Antidepressants

Psychiatrists usually work with people who have severe or recurrent mental health problems that require medical treatment. GPs may refer to a patient to a psychiatrist if they have taken several courses of antidepressants and have not adequately responded to treatment or if their problems are complex. Psychiatrists sometimes see patients in an out-patient clinic, but more often, they work as part of a mental health team with colleagues from other professions such as nursing, social work, psychology and occupational therapy. Some people pay to see a psychiatrist privately.
 
A referral to a psychiatrist often, but not always, involves the prescription of medication. We talked to some people who were under the care of a psychiatrist, or had been in the past. The amount of contact they had with their psychiatrist varied. Once they began seeing a psychiatrist he or she took responsibility for prescribing, reviewing and altering their medicines. Sonia recalled that once she had been referred to the mental health team that ‘the consultant psychiatrist was the one deciding what medication I took’. Rachel said seeing a psychiatrist wasn’t as it was portrayed in films and TV programmes. ‘Despite what they might show on the television you don’t lie on a couch and have them say, you know, let’s talk about your... the psychiatrist will ask about your symptoms and he’ll then look in his book and see what tablets he can send you away with.’ Although some people said their psychiatrist was concerned with wider issues than prescribing medicines, often people said that appointments were short and largely focused on medication.
 
Sometimes the psychiatrist will prescribe an additional antidepressant such as mirtazapine, or other medicines such as antipsychotics, medicines for anxiety, or a mood stabiliser.
 
(See ‘taking an antidepressant with medicines for other illnesses’).

Several people had seen a number of different psychiatrists over time, and had mixed experiences. Like Flora, Hannah had a very difficult time when she was hospitalised, and although she was resistant to taking the medicines her psychiatrist prescribed, she still felt he had been sympathetic and sensitive. ‘I found him really supportive and helpful... I always feel grateful that he was willing to listen to my views’. When she was a teenager Lucy was referred to see a psychiatrist because after taking Prozac (fluoxetine) that had been prescribed by her GP, she had felt progressively worse. The psychiatrist recommended that she should stop taking an antidepressant. ‘At that point I was doing quite badly... I was thinking... you’re leaving me with nothing... I would have thought they’d have more suggestion of what to take’. Now she is older she says she feels more comfortable questioning doctors and more clear about her own needs. Gerry would have liked the psychiatrist he saw to have provided more information about the medicine that he was prescribed. ‘If there was any sort of thing that I would change, I did feel a bit like the specialist just packed me off and said’ right here’s your course’, he didn’t give me any warnings about like you might feel a bit spaced out or you might, he was just like persevere with them I’ll see you again in two weeks’. Others also felt their psychiatrist didn’t listen to them, or had not involved them in decisions about treatment. Several said that when you are experiencing emotional or mental distress it can be difficult to question the authority of a psychiatrist. Some felt that psychiatrists took a paternalistic attitude towards patients and that they were distant or impersonal. Janet felt she was not in a position to disagree with the psychiatrist and said she didn’t like ‘to rock the boat’. Michael had always felt ‘the doctor knows best’ and rarely questioned things. Sonia had mixed experiences talking with psychiatrists about her treatment. ‘Out of three psychiatrists that I’ve had only one I felt has actually involved me in kind of any real decisions’. A few people had come into conflict with their psychiatrist. Olivia X had been taken aback by the way the psychiatrist she saw made a diagnosis after seeing her for 10 minutes. She said it was difficult to get her point of view across ‘you’re in an emotionally vulnerable position you’re fragile’. Her refusal to agree to the psychiatrist’s recommendation for treatment caused events that led to her being sectioned. For some, referral to the mental health team had occurred at a point of crisis, when they needed urgent care. If someone is considered to be very ill, or a danger to themselves or others, the Mental Health Act 1983 is the law in England and Wales that allows doctors to admit the person to hospital, to be detained and treated without their consent. People can be admitted under different sections of the Mental Health Act, depending on the circumstances, which is why the term ‘sectioned’ is used to describe a compulsory admission to hospital. A psychiatrist is almost always involved in the decision to admit someone to hospital against their will, but cannot do it on his/her own. An approved mental health worker (AMHP) always has to agree that this needs to be done and, in nearly all cases, another independent doctor also needs to agree. Sometimes people said they were wary about telling their psychiatrist how they were really feeling, or if they had stopped taking their medicines, because they worried about the power the psychiatrist had to enforce treatment on them.
 
Although the psychiatrist may decide which antidepressant or other treatment to prescribe, or changes the patient’s dose, he or she notifies the GP to issue the prescription. Some said the system worked well and that they usually received copies of letters that were passed between the GP and psychiatrist, but others worried about a lack of continuity. When Sonia needed to see a doctor urgently because she was feeling very unwell, she couldn’t get an appointment to see the psychiatrist so went to the GP, but he was unwilling to make any decisions or changes to her medicines because he had not prescribed them.
 
Often people who were prescribed antidepressants by a psychiatrist also accessed other services provided by the mental health team, for example time with a psychologist, therapeutic interventions such as CBT, or help from a CPN (Community Psychiatric Nurse).
 
(See also ‘Being prescribed an antidepressant’, ‘Antidepressant use and hospital care’, ‘Taking an antidepressant with medicines for other illnesses’, ‘Talking therapies and antidepressants’ and ‘The Community Mental health Team’).

Last reviewed June 2016.
​Last updated June 2016.