Do Neurologists Treat Depression?
Short Answer: Do Neurologists Treat Depression?
Neurologists are not the specialists in treating depression, but they are qualified doctors and so there is nothing to stop them offering treatment, but they usually prefer you to see a psychiatrist.
I work in the United Kingdom for the National Health Service, and I have done work for corporate mental health bodies, and my experience is that neurologists do not treat depression.
As I researched, I found that in the United States, neurologists compete for patients with psychiatrists, though the two specialties have quite different training though they overlap in areas of responsibility.
So, in the USA, a neurologist might treat depression, but the specialist in depressive symptoms is always the psychiatrist.
To complicate things further, neuropsychiatrists are psychiatrists by training who work in neurology units and treat the frequent mental disorders that arise as complications of or are co-morbid with neurological disorders.
And then there are Clinical Psychologists who have another quite different training and a different focus of work, but who are also involved in the treatment of depression.
In this blog, we’ll cover the differences between neurologists, psychiatrists, and psychologists, as well as the differences between anxiety disorders and depression in neurological diseases. We’ll also touch on the situation of mental health support in the United Kingdom and the United States.
Do Neurologists Treat Depression?
Neurologists are medical doctors who specialize in diagnosing and treating diseases of the nervous system. They work closely with psychiatrists, who are also medical doctors, but who specialize in mental health care, including the treatment of depression, posttraumatic stress disorder and panic attacks.
What Do Psychiatrists Do?
Psychiatrists treat psychiatric conditions, or more simply: they help people suffering with disorders of the mind. These can be mental health or emotional problems. Many (but not all) psychiatric conditions are classified as ‘functional disorders’. That means that there are psychiatric symptoms, but there is no evidence that we can yet find in the brain or nervous system. Brain scans and blood tests cannot reveal serious conditions such as schizophrenia and bipolar disorder. Neither do much more common, but still difficult, conditions such as anxiety, major depression, and personality disorder appear in tests.
As a note, we see brain shrinkage in people with schizophrenia, and it used to be thought that this was a result of the schizophrenic disease process, but now it seems that this brain shrinkage is caused by the antipsychotics we give to treat schizophrenia, not the disease itself.
As drug abuse and alcoholism fall under the purview of psychiatry, there are specialist substance abuse psychiatrists.
Some psychiatric disorders do reveal themselves through scans, and these would include dementias like Alzheimer’s disease and dementia with Lewy bodies. Features of these of course are memory loss, but also hallucinations in Lewy Body Dementia. Despite these being, in essence, neurological conditions, they have traditionally been treated by psychiatrists.
Some psychiatrists specialize in the treatment of neuro-developmental problems like learning disability which involves cognitive impairment, as well as autism and attention deficit hyperactivity disorder (ADHD)
Psychiatrists are the people who treat the conditions listed above. DSM-5, the American Psychiatric Association’s statistical manual of mental disorders, lists psychiatric conditions and their diagnostic criteria.
In Europe and the UK, the manual used is World Health Organization ICD-10, soon to be ICD-11, which sets out all illnesses, including general physical diseases but also psychiatric and neurological conditions.
It used to be more common to use surgery to treat mental health problems. It is much rarer these days, but just to make things more complicated, any psychiatric surgical treatment these days is done by neurosurgeons, who may also (though rarely) be psychiatrists, neurologists or neuropsychiatrists.
Other mental health professionals, such as social workers treat depressive symptoms and work in psychiatric care teams.
What Do Neurologists Do Then?
In contrast, neurological disorders that involve brain disorders and problems with the nervous system, like epilepsy, Huntington’s disease, multiple sclerosis (MS), stroke, traumatic brain injury, paralysis, and spinal injury, can be seen in tests and images, and neurological disorders like these are treated by neurologists.
A neurologist is a doctor who focuses on problems with the central nervous system and other parts of the nervous system, like epilepsy, Parkinson’s disease, and spinal cord injuries. They will advise on the treatment of neurologic disease and are experts in neuropathic pain and brain damage.
A neurologist’s main job is to figure out what is wrong with the nervous system and offer treatment options based on the specific symptoms and cause of the problem.
There is a crossover in the medications used in psychiatry and neurology, with many of the medications used for neurological patients with conditions like epilepsy also being used in bipolar disorder, where they are also effective. Medications would include sodium valproate, lamotrigine, and the class known as the anticonvulsants. Lithium is not generally used by neurologists but is prescribed by psychiatrists for mood disorders
The mood swings seen in personality disorders are not thought to be a neurologic condition.
Other professionals are involved in the treatment of neurological conditions such as an occupational therapist or a speech therapist, and especially in neurological rehab, physical therapy.
Clinical Depression Arising From Neurological Problems
People who have neurological conditions often become depressed. A classic case of this is poststroke depression. While it is understandable that having a stroke would predispose someone to negative thoughts or even severe depression, it seems that depression can also be caused by the damage to the brain regions caused by having a stroke.
People with Huntington’s disease are also often very depressed.
There are several types of neurological disorders that can lead to depression. These include seizure disorders, such as epilepsy; brain injury; dementia; and brain tumors. When someone experiences any of these conditions, they may experience chronic pain or other symptoms that could make them feel depressed. It’s important for neurologists to recognize and treat depression in patients with these conditions.
Furthermore, someone with epilepsy, for example, may also have depression or anxiety that is not related to their depression. We would call these comorbid depressive disorders in that they are not secondary to the neurological problem, but occur independently of it.
Sometimes you will hear people talk about neuropsychiatric disorders, but to me this is an imprecise term that seems to be a catchall. It includes neurologic conditions as well as purely psychiatric ones.
How To Get A Diagnosis of Depression
While a diagnosis of depression will usually be made in primary care, or by a psychiatrist, though a neurologist is perfectly qualified to diagnose it too.
Typically, you will first be seen by a primary care clinician who will refer you to either a psychiatrist or a neurologist. but often in primary care it is not clear what the underlying problem is and so scans like magnetic resonance imaging (MRI) or computerized tomography (CT) will be ordered to help the primary care general practitioner know where to refer you. This coordination should be carried out by your family doctor, though the treatment will be left to the specialists.
The Difference between Psychologists and Psychiatrists
Most people with mental health issues are treated by a clinical psychologist or a psychiatric clinician. But there’s a difference between the two. A clinical psychologist has received psychology training and will typically treat patients with psychological therapies. They are not doctors and are not usually qualified to prescribe medication. .
Psychologists are trained to provide psychotherapy services for those with mental health issues. They learn how to use techniques like cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) to diagnose and treat mental health problems.
They use clinical assessment and diagnostic testing to find psychiatric disorders and make treatment suggestions based on the needs and preferences of each person.
A psychiatrist, on the other hand, is a medical doctor who typically treats you with prescription medication, usually selective serotonin reuptake inhibitors (SSRIs). Some may be trained as psychotherapists in addition.
Psychologists are trained to provide psychotherapy services for those with mental health issues. They learn how to identify mental health problems and treat them with techniques like cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).
Psychiatrists are medical doctors who specialize in diagnosing and treating mental illnesses using medications or other therapies, such as group therapy or mindfulness-based therapies. They may prescribe medications for patients with mood disorders, such as bipolar disorder or major depressive disorder, or prescribe medications for epilepsy, schizophrenia, chronic fatigue syndrome, or other conditions. They also provide care for patients with substance use disorders, eating disorders, anxiety disorders, and other mental health conditions.
Both psychiatrists and neurologists have had years of medical school and clinical practice. Both are capable of giving a correct diagnosis depression, (as is your primary health care provider). But they are two different specialties, and where the depression is not accompanied by neurological symptoms, for me, the best way is to go to a psychiatrist for an expert opinion about your depression for the right treatments and solid treatment plan.
The first step is to contact your healthcare provider, who will likely be a primary care doctor, and they can refer you to a psychiatrist or neurologist if they feel they cannot treat your problem in primary care.