Online psychiatrist: how the consultation works and when it is warranted

HICOA · Mental Health Clinic — Online sessions and in Matosinhos

Short answer: an online psychiatry consultation takes place by video call and typically lasts 50 minutes. The psychiatrist reviews your clinical history, symptoms and current medication, and ends by proposing a plan — which may include medication, psychotherapy, both, or neither. You do not need a prior diagnosis to book.

Psychiatrist or psychologist: which one?

The difference is straightforward. A psychologist works through conversation and psychological techniques, and does not prescribe medication. A psychiatrist is a medical doctor: they assess clinically, diagnose, and can prescribe.

They are not competing alternatives. For most common emotional difficulties, the psychologist is the natural starting point. The psychiatrist comes in when symptoms are more intense or persistent, when medication is indicated, or when existing medication needs reviewing.

They frequently work together — psychotherapy with one, medication managed by the other. In moderate to severe depression, that combination is often more effective than either alone.

When psychiatry is warranted

• You are on medication with no specialist follow-up — your GP keeps renewing the prescription, but nobody is reassessing whether it is still the right one, at the right dose. This is the most common situation, and the one that benefits most.
• Symptoms will not shift — anxiety, depression or insomnia persisting despite psychological support, or limiting daily life.
• You want to reduce or stop medication — particularly sleeping pills and anxiolytics taken long-term. Tapering is done with a plan, never on your own initiative.
• You do not know whether you need it — and want an assessment that clarifies. Leaving a consultation knowing you do not need medication is also a result.

How the consultation goes

The first one is an assessment. The psychiatrist asks about your history — what brings you, since when, what you have tried, what medication you take or have taken, relevant personal and family background, sleep, appetite, alcohol. It is not an interrogation: it is the information needed to decide on solid ground.

You leave with a proposal. It may be starting medication, adjusting what you already take, referral to psychotherapy, or waiting and reviewing. You should clearly understand what is proposed and why — and you have every right to ask until you do.

Then, follow-up. Adjustments are rarely made in a single appointment. The first weeks on a new medication call for close monitoring; after that, appointments space out.

Does it really work by video call?

For psychiatric assessment and follow-up, yes. Psychiatric consultation rests largely on the clinical interview: what the person reports, how they report it, what is observed in their speech and affect. None of that requires sharing a room.

What you need at your end: a stable connection, headphones if possible, and a space where you will not be overheard. That last point is the one that most often fails — and in a consultation where you will discuss intimate matters, it is the one that counts most.

What if I live abroad?

This is where the online consultation solves a real problem. Many people living abroad spend months or years with medication supplied by a local GP, without ever reaching a psychiatrist — because of language, waiting lists, or both.

The online consultation fills the gap that was missing: specialist assessment, in a language you are at ease in, with continuity. Prescriptions are issued as normal, and the practical details — which vary by medication and by country — are sorted out with you during the consultation itself.

What to bring to the first consultation

It helps enormously to arrive with three things: the name and dose of the medication you take (a photo of the boxes does the job), a sense of how long you have felt what you feel, and what you have already tried — other medications, therapy, changes in your life. With that, the first consultation goes much further.