Psychiatry

Psychiatry is the medical side of mental health treatment. A psychiatrist is a physician who went to medical school, trained in psychiatry, and can prescribe. That is the practical difference from everyone else you might see. In California, psychologists, marriage and family therapists, and clinical social workers provide therapy but do not prescribe medication.

The distinction matters less than people expect when it comes to choosing where to start, and more than people expect once treatment is underway. Anxiety treatment is often a combination, and the two halves are usually delivered by two different people who may never speak to each other unless someone asks them to.

Who prescribes what

Primary care physicians write the majority of antidepressant prescriptions, and for straightforward cases that is a reasonable place to begin, particularly given how hard psychiatrists can be to reach.

Psychiatric nurse practitioners and physician assistants also prescribe, and in Los Angeles they often have shorter waits than psychiatrists do.

A psychiatrist is worth the extra effort when the picture is complicated: several diagnoses at once, medications that haven't worked, a history of bipolar disorder, or anything where the interactions need someone who does this all day.

What medication does and does not do

For many anxiety disorders, SSRIs and SNRIs — the same medication classes used for depression — are among the best-established first-line medication options.

Two things about them are worth knowing before you start, because not knowing them is a common reason people stop early.

They take time. Some effect may appear within a few weeks, but a fuller response often takes six to twelve weeks, depending on the medication, dose, and disorder. This is not a medication you can evaluate after a few days.

They can make anxiety worse before they make it better. A transient increase in restlessness or agitation in the first week or two is common enough that prescribers often start anxious patients at lower doses than they would otherwise, and raise slowly. If you are not warned about this, the early weeks feel like proof the medication is wrong.

Benzodiazepines work differently. They act within the hour, which makes them genuinely useful in specific circumstances, and their limitations are well documented: tolerance with regular use, difficulty stopping after sustained use, effects on memory and coordination, and elevated fall risk in older adults.

If you are doing exposure-based therapy, tell both clinicians about any medication you take specifically around exposures. Benzodiazepines and other as-needed medications can affect how an exposure is experienced, and their timing is worth coordinating with your therapist and prescriber.

Other options exist and are worth asking about rather than assuming: buspirone for generalized anxiety, hydroxyzine for intermittent use, and beta blockers taken situationally for performance anxiety, which blunt the physical symptoms without the sedation.

What the appointments look like

A first psychiatric appointment usually runs longer than the ones that follow — often an hour, covering history, symptoms, medical background, family history, and what you have already tried.

Follow-ups are typically shorter and focused on how the medication is working. Some psychiatrists provide therapy as well, but many do not, and a fifteen or twenty minute medication check is standard practice rather than a sign of a disengaged clinician. If you want therapy from the same person, ask directly, because it is not the default.

Combining medication and therapy

For most anxiety disorders, therapy and medication both work, and the choice between them is often about preference, access, and severity rather than one being correct.

Combining them is common and reasonable. What is worth arranging deliberately is communication between the two clinicians, which usually requires you to sign a release and ask for it. Without deliberate coordination, therapists and prescribers may never make contact, and each can end up working from a partial account of how you are doing.

What to look for

Ask how they think about the sequence: what they would try first, what would count as evidence it is working, and at what point they would change course.

Ask what to expect in the first two weeks specifically. A prescriber who prepares you for early activation is one who has thought about how people actually stop taking these.

Ask about stopping before you start. Some of these medications need to be tapered rather than discontinued, and knowing that at the outset is better than discovering it later.

If you are already in therapy, say so, and ask whether they will coordinate.

Access in Los Angeles

Many psychiatrists in Los Angeles do not take insurance, and those who do often have long waits. Some practical routes around this: ask your primary care physician what they are comfortable prescribing, check whether your insurer covers telepsychiatry, and ask about psychiatric nurse practitioners, who are frequently available sooner.

If cost is the obstacle, county mental health services and community clinics provide psychiatric care on a sliding scale, and university training clinics are often cheaper than private practice.

This page is general information about what psychiatric care involves. It is not medical advice, and decisions about medication belong with a prescriber who knows your history.