Reddit is most known for holding AMAs, but I'd like to open it up here on OOTify.
I'm a psychiatrist who's trained in multiple types of therapy, uses medication.
Post ANY question you'd like below, and I'll answer below or in a follow-up post.
I'll start things off below with a couple of frequently asked questions I've gotten.
1. What's the difference between a psychiatrist and a psychologist or a therapist?
A. A psychiatrist is a physician first. They go to medical school and then do a residency. Just as a surgeon goes to medical school then does a residency to specialize in surgery, a psychiatrist goes to medical school then does specialty training in the brain and mental health. They prescribe medications for problems and can do therapy.
A psychologist does a Ph.D. (or Psy.D), training only in mental health and focusing more in therapy and research/statistics.
A therapist is anyone that is licensed to do therapy, which can be someone with a Masters (MFT, MSW, LPCC) or any of the above who can do therapy too.
2. Does a psychiatrist even do therapy?
It varies. Originally most therapy was done by psychiatrists, but slowly they started doing more and more medication prescribing and less therapy. For some time, new psychiatrists weren't trained at all in therapy. There are still some psychiatrists that do therapy (and meds), but they're not super common. I trained in seven kinds of therapy, and train psychiatry residents to be better therapists.
Hey Paul- I was wondering how you determine whether someone is in need of medication vs. another intervention (therapy, spiritual/religious intervention, etc.)? It seems we live in a world (especially in the West) that is very quick to seek and prescribe pills as remedies for problems even though they sometimes just make the problem worse. In your practice, how do you determine if medicine is the optimal course of action?
Great question, Sahil. The field of mental health turned much more towards medicating problems in the 90s, as SSRIs really took hold as a low cost, low risk intervention. So psychiatrists started getting paid more for prescribing medications, and meds were viewed as more cost effective than therapy, though I'm not certain that actually maps out in reality. What this has led to is that most psychiatrists default to prescribing medications because that's what they're most trained in.
Personally I use it as a tool. It's available for the patient if they choose to try it. It's the first line IMO if someone has severe depression -- if they're suicidal, or if their depression is putting them at risk of losing their job or something else. In these severe cases, I recommend working more aggressively. For some people in a severe depression, therapy sometimes doesn't take hold as easily because the person is too depressed to fully participate. So I recommend it to get them out of the rut, to get some momentum, and then make whatever other changes are necessary to improve their life.
But it has to be something they want. Some people, by philosophy, don't want medications. I try to respect that, but do mention that therapy may not be fully available for them, and choosing to take a medication now isn't a permanent choice.
Other people want the quickest fix possible. I'll use medications with them, but still nudge them to do some therapy so they can gain some skills and help them prevent relapsing.
IMO medications don't usually make problems worse, but they can open up new problems due to their side effects. I often hear that people are afraid of antidepressants "because I don't want to feel like a zombie." I tell them that at high doses, usually not regular doses, they can just feel "stuck in a good mood." Which is uncomfortable if you can't access the emotions you're used to (like crying at a sad movie). But this won't necessarily happen, and if it does it's reversible by lowering the dose or stopping the med. So that shouldn't limit someone from trying something that might help.
Therapy can also scare people, because they're delving into issues that might feel loaded, too emotional, or scary. The fear of it, though, shouldn't limit one from exploring it.
This was very insightful Paul- interesting to see things from your perspective. Thank you!