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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Poppy on April 17, 2001, at 10:20:06
Hey , does anyone reccomend seeing a psychiatrist over just your local doc? Have been treated by local doctor for over a year (with effexor) and was thinking about seeing a psychiatrist regarding my effexor? is it better?
Posted by stjames on April 17, 2001, at 14:59:51
In reply to Psychiatrist or GP for treatment of depression??, posted by Poppy on April 17, 2001, at 10:20:06
> Hey , does anyone reccomend seeing a psychiatrist over just your local doc? Have been treated by local doctor for over a year (with effexor) and was thinking about seeing a psychiatrist regarding my effexor? is it better?
James here....
Is a specalist better at treating his specality than a generalist ? YES !
IF you are doing well on Effexor, ie 100 %, then there seems no reason to change doc but if things are not as good as they should be, a psychiatrist
is the best choice.james
james
Posted by Leighwit on April 17, 2001, at 16:36:52
In reply to Psychiatrist or GP for treatment of depression??, posted by Poppy on April 17, 2001, at 10:20:06
It's my opinion that GPs should refer patients presenting with major recurrent depression to psychiatrists for psychopharmacology expertise. GPs know just enough to be dangerous. My endocrinologist did just that: he referred me to a Pdoc for the reason I just cited.
> Hey , does anyone reccomend seeing a psychiatrist over just your local doc? >
Posted by SalArmy4me on April 17, 2001, at 19:10:59
In reply to Psychiatrist or GP for treatment of depression??, posted by Poppy on April 17, 2001, at 10:20:06
My experience has been that GPs and Internists are qualified to prescribe SSRI's, but little more than that.
> Hey , does anyone reccomend seeing a psychiatrist over just your local doc? Have been treated by local doctor for over a year (with effexor) and was thinking about seeing a psychiatrist regarding my effexor? is it better?
Posted by willow on April 17, 2001, at 21:41:04
In reply to Psychiatrist or GP for treatment of depression??, posted by Poppy on April 17, 2001, at 10:20:06
I've always been treated by my family doctor, except for the births of my children. When I got married I switched to my husband's family doctor. Since starting symptoms with "Chronic fatigue syndrome" I had been referred to three different specialist, one being a psychiatrist. None, including the family doctor had ever been able to do anything for me which resembled any form of assistance. If anything they increased my anxiety with their diagnoses.
About a year ago I decided to change to a new family doctor who was closer to our little town. This is his first practice since he is a new graduate. With his advice I have been improving. With the other doctors I was getting worse. (I've also been seeing a psychologist who I'd been seeing for a year before I switched family doctors.)
I think the key is to have a doctor who is able to communicate. An important part of communication is listening and making yourself understood. I've read many posts concerning psychiatrists who in my opinion are not able to communicate effectively with their patients.
So for myself, the psychoanylsis with a psychologist and prescriptions through a family doctor have been effective. Again the key being that I trust both of them.
Willow
Posted by Cam W. on April 18, 2001, at 1:04:47
In reply to Re: Psychiatrist or GP for treatment of depression??, posted by stjames on April 17, 2001, at 14:59:51
James - Actually, it may not make a difference if one sees a pdoc or a GP for depression. In this month's (vol.58 April, 2001, p.395-401) Archives of General Psychiatry there is an article entitled "Treatment Process and Outcomes for Managed Care Patients Receiving New Andepressant Prescriptions From Psychiatrists and Primary Care Physicians" by Gregory E. Simon, et al (incl. Carolyn Rutter) from the University of Washington.
Although their sample size is small: patients from psychaitrists (n=165) and from primary car physicians (n=204), they found that clinical differences between patients treated by psychiatrists and primary care phsycians were modest. The real only differences (which were slight) were that in primary care there was more incidence of inadequate follow-up visits and inadequate antidepressant treatment. It seems that, contrary to popular belief, psychiatrists too fail to actively follow-up those with depression and shifting the patient to a specialist does not guarantee that inadequate antidepressant dosing will be addressed.
It is easy for me to say, but I believe that patients do need to take a more active role in learning about their disorders and make sure that they are getting adequate treatment no matter who they are seeing. Docs need to take a more active role in teaching the person about their disease state (concordance) rather than just handing out a prescription and expecting the patient to take it (compliance). This is a two way street, though. The patient needs to be forthcoming and honest about their desires for treatment options and tell the doc when they are not taking their meds or are self-medicating with either licit or elicit drugs. The dialogue between the patient and doc needs to be open and frank, with both parties arriving at the treatment option deemed best by both. This should be done regardless of whether the doc is a pdoc or a GP. I really don't think it matters which profession treats depression, if this relationship is in place.
I know I'm being idealistic, but hey that's me - Cam
Posted by Ratfreek on April 19, 2001, at 16:48:20
In reply to Psychiatrist or GP for treatment of depression??, posted by Poppy on April 17, 2001, at 10:20:06
> Hey , does anyone reccomend seeing a psychiatrist over just your local doc? Have been treated by local doctor for over a year (with effexor) and was thinking about seeing a psychiatrist regarding my effexor? is it better?
Hi,
In my experience there are a few different things I've had to choose from. First, your GP can prescribe, but they're not trained in counseling or therapy. The main thing with anti-depressants, I believe, is that it's not enough to be on meds- you need therapy too! It's how you train yourself to deal with your problems so that someday you can get off the meds. So, I then had a choice of doctors (I have Blue Cross health insurance). Most expensive are the psychiatrists; they can prescribe and do therapy. Next are psychologists; they cannot prescribe and only do therapy. Both of these two have Ph. D's. Then you have family counselors, aka clinical social workers, at the cheapest end of the pay scale; most only have master's degrees. This is all very general, mind.I've found that I do fine with psychologists. It is really going to depend on the individual, whether or not you click with them and communicate, and of course how well they're trained and how much experience they have.
Good luck!
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