How to Speak to an Online Psychiatrist

Are you curious about how to speak to an online psychiatrist? Well, you're in the right place. Here we will go over what an online psychiatrist is and how they can help you, including the types of medications they can, and cannot, prescribe.

We'll also talk about how to speak to a psychiatrist or primary care doctor online and the benefits of online psychiatry and mental health treatment.

PlushCare's online physicians can provide mental health services, including prescription medications (not classified as controlled substances), similar to an online psychiatrist.

Read on to learn how to speak to an online psychiatrist or primary care doctor.

Psychiatry vs. Psychology

Psychiatrists and psychologists are both trained in analyzing, diagnosing, and treating mental health disorders. There is a fair amount of overlap between the two specialties, but a few fundamental differences also set these two fields apart.

What Psychiatry and Psychology Have in Common

Both types of doctors use psychotherapy to help a patient function better with normal life stressors. Psychotherapy is basically a dialogue-based treatment (i.e., talking through issues as a form of therapy). This can be conducted as an individual, group, couple, or family session with a trained psychiatrist or psychologist.

Common issues that both psychiatrists and psychologists treat include:

• Stress

• Anxiety

• Depression

• Panic attacks

• Post Traumatic Stress Disorder (PTSD)

• Obsessive Compulsive Disorder (OCD)

The difference between psychiatry and psychology comes down to educational background and their approach to treatment.

Educational Background

A psychiatrist is a medical doctor (i.e., they have an MD or DO degree), which means that they have gone to medical school, completed one year of a medical internship, and have completed a three-year residency program; all of which are related to diagnosing and treating mental health disorders. 

A psychologist also has a doctorate, but it is a doctorate of philosophy (i.e., a PhD degree) or psychology (i.e., a PsyD degree), and usually, they have completed a one to two-year internship.

A professional therapist or counselor is also different. They usually have an MS (i.e., Masters of Science) degree and also provide talk therapy, but cannot prescribe medication for or diagnose a particular disease state. Therapists often specialize in marriage, family, occupational, individual, or educational therapy. 

The terminology can get confusing. Sometimes “therapist” and “counselor” get used in a general way that includes anybody skilled in providing therapy; including psychiatrists, psychologists, and professional counselors. However, each type of therapist will have a suffix that explicitly describes their specialty.

• MD – Psychiatrist

• PhD or PsyD – Psychologist

• LMFT – licensed marriage and family therapist

• LCSW and LMSW – clinical social worker

• LPC – licensed professional counselor

Approach to Treatment

A psychiatrist takes the diagnostic  approach of physiology and neurochemistry. This approach typically translates into medication-based treatment. 

Psychiatrists are the only type of therapist who can prescribe medications.

Psychologists are more focused on internal/external conflicts and behaviors, and how these behaviors influence a person’s mental health. A psychologist cannot prescribe medication, but they can administer and interpret various psychological tests such as IQ and personality tests.

As such, a psychologist is more likely to help patients develop coping and behavioral strategies through psychotherapy sessions in an effort to improve symptoms of mental health illnesses.  

Although their diagnostic approaches differ, psychiatrists and psychologists frequently work together to provide optimal treatment for a patient in need. In many cases, the combination of psychotherapy and medications is more effective than either treatment approach alone. 

What is Online Counseling?

Online counseling is any psychotherapy service conducted over the internet or phone. This may include a telephone call, video conference, texting, chat rooms, or email. Online counseling may also be referred to as telecounseling, web therapy, phone therapy, or text therapy.

Conducting virtual mental health counseling isn't entirely new. Doctors have been using phone calls to provide treatment to their patients for quite some time, but this was usually done in conjunction with in-office visits. The internet simply makes these types of therapy sessions easier and more accessible.

Online therapy is so easy that a growing number of clients are either increasing the portion of therapy they are receiving online, or forgoing the office altogether and getting their care exclusively online.

Good Things About Online Counseling

• Convenience, which isn't just about convenience. Some mental health issues can be much better served when a patient doesn't have to travel. For example, some people have such severe mental illness that they aren’t motivated to get out of bed or experience trouble leaving their home.

• Comfort. For some people, the fear or dread of talking in person  prohibits them from receiving effective talk therapy. Online counseling can help remove this barrier.

• Potentially cheaper. For people without health insurance, online counseling can be more affordable. Insured patients may also experience low or no copay with telehealth visits. 

• Access. Online counseling makes it much easier for rural communities or people who regularly travel to receive help. Patients can often avoid waiting weeks or months to speak to a mental health professional, which is typical of in office mental health clinics.

Things to Consider Before Seeking Online Counseling

Online counseling is relatively new, and as such, there are important things to consider before seeing a provider. When choosing an online counseling service, make sure that the therapists are licensed and check that they are licensed in the state where you live.

There are also some concerns about confidentiality. Is your therapist working from a coffee shop? Will a text or email be copied, shared, or read by another person? The best thing to do is to make sure your provider is reputable. 

Trustworthy online counseling providers typically adhere to state and federal regulations and implement policies to ensure your protected health information is kept confidential. 

What to Expect at Your First Counseling Session

If you haven't been to a psychiatrist or psychologist before, you may have some questions about what it will be like.

During therapy, your doctor will ask you some questions to better understand your problem. They might ask you why you sought therapy, questions relating to your personal history and current situation, and questions about your symptoms of mental illness.

They may also inquire about underlying medical conditions, drug or alcohol use, and if you take any prescribed medications. 

It is natural for some people to feel a bit nervous before their first counseling session, but it is important to be open and willing to discuss your problems. It is also important to ask questions so that you can be comfortable and understand how therapy works.

Doing some exercises to prepare is a good idea. Try writing down a list or a paragraph about your feelings and why you are seeking help. It is also helpful to say it all out loud after writing it down.

Sometimes speaking to family members and friends can help you identify symptoms or behaviors that you have not recognized. 

What can Online Psychiatrists Prescribe?

Online psychiatrists treat a wide range of concerns and can prescribe most medications, but there are some limits.

Common medications that an online psychiatrist can prescribe include:

Various selective serotonin reuptake inhibitor (SSRI) antidepressants like:

• citalopram (Celexa)

• fluoxetine (Prozac)

• escitalopram (Lexapro)

• fluvoxamine (Luvox)

• sertraline (Zoloft)

Atypical antidepressants such as bupropion (Wellbutrin) and Remeron (mirtazapine) may also be recommended alone or in combination with SSRIs.

Antidepressants are also often used to treat conditions other than depression like anxiety, bulimia nervosa, obsessive-compulsive disorder, panic disorder, and smoking cessation. 

Other examples of medications commonly used to treat mental illness include

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta), which can be used to treat chronic pain and fibromyalgia.

• Anti-anxiety medications like buspirone (BuSpar)

• Alpha-adrenergic blockers like prazosin (Minipress), which can be used to treat post-traumatic stress disorder.

(Note: not all of the following medications will be prescribed online):

• Lamotrigine (Lamictal), which is an antiepileptic/anticonvulsant often used to treat bipolar disorder.

• Quetiapine (Seroquel), an antipsychotic used to treat schizophrenia, bipolar disorder, and refractory depression.

• Lithium, a mood stabilizer used to treat bipolar disorder. This medication is typically monitored very closely due to its narrow therapeutic window and risk for adverse effects.

• Others

Online psychiatrists cannot prescribe controlled substances, medications that require administration by a doctor (such as injections), or medications that need prescribing or monitoring by a specialist.

Medications that cannot be prescribed online

• Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan).

• Methylphenidate (Ritalin).

• Dextroamphetamine (Dexedrine and ProCentra) or amphetamine with dextroamphetamine (Adderall).

• Various sleeping pills like zolpidem (Ambien) and eszopiclone (Lunesta)Cannabis products.

Why Are Some Medications Controlled?

Controlled substances are drugs and medications that can cause physical or mental dependence. These medications are carefully monitored because they can potentially be abused, especially in individuals with a history of drug dependence or substance abuse. 

Such drugs are regulated by the Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) and are categorized from schedule I (heroin, cannabis, crack cocaine, and others) to schedule V (like cough medicine with codeine). Most controlled substances that are prescribed for mental health conditions are schedule IV.

Who Has Online Psychiatrists?

Let's talk about some of your options for online mental healthcare therapy.

BetterHelp

BetterHelp only provides psychology services. You will not be able to speak to a psychiatrist or get a prescription medication initiated or refilled. Through BetterHelp, you can speak with psychologists, marriage/family counselors, clinical social workers, and licensed professional counselors.

On BetterHelp, patients primarily communicate with their counselor through text messages exchanged in a private “room”, which is open 24/7. Patients can schedule other types of sessions with their counselor like video calls, phone calls, and live chats where texts are exchanged with an immediate response.

BetterHelp does not accept any insurance and costs $160 to $240 per month.

LiveHealth

LiveHealth provides a video chat service where you can meet with a psychologist, professional counselor, or psychiatrist. Video calls are approximately 45 min and cost $85 per visit with a therapist or $95 per visit with a psychologist. Psychiatry appointments cost $175 for an initial consultation and $75 for a follow-up visit.

Doctor on Demand

With Doctor on Demand, patients are paired with a psychologist or psychiatrist for therapeutic sessions via one-on-one video sessions. This can be done over a computer through their website or on a phone or tablet through their app. You can meet with a doctor for therapy shortly after registering.

Doctor on Demand accepts many insurance plans and also offers employee discounts (WalMart, American Airlines, and more). The cost without insurance is:

• Psychology: $79 for initial session (25 min) and $119 for follow-ups (50 min)

• Psychiatry: $299 for initial session (45 min) and $99 for follow-ups (15 min)

Online mental healthcare is easily accessible and often more affordable than traditional in person care. It can be a great option for those who want or need mental health support. 

Next time you are thinking about speaking to a mental health professional, consider looking into online psychiatric care and decide if it’s right for you. 

If you have a behavioral or mental health crisis such as suicidal thoughts, please call 1-800-273-8255 (National Suicide Prevention Lifeline) for immediate help. For emergencies, call 911 or go to an emergency room for immediate care.

Read More About How to Speak to an Online Psychiatrist

• What Are Some Common Types of Therapy?

• Antidepressant prescription online

Sources

• Medlineplus.gov. Stress and Your Health. Accessed June 5, 2020 at https://medlineplus.gov/ency/article/003211.htm

• Suicidepreventionlifeline.org. National Suicide Prevention Life Line. Accessed June 5, 2020 at https://suicidepreventionlifeline.org/

• Mayoclinic.org. SSRIs. Accessed June 5, 2020 at https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825