It Takes a Team

    Friends and family will often say things to me like, "I'm going to ask my doctor for some Prozac or Paxil or Zoloft. I've been feeling depressed/anxious, and I just hate feeling that way." Then they'll go to their general practitioner family doctor, and they come back with a bottle of the psychotropic medication because the doctor wrote them a prescription for it, pretty much because they told the doctor they wanted it. When I ask them about a therapist and a psychiatrist or mention the words "mental healthcare team" they incredulously reply, "I don't need any of that stuff. I just need these pills from my doctor, and I'll be fine." (Spoiler: Most of the time, they're not fine with whatever they asked to be prescribed, and then they're angry that the medication didn't make them feel "fine". Sometimes the medication even makes them feel worse.)

    It's common practice in my state for general practice family doctors to prescribe psychotropic medications to their patients without consulting or referring to a psychiatrist or a licensed therapist for counseling. Family doctors here hand out anti-depressants, anti-anxiety medications, and some mood stabilizers like they're Advil or Tylenol. Pediatricians even prescribe ADHD medications for small children and anti-depressants and anti-anxiety medications to their teenage patients. Here, a person's general practice family doctor is usually the first and last stop for mental healthcare.

    Did you know that your general practice family doctor isn't supposed to prescribe medications to treat mental health conditions? I did not know this until I was majoring in psychology in college, and most people in my area do not know this. Let me put it like this: Getting psychotropic medications from your general practice family doctor is a bit like asking your cardiologist to prescribe the right eye drops to treat your eye infection.

    A general practice family doctor doesn't have the specialized training that is required to know how medications for mental illness (AKA psychotropic medications) work with the brain to treat the mental illness. Sure, they know what the pharmaceutical sales rep told them, what's on the package insert, and they know what the medication is prescribed for...but that's not enough to SAFELY prescribe them. They don't understand what these medications do as they work with a person's brain chemicals to make them feel differently or how they interact with each other if more than one medication is needed. The only medical professional that is specifically trained to understand how psychotropic medications work in the brain, with the mental illness that lives there, and what combinations of medications work well with or against each other is a psychiatrist. A psychiatrist is actually a medical doctor who specialized specifically in the study of the brain, mental health conditions, and the medications meant to treat them.

    Your general practice family doctor should definitely be involved in your mental health treatment, but your general practice family doctor should NEVER be the only person treating your mental health condition. Treating mental illness should ALWAYS involve a team of professionals. That team should include a therapist for counseling, a psychiatrist for prescribing any needed medications if medications are part of the treatment plan, and then your family doctor to help monitor the medication in your body and to consult with the psychiatrist about side effects and medication levels and your overall health.

    I'll end with this: Treatment for mental illness isn't a thing that can be accomplished by one single medical professional. Mental health treatment requires a team that includes a licensed mental health counselor for therapy sessions, a psychiatrist to prescribe medications, and your family doctor for things like monitoring the medications and side effects. Your general practice family doctor should NEVER be the only member of your mental healthcare team, and your family doctor should NEVER be the person prescribing your psychotropic medications. The only person with the proper training and knowledge to SAFELY prescribe psychotropic medications is a psychiatrist.