Psychologist or Psychiatrist

Discussion in 'General Parenting' started by olemissreb85, Mar 3, 2008.

  1. olemissreb85

    olemissreb85 New Member

    That is my dilemna! Our current psychologist is recommending a psychiatrist to further evaluate my difficult child to see if additional medication is required. difficult child was diagnosed in Sept with ADD, ODD and mildly elevated anxiety and depression (non-specific). Original thought with dr. who performed evaluation and difficult child's pediatrician was situational anxiety and depression after having been "indefinitely suspended" from private school. (He was back in school 7 weeks after suspension started).

    This past Friday, difficult child had 2 episodes at school where he totally lost his temper. He was able to calm himself down within 5-10 minutes and rejoin his classmates, but it worried his teachers. This also worried me because it hadn't happened since starting Concerta back in Sept. I have made an appointment with the psychiatrist, but here are my questions:

    Could the Concerta cause this? (He's on 90mg)
    Who is better equipped to handle these cases: psychologist or psychiatrist? I don't really want to see both (insurance covers the psychiatrist but not the psychologist).
    If additional medication is prescribed for anxiety/depression, what kinds of questions should I ask? What are good medications to work with the Concerta?

    Psychologist has recommended Prozac, but also mentioned that it could make difficult child hyper instead of calming him down so that he can work on his social skills. I guess the psychiatrist would know better???

    Please help!
  2. JJJ

    JJJ Active Member

    Psychologist should not be recommending medication. In my experience, you really need a psychiatrist who works with a psychologist. The psychologist can report what she is seeing to the psychiatrist so that she can prescribe the medications.
  3. olemissreb85

    olemissreb85 New Member

    Thanks JJJ.

    But is there really a need to see both? I thought that they basically did the same thing but that the psychiatrist can prescribe medications while the psychologist can't.
  4. smallworld

    smallworld Moderator

    Sometimes there is a need to see both, sometimes not. Our kids see a psychiatrist for weekly psychotherapy AND medication management. But if the psychiatrist did not do therapy, we would need to see a psychologist. What role is your psychologist playing? Who is writing the prescriptions for the medications?

    Concerta can exacerbate anxiety and cause depression. Your child is also on a very high dose of Concerta (higher than recommended) so you really do need to get yourself to a medication specialist (i.e., psychiatrist).
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    A psychiatrist has a medical degree. Big difference. I wouldn't put them on the same level at all. The psychologist may have a working knowledge of medications, but she hasn't been to medical school. I definitely would prefer a psychiatrist. Prozac is not a good medication for many, many kids. I'd want the Psychiatrist to come up with his own evaluation. All the labels your child has really means, "I don't really know."
  6. JJJ

    JJJ Active Member

    As MWM said, a psychiatrist is a MD. You need the MD for medication management. You don't say how old or what your son weighs. My 12-year old, 80-lb son is on 54mg of Concerta. 90-mg sounds high but if your son is large, maybe it is right? I don't know. Is the concerta rx by your pediatrician?

    Many different professionals can provide therapy. We have worked with Social Workers, Clinical Therapists and Psychologists. From my experience, it depends on the "match" between the professionals personal strengths and experience and your child's needs. My Kanga is an incredibly complex and severely mentally ill child. We deal almost exclusively with PhD for her -- although we had one amazing social worker at one of the hospitals. Tigger's best progress was made with a clinical therapist.

    Basically, you need medication management and therapy. Only an MD can do the medication management and very few of them also offer therapy.

    Could you tell us more about your son and who diagnosed him? It would be great if you could go to your "User CP" and create a signature (see mine at the bottom of the post).

  7. olemissreb85

    olemissreb85 New Member

    Thank you all for your thoughts. My 12yo was diagnosed with the ADD by his pediatrician. This diagnosis was based on actions/traits that I described as well as what he saw in his office. The Concerta was prescribed by our pediatrician. The ADD diagnosis was confirmed after the psycho ed evaluation that was done by a psychologist (different from the one we are seeing). The evaluation also discovered the ODD and non-specific anxiety and depression. My son weighs 82 pounds and seems to be doing well on the 90 mg of Concerta. His pediatrician recognizes that this is a high level and we are watching him. Thanks for letting me know about the Concerta exacerbating the anxiety and the depression. I'll bring that up next time I'm in the pediatrician's office.

    We went to see the psychiatrist that our psychologist recommended. She was very nice and I was so totally comfortable with her. She seemed to really "get" my son - after only one meeting. She is going to confer with the psychologist and probably our pediatrician to discuss the medications. She is supposed to be very knowledgeable about those types of things. I'm waiting to hear back from her. From what I can tell she also does therapy. If I'm right, I think we will probably switch to her - my son said he was comfortable with her and liked her better than the psychologist!