Frequently Asked Questions About Mental Disorders
Dennis B. Kottler, MD
Westlake Village, CA
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1. Is depression (anxiety, etc.) a mental disorder or chemical imbalance?
Mental disorders, like all mental activity in general, involves physical and chemical processes in the brain. Although cognitive and behavioral states are experienced by a conscious person, these experiences would not exist were it not for the underlying chemistry. When there is a clinical psychiatric problem it is therefore a result of some alteration in the "normal" chemistry.
2. When is it necessary to use medication to treat a mental disorder?
This is a decision left to the judgment of a trained professional, and not all professionals would necessarily agree on a threshold for using medication. Certainly, one factor to consider is the severity and duration of the disturbance. Another factor concerns whether there are effective medications to treat the particular mental disorder. In many cases a combination of some form of psychotherapy and medication can be the most powerful intervention. In other cases psychotherapy alone can be very effective. It is impossible to generalize an answer to this question.
3. How long do I need to be on medication?
Again, as with most of these questions, there is no simple answer or formula. Each situation is different. The psychiatrist must carefully and continuously evaluate the patient regarding the efficacy and continuing need for a given medication and whether a change in medication or dosage is necessary. In general, it is not advisable to discontinue a medication as soon as symptoms have abated. Thus, for example, in treating a major depressive disorder, it is customary to continue an antidepressant for six months to one year. Of course individual circumstances may vary and, in some cases, medication may need to be continued considerably longer. The same considerations hold true for anxiety disorders. Some psychiatric disorders, such as bipolar disorder, may necessitate a indefinite course of mood stabilizing medication to prevent recurrence of the disorder. However, even in these cases there are exceptions. In the case of some long-term conditions, such as obsessive-compulsive disorder, after a period of combination therapy (medication and behavioral therapy), the behavioral treatment alone may suffice to keep symptoms at bay. Again, each situation is different and sometimes it is only through an empirical approach that the "correct" medication course can be determined.
4. How is a psychiatrist different from other mental health providers?
A psychiatrist is a medical doctor (MD) who has received training in all aspects of medicine, not just psychiatric disorders. A psychiatrist is trained in the proper use of medication and has received extensive training, in a residency program, in diagnosing and treating a wide range of psychiatric disorders. In addition, many psychiatrists, are also excellent psychotherapists.
5. Doesn't a psychiatrist just manage medications?
Many psychiatrists are excellent psychotherapists as well as psychopharmacologists. However, some psychiatrists do prefer focusing on the medication aspects of a problem. This is a very important question to ask the psychiatrist prior to starting treatment.
6. Will my insurance cover a mental disorder?
There is no way to know this without contacting the insurance company and asking very specific questions about the coverage available.
7. What are some useful articles (or books) I can read regarding various mental disorders?
Please see the list of suggested readings at: Summary of Suggested Readings
8. How do I know if my psychiatrist is well-qualified and the right person for me?
In addition to technical competence a psychiatrist must be able to establish a relationship of trust with his patient. The technical part is often easier to ascertain. Such things as educational background, board certification, type of practice, years of experience, treatment modalities offered, and current professional activity give indications of a psychiatrist's technical expertise. However, it is also important to establish that the psychiatrist has had sufficient experience in treating the type of problem in question....e.g., anxiety disorder, obsessive-compulsive disorder, depression, etc. The comfort level a patient might feel with a given psychiatrist is a more complex consideration. Sex and age of the psychiatrist are common factors in either direction. Before, deciding that a therapeutic relationship is impossible, the patient should attempt to explore with the psychiatrist the factors that obstruct this relationship. Sometimes such an exploration gets to the very heart of the patient's "core" problem. A good psychiatrist will guide the patient in this process. Sometimes the problem is a strong, instant negative transference, a carry over from the patient's earlier family relationships. The fact that this recurs in the therapeutic setting is usually a positive, since it allows therapeutic work to be done in this area.
9. Should I see a male or a female psychiatrist?
There is of course no rule regarding gender of the psychiatrist. This is a personal choice of the patient. However, frequently a strong preference for a particular gender masks a conflict the patient may have from the past. This can only be ascertained by persisting in a therapeutic relationship even if it is sometimes uncomfortable. A good psychiatrist will help the patient explore this gender issue further.
Note: Look for other Frequently Asked Questions to be posted in the future.
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