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Is It Good Enough to Go to Your Doctor or Do You Need to See a Psychiatrist? Our Decision-Making Guide

Is It Good Enough to Go to Your Doctor or Do You Need to See a Psychiatrist? Our Decision-Making Guide

If you're taking or want to take medication for your mental health, it can be hard to know where to go. Maybe you've been taking the same medication for years and aren't sure if it's working as well as it should. Maybe you've been on the fence about whether to try medication. But you know you need help. And you need to trust that the person you go to for help is the right person. Is your primary care physician the right person for the job, or do you need to see a psychiatrist?

 

As with so many things in mental health, the answer to that question is "It depends." It depends on whether you've taken medication before, on which symptoms you want to treat, and on your personal preferences. The simplest answer is to trust your gut—if you feel good starting with your primary care physician (PCP), that's probably where you should start, and if you prefer starting with a psychiatrist, that is probably the right choice for you.

 

But if you're still not sure, you can use this article as your decision-making guide. Answering the following seven questions will give you the information you need to make a decision. Read on to learn when a primary care doctor is the best choice and when a psychiatrist is the better option.



Have You Been in Treatment Before or Will This Be Your First Time?

 

If you've never had mental health treatment before, your primary care physician's office is often the best place to start your journey.

 

First, it's less intimidating to go to your doctor's office than to go to a mental health clinic. Second, if you have a good relationship with your doctor, it's probably easier to talk to them than to reach out to someone you've never talked to before.

 

And, finally, if you haven't yet learned through trial and error what does and doesn't work for you, it makes sense to start with the most straightforward options and medications—which are also likely the ones your PCP will be more comfortable prescribing.

 

On the other hand, if you've been through treatment before, you probably already know a little more about what works for you and what you want. In this case, it can still be a good choice to go to your PCP, especially if they were the one who treated you before and if that treatment was at least somewhat successful.

 

But it might make more sense to see a psychiatrist at this point, especially if your first attempt with a PCP wasn't very successful. Primary care doctors have less specialized training in mental health than psychiatrists, and they aren't always comfortable making clinical judgement calls about psychiatric treatment when their patients want to go beyond the basics.

 



Are You Sure You Want to Take Medication or Are You Still Deciding?

 

If you're sure you want to take medication, it makes more sense to start with a PCP than if you're not sure whether medication is right for you. While primary care doctors use many tools, medication is often their primary clinical tool and it is likely to be the first thing they recommend. All PCPs have some training in mental health, but most lack the level of specialized training to know when a patient is less likely to respond to medication.

 

Psychiatrists specialize in medication-based treatment, but they are more familiar with the full array of mental health treatment options than most PCPs and may even be able to provide some of those options directly. Due to high patient volumes and the changing nature of the mental health field, fewer psychiatrists provide therapy today than in the past—but some still do.

 

Even when psychiatrists don't offer therapy, they can usually recognize when it would be helpful instead of or in addition to medication. They also have more specialized knowledge about which kinds of therapists or therapy methods work best based on a patient's specific needs. In many cases, they can refer you to a therapist they personally recommend.

 

While we always recommend seeing a professional for help with decisions like this, we also recommend reading our article on "Therapy vs. Medication" for more guidance if you're not sure whether medication or therapy is the better choice for you.

 

And if you already know you want to do therapy instead of medication, it makes more sense to start with a therapist than a psychiatrist or PCP. You can use the tools on our site like our directory to help find an affordable therapist near you.

 


How Urgently Are You Wanting or Needing to Start Treatment?

 

If you need to start treatment right away, your best choice will most likely be your PCP. This is true even if your answers to the other questions in this guide suggest that a psychiatrist might be a better choice. Even though primary care practices can also have waiting lists, the wait times to see a PCP are nearly always shorter than the wait times to see a psychiatrist.

 

There is a severe psychiatrist shortage in the United States, and it can take several months to get an appointment with one—if they're even taking new patients at all. It can still be worth it to check in case a local psychiatrist does have an opening, but in most cases, you'll see a PCP a lot faster than you'll get in to see a psychiatrist. And we think it's much better to get started with a PCP, even if they ultimately refer you to a psychiatrist, than to wait to get help until you're in crisis.

 

If you already are in crisis, don't wait for an appointment with a psychiatrist or a PCP—reach out for help immediately. By calling a national crisis line or a local crisis line, you can connect with caring professionals who can help you get the care you need right away.

 


How Severe Are Your Mental Health Symptoms or Issues?

 

If your mental health symptoms are mild, it's easier to get all of your needs met by your primary care doctor. Mild to moderate depression and anxiety are among the most common mental health issues that Americans face, and many primary care doctors are already treating them.

 

Most PCPs are at least somewhat familiar with these conditions and the medications for them. Many patients never need or want more than the antidepressant or anti-anxiety medication their PCP prescribes for them.

 

However, if your symptoms are complex or severe, you're more likely to need a psychiatrist. If you're experiencing any of the following, you need a higher level of care than your PCP can offer:

 

  • Hallucinations,
  • Manic episodes,
  • Suicidal thoughts,
  • Severe panic attacks, or
  • Dissociative episodes.

 

You also probably need to go to a psychiatrist or other mental health specialist if you are experiencing any combination of symptoms that is making it hard for you to function normally in your daily life. You may need emergency care (don't wait to see an outpatient provider if you're in crisis—call a crisis line for immediate help) or you may simply need a psychiatrist who can adjust your medications until your symptoms are under control.

 

People with severe mental health conditions often have to try more than one medication, have their dosage adjusted several times, or take multiple medications for their symptoms to be fully addressed. A psychiatrist has the expertise to make these adjustments and to address any side effects your medications may cause.

 


What Kind of Symptoms or Issues Do You Want to Treat?

 

Not every mental health condition can be effectively treated with medication. Depression and anxiety usually respond pretty well to medications that most doctors know and feel comfortable prescribing. Psychotic disorders also respond well to medication, but often require more trial and error to effectively treat than depression or anxiety. (This can vary depending on personal factors; for example, some people have treatment-resistant depression that requires a lot of experimentation to successfully treat.)

 

On the other hand, it's harder to effectively treat trauma-related conditions like post-traumatic stress disorder and borderline personality disorder with medication alone. Medications can address some symptoms of these conditions, but not the underlying trauma, which nearly always requires therapy to treat. Similarly, substance use disorders (especially alcohol and opioid use disorders) can be partially treated with medication, but usually also require therapy to fully treat.

 

So, in most cases, if you have anything other than mild to moderate anxiety or depression, you're less likely to be able to get effective treatment from your PCP. Whether a psychiatrist is a good choice will depend on whether you have symptoms that can be addressed by medication and want to address them that way. Therapy alone can effectively treat a wide range of mental health conditions, and it's just as viable to start with a therapist and then go to a PCP or psychiatrist as it is to do it the other way around.

 


Do You Have Co-Occurring Physical and Mental Health Issues?

 

Mental health conditions don't just stay in our heads. They affect our bodies, too. They can cause or worsen physical health conditions and can even primarily manifest as physical problems. Anxiety can cause chronic stress that affects the heart. Depression can affect gut health. Many mental health conditions impact your energy level, immune system, or ability to care for yourself.

 

You're unlikely to make progress in the treatment of a mental health condition if it's connected to a physical issue that's not also being treated—and vice versa. Because of this, more doctors are realizing that they have to learn how to treat mental health issues on some level to be able to successfully treat their patients' physical health concerns.

 

And treating both mental and physical health at the same time is way more efficient and effective than treating either in isolation. For example, if your depression is affecting your digestion, or if chronic stomach discomfort is making your depression worse, you probably won't improve your depression until you improve your gastrointestinal health (and vice versa).

 

So, if your primary concern is physical, or if both mental and physical symptoms are affecting your well-being, it makes more sense to start with your PCP.

 


Is Your Primary Care Clinic an Integrated Clinic?

 

Primary care doctors are already treating their patients' mental health conditions by default. According to the Yale Journal of Biology and Medicine, they prescribe nearly 80 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States. They also frequently see and treat people with anxiety disorders.

 

However, while PCPs are trained in mental health in medical school, they lack the same expertise in mental health that a mental health specialist has. This means many PCPs are uncomfortable helping patients with more complex or severe mental health issues.

 

However, a new trend in healthcare called primary care integration is making it easier to get specialized mental health services at a primary care doctor's office. Different ways to achieve mental health integration in primary care include:

 

  • Embedding mental health specialists in primary care clinics,
  • Setting up telehealth rooms in primary care clinics where patients can receive mental health services from a remote clinician, or
  • Adding psychiatrists to the primary care team and having primary care doctors regularly consult and collaborate with them, whether remotely or on-site.

 

Teaming up with psychiatrists and other mental health specialists allows primary care doctors to help clients with more complicated issues than they would normally be able to treat. These specialists can coach them and provide advice or even see these patients face-to-face.

 

What this means for you is that if you go to an integrated clinic with a psychiatrist on staff, you can benefit from the expertise of a psychiatrist without having to wait months to see one. It also means you don't have to pay out-of-pocket to see a psychiatrist that doesn't accept insurance.

 

In some cases, you can even get therapy at an integrated primary care clinic. (Read our article on integrated mental health care for more information on how therapy in integrated primary care works and to find out how to locate your nearest integrated primary care clinic.)

 

So, if your primary care clinic offers integrated mental health care, or if you have an integrated primary care clinic near you, we strongly encourage you to go! It may end up being a better option than either an independent psychiatrist (who might have a long waitlist, not accept insurance, or not even be accepting new patients) or a primary care clinic that doesn't offer integrated care.

 


Conclusion

 

Both primary care physicians and psychiatrists can prescribe psychiatric medication. In general, going to your PCP to get mental health medication is a good choice when:

 

  • You have mild to moderate mental health issues or symptoms,
  • Your mental health issues affect how you feel but you're still functioning fairly well,
  • You have mental and physical health issues that need to be treated at the same time for treatment to be effective,
  • You have anxiety or depression, have never had mental health treatment before, and you want to try medication first, or
  • You want to get started on your recovery soon and can't find a psychiatrist who is taking new patients or who doesn't have a long waiting list.

 

On the other hand, it's probably a better choice to see a psychiatrist if:

 

  • You have complicated, severe, or co-occurring mental health conditions,
  • You've received mental health treatment from a PCP before and it didn't work that well,
  • You've had treatment that worked before, but it required taking multiple medications or making multiple medication adjustments,
  • Your mental health issues have worsened to the point that you are having trouble functioning at work or home, or
  • You are experiencing severe symptoms like hallucinations, suicidal thoughts, severe mania, or dissociative episodes.

 

If your symptoms or issues are severe enough to put you (or others) at immediate risk of harm, don't wait to see a psychiatrist or any other outpatient provider—go to a hospital or call a national crisis line or local crisis line right away. But if you're not at immediate risk, it can be worth the wait to see a psychiatrist when you have more severe and complex mental health issues.

 

That said, all journeys start somewhere, and a primary care clinic is a good place to start. It's often easier to get in to see a PCP than a mental health specialist. An increasing number of primary care doctors are offering integrated care and learning more about mental health so they can make better recommendations and referrals when you need a higher level of care than they offer.

 

So, yes, if you want to try medication, think you need the level of care a psychiatrist offers, and one is available to see you (and affordable), you should start there. But if you can't get in to see a psychiatrist, and are not in immediate risk or crisis, start where you can and talk to your PCP.

 

If you are open to trying therapy or know you want to do both therapy and medication, you can also try starting out with a therapist while waiting to see a doctor. If you think you'd like to see a therapist first, you can:

 

 

Whatever you do, reach out—the care you need might only be a call or click away.



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Stephanie Hairston, MSW
Posted on 06/21/2021 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.