Can I Skip the Psychiatrist and Just See My Doctor? (How to Know)

If you’ve never had mental health treatment before, and you’re interested in trying medication, your primary care physician’s office is a great place to start your journey.

It’s less intimidating to go to your doctor’s office than a mental health clinic, especially if you’ve never been to one. And if you have a good relationship with your doctor, it’s probably easier to talk to them than to reach out to someone you’ve never talked to before.

If you’ve been in treatment before, you probably already know a little about what works for you and what you want. In this case, it can still be a good choice to go to your primary care physician (PCP), especially if they were the one who treated you before and if that treatment was at least somewhat successful.

But it might make more sense to see a psychiatrist, especially if your first attempt with a PCP wasn’t very successful. Primary care doctors have less specialized training in mental health than psychiatrists, and they aren’t always comfortable making clinical judgement calls about psychiatric treatment when their patients want to go beyond the basics.

If you’re sure you want to take medication, it makes more sense to start with a primary care doctor than if you’re not sure whether medication is right for you.

While primary care doctors use many tools, medication is often their primary clinical tool and it is likely to be the first thing they recommend that you try. All PCPs have some training in mental health, but most lack the level of specialized training to know when a patient is less likely to respond to medication.

While psychiatrists specialize in medication-based treatment, too, they’re also more familiar with therapy and other treatment options than most PCPs. They may even offer both types of treatment. Due to high patient volumes and the changing nature of the mental health field, fewer psychiatrists provide therapy today than in the past—but some still do.

A psychiatrist also has specialized knowledge about different kinds of therapists and therapy methods and can help you figure out what might work best for your specific needs. In many cases, they can refer you to a therapist they personally recommend.

While we always recommend seeing a professional for help with decisions like this, we also recommend reading our article on “Therapy vs. Medication” for more guidance if you’re not sure whether medication or therapy is the better choice for you.

And if you already know you want to do therapy instead of medication, it makes more sense to start with a therapist. You can use our directory to look for an affordable therapist near you.

If you need to start treatment right away, your best choice will most likely be your PCP. This is true even if your answers to the other questions in this guide suggest that a psychiatrist might be a better choice.

Even though primary care practices can also have waiting lists, the wait times to see a PCP are nearly always shorter than the wait times to see a psychiatrist.

That’s because there’s a severe psychiatrist shortage in the United States. It can take several months to get an appointment with one—if they’re even taking new patients at all. It’s worth checking to see if a local psychiatrist has an opening, but in most cases, you’ll see a PCP a lot faster than you’ll get in to see a psychiatrist.

Of course, if you’re already in crisis, don’t wait for an appointment with a psychiatrist or a PCP—reach out for help immediately by going to an emergency room or calling a mental health hotline.

You’ll access crisis care more quickly than any other type of mental health care. By calling a national hotline or a local crisis line, you can connect with caring professionals who’ll help you get the care you need right away.

If your mental health symptoms are mild, it’s easier to get your needs met by your primary care doctor than if your symptoms are severe.

Mild to moderate depression and anxiety are among the most common mental health issues that Americans face, and many primary care doctors are already treating them. Most PCPs are at least somewhat familiar with these conditions and the medications for them.

However, if your symptoms are complex or severe, you’re more likely to need a psychiatrist. If you’re experiencing any of the following, you need a higher level of care than your PCP can offer:

• Hallucinations,
• Manic episodes,
• Suicidal thoughts,
• Severe panic attacks, or
• Dissociative episodes.

You also probably need to go to a psychiatrist or other mental health specialist if you are experiencing any combination of symptoms that is making it hard for you to function normally in your daily life.

You may need emergency care (don’t wait to see an outpatient provider if you’re in crisis—call a crisis line for immediate help) or you may simply need a psychiatrist who can adjust your medications until your symptoms are under control.

A psychiatrist has the expertise to make these adjustments and to address any side effects your medications may cause.

Not every mental health condition can be effectively treated with medication.

Depression and anxiety usually respond pretty well to medications that most doctors know and feel comfortable prescribing (though not always; panic disorders and treatment-resistant depression can require a lot of experimentation to successfully treat.)

Psychotic disorders also respond well to medication, but often require more trial and error to effectively treat than depression or anxiety.

On the other hand, it’s hard to treat trauma-related conditions with medication alone. Medications can address some symptoms, but not the underlying trauma, which nearly always requires therapy to treat.

And while some substance use disorders (especially alcohol and opioid use disorders) can be partially treated with medication, you usually need to also go to therapy or a treatment program to fully recover.

Whether a psychiatrist or a therapist is a better choice will depend on whether you have symptoms that can be addressed by medication and whether you want to address them that way.

Therapy alone can effectively treat a wide range of mental health conditions, and it’s just as viable to start with a therapist and then go to a PCP or psychiatrist as it is to do it the other way.

Mental health conditions aren’t just in your head. They affect the rest of your body, too. They can cause or worsen physical health symptoms you may also need to address to get well.

Anxiety can cause chronic stress that harms your heart. Depression can affect gut health. Many mental health conditions impact your energy level, immune system, or ability to care for yourself.

You’re unlikely to make progress in the treatment of a mental health condition if it’s connected to a physical issue that’s not also being treated—and vice versa.

Because of this, more doctors are realizing they have to learn how to treat mental health issues on some level, or at least know when to refer patients to a mental health professional, to be able to successfully treat their patients’ physical health concerns.

For example, if your depression is affecting your digestion, or if chronic stomach discomfort is making your depression worse, you probably won’t improve your depression until you improve your gut health (and vice versa).

So, if your primary concern is physical, or if both mental and physical symptoms are affecting your well-being, it makes more sense to start with your PCP. They can start treating your physical symptoms right away and refer you to a psychiatrist if needed.

Most primary care doctors find themselves treating mental health conditions whether or not they feel comfortable treating them, and some are taking matters into their own hands by integrating their primary care practices.

Treatment teams at integrated primary care offices embrace mental health treatment as part of their mission. They may collaborate closely with a local mental health agency or even hire dedicated mental health staff. They may use telehealth for mental health consultations or train their doctors and nurses to better detect, assess, and treat mental health conditions.

However doctors integrate mental health care into their practices, it leads to better outcomes for their patients, who are already seeking to address mental health issues with them. So, if your primary care doctor’s clinic is integrated, it makes even more sense to go there for your mental health needs.

Teaming up with psychiatrists and other mental health specialists allows primary care doctors to help clients with more complicated issues than they would normally be able to treat. These specialists can coach them and provide advice or even see patients face-to-face.

What this means for you is that if you go to an integrated clinic with a psychiatrist on staff, you can benefit from the expertise of a psychiatrist without having to wait months to see one. It also means you don’t have to pay out-of-pocket to see a psychiatrist that doesn’t accept insurance. You can sometimes even get therapy at an integrated primary care clinic.

So, if your primary care clinic offers integrated mental health care, or you have an integrated primary care clinic near you, we strongly encourage you to go!

It may end up being a better option than either an independent psychiatrist (who might have a long waitlist, not accept insurance, or not even be accepting new patients) or a primary care clinic that doesn’t offer integrated care.

If you’re not sure whether there are integrated clinics near you, but would be interested in trying one, you can read our article, “Clinics Where Doctors and Therapists Work Together,” to learn more, or go to the Integrated Care Map to search for a clinic.

Both primary care physicians and psychiatrists can prescribe psychiatric medication.

All journeys start somewhere, and a primary care clinic is often a good place to start your journey to better mental health. It’s probably more familiar and comfortable to you, and it’s usually easier to get in to see a primary care doctor than a mental health specialist.

It can be better to start with a psychiatrist if your symptoms are severe or you have a mental health condition primary care doctors aren’t used to treating. However, some primary care doctors are doing what they can to increase their mental health expertise so they can address a wider range of patients’ mental health needs.

Some are offering integrated care and hiring mental health professionals to work with them. Others are learning more about mental health so they can provide treatment themselves, recognize when you need a higher level of care than they offer, and know where to refer you when you do.

It can be worth the wait to see a psychiatrist when you have severe or complex mental health issues.

But sometimes you shouldn’t wait to see a psychiatrist or a primary care doctor. If your symptoms or issues are severe enough that you feel like you’re in crisis or at risk of harm if you don’t address them soon, get the crisis care you need by going to a hospital or calling a mental health hotline or local crisis line right away.

If you’re not in crisis, but you don’t want to wait and you’re open to trying therapy, think you might prefer therapy, or know you want to do both therapy and medication, you can start with a therapist. They can get started on your treatment while you wait to see a doctor—or help you figure out if you even want medication at all.

In summary, if you feel more comfortable with your primary care physician and don’t think you need a psychiatrist, talk to your doctor about your mental health at your next primary care visit.

On the other hand, if you want to try medication, think you need the level of care a psychiatrist offers, and one is available to see you (and affordable), you should start there. If you want to see a psychiatrist but can’t get in to see one, and are not in immediate crisis, start where you can and talk to your PCP.

Whatever you do, reach out—the care you need might only be a call or click away.