I’ve had a depressive disorder for years and am finally looking for help. I’m bewildered by the choices: there are psychiatrists, social workers, counselors, and psychologists. Where do I start?

All of those labels are confusing, because some of them are about the degrees that people have and some are about the treatment they provide. Psychiatrists are medical doctors with MD degrees and they can prescribe psychiatric medication. Some psychiatrists also provide psychotherapy or counseling, but that is less common than in years past. In many states, nurse practitioners can also prescribe psychiatric medications. Primary care doctors actually prescribe the majority of antidepressant medications, especially for people with less severe or complicated depression.

Psychotherapy or counseling can come from people with a variety of trainings or degrees, including psychologists who have PhD degrees; social workers who have MSW degrees; and other masters-prepared therapists who typically have MA or MEd degrees. Psychologists usually have more years of training, but all of the types of therapists mentioned here have completed classroom training and clinical supervision before getting certified or licensed.

All people holding these degrees might be called therapists or counselors because that is the treatment they provide. Some states also allow other types of registered counselors, but they may not be required to have any specific training or licensure. So a person with specific training that provides psychotherapy could be called a counselor, everyone called a counselor may not have that specific training. That’s important to understand.

So where should you start? If you have a family or primary care doctor you trust, that can be a good place to begin. Most primary care doctors know how to diagnose depression and can help you think about different options for treatment. If you already know that you want to see a therapist, you’ll probably need to start by calling your insurance company to get a list of therapists (PhD, MSW, MA, or MEd) covered by your insurance. And you may still want to check with your primary care doctor for recommendations.

Starting by seeing a psychiatrist makes sense for people who have more severe or complicated depression. Here as well, you’ll probably need to start by finding out about your insurance coverage. If you are interested in seeing a psychiatrist who can provide both psychotherapy and prescribe medication, be sure to ask the doctor about that up front.

Finding any kind of mental health provider can be difficult. People don’t tend to share recommendations about psychiatrists or therapists as freely as they share recommendations about dentists or car mechanics. If you find a mental health provider you like, be sure to share your recommendation on DBSA’s Find a Pro page.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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