Many of my clients have been prescribed medication for depression or anxiety by their primary care physicians. Some of them have initiated this discussion with their physicians after a discussion we have about going the medication route. Others have had this discussion before they found their way to me, and chose medication.
Clients also tell me that their doctors suggested they consider medication, in many cases after receiving a medical diagnosis and their doctor’s concerns about how the diagnoses will impact them emotionally. I always appreciate when physicians have a concern for the emotional states of their patients.
What I also hear from my clients is that the conversation with their primary care physicians about depression or anxiety medication is not always an easy one. They may not know how to bring it up with their doctor. Or they may have concerns about what they should know before consenting to beginning medication.
The Medication Decision is Another Opportunity to Team Up With Your Doctor. Here are some guidelines to help you to have this conversation:
If requesting medication, be direct and specific.
Let your doctor know that you are concerned about your mental health and why. Something like, “I think I may be experiencing depression. Over the last ____________ (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.
Caution: Some of my clients living with chronic pain have told me that their doctor is hesitant to prescribe psychiatric medication to them, sometimes out of fear of drug interactions with pain medication, and other times out of suspicion that they are drug-seeking. So be prepared to come up against some potential resistance, and to be clear and direct in this discussion, and to bring in other doctors or a mental health professional into the discussion if needed.
If your doctor recommends medication, ask them to be direct and specific.
After asking some questions about your mental health, your physician may suggest medication. If so, ask your doctor to explain what they heard you say, or observed, that leads them to diagnosing you with depression or anxiety and why they are suggesting medication.
Ask why a specific drug is being recommended.
Your physician may have specific reasons why one medication is being recommended. Or the medication being recommended may be your physician’s standard “go to” medication, which they generally recommend 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.
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 be more confident about your medication decision. Let’s be honest, asking this question 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 better, or at least not worse. You may notice a shift in your mood as a result of your 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 you 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.
And what about, how long?
While you’re at it, also ask your doctor if he/she can give you a sense of how long they think you might need the medication. Are we talking help getting through a rough spot or for life?
Get an idea of likely potential side effects.
This is an important discussion to have with your doctor if he/she is recommending medication. Some medications have quite pronounced side effects, such as weight gain or changes in libido, while others have relatively low 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 from one to the next in terms of how pronounced the side effects are, or if they experience them at all. Getting clear with your doctor on potential side effects – common and rare – will help to set your expectations for how you might be impacted. As well as 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 the options. You may 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 get in touch with 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.
And don’t hesitate to be high maintenance.
Keep your doctor abreast of how you’re feeling. Raise your hand if you have any concerns 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.
You, your doctor, and depression or anxiety medication. Ask questions. Express your concerns. Do your own research. If you take the next step, do it with confidence!