Should I see a psychiatrist?

A psychiatrist manages medication for mental-health concerns – so they are who you go to for medication prescriptions and for help and support in finding the right medication and dosage.  

A psychologist, on the other hand, is trained to help people better understand and process their experiences. They do not prescribe or manage medications but help their client recognize and manage healthy and unhealthy life experiences, and find practical solutions to their problems.

What to expect

Usually, visits with a psychiatrist are relatively short(15-30 minutes) and happen somewhat infrequently(monthly or several times a year). The psychiatrist needs to know how you react to medications, your overall state of mind, and your medication/treatment history.

They simply need to be professionals who listen to your history, respect your perspective on medications, understand your condition, and listen when you tell them about reactions and symptoms.  

If the psychiatrist works alone, it is possible that you are the only patient in the waiting room, and only one or two others waiting can be a good sign, as it indicates that the psychiatrist tends to stay on or close to schedule.

If they are sharing their waiting room with other practitioners(also a somewhat common practice), you should expect there to be about as many patients as there are doctors and no more than twice as many patients as available doctors.  

Partially due to the social stigma, people can experience anxiety over others knowing they see a psychiatrist, so most psychiatrists are more likely to minimize patients in the waiting room, which decreases the likelihood of their patients meeting one another.

What you want (and don’t want) in a psychiatrist

Your goal with a psychiatrist is to have one who is looking into newer medications to find improved treatments, and who is willing to change your medication after a conversation with you about it.  

They should be respectful of your needs and requests and be able to make sure you have continuity of care.

There are red flags to watch out for – if the psychiatrist exhibits these behaviors, it’s time to consider replacing them.

My Experiences with Psychiatrists – traits to look for, and traits to avoid

I have a life-long history of mental illness.  

I was diagnosed with depression when I was 9 years old.  At that time, I saw a psychiatrist who had multiple child patients.  

His sessions often combined psychological counseling along with medication management.  

I saw him very regularly, and we talked about how I was doing and how I was feeling. Under his care, I took antidepressants into my early teens.  

My first medication worked well, and after several years I was doing well enough that we agreed I could taper off the medication.

Over the course of a year, I decreased my dosage, eventually being medication-free.  He was a thoughtful doctor, and it was a very positive experience.

Red flag 1: Don’t see a doctor who insists your diagnosis is wrong

When I was finally diagnosed with conversion disorder two years after graduating from college, I thought a psychiatrist was a very appropriate next move.  I returned to my previous psychiatrist. 

I explained my situation – that I had conversion disorder(now properly called Functional Neurological Disorder(FND)) and wanted him to manage my antidepressants again. 

He paused for a moment, then started patiently explaining to me that I didn’t have conversion disorder. 

He started telling me about research on ticks, and how I most likely had Lyme disease.  He started suggesting treatment for my (non-existent) Lyme disease. 

After another attempt to clarify that I already had a diagnosis was ignored,  I thanked him politely and did not return to his office. 

I was positive that I had Conversion Disorder, after my experiences and conversation with my neurologist. 

This suggestion of Lyme disease came out of nowhere and didn’t match my symptoms. 

Since he wasn’t willing to accept my conversion diagnosis, I knew that I needed to find somebody new to see.

While he had been the correct choice when I was being treated for depression, his unwillingness to accept my diagnosis was a red flag that I could not ignore.

Red flag #2: Not explaining medications – what they are, how they work, and possible side effects

The psychiatrist I found next kept me on the antidepressants that I’d been prescribed, and at first, was content with that.  

Maybe a month after I started seeing him, I had a bad symptom day when I was going to an appointment by train.

Several people assumed simultaneously that I was having a seizure and tried to hold me down.  I literally ran away from them as the train pulled into my stop. I was pretty upset by the whole thing.

My diagnosis was really new to me, and I hadn’t previously experienced people assuming I didn’t have control over my body.  

Sadly, I know to anticipate that issue now. I ended up communicating with the psychiatrist that day, and I was understandably upset.

He interpreted things slightly differently, and when I saw him next, he prescribed some more medications to me to ‘help you calm down”.  

I didn’t ask enough questions, and accepted his suggestions, as he was my doctor. 

I trusted him.  My experience with him is one of the reasons I no longer automatically trust doctors.

Red Flag #3: Keep your medication under control: don’t allow prescription cascades

Another visit, I mentioned that I was having difficulty sleeping, so he prescribed me medication to help me sleep.  

Another medication I was taking made me sleepy, so he suggested that I take an additional medication that was often used to treat narcolepsy.  I resisted, and he relented on that front.

I realized that I was on four or five different medications, and his solution to any problem I mentioned was to give me more medication.  

I asked him if I really needed to take all that, and he asked if I wanted to go back to the way I’d been before he medicated me.

I should have left then.

At the time, I was not emotionally ready to search for a new psychiatrist, so I stayed with him, though I felt suspicious and concerned about how he was handling things.  

I now know that what he was doing is known as prescription cascades, and it’s a somewhat common practice among psychiatrists.

It is often detrimental to the patient.

When you talk to a psychiatrist, they should listen to how you are doing, what side effects you may be experiencing(if any), and suggesting medication adjustments to aid you in improving your life. 

If each time you leave the office, you are carrying a new prescription for an additional medication (as opposed to changing the dosage or trying a different medication for the same issue), you need to find a new doctor

Red Flag #4, Not discussing side effects: My brush with Tardive dyskinesia

A few months after that, my mother told me that my speech had been getting slurred off and on for the last while, and asked if I had noticed.  

I thought she was criticizing me, but eventually, I realized she was just trying to help.

She told me that sometimes it looked like I was chewing things, and my tongue was moving around in my mouth.  I had no idea what she was talking about.

After she mentioned it, I wondered if it was a new conversion symptom. 

I agreed we needed to explore this further.  She came with me to my next appointment with the psychiatrist and explained her concerns.

He paused, grunted, and told us that it might be tardive dyskinesia, which is a rare side effect of the antipsychotics I was taking. 

What antipsychotic??

The medication to “calm me down” was actually an antipsychotic! (That red flag number 2 I mentioned earlier).  I had diagnoses of depression, anxiety, and conversion disorder.

There was no reason for me to be taking that medication. I asked him what we should do.  He told me to stop taking the medication.

If I had listened to him, the tardive dyskinesia would have become permanent.

Tardive dyskinesia has also been referred to as ‘flycatchers syndrome’. It was a pretty common side effect of many of the older antipsychotics.  

You know those scenes in movies, where somebody is committed, and there are people in the corner with their mouth open at a funny angle, or are drooling all over themselves?  

That’s tardive dyskinesia(except in the cases where it’s heavy sedation). That image isn’t actually a symptom of the person’s mental issues, but is, in fact, a side effect of the medication they were taking. 

That was not a look I needed to be sporting, as it would have been very detrimental to my quality of life.

If you don’t trust your psychiatrist, run their suggestion by a doctor you trust!

The only reason I do not have tardive dyskinesia today is that I mentioned all of this to Dr. Mazzoni before I went off the medication.

 He got really concerned and told me that stopping the medication cold turkey would likely make the condition permanent. He felt so strongly, he told me, that he would write the prescription for the medication himself, and help me taper it down.  

I spent a year very slowly reducing the medication.

I spent months taking pill capsules apart and throwing away some of the powder.

I had friends who occasionally helped me with the medication(my hands were too shaky to be able to do it myself) and shared that they felt like they were coke dealers or something – dividing up the white powder. 

It was inconvenient, made me extra dependent on others, and took up extra time and energy. 

However, it was worth it.

At the end of the year, I had no symptoms of tardive dyskinesia.

I am so grateful that Dr. Mazzoni stopped me from following that psychiatrist’s advice. After that, Dr. Mazzoni managed my medications until he moved halfway across the country.

Dr. Schneider(my current neurologist, who specializes in FND) handles them for me now.  In my case, once I found the right antidepressant I did not need to see a psychiatrist.

More details on side effects

If the doctor does not explain possible side effects and the necessity of consistently taking the medication, you need to move on quickly.  

Psychiatric medication can be very powerful stuff, and the medication is designed to affect how you process thoughts and feelings.

These medications also interact with people’s body chemistry in different ways, so what might be very helpful for one patient could cause another patient with the same condition to have suicidal ideation, or to break out in hives.  

The first time going on psychiatric medication can be stressful, but when the medication is needed, it’s a risk worth taking.

As a patient, you need to be vigilant about your symptoms, and about taking your doses consistently.

The psychiatrist needs to make you aware of effects from suddenly changing or stopping your medication – for some medications, stopping a high dosage can be very dangerous(as I described above), and it is necessary to slowly wean off the medication.  

They might not talk about all the possible side effects(some are very uncommon, and a whole list of possibilities is scary), but if they don’t mention the possibility of side effects, they are likely to be less careful about other aspects of your treatment as well.

Once you have been prescribed a medication, it’s useful to read over the possible side effects(which should always be attached to your prescription when you pick it up) and be aware of what to look for. 

You also want to be sure that all of your medications are at the same pharmacy, so the pharmacists can warn you if there is a risk of interactions between medications you are taking. 

If you shouldn’t know the side effects (hypochondria or other anxiety responses) or are not sure if you will be able to recognize them, have a friend or family member who sees you regularly read that information so they can keep an eye out for those side effects as well. 

This will not only give you peace of mind, it likely will ease some of the concerns your loved ones have about your safety while taking psychiatric medication.

Red flag #5: Beware doctors who insist on prescribing brand name products

This is something I did not experience, but know can happen.  A psychiatrist’s job is, of course, to prescribe medications.

However, they should be agnostic about the brand or have a very specific reason for you to choose one brand over another.  

All older medication has multiple generic forms, which tend to be less expensive.

If your prescription is for the brand name only when there are good generics out there, it might be a sign that he or she is getting some form of kickbacks from the drug company.  

You can find out if generics are available when you fill your prescription by talking to your pharmacist. There’s a box the psychiatrist checks to refuse the option of generics. If he or she is doing so, ask him or her why.

There can be legitimate reasons, like side effects or allergies, but be sure to check.  

If their explanation sounds reasonable, they might be ok.

If they give a poor explanation or keep adding more brand-name medications without giving you the option to go generic, you might want to question their motives and look for a new psychiatrist.

If they are getting kickbacks in some form, they are not prescribing for your best interest, and they are breaking the law.

Should I see a psychiatrist?

For people with more variable or severe mental health concerns, a psychiatrist is often necessary.

They have significant responsibility, and psychiatric medication affects how you think in ways other types of medication generally don’t.

Please, make sure you know exactly what they are giving you, and precisely why.  Your goal is to take the minimum number of necessary medications and to find better medications for the same purpose if the first medication doesn’t serve you well.  

Good psychiatrists are hard to find, and bad ones can do a lot of damage. 

Psychiatric medications are designed to impact how your brain processes information, so it is possible that your judgment itself may be compromised by taking, or by not taking psychiatric medication.

Keep an eye on what they prescribe, and if possible, run anything that feels strange past another doctor you trust(such as your PCP or specialist).  

While other doctors might not know what to prescribe, they should be able to help you judge if what was prescribed makes sense and if there are effects to stopping the medication.

You deserve to find the right doctor for you, and psychiatrists can be very helpful when needed.

Deciding if you need a psychiatrist, and choosing the correct source for psychiatric medication can have severe consequences on your mental health, so it’s worth taking the time to search out the right practitioner for you.