Many adults with anxiety or depression end up with a small team: a primary care doctor who first raised the issue, a therapist they see weekly or every other week, and sometimes a psychiatrist or psychiatric nurse practitioner who manages medication. Each sees a different slice of your life. Without some coordination, they can work at cross-purposes, and you end up repeating your story, carrying messages between offices and guessing who should know what.
Who does what
- Primary care provider: rules out medical causes, orders lab work, may start a medication, and refers you onward
- Psychiatrist or psychiatric nurse practitioner: evaluates and manages psychiatric medication, often in shorter visits
- Therapist (psychologist, counselor or social worker): weekly or regular talk therapy; psychologists in Michigan do not prescribe
NIMH notes that medication is often used in combination with psychotherapy, and that it can take several tries to find the medication that works best with the fewest side effects. That trial-and-error stage is exactly where coordination helps. Your therapist sees you more often and may notice changes in sleep, energy or mood first. Your prescriber needs that information to make good decisions. For the differences between these professionals, read Psychologist, Psychiatrist or Counselor?.
Step one: a release of information
Your providers usually will not talk to each other about you until you give written permission. A release form names who can share information, with whom, what kind and for how long. HHS explains that HIPAA gives you rights over your health information and limits who can see it; a release is how you use those rights on purpose.
You can tailor a release. Some people allow full communication. Others limit it to medications, safety concerns and a brief treatment summary, keeping the details of therapy private. Both are reasonable. Ask each provider what they would usually share, then decide.
Step two: one medication list everyone sees
NIMH recommends telling your health care provider about all the medications you take, including over-the-counter drugs, herbal remedies, vitamins and supplements. Keep one list, on paper or your phone, with each medication, the dose, when you started it and who prescribed it. Bring it to every appointment, including therapy. It takes five minutes and prevents a surprising number of problems.
Step three: tell each person about changes
A new prescription, a dose change, a side effect or a new diagnosis can matter to everyone on the team. So can life changes: a job loss, a new baby, a death in the family, starting to drink more. You do not have to wait for the next appointment to pass news along; most practices have a way to leave a message. A one-line message such as "Started a new dose last Monday, sleeping worse since" is enough.
If something in therapy makes you question a medication, bring it to your prescriber. NIMH warns that people should not stop a prescribed medication, even when feeling better, without the help of a health care provider, because stopping too soon can cause unpleasant or harmful effects. Talk with your prescriber before changing anything.
What to bring to a doctor visit about mood
NIMH suggests preparing ahead because appointments are short. A note on your phone might include:
- What you have noticed and for how long, in a sentence or two
- How it affects work, sleep, eating and relationships
- Your medication and supplement list
- Any family history of depression, anxiety or other mental health conditions
- Two or three questions, such as "Could a medical problem be contributing?" or "What are the options besides medication?"
NIMH also suggests bringing a friend or relative if it would help you remember what was said, and being honest even when it is uncomfortable. If you are having thoughts of suicide, say so plainly. Primary care offices often screen for this, and it is information your doctor needs.
Some clinics build coordination in
Some health systems offer what NIMH calls collaborative care: a team-based approach in which a behavioral health care manager works with you, your primary care provider and mental health specialists on one treatment plan. NIMH notes that collaborative care has been shown to be an effective way to treat depression and reduce suicidal thoughts. If your primary care office has a behavioral health team, ask how it works and whether it can coordinate with an outside therapist.
If your primary care doctor is the one prescribing, the same steps apply. Primary care visits are often short and spaced months apart, so a brief note from your therapist, with your permission, or your own written summary can fill the gap between visits. Ask your doctor how soon after starting or changing a medication they want to hear from you, and put that date in your calendar.
When the team disagrees
Sometimes the doctor suggests medication and the therapist suggests waiting, or the reverse. That is not a crisis. Ask each person what they are seeing and what would change their view, and ask whether they would be willing to talk directly. You are the one who decides, and it is fine to say you want to think it over. Therapy, Medication or Both for Depression? lays out the general evidence.
Dr. Lehmann is a psychologist and does not prescribe. People in therapy for depression or anxiety with a psychologist who also use medication keep working with their own physician, psychiatrist or nurse practitioner for that part of their care.