All primary care providers, including doctors, nurse practitioners and physician’s assistants, can diagnose mental health conditions and prescribe medication. But since mental health can be complicated, your doctor might recommend you see a psychiatrist for treatment.
Not quite sure where to start? Here’s what you need to know about whom to see about medication for mental health, whether you think you might need to start taking something or you need help managing medication you’re already taking.
When to use a PCP for mental health medication
If you think you need medication for a mental health condition and aren’t sure where to turn, you can always start with a visit to your primary care provider (PCP), says Dr. Cliff Hamilton, a psychiatrist with Summit Health in New Providence, New Jersey.
PCPs are generalists, but they typically have enough mental health–specific training to recognize, diagnose and treat common issues. Depression and anxiety, for instance, are well within most PCPs’ wheelhouses, says Dr. Nathan Kakish, an internal medicine and pediatrics physician at Northwestern Medicine McHenry Hospital in McHenry, Illinois.
Starting with a PCP has a few benefits. For one, they already know your medical history, which means they might think of potential underlying causes before making a mental health diagnosis. Say you go to the doctor because you’ve been anxious or moody; your PCP might run lab tests to rule out other medical issues that can cause those symptoms, such as thyroid dysfunction, rheumatological disorders, low vitamin D levels and anemia, before prescribing an anti-anxiety medication or antidepressant.
Being familiar with your health history can also help your PCP avoid prescribing drugs that might interfere with existing medical problems. For example, the antidepressant Cymbalta can cause increased bruising and bleeding, which isn’t ideal for a patient on a blood thinner. Cymbalta can also affect blood pressure, so a PCP would take high or low blood pressure diagnoses into account before prescribing it. That’s not to say a psychiatrist won’t look at the full picture, but it might be easier (and faster) to land on the ideal treatment when you don’t need to reconstruct your personal health history for a new provider.
Another PCP-specific benefit: Most screen patients for anxiety and depression at routine visits, so your doctor might even catch your anxiety or depression diagnosis before you notice symptoms.
When to see a psychiatrist
Psychiatrists are medical doctors who specialize in diagnosing and treating mental illnesses. There may be instances where a PCP decides a psychiatrist is the right provider for a given situation or patient.
Kakish says if he tries two or three medications and the patient doesn’t improve, or if the patient experiences debilitating side effects, he considers involving a specialist. Or, if he’s running out of medications he feels comfortable prescribing, due to a patient’s allergies or pre-existing conditions, Kakish might recommend seeing a psychiatrist instead. “Many times, psychiatrists can find an equivalent medication that will avoid complications or unwanted side effects,” he says.
Acute anti-anxiety meds might warrant psychiatrist involvement, too. Kakish says PCPs sometimes prescribe fast-acting benzodiazepines (e.g., Xanax) as a “bridge treatment” until drugs that need time to build up start working. If you’re relying on benzos to manage anxiety symptoms, your PCP might refer you to a psychiatrist to develop a long-term treatment plan.
Psychiatrists might also be best equipped to handle issues that are complex to treat, says Hamilton. Bipolar disorder, schizophrenia and personality disorders, for example, often involve several drugs with potentially significant side effects. Figuring out the right medication combo can take trial and error, and might require specialized knowledge of mental health disorders.
In addition to managing medication, Hamilton says psychiatrists specialize in recommending lifestyle changes — diet, sleep, exercise — tailored to a patient’s diagnosis and symptoms. Your psychiatrist can also refer you to a psychotherapist for behavioral treatment.
How to see a psychiatrist
While a PCP should be able to refer you to a psychiatrist, many don’t require referrals anymore. You may not need to see a PCP first if you’d rather go straight to a psychiatrist.
It’s worth noting that many psychiatrists don’t accept insurance. You can talk to the provider and/or your insurance company to figure out your payment options. For example, if you have out-of-network coverage, your insurance plan might reimburse you for part of the cost of treatment. (This guide to paying for therapy has info on psychiatry visits.)
If you can’t get an appointment with a psychiatrist right away and feel like you’re struggling, your PCP should do their best to make sure you have the care you need. If outpatient psychiatric care isn’t an immediate option for a patient, Kakish says, he’ll consult with a psychiatrist on what to prescribe and how to manage their condition until an opening arises. If you need acute care for issues like self-harm or suicidal ideation, a PCP would recommend in-patient treatment to stabilize your symptoms and keep you safe. Your PCP might also recommend psychotherapy and connect you with community resources and social support.
When you do see a psychiatrist, it might be on a short-term basis — depending on factors like your condition, treatment plan and your PCP’s level of comfort with long-term medication management. Once you stabilize (Hamilton says he looks for patients to feel better I. anywhere from six to 12 months), your psychiatrist might suggest continuing to see them for check-in visits or returning to your PCP until another acute need arises. Either way, your doctors will work together to improve your wellbeing. “Our goal is to get the patient on a better trajectory,” he says.