Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- Who leads the session
- a psychiatrist responsible for choosing, monitoring, and adjusting your treatment
- Format
- video consultations, with messaging contact with the doctor between them on agreed-upon issues
- Duration
- first appointment 40–60 minutes; follow-ups 20–30 minutes every 2–4 weeks
- Anonymity
- consultations without your surname; issuing a prescription requires identification under Kazakhstan law
- When it is urgent
- severe adverse reactions, high fever with muscle rigidity, suicidal thoughts—call 103 or 112
- Outcome
- an effective, well-tolerated regimen, a plan for maintaining it, and criteria for eventually stopping it
What you should know
Why is the right treatment rarely found on the first try? The response to psychiatric medications is individual: it depends on a person’s metabolism, other health conditions, other medications, and the severity and type of symptoms. Clinical guidelines describe a step-by-step algorithm: choose a first-line medication, take it for long enough, assess the response using rating scales, and then continue, adjust, switch, or augment. This is a normal process, not a sign of failure.
The key to success is regular monitoring. The most common mistakes are stopping a medication after a week because “it isn’t helping” or taking it for months without any effect because “you can never get an appointment.” The online format solves both problems: short follow-up appointments fit easily into a work schedule, there is no need to drive from the right bank to the left bank through a blizzard and strong wind, and the doctor sees your progress without gaps and responds to changes in time.
When You Need Medication Selection or Treatment Adjustment
- you have been diagnosed and need to choose your first treatment with a doctor
- you have been taking a medication for more than 6–8 weeks without noticeable improvement
- you have improved partially, but some symptoms remain
- side effects—drowsiness, weight gain, reduced libido—are interfering with your life
- your symptoms came back after improving, while you were on the same treatment
- you are planning a pregnancy or have developed a new physical health condition
- you want to gradually reduce or stop your medications under a doctor’s supervision
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
Why Treatment May Not Work as Expected
The effect of most antidepressants and several other drug classes develops gradually: the first changes are usually noticeable after 2–4 weeks, and the full response is assessed after 6–8 weeks at an adequate dose. The mechanism has less to do with an instant change in neurotransmitter levels and more to do with receptor adaptation and neuroplasticity. That is why concluding too early that a medication does not work is one of the most common reasons treatment selection fails.
Other reasons include taking medication irregularly, drug interactions, unreported alcohol use, an undiagnosed co-occurring disorder, and an incorrect initial diagnosis. Lifestyle matters too: chronic sleep deprivation, lack of daylight during the long winter, and overload at work can partially cancel out the effect. The doctor’s job is to find the specific cause rather than simply swapping one medication for another.
How Medication Is Selected Over Video
At the first appointment, the doctor clarifies your diagnosis, treatment history, other health conditions, and everything you take, including supplements and over-the-counter medicines. You discuss priorities: which symptoms matter most and which side effects are unacceptable to you. At follow-up appointments, you complete short rating scales, and the doctor assesses your progress and how well you are tolerating the treatment. Keeping a sleep and mood diary is helpful—you can share it on screen.
Prescribing and issuing prescription medications depend on Kazakhstan law and the requirement for an initial in-person examination, so an in-person visit is sometimes needed. Some drug classes require lab monitoring—blood tests or an ECG—which you complete at a laboratory with a referral. Severe adverse reactions or a sudden deterioration call for urgent in-person care: call 103 or 112.
How we help
Choosing a first-line medication
The decision takes into account your diagnosis, symptom profile, other health conditions, possible interactions, and your preferences regarding tolerability. For example, different classes of antidepressants are chosen for severe insomnia and for apathy. The doctor explains the reasoning behind the choice, when to expect an effect, and possible side effects, so you know what to watch for.
Monitoring the response with rating scales
Objective scales for depression, anxiety, and sleep quality help distinguish real improvement from ordinary mood fluctuations. Clinicians distinguish between a response to treatment and remission: the goal of treatment is remission, when symptoms have virtually disappeared and functioning has been restored. A partial response is a signal to adjust treatment, not a reason to put up with residual symptoms.
Adjusting, switching, augmenting
When the effect is insufficient, clinical guidelines provide for several steps: optimizing the dose within the approved labeling, switching to another medication in the same class or to a different class, adding an augmenting agent, or adding psychotherapy. Each step is taken one at a time, with the result assessed, so it is clear exactly which change made the difference.
Maintenance treatment and discontinuation
After remission is achieved, treatment is usually continued for several months to reduce the risk of relapse. Discontinuation is done gradually, on a schedule agreed with the doctor: stopping many medications abruptly causes discontinuation syndrome and increases the risk of symptoms returning. Online monitoring is especially convenient at this stage and makes it easy not to miss appointments.
Myths and facts
MythIf a medication doesn’t help within a week, it isn’t right for you
FactMost medications need several weeks to take effect. The assessment is made after 6–8 weeks at an adequate dose, and switching too early only drags out the selection process and creates the feeling that “nothing works.”
MythAntidepressants are addictive
FactAntidepressants do not cause addiction in the clinical sense: there is no craving and no increasing tolerance. Stopping abruptly can cause discontinuation syndrome, so they are tapered gradually—but that is not the same as addiction.
MythYou’ll have to take medication for the rest of your life
FactThe duration depends on the diagnosis and the number of past episodes. After a first episode of depression, treatment is usually continued for several months after remission and then gradually stopped. Lifelong therapy is needed only for certain conditions.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
Psychiatry Online in Astana: same-day video appointments and two branches for in-person visits — 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Our mobile team works around the clock: all city districts and nearby settlements. If you live elsewhere in Astana and Akmola Region, starting online is usually easiest.
Confidential and private
Information about your visit, diagnosis and treatment is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”. We never share it with your employer, school or relatives without your consent; the only exceptions are those expressly set out by law. For an online consultation your first name is enough, video runs over a secure channel and nothing is recorded without your consent.
Questions and answers
Can an online psychiatrist prescribe medication?
The doctor gives recommendations on the drug class and the monitoring plan. Issuing a prescription depends on Kazakhstan law and the requirement for an initial in-person examination, so an in-person visit will be needed for some medications. We explain the procedure in advance and do not promise a prescription without assessing your condition.
How often are follow-up appointments needed?
At the start of treatment and with each adjustment, every 2–4 weeks; once you are stable, every 1–2 months. If side effects or a deterioration occur, you can contact the doctor sooner, without waiting for a scheduled appointment and without risking changes on your own.
What should I do if I have side effects?
Do not stop the medication on your own if the reaction is not dangerous: message your doctor, who will advise you on what to do. Many side effects ease during the first few weeks. For severe reactions—rash, swelling, high fever, seizures, confusion—call 103 or 112.
Do I need lab tests?
For some drug classes, yes: monitoring of liver and kidney function, blood levels of the medication, and an ECG. The doctor will tell you which tests are needed and how often. You can have them done at any laboratory, including one near your home in the Saryarka or Baikonur districts, and send in the results.
Can medication be combined with psychotherapy?
Yes, and for many disorders the combination is more effective than either approach alone. At Psychiatry Online, a psychiatrist and a psychotherapist can treat you together, coordinating their goals: medication reduces the severity of symptoms, while psychotherapy helps change the factors that keep them going.
How do I know the treatment is right?
The signs include a sustained reduction in symptoms on rating scales, restored sleep, ability to work, and interest in life, along with acceptable tolerability. The goal is remission, not just feeling “a little better.” If residual symptoms persist, that is a reason to discuss an adjustment with your doctor.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
