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What is Psychiatry?

By Deb Kiehlmeier, MD

Psychiatry is the medical specialty devoted to the diagnosis and treatment of mental disorders. Psychiatrists are physicians who complete medical school and then spend four years in residency, where they train in psychiatry. Psychiatrists are capable of diagnosing and treating mental disorders. They do this in many settings, including but not limited to hospitals and clinics. They will recommend (or not recommend) specific psychotropic medications based on their assessments. They also can utilize other treatments, such as ECT (electroconvulsive therapy) or TMS (transcranial magnetic stimulation). Every psychiatrist receives psychotherapy training as well. 

How does a psychiatrist differ from a therapist or psychologist? What are the similarities and differences? How do you know someone needs to be seen by a psychiatrist?

Although all psychiatrists have training in psychotherapy, many choose not to practice psychotherapy after completely their residency training. Generally, if someone wants therapy, they will end up seeing an LCSW or a psychologist (usually PsyD). These are two degrees that show extensive psychotherapy training for someone who intends on only doing that. If someone’s mental health is suffering due to social stressors, starting by seeing a therapist would be the best approach. If someone is still struggling with depression or anxiety, they should initially see their primary care physician to be started on medication. If they fail a medication trial, it may be time to see a psychiatrist. More serious issues, like mania or psychosis, can only be managed with medication and this should always be done by a psychiatrist. Other disorders (e.g. ADHD) may need to be managed by a psychiatrist as well. 

Why is it an important resource for professionals to know about?

It is important for psychotherapists to know when they should refer their patients to a physician (primary care physician or psychiatrist) to begin medication. Psychiatrists often work directly with therapists to assist in management of mental illness. 

Who would benefit from seeing a psychiatrist?

  • Someone who is in therapy but still struggling significantly with symptoms of anxiety and/or depression and has failed a medication trial with a primary care physician 
  • Someone who has ADHD
  • Someone who has symptoms of mania or psychosis (although generally these individuals lack insight to seek care on their own) 

Are there any reasons why someone should not see a psychiatrist?

Recently, it has become popular for individuals to see psychiatrists for the purpose of validating a self-diagnosis. For example, if an adult who believes they are on the autism spectrum, but lack any co-morbid mental illness, this is not something that would be treated. Another example would be someone who believes they suffer from something like depression or anxiety does not wish to begin medication. Ultimately, someone should only see a psychiatrist if they have a treatable mental illness that they wish to receive psychopharmacological treatment for.