psych eval okay, now i'm just angry - psych eval failure1

[vanishingirl 1]

I had my initial psych eval about a month ago. Everyone kept saying that it was easy and not to worry, and I told myself that I'd be cool with whatever recommendations they make. I had an hour long clinical interview followed by several screening tests. Days before i was supposed to go back for my follow-up to see if i had been cleared for wls, I got a call that they wanted me to do even more testing. I had to take the 550+ questions on the mmpi.

I have had a life long history of low levels of depression and social anxiety, and I've been treated for it. Anyway, the tests came back and indicated that I do have clinical levels of depression and generalized anxiety, and so I am being referred to an actual psychiatrist for med changes and I have to go to therapy. She will not clear my for wls until I have been "stable" for at least 6 months. That's at least 6 months of counseling.

She read me my entire report which indicated that I don't binge eat, or have problems with emotional eating, that I've never been suicidal, that i have a good support system, that i understand the surgery and am doing it for health reasons and that i am an excellent candidate with a great chance of success...after i go to therapy for at least 6 months. At first I tried to just accept it and see the positives in the situation - it would be awesome to have whatever mental health issues i might have "under control," but I just feel angry now. *I* don't think my depression is that bad, nor that my social anxiety will have much of an impact on my weight loss.

Maybe I'm just scared because I don't think the depression and anxiety actually can be fixed? I've been in therapy 3 times before and for the most part it was a complete waste of time. I've been on more meds than just about anyone I know - and they've never really helped at all. i've never actually been much less depressed or anxious than I am now at this point in my life. I admit that I do have some level of depression and anxiety, but it's always proved very resistant to treatment....so now I feel like the chance for surgery is being taken away from me, and that no matter what I do to prove I'm committed to this- unless this depression and anxiety go away, it will never happen.

I'm still going to continue doing everything that my insurance company and the weight management institute are asking me to, but I feel like right now losing on my own, without the surgery as a tool, is my only choice - and I've been failing at that my whole life. At this point, I won't be able to have surgery until March at the earliest, and we were shooting for December before. I just keep thinking that my social anxiety is that I always worry that people are judging me for being fat, and my depression is mostly because I never feel physically well enough to do anything because I'm fat, and even though I've never thought that surgery would cure my emotional issues, my weight really is my biggest problem emotionally.

......so...has anyone else ever had to deal with this?

[ArnoldS 46]

Omg, that could be me talking. What you are going through has been my biggest fear since this whole process has started.

I have a history of depression and social anxiety. At my initial psych interview, I could tell she was dissatisfied with me. I'm in outpatient treatment for my condition. I'm doing well. She frowned and gave me two release of info forms for me to sign. One going to my psych who prescribes my meds and one for my therapist.

I since spoke to my therapist who is going to give me clearance. I haven't spoken to my psychiatrist.

This seems much ado about nothing. I think I'm doing very well.

Years ago I was doing badly. However, I think that now I am very stable.

I hope all goes well for you. Let us know how it goes.

Hugs.

[Daydra 345]

Wow... this is the first time I've heard of someone that is functional "failing" the psych eval. That sounds like complete bs to me. Is your depression diagnosis major depressive disorder or something more like dysthymia (chronic depression)? Not that it really matters, but if you're functional, capable, are a good candidate, have a good support system, and understand what you are getting into, there really isn't any reason not to approve you.

As far as meds go... I've been diagnosed with dysthymia for years (my my MD). I've been on and off meds because I never really felt like they were that helpful and I never really felt like I had a horrible life situation. I always wondered if I actually did have depression or if it was just life stresses (primarily weight) that essentially gave me the symptoms of depression. I feel like I have a good life, I'm intelligent, I have friends and family that love me, a great career, a nice house, a good marriage, so I never really understood why I felt so crappy because I never felt like my life was crap. I started seeing a therapist recently because of some stress with my aging parents and after talking about this for a little bit, she said it sounded more like anxiety than depression. So all along, we may have been trying to treat depression when it might be anxiety instead. Anyway, just to make a long story longer, I'd been on Prozac, didn't feel it was effective, didn't like the sexual side effects of Celexa, Zoloft didn't seem very effective, Wellbutrin added to Zoloft still didn't seem very effective. My doc said that since I'd "failed" 2 of the cheaper antidepressants, that would qualify me for some other, more expensive options. I've been on Pristiq for several months now, and I feel pretty decent on it. It apparently works both on serotonin and dopamine. Anyway, that is just to let you know there are options other than the standard players...

I would recommend, though, that you look into whether getting a second opinion is possible. Your insurance may not cover it, but if a second opinion will be acceptable for approval it might be worth the out of pocket cost. Unless you are having major upheaval in your condition or are having major life changes and stressors, I really don't see any reason to make you wait an additional 6 months. But, I'm certainly no professional. If you get a second opinion and they say the same thing, at least you might be more confident that the initial assessment is valid...

Good luck. I'm really sorry you got delayed.

[vanishingirl 1]

I've been diagnosed with dysthymia in the past, but all she said was that the tests showed I had clinical levels of depression, which I think is mostly anxiety as well. I guess I'm just frustrated because I feel fine and stable, and I know they're looking for things that could possibly pop up after surgery and they want to prevent that from happening, but I just don't know how effective that it will be. I've been on effexor, prozac, paxil, celexa, zoloft, welbutrin, lithium (my doc was trying everything at that point!) and abilify.

I probably should have mentioned that she thinks my biggest problem is that I probably have undiagnosed ADHD, but they don't do that in their office, and I'm supposed to go get tested for ADHD before I do anything else. I guess initial depression screening she did didn't even show I had depression, just the mmpi.

But I'm fine! Generally happy, positive, and optimistic! She said that herself. I guess I should have known when I went in for my eval that it wasn't going to be so easy, because right away I could tell that she was being much more indepth than anyone else I'd heard about.

[VSGKirk 855]

What's 6 months for a future that will lead to health and hopefully a longer life? Let's look at this from a glass half full... you have insurance that will eventually cover this. I would gladly have traded 6 months for the $17K I spent on the surgery. Hang in there and don't look at this from an all or nothing point of view. You have clearly aligned yourself with a program that is first and foremost concerned with your well-being. That's a great thing!

[italian-girl 152]

I agree with the poster above me, Heath is important first and foremost. Mental health included. My psych eval paperwork was like taking the SAT's idk if everyone's psych eval is similar or not but I did it. It took a good couple hours of my life to get through. And I had to do that before the dr would even see me. My ins had hoops to jump through and I gladly jumped as high as they wanted me to because I needed them to cover this surgery. The first time I tried it was 3 years ago with a different insurance. They denied me and said diabetes and bmi of 42 wasn't a good enough reason. So I kept looking for a way to afford it... Then my company changed ins carriers this year... So I started the process all over it took months but it worked out and was worth all of the things I went through to get it done.

[gmanbat 5,889]

What's 6 months for a future that will lead to health and hopefully a longer life? Let's look at this from a glass half full... you have insurance that will eventually cover this. I would gladly have traded 6 months for the $17K I spent on the surgery. Hang in there and don't look at this from an all or nothing point of view. You have clearly aligned yourself with a program that is first and foremost concerned with your well-being. That's a great thing!

I was ready to bring my arsenal of vitriolic language to join you in utter disdain for psych evals but this post cooled my jets. VSGKIRK is right.

My psych eval rejected me because I was a hippy in the 60's, hence the name above my picture. In 1969, I quit drugs and was healed of hippytitus. I've been a minister and clean ever since. My surgeon was livid with anger and sent off an immediate appeal to the insurance company. I was soon approved.

If you can make an appeal and get this changed it would be great. If not, it will still be good..IF you get cleared after the period and after you've jumped through all the hoops.

I would appeal to the surgeon first, though.

[Sydney Susan 333]

Sounds like a rort to me, but as others have said 6 months will fly by. Appeal but don't get hooked in too much.

Did you ask the psych why she's declining you given the positive statements in the report? You need to be clear about what she needs to see change before she approves. "Doing time" with a psych is a rort and if that's the response you get - and I'd try to get it in writing - it might help your appeal. If she specifies things that make sense to you and your GP or second opinion doctor, then that would be good. But if not.... More info for the appeal.

[sherri scheffler 10]

I had my initial psych eval about a month ago. Everyone kept saying that it was easy and not to worry' date=' and I told myself that I'd be cool with whatever recommendations they make. I had an hour long clinical interview followed by several screening tests. Days before i was supposed to go back for my follow-up to see if i had been cleared for wls, I got a call that they wanted me to do even more testing. I had to take the 550+ questions on the mmpi.

I have had a life long history of low levels of depression and social anxiety, and I've been treated for it. Anyway, the tests came back and indicated that I do have clinical levels of depression and generalized anxiety, and so I am being referred to an actual psychiatrist for med changes and I have to go to therapy. She will not clear my for wls until I have been "stable" for at least 6 months. That's at least 6 months of counseling.

She read me my entire report which indicated that I don't binge eat, or have problems with emotional eating, that I've never been suicidal, that i have a good support system, that i understand the surgery and am doing it for health reasons and that i am an excellent candidate with a great chance of success...after i go to therapy for at least 6 months. At first I tried to just accept it and see the positives in the situation - it would be awesome to have whatever mental health issues i might have "under control," but I just feel angry now. *I* don't think my depression is that bad, nor that my social anxiety will have much of an impact on my weight loss.

Maybe I'm just scared because I don't think the depression and anxiety actually can be fixed? I've been in therapy 3 times before and for the most part it was a complete waste of time. I've been on more meds than just about anyone I know - and they've never really helped at all. i've never actually been much less depressed or anxious than I am now at this point in my life. I admit that I do have some level of depression and anxiety, but it's always proved very resistant to treatment....so now I feel like the chance for surgery is being taken away from me, and that no matter what I do to prove I'm committed to this- unless this depression and anxiety go away, it will never happen.

I'm still going to continue doing everything that my insurance company and the weight management institute are asking me to, but I feel like right now losing on my own, without the surgery as a tool, is my only choice - and I've been failing at that my whole life. At this point, I won't be able to have surgery until March at the earliest, and we were shooting for December before. I just keep thinking that my social anxiety is that I always worry that people are judging me for being fat, and my depression is mostly because I never feel physically well enough to do anything because I'm fat, and even though I've never thought that surgery would cure my emotional issues, my weight really is my biggest problem emotionally.

......so...has anyone else ever had to deal with this?[/quote']

The trick to passing is (stress eating) I was a stress from my son going to prison, death of two brothers &my mother all in less than ten yrs. Just tell them its not depression but you sre a stress eater. &hopefully that will help anyone trying to pass a psych evaluation. As lso tell them you wake up w/food in ur bed &don't remember e as ting it, tha t also helps. As far as the written test they want similar answers but don't use that info to base surgery on , only use the psychological evaluation person yo person to see if you are mentally stable for post surgery affects which ca n put you into temporary depression so if depression already is set in that m as y not be good. So again use STRESS EATING as your crutch Please. ..

[Jerzygurl 372]

It's amazing that there is no standard for the psych evals. There was no test for mine, but we did talk for about 45 minutes..mostly about my eating habits and my support system... in addition to meditation and relaxtion techniques when I feel stressed or want to eat..out of boredom, anxiety or fear.

I actually asked him questions about himself..and like your Hippie Uncle above, he grew up in the 60s too..,,he said he could pretty much tell if someone was putting on a front to pass the test, or were genuinely on solid ground. I haven't seen my write up yet, but the NP said it was two thumbs up. I would hate to get my hopes up and expect surgery soon, only for it to be put off by a psych or doc that could have their own issues with the surgery, etc. Believe they are out there, I've seen it..they don't approve of WLS, so they throw up all these road block for the patient.

I wish you the best of luck....and I would talk to the surgeon to see if maybe you can get the surgery but agree to stay in therapy, thereafter for the 6 month period.

[Squid 23]

I didn't really have an indepth interview but told them I was in therapy for depression and was on abilify and prozac for less than a year before discontinuing (my choice). and was green lighted.

I should probably still be in therapy and on mood stabilizers but my family just gave me so much crap about being in treatment. Sort of anti meds/gut through your problems silently sort of people.

Anyways I digress, its good that your doctors have your best interests and long term success in mind. One of my friends who never had any depression problems had to get into treatment post gastric bipass due to the initial stressful transition. So it can be a trigger. Just take the next six months to try be healthier in all capacities =]

[ArnoldS 46]

Ugh! I am livid.

The psych lady at my weight loss center wants an opinion from the psych that I am seeing locally, in addition to the opinion of my therapist.

Yesterday I saw my therapist and explained the entire pre-surgery, post-surgery program to her as well as the actual surgery procedure. After that long session, she said that she would be with me on this and give me her blessings. So, that was one hoop that I jumped through.

Today I saw the new psychiatrist that replaced the psychiatrist that I've been working with for a long time and have come to know and love. This new lady is a crackpot. She's nuts. I won't go into detail.

Omg, she said that she would not approve the surgery b/c people die from it. She said that I would not be able to take my meds if I have it. I took out two diagrams and compare the vsg to the roux-en-y. She couldn't comprehend the difference. Then she put me on the old scale in her office. I had to explain to her how to operate the scale, after she said that it wouldn't go up that high. My present weight is 297. The she said, "We haven't changed your meds in a long time." What the %#@*. This is only the second time I've seen this new doctor. I told her that I'm doing very well on the meds that I am on, Thank you very much. Then she told me that my therapist talked to her and said that the therapist was dead set against the operation.

I met my therapist outside after I saw the psychiatrist and asked her if this was true. The therapist told me no. That she had not even spoken to the psychiatrist.

I don't know how to handle this situation w my local psychiatrist. Any suggestions?

One thing that I have done: I sent an email to my family doctor to ask him if he will take over prescribing my meds to me. That's the only thing I need this psychiatrist for. I don't think he will. We'll see what he says.

Thanks for reading.

Any help would be appreciated.

[Macy6 356]

I am sorry you are having to deal with this. I feel psychiatry is so objective. It is difficult for anyone person to absolutely know what is going on in someone else's head, unless you are that person. I too have dealt with Major depression (for nearly two years) and generalized anxiety. I had gone back to my physician in January when I felt a relapse coming on, that was the appt when she referred me for bariatric surgery. Don't give up! Persevere, good things come to those who wait. I wish I could make it better, but I can't! I do wish you all the luck in the world.

[Daydra 345]

VSGKirk and Gmanbat are right... but I'm still pissed off for you. I agree that you should give an appeal a shot, but they are totally right. It's just 6 more months to get prepared. (I'm just glad no one told me that when I decided to pay out of pocket instead of jumping through my insurance hoops because I was unwilling to deal with their bs... I might have blown a gasket :-)

[sherri scheffler 10]

I had my initial psych eval about a month ago. Everyone kept saying that it was easy and not to worry' date=' and I told myself that I'd be cool with whatever recommendations they make. I had an hour long clinical interview followed by several screening tests. Days before i was supposed to go back for my follow-up to see if i had been cleared for wls, I got a call that they wanted me to do even more testing. I had to take the 550+ questions on the mmpi.

I have had a life long history of low levels of depression and social anxiety, and I've been treated for it. Anyway, the tests came back and indicated that I do have clinical levels of depression and generalized anxiety, and so I am being referred to an actual psychiatrist for med changes and I have to go to therapy. She will not clear my for wls until I have been "stable" for at least 6 months. That's at least 6 months of counseling.

She read me my entire report which indicated that I don't binge eat, or have problems with emotional eating, that I've never been suicidal, that i have a good support system, that i understand the surgery and am doing it for health reasons and that i am an excellent candidate with a great chance of success...after i go to therapy for at least 6 months. At first I tried to just accept it and see the positives in the situation - it would be awesome to have whatever mental health issues i might have "under control," but I just feel angry now. *I* don't think my depression is that bad, nor that my social anxiety will have much of an impact on my weight loss.

Maybe I'm just scared because I don't think the depression and anxiety actually can be fixed? I've been in therapy 3 times before and for the most part it was a complete waste of time. I've been on more meds than just about anyone I know - and they've never really helped at all. i've never actually been much less depressed or anxious than I am now at this point in my life. I admit that I do have some level of depression and anxiety, but it's always proved very resistant to treatment....so now I feel like the chance for surgery is being taken away from me, and that no matter what I do to prove I'm committed to this- unless this depression and anxiety go away, it will never happen.

I'm still going to continue doing everything that my insurance company and the weight management institute are asking me to, but I feel like right now losing on my own, without the surgery as a tool, is my only choice - and I've been failing at that my whole life. At this point, I won't be able to have surgery until March at the earliest, and we were shooting for December before. I just keep thinking that my social anxiety is that I always worry that people are judging me for being fat, and my depression is mostly because I never feel physically well enough to do anything because I'm fat, and even though I've never thought that surgery would cure my emotional issues, my weight really is my biggest problem emotionally.

......so...has anyone else ever had to deal with this?[/quote']

Ask your dr if he can refer you to the psych he sends patients to , most dr have one they prefer to send you to. It doesn't hurt to ask...