her also to see if they recommended a frequency to see the doctor.  If she DOES want to talk about whats going on inside her head, that is a bonus and pull up a chair and let her talk away Mom!!!!
  3. Since she is recently out of the hospital, I would have thought the doctors would have your daughter on a more steady therapy schedule. I was seeing mine at least once a week for the first few months I was out of the hospital, but now, I can go anywhere from a few weeks to a few months.  (He always gives me the opportunity to call him whenever I need to if I need an appointment sooner and gets me into his office within a day or two)  From my experience, the frequency of the visits and if the patient or doctor picks the frequency depends on the situation and the relationship they have.

I know you want to help your daughter and I’m sure its painful to see her suffer.  I just turned 32 years old and had to move home due to a divorce and my mom has a very hard time watching me everyday, especially in my depressive states, so I can empathize with your situation.  Sometimes though, the reality is that more frequent doctors visits may or may NOT help.  Sometimes you just have to let the cycle run its course, as hard as it might be to watch.  That decision is something that is made between your daughter and her doctors though.  As much as I wish there was, there is no handbook or guide that gives a set “amount” of doctor visits.  Everything in done on a case by case basis and the only way to find out about your daughter’s care is to talk with her directly about it.

I hope this helps!  Thank you for writing in!

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