At the psych ward I worked at, 30 minutes to an hour was the usual amount of time for the first time the patient met with the psychiatrist. 

Psychiatrists did meet with all the patients every day, but after that first session, the meetings were generally very quick, typically anywhere from 5-20 minutes.

This rush is because all of our psychiatrists saw outpatients in the afternoons. Our area is seriously underserved, meaning that there are nowhere near enough psychiatrists for the amount of people who need to see them. 

Note: This is what I personally saw when I was working in an inpatient psych ward in a rural setting. Other hospitals have different policies / ways of doing things. 

Disclaimer

This is a bit vague, and it really depends on what exactly you mean by “psychiatric”, as it’s a word often confused with “psychological”.

Psychiatry deals with the medical & medication side of treating mental illness. The first session with a psychiatrist typically focuses on getting an accurate medical history and finding out what symptoms the client is experiencing so the psychiatrist can figure out what medicines to prescribe.

If that’s not what you meant, let me know and I’ll throw up a post on psychological assessments!

Disclaimer

CW: self-harm, suicide

Yes, totally possible. While antidepressants are often used to treat anxiety disorders, they can also cause symptoms related to anxiety too. It’s most frequently described as jitteriness, but there are more symptoms associated with it as well (scroll down to table one here).

 Two drugs are especially associated with causing anxiety: imipramine (Tofranil) and fluoxetine (Prozac). Of those two, I would lean towards Prozac, as it’s considered a first-line treatment and is extremely common. Tofranil is a bit outdated and rarely used anymore.

Note - Typically the anxiety occurs within the first few weeks of treatment, and it actually does go away fairly quickly. A psychiatrist may try to see if the anxiety symptoms go away before switching to a different drug. 

Now, the self-harm is a bit of a different story. All antidepressants may potentially increase the risk of suicidal tendencies in children, adolescents, and young adults (ie under the age of 25 or so). 

Because this question was sent off anon, the Shrink asked how old this character is, and she’s 17. A psychiatrist could easily see an increased desire to self-harm as a warning sign that this specific antidepressant may be making your character suicidal. That’s definitely enough to merit changing what medication she’s on!

Disclaimer

There are a lot of factors!

Three random examples of things a psychiatrist could consider, off the top of my head:

If someone has insomnia as part of their depression, they might be prescribed Remeron / Mirtazapine (to be taken at night) because it is likely to help them sleep.

If a character also has ADHD, Strattera / Atomoxetine might be an option.

One class of antidepressants, MAO inhibitors, are almost never prescribed without the patient trying a lot of other antidepressants first. This is because you have to follow an extremely strict diet or risk death. And by “strict diet” I mean that you can’t eat cheese, cured or processed meats, anything with soy, or drink beer (among many other things). If the character is willing to put up with that diet, and nothing else has worked for them so far, MAOIs might be an option; otherwise, they’re not going to be prescribed.

There are literally hundreds, if not thousands, of little things like that to consider when prescribing psychotropic medications. That’s why they pay psychiatrists the big bucks.

Disclaimer

I’d say one of the misconceptions that really pisses me off is the idea that all therapists are Freudian. I really hate Freud.

For intense trauma work, meeting with a psychologist twice a week is pretty reasonable.

With severe mental illnesses, it’s typically recommended to see a psychiatrist in addition to a psychologist in order to be prescribed medications. A character would typically see a psychiatrist roughly once a month or so (less often if the character has remained stable on their medications). CPTSD and PTSD are a little squidgy because there aren’t really medications that deal specifically with those disorders, but sometimes SSRIs or a drug like Prazosin would be prescribed.

For the rest of your questions, I’ve got a few posts in my archives that I think you should check out!

Differences between different kinds of mental health professionals

Why seeing more than one therapist at a time isn’t recommended.

Important things to note when writing characters with C-PTSD

Treating PTSD

Disclaimer

When a psychotropic medication isn’t working, there are a couple of different options. 

Which is chosen depends on the doctor; there’s benefits and drawbacks for each option.

Typically, if a character developed tolerance to a medication quickly, and increasing the dosage did not work, they would not be tapered off and put back on it. There are a lot of other antidepressants out there (~30 FDA approved medications for treating depression, and god knows how many other drugs that are prescribed off-label for it), so it doesn’t make sense to waste time putting your character back on a medication that they already know won’t work for very long.

And as an FYI, when someone has severe depression that’s resistant to many different medications, ECT might be recommended as a treatment.

Disclaimer

CW: suicidal ideation

It is indeed possible for a character to become suicidal after beginning to take antidepressants (which is actually the reason for the so-called “Black Box” warning that accompanies those medications).

If a character doesn’t have a support system like you describe, they may be scheduled to see their therapist and psychiatrist more frequently than before to make sure that they’re not having bad side effects. The therapist would also likely make sure that your character knows about other emergency supports available to them, such as suicide hotlines and voluntary hospitalization.

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I’m not 100% sure what you mean by this, but I’ll give it my best shot.

Therapist: A general term that refers to any mental health professional that sees clients in a therapy context. This is sometimes used interchangeably with “counselor”, but on this blog I exclusively use the first definition.

Psychiatrist: medical doctors that prescribe psychotropic medications. They do a little therapy too. They can diagnose mental illnesses. Typically, they work with more severe mental illnesses that can’t be treated with therapy alone.

Psychologist: also doctors, but PhD or PsyD, not medical doctors. These are the talky talky ones. They can diagnose mental illnesses and administer psychological testing. They usually cannot prescribe medications, but it depends on the state. 

Counselor: someone with less training than psychologists (a master’s degree). They can do therapy stuff, but they cannot diagnose mental illnesses. Typically, they don’t deal with severe, chronic mental illness; instead, their focus tends to be more on helping people who have acute problems.

Social worker: someone with a bachelor’s or master’s degree (a master’s is required if they want to practice therapy). Their goal is improving well-being and help people overcome challenges (poverty, addiction, etc.) in their lives. Typically, they work with more vulnerable / disadvantaged populations.

There’s also a few others that don’t require licensing:

Religious leader: Titles and roles vary greatly by religion, but overall, anyone who gives advice / support to any of their congregation who’s going through a tough time.

Life coach: someone with zero qualifications that gives “”advice”” on life / business stuff. 

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The Scriptshrink consultants provide their personal experiences with being treated for depression after the jump.

CW: Various medications are discussed.