That's Not Crazy Talk

Many of my therapy clients have been prescribed medication for depression or anxiety by their primary care physicians. Some of them initiated these discussions with physicians following a conversation we had about trying medication. Others have had this discussion with their doctors before finding their way to me. Still other clients have told me their doctor suggested they consider medication after they’ve received a medical diagnosis — including learning they are HIV-positive — that their doctor worried would impact them emotionally.

I always appreciate when physicians have concern for the emotional states of their patients, but I also hear from clients that conversations with their primary care physicians about depression or anxiety medication are rarely easy. People don’t always know how to bring up mental health issues with their doctor. Or they may have concerns about what they should know before consenting to begin medication.

I like to present the discussion about such medications as an opportunity for clients to team up with their doctors in their health care. Here are some guidelines to help you have this conversation:

If you are requesting the medication, be direct and specific. Let your doctor know that you are concerned about your mental health and why. Say something like, “I think I may be experiencing depression. Over the last (be specific about the timeframe), I have been feeling (briefly list your symptoms).” If you have talked this over with a therapist, make sure your doctor is aware of that as well. If your doctor recommends medication, ask them to be specific about what they are recommending and why.

Alternately, your doctor may initiate the conversation, by asking you some questions about your mental health, and then suggesting medication. If so, ask them to explain what they heard you say, or what they observed, that led them to diagnose you with depression or anxiety and why they recommend a pharmaceutical solution.

Ask why a specific drug is being recommended. Your physician may have specific reasons why one medication is being recommended over another. Or the medication being recommended may be your physician’s standard “go to,” which they generally recommends for patients who have symptoms similar to yours. If you have questions about how well it’s working, later on, or want to talk about it with another physician, this will be important information.

And ask if there are other options. Not only other medications, but also therapy. Get fully informed on your physician’s thinking behind their recommendation. You may want to research some of these alternatives on your own to help you to make the medication decision. Asking these questions will also help you to feel confident about your physician’s level of experience in treating depression or anxiety.

Understand how the medication should benefit you, and how soon. I often hear from my clients that they have no idea how their medication should make them feel, if they should feel better, or just not feel worse. Some people do notice a shift in their mood as a result of medication. Or, your medication may put a “floor” under your depression, so you don’t sink any lower, or a “ceiling” over your anxiety so you don’t experience anxious episodes or panic. Ask your physician to let you know what you should expect in terms of any symptom relief or prevention. And ask how soon you should expect to experience the benefits. This will help you to determine if the medication is helping or not. Ask your doctor if they can give you a sense of how long they think you might need the medication. Is this to help get you through a rough spot or something you might have to take indefinitely?

It’s also important to get an idea of potential side effects of any medication your doctor recommends. Some medications have quite pronounced side effects, such as weight gain or changes in libido, while others have relatively few side effects. So ask your doctor to give you an idea of what you might expect. While you’re at it, also ask if there any side effects that, if experienced, should be reported immediately, or that might be dangerous. Keep in mind that individuals vary in terms of whether they experience side effects and how pronounced those side effects are. Getting clear with your doctor on potential side effects — both common and rare — will help to set your expectations for how you might be impacted. This will help you decide if this is the right path for you.

Don’t start until you are ready. The decision to go on medication for depression or anxiety is a big one. You may not be ready to give the go ahead after a brief discussion with your doctor. You may want to say something like, “I need some time to digest all of this, and do some of my own research. I will get back to you soon.” And then do your own due diligence by researching the recommendation and your options. You may then want to schedule another appointment to talk about what you learned.

Consider a second opinion from a psychiatrist. Many primary care physicians have been prescribing psychiatric medications for years, and are very competent. But still, consider this: If you had a serious skin condition, you would probably want to consult with a dermatologist. If you had eye trouble, you would probably go to an ophthalmologist. So if you are experiencing depression or anxiety or another mental health issue that may require medication, you might also want to seek the opinion of a psychiatrist. I specifically recommend seeing a psychiatrist in this context rather than a psychologist, counselor, or other mental health professional because only psychiatrists can prescribe medication.

Don’t hesitate to be high maintenance. Keep your doctor abreast of how you’re feeling. Raise any concerns you have about how the medication may, or may not, be affecting you. Your doctor can’t help you if you don’t keep them in the loop.

To reiterate: Ask questions. Express your concerns. Do your own research. That way, if you take the big step of starting medication, you’ll do it with confidence!