Should I see a GP or a psychiatrist for anxiety or low mood?

Maybe your mood hasn't lifted for weeks, anxiety is running your days, or sleep has fallen apart. Or perhaps you already take a medicine that needs reviewing, or you're worried about a relative. You know you want help, and you're not sure whether that means your GP or a psychiatrist.

The short answer: a GP is often the right first conversation, and a consultant psychiatrist is the right person when the question has outgrown that first conversation, or you want a specialist opinion from the start. Both are available here, and you don't need a referral for either.

If you'd rather skip the reading, you can send a psychiatry enquiry to Dr Shoka or call 0207 499 1991, and the clinic will arrange the first appointment. A consultation with Dr Shoka is £250, and a private GP appointment is £150.

If you need help right now

If you're in immediate danger or can't keep yourself safe, call 999 or go to A&E. Medical Express Clinic offers planned appointments rather than crisis care.

If you're struggling to cope or having thoughts of suicide, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123. NHS 111 runs around the clock, so it's also the place to turn if you're getting worse after the clinic has closed. A private GP appointment can often be same-day, and a psychiatry enquiry arranges a planned consultant assessment.

When is a GP the right place to start?

Low mood, anxiety and sleep problems are everyday GP work, and starting there is a way of taking them seriously. A GP at our GP service sees you in person at 117a Harley Street for £150, with no fixed time limit on the consultation. They can take a history, look at what you've already tried, consider physical causes and review your medicines.

Here's something people often don't expect: a fair amount of low mood and poor sleep has a physical or practical cause. Thyroid function, alcohol, caffeine, a change of shift or a new tablet can all play a part. If nobody has checked those yet, a GP can look at them first. When an examination, blood collection, an ECG or a breathing test would change the plan, those can often be done that day in the same building.

A first conversation about low mood, anxiety you're still managing at work and home, or sleep that has gone wrong, usually belongs here. You don't need a GP referral to see Dr Shoka, but if a GP has written a letter, bring it.

When should I see a psychiatrist instead?

Consultant psychiatry is the right visit when the question is already psychiatric: a history that has outgrown a first GP conversation, a possible psychotic illness, a complex medicine review, a request to start a controlled drug, or a picture that needs a consultant's formulation.

Dr Ahmed Shoka, Consultant Psychiatrist, GMC 4573207, MRCPsych, is the clinical lead for psychiatry at Medical Express Clinic. He works in general adult psychiatry, with a special interest in psychosis, physical health monitoring for people with severe mental illness, and medico-legal practice.

Medical Express Clinic has practised at 117a Harley Street since 1984 and is CQC-registered.

What happens at the first psychiatry appointment?

You send an enquiry first, and the clinic arranges the appointment, confirming availability when it responds. Dr Shoka mainly offers video consultations, and in-person options can be discussed on request. The first consultation typically lasts 50 to 60 minutes and costs £250.

It usually includes a full psychiatric history, a mental state examination, a discussion of your symptoms and how they affect daily life, and a clinical formulation where that's appropriate. A formulation is a working understanding of what's going on and why, which is often more useful than a single label. The first visit is a structured assessment, so a particular diagnosis or treatment plan isn't guaranteed. If you've asked about a specific medicine, Dr Shoka reviews your history before discussing whether any change is right for you.

Follow-up is booked when it's clinically suitable, usually lasts 30 minutes and is used to review progress. If you've seen Dr Shoka before and he advised a further review, mention it when you enquire.

What if the worry is memory rather than mood?

Memory and thinking concerns have their own service: the memory clinic, led by Prof Arshad Rather, Consultant Geriatrician and General Physician, GMC 6035767, with cognitive screening available at our sister service. It's for persistent change in memory, planning, language, orientation or behaviour that is starting to interfere with work, medicines, money or safety at home, and either the person or a relative can make contact.

If low mood, anxiety or psychosis is the main problem and thinking is otherwise clear, psychiatry is the better specialist choice. If memory, thinking or confusion is the main concern, start with the memory clinic. A GP visit can still help first when a general medical review or routine blood tests would be useful. Sudden confusion, stroke symptoms or anyone acutely unwell needs 999 or A&E.

What about repeat prescriptions and controlled drugs?

Some medicine questions need a prescription review rather than a full assessment. If you've run out of an established medicine, eligible repeat requests can go through our prescription-only GP service. A doctor reviews each request in person at 117a Harley Street and may approve it, decline it, or ask you to attend for a full GP consultation. A new medicine always needs a full consultation.

Controlled drugs have tighter rules. Continuing an existing controlled-drug prescription needs a clinician review: some can be continued by a GP, while others need the consultant psychiatrist. Either way, you'll need evidence of the previous prescription, and the clinic may contact the doctor who first prescribed it.

Starting a controlled drug is a psychiatrist's decision, made after a consultant assessment. Patients who need an initial controlled-drug assessment can send a psychiatry enquiry to Dr Shoka. Controlled drugs are only started after the checks the medicine requires, which may mean an in-person visit, and any prescription remains subject to clinical judgement.

Where to start, at a glance.

Making your enquiry count

Send letters, a medicine list and any old results with your enquiry, so the history doesn't start from a blank page.

• If a family member has useful observations, mention that they could help.
• If the appointment is for a relative, say who it's for.
• If video won't work for you, ask about in-person options.
• If you're unsure which service fits, say so when you enquire.

Related reading: when a memory concern needs a memory clinic and how a private prescription review works. For full details of the service, see our private psychiatry page.