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Therapist Vs. Psychiatrist Vs Primary Physician

May 3, 2000

Hi Mr. Shernoff -- Just read your response to "Antidepressants" (May 1). My primary physician referred me to a psychiatrist about 3 months after I was diagnosed w/HIV. The psych put me on Celexa (a new SSI for depression). My psych, I'm sorry to say, who specializes in HIV/Gay issues was not helpful at all. He even told me up front that most of my depression will be resolved by taking medication. After about 2 months of "treatment" I fired my psych, because I didn't think I was getting anything for $200/hr, and I decided to stop taking the Celexa too -- I thought it was making me more depressed. A few weeks later, I became even more depressed, so I decided to see a Therapist. He's been more helpful than my psych was.. a lot more helpful in terms of two-way communication and counseling. I decided two days ago to start taking my Celexa again (I had a full bottle) because my depression was getting worse and I felt that I'd give it another try. I was surprised at how fast I began to feel like my old self again..happy.. motivated.. energetic.. I haven't told my therapist yet that I started taking my meds again (I will the next time I see him). I know that my therapist can't prescribe or authorize refills to medications. Do you think I should call my primary care physician (an internal medicine doc) and ask him to prescribe Celexa? Or, do I have to go back to a psychiatrist again? I'd prefer just seeing my therapist. Thanks for any advice you can give me.

Response from Mr. Shernoff

I am glad that you fired your old psychiatrist, he sounded like a real jerk, or at least overworked. All of the empirical research has shown that a combination of talk therapy and anti-depressants is the most successful for treating depression. I am also glad that you found a good interactive therapist who is helpful. I have always found it best for a person to have psychiatric medications prescribed by an MD who specializes in this area. The reasons for this are that the psychopharmacologist is a specialist in these drugs and is alert to nuances about timing of the doses, how slight modifications of the dose can affect the patient and how to minimize or respond to side effects. Tell your primary care doctor that you were unhappy with your last psychiatrist and ask him or her for a referral to another one who will only be in charge of your medication. This is always what I suggest to my patients to insure that they receive the highest level of interdisciplinary mental health care.

Michael Shernoff, MSW

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