The brain-body connection is real. For mental health conditions with a strong biological basis, seeing a psychiatrist could be your best choice to receive appropriate treatment. As medical doctors, psychiatrists take a holistic, comprehensive approach that can involve medications, brain-stimulating devices or talk therapy.
With extremely serious or urgent conditions, or when a mental health problem’s cause is unclear, psychiatrists are ideally the first stop for patients. However, not every mental health issue requires a psychiatrist, and in many cases a psychologist or other clinical therapist can give all the help you need.
Here’s when to see a psychiatrist — right away or for ongoing, next-level care — and what they can do for you.
What Is a Psychiatrist?
“A psychiatrist is a medical doctor who specializes in mental health,” explains Dr. Melissa Stennett Deuter, a psychiatrist in San Antonio, Texas, and founder of Sigma Mental Health Urgent Care, which provides immediate psychiatric and therapeutic services both in person and virtually. “A person should see a psychiatrist when they may need consultation with regard to the medical piece of mental health — either because they need to clarify their diagnosis, or because they need to take medication or suspect that (medication) could be a need.”
A psychiatrist must graduate from medical school and complete an additional four-year psychiatry residency. Many psychiatrists go on to receive additional training in specific types of mental health conditions.
What Conditions Do Psychiatrists Treat?
Psychiatrists treat a wide range of conditions including:
— Anxiety disorders.
— Bipolar disorder.
— Eating disorders.
— Post-traumatic stress disorder.
— Substance use disorders.
A suicide attempt, or new onset of suicide ideation — having suicidal thoughts or planning suicide — is a major reason that a person should see a psychiatrist.
The onset of psychotic symptoms — hearing voices or not being able to discern reality from not-reality — or profound inability to sleep combined with excessively high energy — are “situations where absolutely a person should go find a psychiatrist,” Deuter says.
Who to See for Mental Health Evaluation
Psychiatrists are trained differently than other mental health providers such as psychologists, therapists or clinical social workers. If you’re wondering which type to see first, “one of the key things driving that decision is that fact that many, if not all, psychiatric conditions have a strong biological basis,” says Dr. Maria Oquendo, a professor and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania and president of the American Foundation for Suicide Prevention.
“Psychologists are very well-trained to understand the psychological aspects but are not biologically trained,” notes Oquendo, who is also a past president of the American Psychiatric Association.
As physicians, psychiatrists can order medical as well as psychological tests. That allows them to diagnose physical conditions that may be the underlying cause of symptoms, such as blood tests for high or low thyroid levels, or brain or other imaging scans that may reveal tumors or abnormalities.
Another kind of mental health provider can prescribe psychiatric medications, too: “Clinicians who are trained as nurse practitioners do have a biological background and if the condition is not super-complex, they’re a very reasonable first approach as well,” Oquendo says. However, she adds, it can be best to see a psychiatrist, “especially if it’s a complex type of situation, for example multiple diagnoses, or maybe even the presence of a complex psychosis.”
Therapies Psychiatrists Offer
Psychiatrists treat mental health conditions using a variety of approaches:
— Talk therapy.
Depression, anxiety, bipolar disorder, OCD, attention deficit hyperactivity disorder, schizophrenia and some types of personality disorders are among conditions that typically require treatment with psychotropic drugs. These drugs affect how the brain works and affect mental function, mood, emotions, thoughts, awareness or behavior.
Antidepressants, antianxiety agents, anti-obsessive agents, antipsychotics, stimulants, anti-panic agents and mood stabilizers are the main psychotropic drug categories. Psychiatrists initiate psychotropic drug treatment for new patients and adjust doses or substitute medications for better effectiveness as treatment progresses.
Psychiatrists are also versed in prescribing certain cutting-edge medications, such as using the drug ketamine to treat people with suicidal thoughts. “We also now have biological approaches, such as emerging data suggesting that use of either intranasal or intravenous ketamine can be very useful,” Oquendo says.
Psychiatrists can evaluate patients for and prescribe device-based treatments to treat certain brain-based mental health conditions, particularly when standard medications have failed or cannot be tolerated. Treatments include:
— Transcranial magnetic stimulation. TMS, also known as repetitive TMS, or rTMS, is a noninvasive procedure using magnetic fields to stimulate nerve cells, or neurons, in the brain. Treatment is typically delivered through an electromagnetic coil placed on the scalp. In the U.S., it’s approved to treat major depression and OCD, or as smoking-cessation therapy.
— Electroconvulsive therapy. ECT, sometimes called “shock therapy,” is used to treat severe depression that doesn’t respond to standard antidepressants. With ECT, electrodes are placed on the head to deliver small electrical pulses to the brain and intentionally cause a brief seizure. ECT is performed under general anesthesia and patients are given muscle relaxants to prevent injury. “For somebody who is severely suicidal, electroconvulsive therapy is a very effective treatment,” Oquendo says. ECT also has indications for bipolar disorder, schizophrenia, psychosis, mania and catatonia.
— Deep brain stimulation. DBS uses electrodes that can be surgically implanted in targeted areas of the brain to regulate abnormal brain impulses in conditions including OCD.
— Vagus nerve stimulation. Similar to DBS, vagus nerve stimulation uses an implantable device under the skin of the chest to transmit electrical signals from the left vagus nerve to the brainstem, and is approved to treat depression (and epilepsy).
— Light therapy. Treatment using a lightbox that provides bright light to treat seasonal affective disorder, or SAD, is sometimes recommended to improve sleep and mood symptoms.
Psychiatrists may use several forms of talk therapy, often in conjunction with medication, including these:
— Cognitive behavioral therapy. CBT helps patients identify, change and control negative or irrational thoughts and feelings (cognition), and instead use helpful thinking to promote a healthy plan or response (behavior) for mental health disorders like depression or physical problems like chronic pain.
— Dialectical behavioral therapy. A form of CBT, dialectical behavioral therapy includes both individual and group therapy during which patients learn mindfulness techniques to regulate their emotions, cope with distress and interact with others in a healthier way.
— Group therapy. In group therapy, several patients facing similar mental health issues meet regularly with a psychiatrist (or other clinician) to promote coping skills, offer support, reduce stigma and isolation and provide a sounding board of people with similar experiences.
— Psychoanalysis. Treatments like psychoanalysis help patients resolve deep-rooted internal conflicts that are often based on childhood trauma or experiences. However, this time-intensive therapy is used less frequently than in the past, declining by half since the 1990s, according to a study published Dec. 8, 2021, in the American Journal of Psychiatry.
— Mentalization. Mentalization-based therapy encourages people to reflect clearly about their own thoughts, emotional responses, intentions and actions and those of others (mentalizing), and avoid non-mentalizing patterns such as distortion, catastrophizing, generalizing and thinking in negative extremes. It can be particularly helpful for people with personality disorders, Deuter says.
Getting a Diagnosis
If you’re seeing a psychologist or other mental clinician and you realize it’s not working, it may be time to switch over to a psychiatrist for clarity about your individual condition.
“The one thing I would really, really counsel patients and families to do is insist on a diagnosis,” Oquendo says. “It may be that it’s impossible to know what the precise diagnosis is, and that’s true even if you see a psychiatrist.” However, she adds, “The (psychiatrist) might say: Look, my leading diagnosis is a bipolar that is just showing up now with depression (perhaps) because of family history.”
Parents need to know where to go when a child shows signs of a serious emotional problem. “Child psychiatrists very often are treating self-harms or self-harm ideation, or aggression,” Deuter says, “and, sometimes, problems like emotional meltdowns or inability to regulate emotions.”
If your child shows signs of issues like these, it’s better to seek an evaluation sooner rather than later, Oquendo emphasizes.
“With any presentation that happens in childhood, I would strongly recommend starting with a psychiatrist, just because for most conditions that start early on in life, generally it means that the condition is stronger or maybe even more severe,” Oquendo says, while noting that some psychiatric disorders seen in early childhood, like autism, are neurodevelopmental in nature. (Neurodevelopment conditions are lifelong, begin at a very young age or at birth, and may include physical, behavioral and cognitive symptoms.)
“But, for example, if you have a child who is showing symptoms of anxiety or of depression at age 5, 7 or 9, usually those illnesses don’t show up until, on average, at age 15 to 17,” Oquendo says. “So if they’re showing up earlier, it may be that that child has a more severe variant of the illness and you can make a huge difference by getting the symptoms under control earlier. In particular, because if the child is very depressed or anxious, that’s going to interfere with their maturation and their ability to develop skills to cope later on. So, the sooner you can get things under control, the better.”
When Not to See a Psychiatrist
Seeing a psychiatrist is not always indicated. “A psychiatrist is a medical doctor — and some issues don’t require a medical approach,” Deuter says. “For example, if someone is having a parent-child conflict like defiance, I recommend a counseling professional.”
Mental health or emotional situations that may benefit just as much or more by working with a psychologist or other therapist include:
— Stage-of-life crisis. A midlife or quarter-life crisis can churn up emotional turmoil.
— Transitioning to college. Campus mental health counselors are well-versed in helping students cope with related anxiety and stress.
— Major move or career change. Talk therapy helps most when adjusting to big life changes.
— Divorce, marital or relationship problems. Marriage counseling, couples therapy and divorce therapy focus on these issues.
— Relatively mild problems. If you’re experiencing temporary blues or having normal anxiety about a coming event — like a cross-country trip or a first date — prescription medicine likely isn’t the answer.
— Managing general health problems. High blood pressure, diabetes and other common conditions like thyroid disease can sometimes cause mental health symptoms. Once your primary care doctor diagnoses and treats underlying conditions, behavioral and emotional symptoms may resolve.
“One of the concerns that I have is people run pretty quickly, for example, to their primary care doctor when they’re having trouble with their emotional health and get thrown on medication for a normal life stressor,” Deuter says. “If you think about these kinds of things — stress, job loss or job change, relationship problems — it’s probably more helpful to go to a counseling professional who can walk with you and help you wrap your mind around and adapt to those issues than to jump into a medication.”
Issues With Access to Mental Health Care
It can be difficult to find an available, local psychiatrist for a number of reasons. Psychiatrist shortages have been an ongoing issue. By 2030, the supply of adult psychiatrists in the U.S. workforce will have further decreased by 20%, according to Health Resources and Services Administration statistics.
In addition, reimbursements to psychiatrists from insurers are typically quite low, Oquendo says. Some psychiatrists only accept direct pay rather than working with insurers, leaving patients to seek any reimbursement on their own.
“In my local community, there’s easily a two-month wait for cash-pay, unrestricted access — and three to six-months for insurance-based care,” Deuter says. That’s one of the reasons she opened her urgent care clinic: “Because many of those illnesses will get worse during the wait time and will be worse lifelong for that individual due to that two-month or six-month wait for care.”
The National Alliance on Mental Illness suggests these sources for finding a psychiatrist to meet your needs:
— A referral from your primary care doctor or therapist.
— Recommendations from family members or friends living with mental health issues.
— Online directories like the U.S. News doctor finder.
— Checking with medical centers in your area.
— Looking for psychiatric subspecialty websites such as the American Academy of Addiction Psychiatry.
Treatment Time Frame
It may not take too long to see results from psychiatric treatment. “For most common conditions like anxiety disorders and depressive disorders, there is a significant proportion of the population that get better in 12 to 16 weeks,” Oquendo says. “That’s not instantaneous, and it also requires that the person actively participate in the treatment: You’re going to get homework, and you’re going to have to do it.”
Although there’s no magic wand to wave for instant improvement, “people can get better relatively quickly,” Oquendo says. “In the case of medications, people oftentimes start seeing some improvement within three to four weeks.”
Some patients who are responsive to the treatment may see their symptoms resolve with six to 10 weeks, she says. Overall, she adds, “It might take a while, but most people get better.”
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Update 04/26/22: This story was published at an earlier date and has been updated with new information.