November 25, 2010 Psychiatrist vs. Psychologist
Should you see a psychiatrist or a psychologist?
If the symptoms of stress, depression, anxiety and fatigue are seriously impacting your performance and well-being, it’s time to seek professional help. But how do you decide who to see, a psychiatrist of a psychologist?
This article describes the difference between the two, and provides some suggestions for choosing the right specialist for your condition.
What is a psychiatrist?
Let’s start with a definition1:
A psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy. As part of their evaluation of the patient, psychiatrists are one of the few mental health professionals who may prescribe psychiatric medication, conduct physical examinations, order and interpret laboratory tests…
The important thing to note is that a psychiatrist is a medical doctor (M.D.) that is a specialist in mental disorders. She will have gone through four years of medical school, just like your regular doctor1.
A psychiatrist has the power to prescribe psychiatric medications, and can order all manner of laboratory and other tests to help diagnose and treat you.
What can I expect from a psychiatrist?
A psychiatrist can help you select medication to control your symptoms. Although a general practitioner may be able to prescribe certain psychiatric medications, such as antidepressants, he is probably not nearly as experienced as a psychiatrist at prescribing them.
Diagnosing and treating mental disorders is very difficult. Since many of the symptoms are subjective, i.e. you have to describe them to your doctor because there is no test for them, it really takes an experienced specialist to figure out what’s going on and recommend the best treatment.
A good psychiatrist can also help you to deal with the possible side-effects of medication. Since psychiatric drugs can have a strong impact on your mind and body, they might also have some effects that may not be desirable.
A psychiatrist will be familiar with the common side-effects of different medications, and can suggest alternatives for you.
What shouldn’t I expect from a psychiatrist?
Although your psychiatrist has probably received training in psychotherapy, chances are that she doesn’t offer this service. That’s because therapy is really a separate type of treatment that requires its own set of skills and experience. If your psychiatrist does offer therapy, I see no reason not to take advantage of this to maximize your chances of success.
In most cases, your psychiatrist will focus on what your symptoms, such as problems with sleep, appetite, mood, energy, and negative thinking, as well as the severity of these symptoms. This allows her to form a good picture of your illness, and how severely it is affecting your ability to function.
I know you may be dying to have someone to listen to you and take you seriously, and a good psychiatrist should be patient and take the time to listen to you. But there just isn’t enough time to delve into the complicated nature of your thoughts, feelings, and behaviors in the relatively short amount of time you’ll have during your appointment.
Stay focused on describing your symptoms as clearly as possible, and don’t take it personally if your psychiatrist doesn’t appear to show a lot of empathy. It’s not that she doesn’t care, she’s just trying to figure out the best medication for you so you can get better as soon as possible.
I recommend seeing a psychiatrist first
I recommend seeing a psychiatrist first, because you need a proper diagnosis before you can begin treatment. A psychiatrist also has the medical training to determine if your symptoms might be due to something other than mental disorder.
If it turns out that you do have a mental disorder, and the best treatment is medication, you can get started right away with a prescription. It’s possible that the right medication may relieve most of your symptoms.
Assuming you do respond to medication, and are able to eat, sleep, and maybe even do some light exercise, you can start building your energy so you can face the work of recovery.
I do caution you not to expect medication to cure you completely. Depression and anxiety almost always result from stress and lifestyle factors, so it will be necessary to address the sources of stress in your life.
Be prepared to take an honest look at your lifestyle, and make the necessary changes to improve your chances of getting better and staying well.
What’s a psychologist? What do they do?
Psychologists refer to all people who study and apply psychology, the science of mind and behavior3:
Most typically, people encounter psychologists and think of the discipline as involving the work of clinical psychologists or counseling psychologists. While counseling and psychotherapy are common activities for psychologists, these applied fields are just one branch in the larger domain of psychology. Research and teaching comprise a major role among psychologists.
That means not all psychologists are counselors or therapists. A psychologist that practices therapy will have an advanced degree as well as clinical experience conducting therapy with patients.
What is psychotherapy? What kind of psychotherapy should I get?
Psychologists help patients with mental disorders to increase their sense of well-being by employing various forms of psychotherapy.
In general, psychotherapy involves the patient and the therapist gradually forming a trusting relationship, so that the patient can feel comfortable talking freely about his thoughts and feelings.
The goal of therapy is to help a person to better understand his thoughts, feelings, and behaviors, with the goal of resolving problems that are interfering with his ability to live a healthy life.
There are a number of different kinds of therapy, and it isn’t possible to single out one type as the best. One popular type of psychotherapy is called cognitive-behavioral therapy(CBT).
CBT helps a person to become more aware of his thoughts and behaviors and how they influence each other to cause some of the symptoms of mental disorders. It is considered an effective therapy for depression, anxiety, and other mental disorders.
Depression can cause negative thinking, low self esteem, and make it hard to accomplish even basic tasks. Not being able to accomplish tasks can cause further negative thinking and feelings, and so on it goes, causing a person to spiral lower and lower.
CBT trains you to break that cycle and substitute more positive ways of thinking, which will affect how you act. How you act affects how you feel about yourself, thus creating a positive spiral.
There are many other forms of psychotherapy, and one should start off with an open mind. This article from psychologytoday.com takes a look at the effectiveness of various forms of psychotherapy.
Do I need medication or therapy?
In some cases, therapy alone can relieve the symptoms of depression, so that a person can feel well enough to function. In fact, in some studies, therapy has been shown to make as much of change to the structure of the brain as antidepressants4, although the changes are not exactly the same.
The point is, therapy definitely helps, and that help can be seen in brain scans.
The best advice, however, is to combine medication with therapy. Both treatments will help you to cope with life’s pressures in a more positive way.
Since medical treatment can be expensive, you may have to choose to see only one specialist. In that case, it’s best to find out how severe your illness is. Then you can select the most effective and affordable treatment.
Find out how severe your illness is first
Since you really can’t diagnose yourself, go see a psychiatrist first. Tell him everything you can think of about your symptoms.
If your doctor does not suggest it himself, ask to fill out some form of questionnaire, so the doctor can compute a score that describes how severe your illness is. Just ask if you can take a “mood questionnaire” or if there is a way to have your symptoms scored.
It’s easy to forget details about your symptoms once you’re actually sitting in front of the doctor.
Ask the doctor to print out the form for you at the end of each visit, along with any prescriptions. Remember to fill it out before your next appointment, or at least fill it out while you’re waiting to see the doctor.
Therapy might be the way
If your depression turns out to be mild or moderate, that is, you are still able to function for the most part, and you are not suicidal or utterly hopeless, you and your doctor may decide that you don’t need to take medication.
Therapy might be able to help you to sort things out so you can feel better and behave in a way that is consistent with your true self.
It doesn’t mean that you don’t have an illness, by the way, just because therapy is mainly talking. Like I said before, therapy can actually make positive changes to your brain.
Be prepared to be open minded and honest with yourself and your therapist. Therapy is not easy, but addressing your thoughts and feelings will go a long way toward helping you to get well.
Don’t forget about exercise!
Don’t forget that exercise is a powerful and free treatment for depression and anxiety. Some studies have concluded that it just as effective as taking medication5.
When medication is the right choice
If your sleep, appetite, and energy are disrupted to the point that you cannot function and/or you are starting to feel hopeless, you need some sort of intervention to help you get back on your feet. That’s when you will want to consider medication.
I know that taking psychiatric medication carries a very negative stigma. But denial will only delay your recovery, so try to let go of your hangups and make getting well your highest priority.
Selecting medication is far from an exact science. People have their own unique responses to medication, so the only way to find the right one is to give each medication a fair trial. That usually entails taking the medicine for at least a month.
If you really aren’t comfortable with the medication your doctor suggests, don’t be afraid to speak up. Remember: you are the one in charge of your recovery, and you’ve enlisted the help of a psychiatrist to help you.
Your psychiatrist should inform you of the usual responses to a particular medication, as well as the potential side-effects. If he doesn’t, make sure to ask.
You always have the choice to decline treatment, ask for other options, or even switch doctors if you really don’t feel comfortable with the one you are seeing.
I will go into more detail about the process of selecting and trying out medications in a future article. It’s a pretty large topic, but as usual I will try to boil it down to the essential information and action steps.
Whichever way you choose to go, remember that you’ve taken a big step toward feeling better.
Good luck and never give up.
This article from the New York Times Magazine, written by a psychiatrist, gives a candid and sometimes critical view of psychiatry, psychotherapy, and treating mental illness. It’s definitely worth reading.
2 In the UK and Ireland, training is typically longer than in the US or Canada.