According to Eric Lenze, MD, head of the department of psychiatry at Washington University’s School of Medicine in St. Louis, there’s even a version of the questionnaire providers use to guide diagnoses, called the PHQ-9, online. If you take it, and your total score is 10 or higher, he recommends talking to a doctor about SSRIs, as well as your therapy options. (Gentle reminder: That score doesn’t replace an official diagnosis from a health care provider.)
If you decide to seek help and your provider agrees that antidepressants and/or therapy make sense for you, know that you don’t have to take SSRIs forever once you start them. “I see many patients who are able to take medication—and ideally, engage in therapy—feel better, and then taper off medication [under the guidance of their doctor] after they’ve been doing well for several months or a year,” Dr. Hirst says.
Dr. De Faria agrees and makes a good point: “Would we be having this conversation if you had pneumonia and needed an antibiotic?”
How to talk to your provider about starting an antidepressant
When I decided to pursue medication, I sought out a practice that specialized in anxiety and ultimately saw a psychiatric nurse practitioner, who treated me. Even a psychologist or therapist, unless they have certain credentials (typically MD or DO—and, in some states, PhD or PsyD), can’t prescribe medication.
Primary care doctors are actually the most common prescribers of antidepressants in the United States, Dr. Hirst says. “It’s as simple as telling your provider that you are depressed or anxious, and you want to know if medication could be helpful,” she explains.
Put another way, Dr. De Faria says it’s worth asking directly: “Can we assess my symptoms to see if there’s a need for further treatment?” And when talking about your symptoms, Dr. Forcier says it’s important to highlight those that especially worry you, how often they occur, and how they affect your daily life. (Note: You should be screened for bipolar disorder before you start SSRIs, as they may worsen symptoms of the condition for some people. And be sure to discuss any potential thoughts of self-harm with your doctor before starting any new medications.)
Most people notice the impacts of an antidepressant—good and bad—after about four weeks, Dr. Lenze says. The biggest potential side effects to be aware of include a lower sex drive, weight fluctuations, and sleep problems. If the dose of your prescription needs to be tweaked, don’t be discouraged—the process often takes some trial and error. “We know that the majority of patients can get well with treatment, so don’t settle for a medication that doesn’t work or only works a little,” Dr. Lenze urges. “Dose increases and medication changes are often necessary to get well.”
Again, experts strongly recommend taking medication and going to therapy for the best results if you’re dealing with severe mental health symptoms. “They work better together in many cases,” Dr. Forcier says. Both SSRIs and therapy are designed to correct the biological causes of anxiety and depression; therapy also teaches you how your symptoms show up in everyday life, and how to respond to them productively. Of course, whether you try one or the other or both is an extremely personal decision.
For me, when I had both at play, it was like a critical switch—one that was snapped off and stuck in fight or flight for years—was repaired with a spare part and, finally, slipped into neutral. I still have bad days and will always be joined by anxiety in some way. The little blue pill I take simply demotes it from cocaptain to backseat driver, where its voice is a lot quieter.
If you are struggling and need someone to talk to, you can get support by calling the Suicide & Crisis Lifeline at 988 or by texting HOME to 741-741, the Crisis Text Line. If you’re outside the United States, here is a list of international suicide helplines.
Related:
10 Things to Try When You’re Too Depressed to Get Out of BedHow to Rest, for Real, When You’re a Very Anxious PersonHere’s What ‘Processing’ Trauma Really Means—And How It Helps You Heal
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