Two many doctors?

July 12, 2007 3:53 PM

Do I need a psychiatrist as well as a psychologist?

A few years ago I was going through some personal crises. Being generally of a depressed and morbid personality anyway, I decided that I had better see a therapist. While I was seeing him, I was also referred to a psychiatrist, who put be on 20mg of Prozac. Well, to make a long story short, I made it through the problems, went off the medication, stopped seeing the therapist.

Fast-forward to today. I'm again having some problems, and also realizing that I perhaps need therapy on a slightly more long-term basis in order to really address some more serious & recurring issues I have. I started seeing a clinical psychologist. I attempted to get an appointment for a psychiatrist as well, but the earliest appointment that I could get is 3 months from now. I asked a friend's father, who is an MD, to write me a prescription for Prozac 20mg since it had seemed to help in conjunction with the therapy previously. He did so, and I'm currently taking the meds w/ no side effects (note, I've been on the generic prozac for about 2 1/2 weeks).

So, my question is, do I need a psychiatrist as well as a psychologist? Or just one or the other? Will a psychiatrist who specializes in my problems give me the same kind of therapy as a clinical psychologist, or are they primarily concerned with the medical & neurological aspects? For long term, do I need one person to deal with the therapy, and one with the meds, or can one person (the psychiatrist) do it all? My previous therapy experience was very brief, only a few months, so I'm not sure what its like being a psychiatric patient long-term. Is it better safe than sorry to see a psychiatrist in case I need to change or go off my medication? The guy who prescribed the meds for me is not my physician, and in fact lives in another state. While he wouldn't have a problem continuing to prescribe them, I'm wondering about ethical issues as well as what's best for me.

And of course, the clincher is that my insurance only covers 20 behavioral health appointments per year, and I can't really afford to pay a lot of out-of-pocket medical expenses.

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posted by anonymous to health & fitness (11 comments total)

The psychologist will let you know if s/he thinks you should see a psychiatrist (as opposed to a GP for medication), and I would go with his or her recommendation. IANApsy, but my mom is a psychologist. She refers patients both to psychiatrists and GPs depending on how complicated their cases are.

If you wanted to switch to just seeing a psychiatrist, I would say that some will be very competent at counseling and see that as their role, and others will just be focused on meds. It depends on the doc.

I think you should mention your financial and prescription concerns to your psychologist and see what they recommend. If you need to see a psychiatrist on a regular basis, I'm sure your psychologist can refer you to a good one who can do long term counseling, and he or she wouldn't be offended if you swapped over.
posted by paddingtonb at 4:30 PM on July 12, 2007

If you're taking medication, you need a psychiatrist.
posted by The World Famous at 4:30 PM on July 12, 2007

The Prozac should start showing good effects pretty soon. If you are not feeling better in 3 months you have a good reason to see the psychiatrist because there are other drugs that might be better for you.

If Prozac worked for you then it will probably work now as well so you can hopefully cancel the appointment before then.
posted by uandt at 4:32 PM on July 12, 2007

If you want talk therapy, see a psychologist or a MSW. A psychiatrist deals mostly with drugs these days.

Further, a psychiatrist is really only necessary if you fail first line drug treatment and you need to experiment with different treatments. I have had a psychiatrist tell me that a treatment that worked before should work again, so that previous treatment that worked should be the first course of action on a second round of treatment. So your first instinct to take the treatment that worked before is probably what a psychiatrist would do. If it works, great. Find an MD in your area to talk to and to handle your meds. That MD should refer you out if your case is too much to handle. If you are doing an office visit for an MD, it may not count as a behavioural health visit for insurance purposes. I am not an insurance agent, I am not your insurance agent, your mileage may vary, talk to your MD, etc - but it may help your insurance dollars go further.

Some people need both a psychiatrist and talk therapy, and some people need only one or the other.
posted by crazycanuck at 4:56 PM on July 12, 2007

Suggestion: a psychopharmacologist...?
posted by kmennie at 4:58 PM on July 12, 2007

If you are doing well on prozac at that low dosage, your primary care MD can prescribe it for you. There is no reason to see a psychiatrist just for that.
posted by madstop1 at 5:23 PM on July 12, 2007

If the prozac is working I don't think you need a psychiatrist. Many, many psychiatrists these days only see you every few months to write prescriptions; if you're getting that from a GP I don't see the point.

If you had a complicated combination of prescriptions a shrink might be better than a GP, but just for prozac? No.
posted by Violet Hour at 5:26 PM on July 12, 2007

A psychiatrist is better able to help you decide on a pharmaceutical plan (which drug, dosage) as well as an outside check and balance progress. Sure you may think it's resolved, but s/he sees you and things you're over/under medicated, etc.

S/he's an expert in the drug and interactions it may have, where your MD (or a psychologist) aren't as focused on staying up to date on drug actions (and interactions.)
posted by filmgeek at 6:10 PM on July 12, 2007

(To expand a bit -- I suggested a psychopharmacologist for the same reasons filmgeek suggests a psychiatrist. The psychopharm is, in my experience, more easily a one-shot deal to review things with, rather than somebody you'd need to see repeatedly.)
posted by kmennie at 6:20 PM on July 12, 2007

i was seeing a psychologist and when it got to a point where i was in need of pharmaceutical assistance just to function, she had me see my GP who wrote out the prescription.

if the prozac worked for you before and you find that it is once again working for you, you most likely do not need a psychiatrist. you sound like you are more in need of the pyschologist to sort yourself out for the long term so use your insurance for that.
posted by violetk at 7:59 PM on July 12, 2007

Just to warm you, a psychiatrist can be much more expensive for counseling. So I would do an hourly comparison up front before you switched over, and find out how many sessions your insurance will pay for each type of professional. Having had both types of counseling, I can't say that the psychiatrist was more helpful, other than in writing me prescriptions. And usually your psychologist will speak with your psychiatrist or doctor, if you give written consent. So it doesn't seem to hurt to have two, as long as they are in communication with each other.
posted by amileighs at 6:55 AM on July 13, 2007