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Depression - Choosing a doctor or therapist

Your options, of course, will vary depending on your health plan. Typically a general health care provider -- a family physician, internist, nurse practitioner or physician assistant -- can provide needed medical therapy for most people who have mild or moderate depression. If the depressed person has medical problems or is taking numerous medications, it's best to see a physician -- either a family practitioner or an internist.

A psychiatrist may be needed when one:

  • Is psychotic (has lost touch with reality)
  • Has recurrent depressions
  • Has "double depression" (a major depressive episode on top of dysthymia)
  • Is suicidal
  • Has bipolar disorder
  • Hasn't responded to standard antidepressant therapy
  • Needs electroconvulsive therapy

(For more information on the terms above, see diagnosing depression or consult the glossary).

A general pediatrician can take care of children who have mild to moderate depression. However, the child needs to see a child and adolescent psychiatrist, if he or she is severely depressed, has a dysfunctional relationship with family, friends, or at school, has other psychiatric conditions, is suicidal, or engages in risky or illegal activities (e.g. substance abuse, reckless driving).

In addition to seeing a medical specialist, people with depression often use the services of a psychologist or clinical social worker. These specialists have special training in psychotherapy and may have a master's degree or doctorate in counseling.

If you don't already know a good psychiatrist or psychologist, try to get recommendations on several in your area. You can ask your family physician, friends or relatives who are getting therapy, or a local mental health center for recommendations.

You should talk with a psychiatrist or therapist before starting treatment to explain your situation and to make sure that you both have similar philosophies and goals. The American Psychiatric Association (APA) recommends that you ask the following practical questions before choosing a therapist:

1. Where is your office?

2. How long will I have to wait for an appointment?

3. How long will the first appointment (evaluation session) be?

4. Will you describe to me your findings and conclusions and outline your treatment recommendations?

5. Do you treat only particular psychiatric conditions and, if so, what?

6. Do you use one specific treatment or therapy (e.g. behavioral or interpersonal)?

7. Or do you adjust your approach depending on each patient's needs?

8. How much will it cost?

9. Do you accept my insurance?

10.If I don't have insurance, do you have a sliding scale, or can you refer me to another therapist or a clinic for low cost care?

A psychiatrist is a physician who specializes in psychiatric disorders, and who is trained to prescribe medications and to treat patients with psychotherapy. Psychiatrists are best prepared to evaluate and treat serious depressions, or depressions in conjunction with other problems.

A psychologist is someone who has done a graduate program specializing in human psychology and who is trained to evaluate various psychological conditions and to offer psychotherapy. Clinical social workers and Master's level therapists (MFCCs) also offer psychotherapy.

Whatever the type of therapist you choose, it is most important that you have a good connection and feel comfortable communicating with him or her.

Other useful resources include:

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Psychiatric Association
http://www.psych.org

To locate a psychologist, contact the American Psychological Association
http://locator.apa.org/

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