Nurse Practitioner vs Psychiatrist?
November 16, 2015 8:53 AM Subscribe
I'm currently going to a nurse practitioner as a substitute for a psychiatrist. The problem is, I sometimes get the feeling that she doesn't understand psychotropic medications well enough to be prescribing them; for example, she didn't know what beta blockers were when I brought them up. What are the differences between a nurse practitioner and psychiatrist? Should I trust the nurse practitioner, or should I make the extra effort to find a full-fledged psychiatrist?
This is what a a psychiatrist has expertise in. Make the extra-effort, it is your well-being!! :)
posted by TRUELOTUS at 9:10 AM on November 16, 2015 [1 favorite]
posted by TRUELOTUS at 9:10 AM on November 16, 2015 [1 favorite]
My experience with nurse practitioners (of which I've seen many over the years, because of how my health insurance is structured) is that they are great with dealing with routine problems but sometimes difficult to deal with if you have a more unusual situation or something they haven't dealt with as much before. I've definitely ended up with some weird recommendations/diagnoses that turned out to be wrong, and once I saw a specialist they were sort of horrified at the path it took to get there. (Sorry to all NPs out there for the generalization - I'm sure this isn't true of everyone - just my personal experience.) Basically, I think if you had a totally standard situation and the first medication you tried worked perfectly for you, an NP might be a great choice for continuing care. But it sounds like you're wanting to adjust your medication or try something different, in which case seeing someone who is more of a specialist is probably a great idea.
posted by rainbowbrite at 9:11 AM on November 16, 2015
posted by rainbowbrite at 9:11 AM on November 16, 2015
Did you bring them up in the context of "I am on beta blockers for a different issue, how might they interact with what you're prescribing?" or "I am interested in beta blockers for anxiety"? Because in my experience prescribers are not that familiar with using beta blockers for anxiety. The resident psychiatrist I saw at a community clinic (of a very excellent hospital) was open to the idea when I asked but seemed doubtful and didn't seem that familiar.
So I guess - I don't think it means your NP is incompetent or anything, but if you want someone particularly skilled with meds because you're having trouble finding the right meds, yeah, she's not your person.
posted by needs more cowbell at 9:13 AM on November 16, 2015 [2 favorites]
So I guess - I don't think it means your NP is incompetent or anything, but if you want someone particularly skilled with meds because you're having trouble finding the right meds, yeah, she's not your person.
posted by needs more cowbell at 9:13 AM on November 16, 2015 [2 favorites]
Depends on how complex your medical conditions are and whether or not they could be contributing to your mental health issues.
I can't speak as much to the nursing side of things, but a psychiatrist will have had four years of college, then four years of medical school, and then four years of psychiatry training, which includes time on the medical wards and in many cases in neurology as well. This means that they are trained to and do routinely order EKGs, blood labs, urinalyses, and review medication lists to ensure that other medications or medical conditions are not contributing to mental health symptoms. (For example, beta blockers, which are often used for anxiety, have also been known to cause depression-- not sure if that's a point covered in nursing school).
If I were being treated for something such as bipolar depression or schizophrenia, and I was getting my medications titrated for the first time, I would definitely want to be seen by a psychiatrist. You don't mess around with antipsychotics or lithium. If you are being treated for first-episode depression or mild anxiety, or if you've been stable on the same medications for years, then I think it would be fine and more cost-effective to have your medications managed by a NP.
posted by gemutlichkeit at 9:45 AM on November 16, 2015 [1 favorite]
I can't speak as much to the nursing side of things, but a psychiatrist will have had four years of college, then four years of medical school, and then four years of psychiatry training, which includes time on the medical wards and in many cases in neurology as well. This means that they are trained to and do routinely order EKGs, blood labs, urinalyses, and review medication lists to ensure that other medications or medical conditions are not contributing to mental health symptoms. (For example, beta blockers, which are often used for anxiety, have also been known to cause depression-- not sure if that's a point covered in nursing school).
If I were being treated for something such as bipolar depression or schizophrenia, and I was getting my medications titrated for the first time, I would definitely want to be seen by a psychiatrist. You don't mess around with antipsychotics or lithium. If you are being treated for first-episode depression or mild anxiety, or if you've been stable on the same medications for years, then I think it would be fine and more cost-effective to have your medications managed by a NP.
posted by gemutlichkeit at 9:45 AM on November 16, 2015 [1 favorite]
This is going to vary wildly. In my own psychiatric health history I had not-great experiences with MDs (two psychiatrists, two years apart) prescribing meds. I finally stumbled upon an NP and now I'm on a regimen that's working for me.
Sounds like you may have gotten a dud but I wouldn't rule out psych NPs all together.
posted by pintapicasso at 10:06 AM on November 16, 2015 [1 favorite]
Sounds like you may have gotten a dud but I wouldn't rule out psych NPs all together.
posted by pintapicasso at 10:06 AM on November 16, 2015 [1 favorite]
I would have some reservations about a psychiatrist or a NP who wasn't at least somewhat familiar with the idea of using beta blockers for anxiety. (If the NP literally didn't know what a beta blocker is, then that's a whole different level of red flag.) I believe beta blockers for anxiety is an off-label use, but I'm pretty sure it's nothing new or super rare. (IANAD, just a taker of psych meds.)
Particularly if one of your reasons for getting treatment is to deal with anxiety, then I think this would be a good enough reason to look elsewhere. I also get the sense from your question that this isn't an isolated incident. Personally, I would be inclined to find a psychiatrist, but if nothing else, I would look for a different NP. Psychopharmacology is definitely both an art and a science, and it's important to feel like you can trust your practitioner to be knowledgeable about these meds.
posted by litera scripta manet at 10:36 AM on November 16, 2015
Particularly if one of your reasons for getting treatment is to deal with anxiety, then I think this would be a good enough reason to look elsewhere. I also get the sense from your question that this isn't an isolated incident. Personally, I would be inclined to find a psychiatrist, but if nothing else, I would look for a different NP. Psychopharmacology is definitely both an art and a science, and it's important to feel like you can trust your practitioner to be knowledgeable about these meds.
posted by litera scripta manet at 10:36 AM on November 16, 2015
As said above, it all depends on the person (medical professional, that is). My own experience is that a psych NP actually listened to me and could see me often enough to adjust my medications effectively, when previously a psych MD would make up their mind and hand me the pills and not have any appointments available for three months. But I know that my psych NP is exceptional, and she works very hard to stay up to date on treatment options and new research. I'm pretty sure that I wouldn't be on my odd cocktail that works if I'd been seeing anyone else.
posted by monopas at 10:51 AM on November 16, 2015
posted by monopas at 10:51 AM on November 16, 2015
This is weird and I would consider finding another provider, although I don't think this is an NP vs. MD issue per se.
As a point of reference, I am three months into a BSN program, have not yet taken pharmacology, and the use of beta blockers both on and off label has already been covered, along with the pathophysiology that explains the rationale for off-label use. This is something that RNs are expected to know, and certainly NPs.
posted by charmcityblues at 11:17 AM on November 16, 2015 [1 favorite]
As a point of reference, I am three months into a BSN program, have not yet taken pharmacology, and the use of beta blockers both on and off label has already been covered, along with the pathophysiology that explains the rationale for off-label use. This is something that RNs are expected to know, and certainly NPs.
posted by charmcityblues at 11:17 AM on November 16, 2015 [1 favorite]
Anecdote - I've known beta blockers were used for anxiety since a friend mentioned getting them for that reason and that's at least 16 years ago. And I am not medically trained at all.
I would find a psychiatrist but I might be biased because you wouldn't see a nurse practitioner for this sort of thing where I live. They do have a heck of a lot more education in psychiatry than any other type of doctor.
posted by kitten magic at 11:53 AM on November 16, 2015
I would find a psychiatrist but I might be biased because you wouldn't see a nurse practitioner for this sort of thing where I live. They do have a heck of a lot more education in psychiatry than any other type of doctor.
posted by kitten magic at 11:53 AM on November 16, 2015
A nurse with any training at all not knowing what beta blockers are is troubling.
See a psychiatrist. I do like nurse practitioners, but a psychiatrist is who you should see.
posted by discopolo at 2:00 PM on November 16, 2015
See a psychiatrist. I do like nurse practitioners, but a psychiatrist is who you should see.
posted by discopolo at 2:00 PM on November 16, 2015
Also, we learned about beta-blockers' off label use for anxiety in my one year LPN program. This is either a huge red flag or a misunderstanding.
posted by pintapicasso at 2:05 PM on November 16, 2015
posted by pintapicasso at 2:05 PM on November 16, 2015
Are you seeing a NP as a matter of convenience, or because you do not have insurance? If you have insurance, be aware that it.covers the cost of seeing a doctor, not just a NP (and this is generally true regardless of what medical issue you are seeking treatment for). In this case it sounds like you may need to insist on seeing a doctor.
posted by vignettist at 5:36 PM on November 16, 2015
posted by vignettist at 5:36 PM on November 16, 2015
NP who works in psych right now - agreeing with those who say you've got a dud. I'm upset -- she should know, and there are a number of medications used for various purposes including neuropsychiatric conditions that aren't necessarily obvious -- but not surprised, given experiences I've had with some of my peers. Then again, two of my collaborating docs will go right at heads regarding a few particular psychotropics and their utility.
If you are also getting talk therapy from this practitioner, or it's a group and it's not a matter of 'switching for a different day of the week', this might be a trickier switch. If she's good at talk therapy, it might be a vestige of her training, as certain programs are going to emphasize certain things.
posted by cobaltnine at 9:37 PM on November 16, 2015
If you are also getting talk therapy from this practitioner, or it's a group and it's not a matter of 'switching for a different day of the week', this might be a trickier switch. If she's good at talk therapy, it might be a vestige of her training, as certain programs are going to emphasize certain things.
posted by cobaltnine at 9:37 PM on November 16, 2015
What are the differences between a nurse practitioner and psychiatrist?
I just want to make sure this is crystal clear, although gemutlichkeit's answer gives a good explanation above.
A nurse practitioner is a nurse with advanced training who is allowed to prescribe medications. They generally get a bachelor's degree plus two to three years of additional training to do this. NPs are likely cheaper and so they may have more time to talk to you as well.
A psychiatrist is a doctor. As gemutlichkeit alluded to, doctors get a bachelor's degree plus EIGHT years of additional training to become psychiatrists. So, it is about twice as many years of training or more.
As you can see, there are huge differences between an NP and a psychiatrist. Personally, if I had psychiatric concerns enough to warrant seeing a mental health professional specifically and not just a primary care provider, I would want a physician. (disclaimer: I am a physician but not a psychiatrist)
posted by treehorn+bunny at 9:10 PM on November 17, 2015
I just want to make sure this is crystal clear, although gemutlichkeit's answer gives a good explanation above.
A nurse practitioner is a nurse with advanced training who is allowed to prescribe medications. They generally get a bachelor's degree plus two to three years of additional training to do this. NPs are likely cheaper and so they may have more time to talk to you as well.
A psychiatrist is a doctor. As gemutlichkeit alluded to, doctors get a bachelor's degree plus EIGHT years of additional training to become psychiatrists. So, it is about twice as many years of training or more.
As you can see, there are huge differences between an NP and a psychiatrist. Personally, if I had psychiatric concerns enough to warrant seeing a mental health professional specifically and not just a primary care provider, I would want a physician. (disclaimer: I am a physician but not a psychiatrist)
posted by treehorn+bunny at 9:10 PM on November 17, 2015
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