A mental health diagnosis can be an important step in understanding what a person is experiencing. It can also bring a sense of relief. After struggling with depression, anxiety, attention problems or changes in mood, finally having an explanation can help things make more sense.
But a diagnosis alone doesn’t tell us how a person should be treated.
As mental health professionals, we look at the individual behind the diagnosis. Two people can meet the criteria for the same condition and have very different symptoms, medical histories, life circumstances and responses to previous treatment.
That’s why we don’t believe mental health care should follow a standard formula. Before recommending treatment, we want to understand what you’re experiencing, what you’ve tried, what has helped, what hasn’t, and what you hope will change.
The diagnosis gives us a place to start. Getting to know you helps us figure out where to go from there.
Two People. Same Diagnosis. Different Needs.
Let’s say two people come in with depression. We’ll call the first patient Sarah who has two young children and works full-time. She’s exhausted most of the time. She doesn’t sleep well and has trouble concentrating at work. She has stopped doing things she used to enjoy.
Her days feel like one long list of things she needs to get done. She hasn’t taken medication for depression before. She’s never seen a psychiatrist.
When Sarah comes in for an evaluation, there are a lot of things to consider. How long has she felt this way? How much is sleep affecting her mood? What kind of stress is she dealing with? Does she have any other medical conditions? What medications does she take? What would she like to change?
Her treatment may include medication. Therapy may also be useful. Her psychiatrist may want to address several things that are contributing to how she feels.
Now consider James. We’ll say he’s 52 and has been dealing with depression for years.
He’s already tried several medications and one helped for a while and then stopped working. Another caused side effects that made it difficult to continue. He tried another medication but felt emotionally numb while taking it.
He’s also been to therapy. James isn’t coming into the office wondering whether he needs help. He’s already spent years looking for it.
He’s still depressed.
He has very little energy. Work has become harder. He doesn’t enjoy the things he used to. He’s frustrated because he feels like he’s tried everything people have told him to try.
James may have the same diagnosis as Sarah, but his psychiatrist is starting from a very different place.
His previous medications matter. His response to those medications matters. The side effects matter. His treatment history matters.
He may need to consider different treatment options than Sarah. That’s why there isn’t one depression treatment that works for everyone.
The Diagnosis Is Only Part of the Story
A diagnosis gives a psychiatrist important information, but it doesn’t describe everything you’re dealing with. Think about depression…
For one person, the biggest problem may be sleeping all day and having no energy. Someone else may still go to work every day but feel miserable and disconnected once they get home.
Another person may struggle with severe anxiety at the same time. Someone may have tried several antidepressants. Someone else may have never taken one.
Those differences matter when deciding how to approach treatment.
The same thing is true with ADHD.
One adult may constantly lose things, miss deadlines and struggle to stay organized.
Another may have created a very strict routine to manage those problems but still struggle with focus, impulsivity or emotional regulation.
Someone else may not realize they have ADHD until adulthood, when work, parenting or other responsibilities become harder to manage.
The diagnosis is the same but the experience isn’t.
What You’ve Tried Before Matters
If you’ve already tried treatment, tell your psychiatrist what happened.
Don’t just say, “It didn’t work.” Talk specifically about what you noticed.
Did your symptoms improve at all? How long did you take the medication? Did it help at first? Did you have side effects? Did you stop taking it because you felt worse, or because you didn’t notice any change?
That information can help your psychiatrist understand what to consider next.
The same applies to therapy.
Maybe therapy helped you tremendously. Maybe you didn’t connect with the therapist. Maybe you liked the therapist but didn’t feel the approach was right for what you were dealing with.
That doesn’t mean therapy “doesn’t work” for you. It means that experience is part of your treatment history.
Treatment Can Change as Your Life Changes
Another thing to consider is that your treatment plan may need to change over time. That’s not unusual.
Your symptoms can change. Your health can change. Your work or family situation can change. A medication that worked well for years may not work as well anymore.
You may also reach a point where your current treatment is helping, but not enough.
That’s worth talking about. You don’t have to wait until you’re in crisis to tell your psychiatrist that something isn’t working as well as it used to.
And you shouldn’t feel like you’ve failed because you need a different approach. Mental health treatment often involves adjustments along the way.
Your Psychiatrist Needs to Know What Life Actually Looks Like
A medication list doesn’t tell us what it’s like for you to get through a Tuesday. That’s why the conversation matters.
Are you sleeping?
Can you get through your workday?
Are you avoiding people?
Are you having panic attacks?
Can you get yourself organized?
Are you struggling to get out of bed?
Are side effects making it difficult to stay on medication?
Are things better than they were six months ago, or are you still struggling?
These details help paint a much clearer picture. You should also feel comfortable talking about what you want from treatment.
Maybe you want to be able to concentrate at work again. Maybe you want enough energy to spend time with your family. Maybe you simply want to feel like yourself again.
There Isn’t Always One Right Answer
Psychiatry isn’t about finding one treatment and assuming it will work forever.
Sometimes the first treatment helps.
Sometimes it doesn’t.
Sometimes it helps a little, but you need more.
And sometimes someone has been treated for years without getting the results they hoped for.
That can be incredibly frustrating. If that’s where you are, it doesn’t mean you’ve run out of options.
It may mean it’s time to take another look at the bigger picture.
At Montana Psychiatry & Brain Health Center, we work with people at different points in their mental health journey. Some are reaching out for psychiatric care for the first time. Others have tried multiple treatments and are still struggling.
Our care can include psychiatric evaluations, medication management, therapy and advanced treatment options for conditions including treatment-resistant depression, anxiety and ADHD. We offer appointments in person as well as through telepsychiatry.
The starting point is understanding what you’re actually experiencing and what you’ve already tried.