Do some soul-searching.     "People often obtain drugs after very cursory appointments where vitally important distinctions are not made," says Joseph Glenmullen, MD, a clinical instructor in psychiatry at Harvard Medical School. A proper intake interview should last at least 50 minutes, he says. "If someone is offering you a prescription after 15, something is seriously wrong."

Antidepressants are serious drugs that have profound effects on brain chemistry. It is up to you to try to distinguish temporary stress or grief from the relentless symptoms of clinical depression. Ask someone who knows you very well—a good friend or relative—to help you assess your condition:

  • Have you experienced a significant change in your ability to function?
  • Do you have ongoing feelings of extreme sadness, helplessness, and hopelessness?

If the answer is yes, a good approach is to make an appointment with a psychologist who can help you evaluate treatment options. She may refer you to a psychiatrist if she suspects that drugs will be helpful.

Get a full medical checkup.
A thyroid condition, hormonal imbalance, or viral infection like mononucleosis can leave you feeling lower than a toad's belly. Some drugs—antihistamines and steroids like cortisone among them—can also make you feel depressed, so be sure to tell your doctor what you're taking.

Keep in mind that when a primary care doctor writes an Rx for an antidepressant, this is not usually her area of expertise. Psycho-pharmacologists, on the other hand, are highly specialized in prescribing psychiatric drugs and are a good choice if you've taken antidepressants without success or know you want to try medication. If not, consider making an appointment with an expert who practices cognitive behavioral therapy to see if that non-drug approach might work.

Ask your psychiatrist or psychopharmacologist:
"Would a combination of talk therapy and medication be most effective?"

If he says that the drugs alone will do the trick, look for another doctor.

Ask your psychiatrist or psychopharmacologist:
"Are there other approaches I should consider?"

If she invokes the benefits of exercise and plenty of sleep, discusses meditation, and suggests that you add omega-3 fatty acids to your diet, she's on target.

5. Examining the Doctor Question 3
Ask your psychiatrist or psychopharmacologist:
"Why have you chosen this particular medication or combination of medications?"

If your practitioner doesn't have an answer based on your particular symptoms, it may be time to move on.

Ask your psychiatrist or psychopharmacologist:
"What are the expected results of this treatment? What signs should I look for that it is working, and how soon will I see them?"

Typically, an antidepressant will cause significant improvement within four to six weeks. If you're not feeling better within eight weeks, discuss switching drugs or trying other treatment options with your doctor.

Ask your psychiatrist or psychopharmacologist:
"What are the risks and side effects of these meds?"

The potential for increased risk of suicide, sexual dysfunction, and weight gain should be mentioned; if your doctor also discusses cognitive side effects, you're probably in good hands.

Ask your psychiatrist or psychopharmacologist:
"How often will I see you, and what symptoms or side effects should I phone you about?"

Three to four visits in the first three months are standard, but there are no guidelines for what happens after that. Some doctors refill prescriptions over the phone and see the patient rarely. That might sound convenient, but have more faith in a doctor who wants to see you at least every three months, even after you're stabilized on the medication.

Ask your psychiatrist or psychopharmacologist:
"How will I know when to stop taking the drugs?"

Once your depression is in remission, you and your doctor have to decide, given your history, whether you can go off or if relapse is likely. The rule of thumb is that once you feel better, you should give yourself 16 to 20 more weeks before even thinking about stopping.

10. Safe Withdrawal
When it's time to get off, do it safely.
Under no circumstances should you go cold turkey. The key is to work closely with your doctor to ease off the drugs very slowly and precisely—it usually takes several months. Withdrawing too quickly can result in dizziness, flu-like symptoms, headaches, diarrhea, vomiting, burning, tingling, or "brain zaps," and electric shock-like sensations in the body. It may also provoke crying spells, insomnia, irritability, agitation, and memory problems—all of which mimic depression, causing doctors to assume the disorder is unremitting and to put patients back on the medication, often at a much higher dose.

If, weeks or months after you've withdrawn completely, you find your old bad feelings returning, see your doctor or another specialist who can help you regain control, examine issues that may be tripping you up, and decide on the best approach to treatment. Recurrent major depression is a serious matter, and it should not go untreated.


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