Do I Need to See a Psychiatrist?

By Andrew McNaughton, LCSW, CADC

Symmetry Counseling Chicago

In working with clients in individual psychotherapy, there are times when progress has slowed or become increasingly difficult to sustain. A mentor of mine once told me, “Therapy treats the mind while psychiatry treats the brain.” Psychiatry is the practice of utilizing medical interventions by a MD to treat mood disorders. It is not the same as therapy, as psychiatrists primarily focus on the treatment of symptoms through medication management while therapists are concerned with teaching clients new ways of coping with stressors to manage their mood disorders. 

Do I Need to See a Psychiatrist? And What Should I Expect?

Choosing to speak to a psychiatrist for an evaluation and possible prescription of medication can be a difficult decision. I tell my clients who are sometimes understandably reluctant to talk to a psychiatrist what to expect from an initial psychiatric appointment. A psychiatrist (or psychiatric nurse practitioner who also can prescribe medication) will gather information from a new patient, gaging severity and frequency of adverse symptoms, as well as inquiring about family history and other physical health issues that may be contributing to low moods and energy. If a psychiatrist determines that a new patient could benefit from psychiatric medication, they will often prescribe a medication from the family of Selective Serotonin Reuptake Inhibitors (SSRIs). These are tried and true medications that are proven to reduce symptoms of depression and anxiety. Prescriptions for these types of medications generally start at a low dose. Since it takes most of these medications up to a month to begin benefiting patients but they may carry the risk of adverse side effects, patients begin with low doses.  This is done in order to build up the medication in the brain and body without overwhelming the patient with a high dose. At the same time, the psychiatrist will carefully screen for adverse side effects which may occur. These are the side effects that are rattled off at the end of every pharmaceutical drug television commercial, though side effects are far less common than is generally understood by the public. 

At the follow-up visit, patients are asked if they have any side effects, and if they are tolerable or not. Patients are asked if they are experiencing any relief of symptoms. If the medication is beneficial and the side effects are minimal or tolerable, the psychiatrist will likely increase the dosage to achieve maximum benefit. If the patient is not responding favorably to the medication, the psychiatrist will utilize their medical knowledge to prescribe a different medication. The prescription process tends not to be an exact science, but since it can be imprecise, doctors take care and caution in determining medication types and dosages. 

I often tell my clients who are considering psychiatry to imagine themselves as a football player on the field. Psychiatric medication is like the helmets and pads that players wear to protect themselves from serious injury. Players still feel the blows from contact with opponents, but are not playing unprotected and can recover more quickly from being tackled or knocked down during the course of a play. The protective equipment does not eliminate the hits taken, but makes them more tolerable. This is my metaphor for using psychiatric medication in the course of mental health care.

It should be noted that the therapists at Symmetry Counseling consist of Clinical Social Workers, Professional Counselors, Marriage and Family Therapists, and Psychologists (not Psychiatrists). We are unable to prescribe medication as this is outside the scope of our training, however in our work with individuals, we can make referrals for our clients to seek a consultation with a psychiatrist to consider the possible benefit of medication. We are also able to consult directly with psychiatrists with written consent by our mutual clients.  Regardless of the recommendation we make, the decision to see a psychiatrist and take psychiatric medication is always made by the clients themselves.