One of the common questions I have been asked is what the differences are between Psychiatrists and psychologists. The short answer to that is psychiatrists can prescribe medicine, whereas psychologists do not. Yet there is more to that. 

Training Background

Psychologists and psychiatrists have very different training backgrounds. 

PSYCHIATRISTS are Doctors of Medicine (MD) or doctors of osteopathic medicine (DO) who graduated from medical school. Psychiatrists have to go through residency where they work with patients in various settings such as hospitals and outpatient settings. They also have clinical training on mental illness diagnosis, medication, therapy and treatments. Psychiatrists are required to take the American Board of Psychiatry and Neurology exam to become board certified psychiatrists.

PSYCHOLOGISTS are Doctor of Philosophy (PhD) or Doctor of Psychology (PsyD). Psychologists earn their doctoral degree and then complete one to two years of postdoctoral training to take the Board of American Psychology Association exam to become a licensed psychologist. They also must take an additional state licensing exam according to state regulations. 

Treatment Modalities

PSYCHIATRISTS can provide medication and medication management. Their training allows them to prescribe medicine, monitor the progress or side effects of the medication, and adjust dosage. They can also order labs to check on your physical health and the effects of medication. In addition to prescribing medicine, psychiatrists can provide Electroconvulsive therapy (ECT). ECT is a brain stimulation therapy that can be helpful to treat severe depression. Light therapy is another treatment psychiatrists use to treat seasonal depression by using artificial light to help patients whose seasonal depression stems from not having enough sunlight. Other treatments available to psychiatrists include Deep brain stimulation (DBS), vagus nerve stimulation (VNS), and transcranial magnetic stimulation (TMS) for certain mental illnesses.

PSYCHOLOGISTS, by contrast, focus on talk therapy and assessments. Based on their training, they can also work in a variety of settings and provide a wide range of treatment modalities. They usually provide talk therapy to help patients discuss any issues they are facing in their life. They help their patients increase awareness, release suppressed emotions, improve relationships, and manage symptoms. A session with a psychologist can take many forms, such as individual therapy, couples therapy, family therapy, and group therapy. The development of contemporary psychology has allowed psychologists to offer additional specialities in child custody assessment, forensic psychological evaluation, EMDR, sand-tray therapy, play therapy, biofeedback therapy, etc. Read more about these therapies on Maybe You Should Go See A Psychotherapist

Treating Conditions

PSYCHIATRISTS can provide medication treatment for a wide range of mental illnesses. After completing thorough evaluations or analyzing lab results, psychiatrists can prescribe medications to help treat mental disorders. Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Patients on long-term medication treatment will need to meet with their psychiatrist periodically to monitor the effectiveness of the medication and any potential side effects.

• Classes of Medications:
  • Antidepressants –depression, panic disorder, PTSD, anxiety, OCD, borderline personality disorder, and eating disorders.
  • Antipsychotic medications – psychotic symptoms (delusions and hallucinations), schizophrenia, bipolar disorder.
  • Sedatives and anxiolytics – anxiety and insomnia.
  • Hypnotics – Insomnia
  • Mood stabilizers – bipolar disorder.
  • Stimulants – ADHD.

Psychiatrists often prescribe medications in combination with psychotherapy.

PSYCHOLOGISTS can conduct assessments to determine recommended treatment or resources for the patients. Psychological evaluation and testing include:

• Neuropsychological assessment
• Personality assessment
• Psychosocial assessment
• ADHD/ Learning Disorder assessment

These tests may evaluate intellectual skills, cognitive strengths and weaknesses, vocational aptitude and preference, personality characteristics, and neuropsychological functioning.

Psychologists can help a wide variety of people with many kinds of issues. Some people may experience depression, anger issues, anxiety or panic attacks. Others may just have some short-term problems they need help with. Some psychologists are trained to use EMDR or hypnotherapy, which research has found to be effective for a wide range of conditions including pain, anxiety, and mood disorders.

Which To Choose

For some conditions, psychologists work with psychiatrists, primary care physicians, or pediatricians to provide multidisciplinary treatment to serve patients’ best interest.   

When to see a psychiatrist:

There are some conditions for which it is recommended to see a psychiatrist for proper treatment. 

• Schizophrenia Spectrum and Other Psychosis:Patients with schizophrenia or psychosis have difficulty distinguishing reality from the imaginary world. The causes of psychosis can be genetic, a chemical imbalance in the brain (e.g. excessive dopamine) or abnormal brain structures (e.g. enlarged brain ventricles or deteriorated brain tissues). 
• Bipolar Disorder: the main symptom of bipolar disorder is the cycle of recurrent episodes that go from mania or hypomania (exaltation or euphoria) to depression (sadness, inhibition, and ideas of death). The cause is, in its origin, essentially biological and genetic.  Limbic systems function erroneously, in individuals who have a bipolar disorder, causing their mood to undergo sudden changes without cause. 
• Severe Major Depressive Disorder: when someone constantly experiences a depressed mood, feelings of meaningless and hopelessness, suicidal plans and attempts, the person is no longer able to take care of themselves and think logically. 
• Severe Anxiety Disorder: when someone experiences intense, excessive, and persistent worry or fear, and is unable to control the worry; or experience repeated episodes of sudden, intense fear or terror that reach a peak within minutes (panic attacks) which causes impairment in school, personal, or social life.  

In the above situations, it is better to see a psychiatrist than a psychologist. If you are not sure which help you need, please reach out to your primary care physician to discuss your current issues. They might be able to help recommend the correct treatment for you.