Getting medication for your mental health can be daunting. After all, how can you be sure you’ve been prescribed the right meds?
This is an issue that affects so many of us: around 40 million Americans take psychiatric drugs. One in six US adults reported taking one of more psychiatric drugs in 2013, according to Advisory.
It appears this figure is rising — the use of psychotropic [psychiatric] drugs by adult Americans increased 22% between 2001 and 2010, reports the American Psychological Association.
“Psychotropic drugs are valuable tools in treating many mental health disorders, but inappropriate prescribing can cause serious harm,” wrote Brendan L. Smith in a 2012 edition of the APA’s Monitor on Psychology magazine.
So how can we trust we’re being prescribed the right medication, and the right dosage, for our condition?
Who Can Prescribe Mental Health Medication?
First, let’s consider which professionals can legally prescribe medication. According to Mental Health America, this list includes psychiatrists, psychiatric or mental health nurse practitioners, primary care physicians, physician’s assistants, or nurse practitioners (depending on the state).
So your GP can, and and many often do, prescribe medication for mental health conditions and disorders, but it’s important to keep in mind that this may not always be your best option for mental health care and the careful management of your treatment.
Getting Meds Without An Evaluation Can Be Risky
Many people receive psychiatric medication without a full evaluation or diagnosis by someone trained specifically in treating mental illness.“Today, patients often receive psychotropic medications without being evaluated by a mental health professional,” wrote Brendan L. Smith, in reference to a study from 2011 by the Centers for Disease Control and Prevention.
Research published in Psychiatric Services in 2013 found that 58% of individuals who were prescribed a psychotropic medication in 2009 had no psychiatric diagnosis during the year.
But being prescribed drugs before a formal mental health evaluation has been carried out can be “quite risky”, according to psychiatrist Victoria L Dunckley, M.D. “In psychiatry, there is a lot of symptom overlap, so the same symptom can represent more than one disorder, making diagnosis tricky — and increasing the likelihood of the wrong kind of medication being prescribed,” she wrote in Psychology Today.
There’s a shortage of psychiatrists in the US, making it difficult for patients to get an appointment, explains Talkspace therapist Cynthia Catchings, LCSW-S, CFTP, CMHIMP.
As a result, “it is acceptable for a GP to prescribe psychotropic/mental health drugs without an evaluation from a mental health professional, if the specific situation requires it,” she says. “It is a common practice. However, both the GP and the patient must create a follow up/referral plan for the patient to see a psychiatrist and a counselor as soon as possible.”
It’s Better To Get Your Medication From A Psychiatrist
Just because you technically can be prescribed medication by a GP, and just because you can do so without an in-depth evaluation, doesn’t mean you necessarily should. In fact, it’s usually preferable to receive your meds from a psychiatrist.
Why? “A psychiatrist is a doctor that specializes in mental health,” Catchings points out. “As a specialist, this professional has more experience and knowledge in the subject and can better diagnose and prescribe medication.”
This is not at all to disparage general practitioners — GP’s are the primary point of contact for most Americans with the health care system and their contribution is invaluable. However, Catchings points out that “a GP or generalist is familiar with psychiatric illnesses, but does not specialize in treating mental health. For that reason, such illnesses are undetected sometimes and, when detected, are often poorly managed.” It’s simply that their training is rightly broad, wheras a psychiatrist is highly specialized in your mental health and treating it with medication.
As Dunckley wrote in PT, in a GP setting “the patient has a 10 or 15 minute appointment to describe their complaints — compared to a one or two hour session or multiple sessions with a psychiatrist or psychologist. The patient typically wants some action to be taken immediately, and the doctor only knows what the patient tells them. The physician feels pressure to do something to provide some relief, and voila — the patient walks out with a prescription (or two).
Generally speaking, primary care providers do not have the time or the expertise to obtain a really good psychiatric history and complete a thorough assessment.”
Psychiatrists offer an in-depth evaluation
Another advantage in seeing a psychiatrist, is that they will typically carry out an evaluation and a diagnosis, or both, before prescribing any medication, says Catchings. “These professionals have the knowledge and experience to carry out an evaluation and diagnose.”
Good psychiatrists take a patient-focused approach
Psychiatrists are encouraged to take an approach that’s client-centered. They are also encouraged to share their treatment decisions with their clients, as a 2015 report in Social Science & Medicine observed.
The study used field recordings of actual psychiatric visits to “analyse how psychiatrists justify their psychiatric treatment recommendations to clients.” The researchers discovered that psychiatrists use two different types of ‘accounts” (i.e. rationales) for recommending medication. First, they tailor their recommendations to the clients’ concerns and needs; second, they base their recommendations on their professional expertise.
The report concluded: “Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists’ orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship…this study provides an illustration of how caring yet authoritative decisions might look in practice.”
They can also provide valuable insight
Catchings also makes the point that because of their specialist expertise, psychiatrists are able to provide clients with added “insight” into their disorder or condition. (Insight in this context refers to a patient’s judgement of his own illness. A person with schizophrenia, for example, might not understand that their delusions aren’t real — considered impaired insight, or a lack of it altogether.)
“Individuals with medical illnesses do not understand the illness itself, but they know that they are ill and that they will benefit from treatment,” she says. “By contrast, those with psychiatric illnesses often do not recognize that anything is wrong. They don’t think they need help, or they believe there is nothing that can help them.”
“Psychiatrists are well aware of this and for that reason they place more emphasis in how psychiatric illnesses affect the patient and what specific medications may be better for them. Patients’ insight must overcome states of high internal emotion and/or low motivation in the presence of frequently erroneous perceptions. A psychiatrist will take this into consideration and will be able to create a better treatment plan by choosing the right medications for that specific patient.”
Specialist Expertise Is Best
Once they evaluate and diagnose you, a good psychiatrist will also then take the time to explain the various treatments available — including those which do not involve medication, for example cognitive behavioral therapy with a licensed therapist.
“More importantly, he/she/they are going to ask the patient what they think is better for them,” says Catchings. “In some cases, a patient may present symptoms that require the need of an immediate prescription and in other cases the patient can wait and try other interventions. The latter gives both psychiatrist and patient the opportunity to discuss treatment options and make an informed decision.” While your general practitioner is an incredibly valuable resource about almost any issue related to your health, when it comes to your mental health, a full evaluation and proper diagnosis from a psychiatrist is typically considered preferable when possible.