During the COVID-19 pandemic, concerns about mental health and substance use have been on the rise. But even before the pandemic, one in five adults (47 million) reported having a mental health disorder, according to the National Institutes of Health. While lifestyle changes and therapy are often effective, many individuals also need medication for relief.

“Everyone’s normal mood levels are different,” says Dr. Misty Tu, M.D., the medical director and a psychiatrist at Seattle Anxiety Specialists, PLLC “When mood swings, anxiety and depression become dysfunctional, it’s often past the time when you should talk to a doctor about medication. Well over 50% of people suffering with a mental health disorder have their first contact with a doctor for assessment in an emergency room or hospitalization. That, of course, is not ideal. “

When should you get a mental health assessment?

According to the American Psychiatric Association there are a number of signs that may indicate the need for a mental health evaluation.

  • An unusual drop in functioning at work or school and in daily activities.
  • Changes in sleep or appetite.
  • Difficulty with memory, thinking and other mental tasks.
  • Exaggerated beliefs about personal powers or magical thinking.
  • Feeling disconnected from surroundings.
  • Heightened sensitivity to sight, touch, sound or taste.
  • Loss of desire, apathy.
  • Mood changes.
  • Paranoia or fear or others.
  • Unusual behavior.
  • Withdrawal or loss of interest from activities.

Who should do a mental health evaluation?

According to Tu, this is a multilayered question. “People typically think of psychiatrists as prescribing mental health medication, and that’s true,” she says. “But your primary care physician should be your first visit for a mental health assessment. They may be able to prescribe a low dosage of medication and, if needed, they can refer you to a psychiatrist for more in-depth assessment and treatment.” 

“Folks often self-medicate for mood disorders, sometimes without meaning to,” says Dr. Katharine Liang, M.D., Ph.D., a consulting psychiatrist at Seattle Anxiety Specialists. “If you notice that your alcohol or substance use is increasing because of stress, anxiety or depression it’s time to go see your doctor.”

Tu recommends getting a mental health assessment with your annual physical, or more often as signs of increased anxiety, depression or other mood disorders appear. Physical symptoms may include a change of appetite, increased hair loss, inability to sleep, and a jittery feeling. Mental symptoms may include racing thoughts, obsessive worry, emotional volatility and inability to concentrate.

Why see a psychiatrist for medication management?

According to Tu, your primary care physician will help you decide if you need to see a psychiatrist, but here are some indications.

  • You are not satisfied with the medication you are taking.
  • There is some uncertainty about whether your diagnosis is correct.
  • The severity, frequency, and duration of your symptoms have decreased, but not to the low level where you would be considered in recovery, in remission, or doing well.
  • There are other preexisting mental health or physical health conditions that may call for a more careful or nuanced approach.

What happens after the initial evaluation?

The most common types of medications prescribed for mental health symptoms, used for either anxiety or depression, are SSRIs and SNRIs. These medications are effective for most people, but it can sometimes take up to six weeks for the positive effects to kick in. Note that side effects may show up well before that — in a matter of days. So your primary care physician or psychiatrist may want to check in with you after one or two weeks.

“If you’re having side effects, just as with any medication, I would call your doctor to be seen sooner,” Liang advises. “On the flip side, if things are going well you could cancel your follow-up appointment and simply request a refill.” The key is to have consistent contact with your medical provider so that your medication can be assessed and altered as your condition requires.

If you are not satisfied with the medication you are on, you might also consider genetic testing. Different medications are metabolized differently by different people. This is part of the reason that certain medications work better for some than others. Some psychiatrists offer genetic testing so they can more quickly pinpoint which medications are likely to work best for you.

Dr. Misty Tu (Seattle Anxiety Specialists photo)

Take action

There’s a national shortage of psychiatrists that is projected to get even worse over the next few years. If you are struggling with mental health symptoms and can’t get scheduled to see a psychiatrist, there are things you can do:

Find an integrated medical clinic where there’s a psychiatrist who’s available for consultation.

Call your health plan and they might be able to get you a virtual appointment sooner.

If you or someone you know is unsafe (suicidal, homicidal, putting oneself or others in danger, or experiencing a medical emergency), call 911 immediately.

Or you can walk into the nearest emergency room.

“Do whatever you need to keep yourself safe,” Tu advises.

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Seattle Anxiety Specialists, PLLC is a private psychiatry and psychotherapy practice in downtown Seattle, providing evidence-based treatments and in-depth self-exploration for anxiety and conditions that create anxiety including phobias, depression, GAD, OCD, PTSD, ADHD, OCPD and bipolar.