Should I see a specialist or a psychopharmacologist?

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).