My internist is prescribing an antidepressant. How do I know whether to see a specialist or a psychopharmacologist.
A general
practitioner of medicine can often adequately treat depression. There are
situations, however, when a psychiatric consultation should be obtained.
If there are co-morbid conditions such as anxiety or substance abuse,
severe suicidal thinking, or complicated personality issues, a
psychiatrist would be better equipped to manage the antidepressant
treatment. In particular, the psychiatrist may be able to provide more
frequent contacts and have longer sessions than the general practitioner
typically has available. One problem that arises, however, when
depression is treated by a general practitioner is that underdosing of
medication is more common, as well as too short of a duration of
treatment. Certainly if the depression is not responding to a prescribed
treatment, consultation with a specialist is warranted as well.
Some individuals seek the services of a psychopharmacologist. The term
can be somewhat misleading, as it implies a specialty in medication
management of psychiatric conditions. In fact, all general psychiatrists
are adequately trained in pharmacotherapy of mental disorders and need
not be designated as psychopharmacologists. Some psychiatrists restrict
their practice to medication management of mental disorders and thus are
self-described as psychopharmacologists. Psychiatrists are available who
develop more expertise in the management of certain conditions and use of
some medications, by virtue of clinical experience and perhaps research
in academic settings, and thus may take referrals from other
psychiatrists (and mental health clinicians) for more refractory
conditions. In general, however, seeking consultation from a general
psychiatrist is usually appropriate for most emotional problems.
Specialists may be sought within the field of psychiatry for treatment of
children and adolescents (child and adolescent psychiatrist), older
people (geriatric psychiatrist), people who are medically ill
(consultation-liaison psychiatrist), and individuals with substance abuse
(addiction psychiatrist).
