When should you see a psychiatrist?

Seeing a psychiatrist does not mean your problem is severe

Among Persian speakers, seeing a psychiatrist is sometimes tied to the idea of “serious illness”. That idea is not accurate. A psychiatrist is a physician who specialises in mental health, and their assessment helps in many ordinary situations, in the same way that seeing a cardiologist does not mean you have had a heart attack.

The World Health Organization’s mhGAP guide for mental health care stresses that many common disorders, from depression to anxiety, can be identified and treated, and that a timely assessment improves the outcome.

Signs that make a psychiatric assessment useful

None of these is a diagnosis on its own, but each is a good reason to book an assessment:

• Low mood, anxiety or insomnia has lasted more than a few weeks and has not improved with psychotherapy or life changes.
• Work, study, relationships or self-care are noticeably disrupted.
• You take psychiatric medication and have questions about the dose, side effects, interactions or whether to continue.
• You experience marked mood swings, unusual energy with little need for sleep, or experiences such as hearing voices or unusual thoughts.
• You have thoughts of harming yourself or others. This needs urgent assessment; in immediate danger, contact emergency services.
• Your psychotherapist or general practitioner has suggested a specialist assessment.

What clinical guidelines say

The NICE guideline on depression in adults (NG222) recommends psychological interventions as the first option for less severe depression and considers medication mainly for moderate to severe depression or where psychotherapy has not brought enough improvement. The NICE guideline on generalised anxiety and panic disorder (CG113) follows a stepped model too: low-intensity interventions first, then structured psychotherapy or medication.

For many people, then, starting with psychotherapy is reasonable, and a psychiatric assessment becomes relevant when symptoms are severe, the response to treatment is insufficient, or a medication question arises. A meta-analysis in World Psychiatry found that in depression and anxiety disorders, adding psychotherapy to medication gives better results than medication alone; the two paths are not rivals.

What happens in a first session

In a first session the psychiatrist asks about current symptoms, how long they have lasted and how severe they are, physical and mental health history, medications, family history and life circumstances. The outcome can be a recommendation for psychotherapy, further medical investigation, follow-up, or, where appropriate, a discussion of medication options. Prescribing or changing medication depends on the country you live in and the doctor’s professional licence.

Online Persian-speaking psychiatrist on EmotralWhat happens in an online psychiatry session?