How to get psychiatric medication management

Who can prescribe psychiatric medication

A few kinds of clinician can prescribe and manage psychiatric medication.

Primary care doctors prescribe a large share of antidepressants, and for straightforward depression or anxiety, starting with a primary care doctor you already know is reasonable. Psychiatrists are physicians who specialize in mental health, and they are the usual choice for more complex situations, for managing several medications at once, for bipolar disorder, or when first attempts have not worked. Psychiatric nurse practitioners, often listed as PMHNPs, also evaluate, prescribe, and manage psychiatric medication, and they work in many practices and telepsychiatry services.

Therapists and psychologists provide talk therapy, but in most settings they do not prescribe medication. Many people see a therapist and a prescriber at the same time, and the two kinds of care work well together.

In-person care

In-person psychiatric care means visiting a clinic or office. Some people prefer it, particularly for a first evaluation or for more complex care. The main drawback is access. In much of the country there are long waits to see a psychiatrist, and some areas have very few. If you are looking for in-person care, your primary care doctor can refer you, your insurance company's website lists clinicians covered by your plan, and the federal directory at findtreatment.gov can help you search.

Telepsychiatry

Telepsychiatry is psychiatric care delivered by secure video visit. It has become widely available, and for medication management, which is mostly conversation and follow-up rather than physical examination, it works well for many people. It can shorten the wait, and it reaches people in places that have few local psychiatrists.

Several telepsychiatry practices offer ongoing medication management. One of them is shrinkMD, the telepsychiatry practice founded by this site's medical editor, Shariq Refai, MD, MBA. PsychiatryRx lists it here as one option among others, not as a recommendation, and the site earns nothing whether or not you choose it. That affiliation is explained in full on our disclosure page. Other ways to find telepsychiatry care include your insurance company's directory, the federal directory at findtreatment.gov, and a referral from your primary care doctor.

One thing is worth checking with any telepsychiatry service. Prescribing rules for controlled substances, which include some ADHD medications and the benzodiazepines, are stricter and can differ by service and by state. If your care is likely to involve those medications, ask how the service handles them before you start.

What to look for in any option

Whatever format you choose, a few things make for good medication care.

Continuity is the big one. Seeing the same clinician over time, someone who knows your history and can adjust treatment as things change, matters more than almost anything else. It is worth asking whether you will see one consistent clinician or a rotating group.

Beyond that, confirm the clinician is licensed in your state, check whether they take your insurance or what they charge, and ask whether they are comfortable with your particular situation, for example bipolar disorder, pregnancy, or care alongside a therapist.

A note on cost and insurance

Cost varies widely. Many psychiatric medications themselves are inexpensive generics, as the medication guides on this site note. The appointments are usually the larger cost. Insurance often covers psychiatric visits, both in person and by video, though coverage and copays differ by plan, so it is worth checking directly with your insurer. Some practices offer flat self-pay pricing. If cost is a barrier, community mental health centers and federally qualified health centers offer care on a sliding scale, and findtreatment.gov can help you locate them.

Sources

• Substance Abuse and Mental Health Services Administration. FindTreatment.gov.
• National Institute of Mental Health. Help for mental illnesses.
• MedlinePlus, U.S. National Library of Medicine.