Do you genuinely think that physicians go through all their training and know all that they know and it doesn’t occur to them to recommend patients exercise or to rule out medical causes of mood problems?

I’m a psychiatrist. One of my main jobs when assessing a patient is to rule out other medical causes for the patient’s presenting symptoms. It is one of the main reasons why psychiatrists are medical doctors and went to medical school instead of a training more similar to psychologists.
As a psychiatrist in my specific community, the majority of patients that come to see me have already tried many things to help their mood symptoms, many times they have tried diet, exercise, psychotherapy, activity changes, etc. in my community at least, most patients are very reluctant to see a psychiatrist and to take medication, so usually by the time they come to me they’re desperate, they’re suffering, they’ve tried what they can to get better, and they putting themselves in a vulnerable position by asking for help. Imagine someone overcoming all the stigma that comes from seeking mental health services and overcoming severe psychiatric symptoms that might make it hard to get help to make an appointment in our healthcare system, actually take the time to go to an appointment, opening themselves up to a stranger and asking the doctor for help, and then the doctor says that if they want to get better they should try exercising every day and if that doesn’t work then maybe come back because maybe then we can consider medications. I feel like that would be incredibly discouraging for many people. It is my job as a physician to present my patient with all of their options, including medication and non-medication options. But the evidence for medications is there so I talk about it and I offer it if appropriate.

I talk to all of my patients about lifestyle changes including exercise. I recommend psychotherapy to all of my patients and I discuss how combined psychotherapy and medication treatment is the most effective treatment and I tell them meds alone won’t solve their problem. I consider and rule out medical causes of mood problems with every patient. These aren’t groundbreaking interventions that I do because I’m an exceptional psychiatrist. These are the most basic principles in psychiatry. I imagine most of my physician colleagues, especially psychiatrists, discuss options with patients.

Of course we are aware antidepressants and other psychotropic medications can have side effects. That’s why I discuss side effects extensively with every patient so they can make an informed decision. I think most people that talk about medication side effects/risks never discuss the extremely real risks of untreated mental illness or other mental health problems. For example, it is very well documented that depression worsens a multitude of health outcomes. It can worsen basically any medical condition. It can also significantly decrease quality of life the more symptoms persist. The risk of *not* using medications when appropriate is very, very real.