Dr. Torang Shatzmiller Sepah, M.D.

Great question and glad you asked! This shows that you are invested in your healthcare. In medical school, there was an important lesson taught year after year which is the basis of a physician's thought process: there is no wrong question, so ask away until you understand something.

Your question is one that many ask and I can see why it would be easy to not clearly know who is who and what is what given the plethora of healthcare staff. Becoming educated about what the credentials and scope of each person involved in your is a step in becoming a true partner in your care. The more you know, the more empowered you are as a patient.

Here is the difference between the two:
1. Psychiatrists such as myself are physicians, meaning they are "Medical Doctors" as defined as either having an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine--same as MD, just additional curriculum). We are licensed by the Medical Board of California and complete a four year medical residency, then take a two part exam to become diplomates or "specialty board certified" by the American Board of Psychiatry & Neurology. We practice medicine and are licensed as such. Our first year typically is in general medicine, pediatrics and neurology. We also learn the six main therapeutic modalities--i.e. CBT. But this is only part of our education. Our foundtion is in medicine and we use that knowledge along with our psychotherapeutic training to diagnose and treat patients across all psychiatric disorder spectrums.

Psychologists while referred to as "Doctor", are not physicians. They had either a PsyD or PhD in psychology, which is based on studying behavior and the therapeutic modalities also learned by psychiatrists. Psychologists spend more time learning talk therapy. They do a one year "internship" which is seeing patients while supervised by a licensed psychologists. There is no speciality board for psychology as it is not a medical specialty. They are licensed by the Psychology board.

From my experience, and what evidence shows is that treatment in talk therapy is more effective if the patient is also being treated with pharmacological interventions as there is no way to separate the neuroscience of the brain from the rest of medicine. Your brain is attached to the rest of you which is governed by multiple complex processes, genetic variabilities, etc.
The right medication can help patients reach a point where they are more open, forward-thinking and thus able to make better use of their time in therapy.

I hope that helps.

I'm sorry to hear that. The best advice is to talk to your primary care physician or psychiatrist if you have one currently, about what their impression is. Treatment resistant depression is complex and requires a very careful examination of previous treatments, as well as looking at the whole medical picture. There are specific treatment options pharmacologically for rx-resistant depression and also types of talk therapy that can be helpful, such as cognitive behavioral therapy. I would recommend contacting your local department of mental health to inquire about such options in conjunction with engaging your current physicians in helping you with this.

I'm sorry to hear that. There are not necessarily "guidelines," however, physicians prescribe medications based on certain symptoms and criteria, just as we treat other ailments like high blood pressure and type two diabetes. My first advice is to consult with your primary care physician, as most PCP's are the first line physicians in initiating treatment. You should contact your local department of mental health if you do not have a PCP and they can help refer you to a psychiatrist. You should go to the emergency room/seek emergency care should you experience severe depressive symptoms, such as having any thoughts of plans of self harm or harming others or find you are not able to care for yourself, or are experiencing auditory hallucinations (hearing voices that others do not hear). In Los Angeles County, the 24hr crisis line for the department of mental health is 888-854-7771.

She should be seen by a physician right away to rule out an acute cause, such as a urinary tract infection, which can alter the mental status of geriatric patients, or whether there is a chronic condition that can be causing this. Either way, seeing a physician now is the first step.

It should not as prozac (or fluoxetine) is the only weight neutral (not likely to cause weight gain or weigh loss) SSRI, and one of three weight neutral antidepressants, with the two others being Venlafaxine and Buproprion. At times, people who feel better regain their appetite and gain a few pounds post initiation of treatment. This may be the reason. Either way, I recommend discussing with your physician.