Movies and television shows have long portrayed psychiatrists as essential figures in helping individuals navigate mental health challenges, often depicting their expertise as the key to healing. But in real life, deciding when to seek professional mental health support is anything but simple.
For many, therapy with psychologists or counselors offers valuable guidance, yet there are times when the specialized knowledge of a psychiatrist becomes not just helpful, but essential. Understanding when and why to turn to a psychiatrist can be a crucial step in the journey toward improved mental health.
[READ: How to Find the Right Mental Health Counselor for You]
What Is a Psychiatrist?
A psychiatrist is a medical doctor who specializes in treating mental health conditions.
“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,” explains Dr. Melissa Stennett Deuter, a board-certified 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.
Requirements a psychiatrist must meet are:
— Graduate from medical with an MD or DO degree
— Complete an additional four-year psychiatry residency
— Pass licensing exams
— Obtain certification from the American Board of Psychiatry and Neurology
Many psychiatrists go on to receive additional training and sub-specialize in specific types of mental health conditions or treatments.
[Read: Low-Cost Therapy Options for Every Budget.]
What Conditions Do Psychiatrists Treat?
Psychiatrists treat a wide range of conditions including:
— Obsessive-compulsive disorder (OCD)
— Post-traumatic stress disorder (PTSD)
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 as quickly as possible.
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 see a psychiatrist,” Deuter says.
[READ How to Choose an Online Therapist]
Who Provides Mental Health Evaluation
Psychiatrists are trained differently than other mental health providers, such as psychologists or clinical social workers.
“One of the key things driving that decision is the fact that many, if not all, psychiatric conditions have a strong biological basis,” says Dr. Maria Oquendo, professor and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania and vice president of the American Foundation for Suicide Prevention. “Psychologists are very well-trained to understand the psychological aspects, but are not biologically trained.”
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 and other imaging scans that may reveal tumors or abnormalities.
“Clinicians who are trained as mental health nurse practitioners do have a biological background and if the condition is not super-complex, they’re a very reasonable first approach,” Oquendo says.
However, she adds, it may be best to see a psychiatrist, especially if it’s a complex situation that involves multiple diagnoses or a complex psychosis.
What Psychiatrists Offer
Psychiatrists first and foremost approach the diagnosis and treatment of mental health conditions from a medical perspective. They use this perspective to help guide treatment based on a patient’s specific needs, using different approaches to help find what works best. The two most common treatments for mental health conditions that psychiatrists provide are:
Medications
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. Psychotropic drugs are medications that affect brain function, mood, emotions, thoughts and behavior by altering neurotransmitter activity. Common types include:
— Antidepressants. Medications used to treat depression and anxiety (SSRIs like Prozac and Zoloft)
— Antipsychotics. Drugs for the management of conditions like schizophrenia and bipolar disorder (Risperdal, Abilify)
— Anxiolytics (anti-anxiety medications). Reduce anxiety and panic (Xanax, Ativan)
— Mood stabilizers. Help with bipolar disorder (Lithium, Lamictal)
— Stimulants. Used for ADHD (Adderall, Ritalin)
A psychiatrist prescribes the medication they feel will likely help you the most, but it isn’t an exact science. No two people have the same biochemistry, and what works for one person may not be as effective for another. The psychiatrist will work with you to adjust doses or change medications if necessary.
Some 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.
Talk therapy
Some psychiatrists do offer different forms of talk therapy along with medication management, but people can also see a psychologist, clinical social worker or counselor for talk therapy. Different types of talk therapy include:
— Cognitive behavioral therapy (CBT). CBT focuses on the connection between thoughts, emotions and actions, teaching patients practical strategies to manage stress, anxiety, depression and other mental health challenges. It involves learning coping skills, problem-solving techniques and behavioral modifications to promote healthier thinking and improve overall well-being.
— Dialectical behavioral therapy (DBT). 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 while providing support and a sounding board of people with similar experiences.
— 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.
Device-based treatments such as transcranial magnetic stimulation or vagus nerve stimulation for issues such as treatment-resistant depression are typically prescribed and administered by specialized medical professionals, including psychiatrists and neurosurgeons, that have expertise in neuromodulation and psychiatric disorders. Not all psychiatrists provide these treatments, however. They are typically used when medications and psychotherapy have not been effective.
For more extreme cases of mental illness and especially when suicide is a possibility, psychiatrists can admit patients to psychiatric hospitals or inpatient programs.
Getting a Diagnosis
If you’re seeing a psychologist or other mental health 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.”
Child Psychiatrists
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 as well as emotional meltdowns or inability to regulate emotions,” Deuter says.
If your child shows signs of these issues, it’s better to seek an evaluation sooner rather than later.
“If you have a child who is showing symptoms of anxiety or depression at age 5, 7 or 9, usually those illnesses don’t show up until, on average, at age 15 to 17,” Oquendo says. “If they’re showing up earlier, it may be that the 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 recommended.
“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:
— Divorce, marital or relationship problems. Marriage counseling, couples therapy and divorce therapy focus on these issues.
— Major move or career change. Talk therapy helps most when adjusting to big life changes.
— 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.
— 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.
— 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.
“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 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 for that individual due to that extended 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.
— Checking with medical centers in your area.
— Looking for psychiatric subspecialty websites such as the American Academy of Addiction Psychiatry.
— Online directories like the U.S. News doctor finder.
— Recommendations from family members or friends living with mental health issues.
Treatment Time Frame
Every case is different so it’s hard to know when to expect 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 with the proper treatment.
“In the case of medications, people oftentimes start seeing some improvement within three to four weeks,” Oquendo says.”It might take a while, but most people will get better.”
Some patients who are responsive to the treatment may see their symptoms resolve within six to 10 weeks.
Bottom Line
A psychiatrist is a medical doctor specializing in mental health. They diagnose mental health disorders and prescribe medication, and some also provide or recommend talk therapy, lifestyle changes and other treatments for a well-rounded approach to care. In situations where talk therapy is the only necessary treatment, seeing a psychologist, clinical social worker or other therapist may be enough.
If your treatment with a psychologist or other mental health professional isn’t giving you the results you want, seeing a psychiatrist may provide a clearer understanding of your condition and give you access to additional treatment options such as medications. Seeking psychiatric care can be a life-changing step toward improved mental health, stability and a higher quality of life.
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When to See a Psychiatrist originally appeared on usnews.com
Update 03/31/25: This story was published at an earlier date and has been updated with new information.
