Do you need to see a therapist before a psychiatrist

According to the National Institute of Mental Health, mental illness affects millions of Americans, but only about half of those affected get treatment. If you are experiencing mental health issues, when should you get help? And what type of help is right for you?

Psychologist, psychiatrist or therapist: What’s the difference?

Psychiatrists are medical doctors and have medical training specializing in mental illness. Psychiatrists can write prescriptions and may offer psychotherapy, or talk therapy, to their patients.

Psychologists usually have a doctoral degree, or a Ph.D., in Clinical or Counseling Psychology. They can also treat patients using psychotherapy and are trained in making psychiatric diagnoses.

Psychologists can work in clinical, research or educational fields. Unlike psychiatrists, psychologists do not prescribe medication. However, psychologists work closely with psychiatrists if medication is needed when treating a patient.

"Therapist" is a broader term used for those who are trained and licensed in a variety of fields to help people.

Therapists can be:

• Social workers
• Life coaches
• Marriage counselors
• Psychoanalysts
• School counselors

Though there are many professionals who claim to be therapists, it’s a good idea to find someone who is accredited and licensed to work in their field. If you are looking for a mental health professional, talk to your doctor about what type of therapy is right for you.

When should I seek help for mental health issues?

There are many different mental health issues, and they can affect people differently. If you are concerned about changes in your mental health or are experiencing any of the following symptoms, get help right away.

Warning signs of mental illness include:

• Mood changes: Drastic changes in your moods or emotions in a short period of time
• Problems thinking: Problems with concentration, memory, speech or logical thought
• Apathy: Losing interest in activities or people
• Sleep or appetite changes: Either a substantial decrease or increase in sleep or appetite
• Feeling disconnected: Having a sense of unreality or not being able to connect with others
• Drop in functioning: Quitting school, jobs or activities or not being able to perform familiar tasks
• Unusual behavior: Odd or uncharacteristic behavior

Is online therapy right for me?

With the COVID-19 pandemic, many are choosing to do online therapy and many doctors now offer sessions online or over the phone.

Some of the benefits of online, or E therapy, include:

• Convenient: You can do sessions online from home without having to worry about commuting.
• Safe: It’s easy to social distance and remain safe during the pandemic with online therapy.
• A great way to start therapy: Many people can be afraid of starting therapy. With the convenience of doing sessions online, it’s easier to give therapy a try without as much risk.

Some of the downfalls of online therapy include:

• Technology issues: Wrestling with your computer or phone to do a session can be tough for some.
• Insurance may not cover it: Make sure to check with your insurance to see if they’ll cover your sessions.
• It’s virtual: Doing a session online can be hard and there are untold benefits from being able to connect and see your therapist face to face.

How to talk to your doctor about mental illness

If you’re concerned about your mental health, talk to your doctor. These tips can make the conversation easier, so you can get the help you need:

• Keep a list of symptoms, your moods and other behavioral or mental changes to show your doctor.
• Make sure your doctor has your full medical history including what prescriptions, supplements and over-the-counter medications you are taking.
• Find a doctor you can trust and be honest about your mental health.
• Write down notes, questions or concerns to reference during your doctor visit.
• Consider bringing a friend or family member with you who can support and help you during the visit. They might be able to help understand what the doctor is telling you as well as remember and share any mental health changes they’ve seen in you.

And that’s just the first step. The next question is: “What kind of doctor should I see?”

You could see your primary care doctor. Many people do. Of the 8 million appointments for depression, about half of them are made with primary care physicians, according to a news story on PBS.com.

If the primary care doctor route is not for you, you are then faced with another choice: should you see a psychologist or a psychiatrist? How do you know who is right for you?

What’s the Difference Between a Psychiatrist & a Psychologist?

Before we explore the difference, you should first know that many psychiatrists and psychologists work closely together.

The primary difference between the two types of doctors comes down to medication: a psychiatrist can prescribe it, while a psychologist cannot.

In addition to offering treatment through medication, psychiatrists will often conduct talk therapy, cognitive behavioral therapy or other forms of treatment. They may also make referrals to counselors or therapists (like psychologists).

According to Psychology Today: “Psychiatrists receive the same medical school education as any other medical doctor, such as an internal medicine physician or a pediatrician and, therefore, hold a doctor of medicine degree (M.D.).”

When to Choose a Psychologist

A psychologist doesn’t hold an M.D. degree. Psychologists will assess patients and treat them through counseling or talk therapy.

Talk therapy is a method of treatment that helps patients re-evaluate their feelings and attitudes, creating healthier behavior according to the American Psychological Association. The Association states that psychologists are “highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis and treatment, and behavior change.”

Applying scientifically validated procedures, a psychologist will work with a patient to help them identify and isolate a problem, recommend potential behavioral changes, and determine the best course of action.

Marian Margulies, PhD, a psychologist in New York City and candidate in psychoanalysis at the Institute for Psychoanalytic Education at the NYU Medical Center, said talk therapy is important because you aren’t just treating the symptoms – you are finding out what’s causing the pain.

“If you’re not getting to the cause of the pain, you’re essentially chained to the past,” Dr. Margulies told Forbes. “Psychotherapy gets to the root.”

When to Choose a Psychiatrist

Even if psychotherapy is getting to the root of the problem, you still may need additional help.

With a medical background, a psychiatrist can review your complete medical history. Understanding the full picture is important because some mood disorders may be caused by physical conditions like hormonal changes (pregnancy or thyroid disorder), according to the Mayo Clinic.

“Because we learned how the body interacts with the mind, we can rule out physical disorders as a cause of mental illness. This is important, since a person may have a hyperactive thyroid, for example, which can trigger panic attacks, anxiety, insomnia, or anorexia. We can look at thyroid blood tests or have a patient consult an endocrinologist if we suspect the problem stems from thyroid disease,” Carol W. Berman, M.D., a clinical assistant professor of psychiatry at NYU Medical Center in New York City, wrote in the Huffington Post.

If depressive symptoms are significantly impacting your body and daily life, a psychiatrist can help determine if medication will help. Importantly, a psychiatrist can consider drug-drug interactions if you are already taking medication for other conditions.

If a patient needs it, a psychiatrist has the authority to recommend hospitalization. However, Dr. Berman writes that hospitalization is often a last resort:

“The most common types of psychiatric hospitalizations are for suicide attempts, detoxifications from drugs or alcohol, psychotic episodes caused by mania or from schizophrenia. Most psychiatrists use hospitalization sparingly as a last resort if no other treatment will work.”

Choosing A Provider who is Right for You

If you feel you may be experiencing depressive symptoms, a good way to start is to talk to your primary care physician about a referral. This way, the physician who sees you the most can determine which type of mental healthcare provider you should see based on your medical history.

Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider.

The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors.

If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.