I’m positive that most of my patients don’t want to be on medication. In fact, that’s what most of them tell me the first time that we meet. Honestly, I appreciate their candor. As humans, it doesn’t feel natural or authentic to take a medication every day of our lives. This goes for blood pressure, cholesterol, thyroid, and many other medications that are taken daily to control various areas of the body. Yet, when I ask my patients if they would hesitate to take a blood pressure pill every day, most of them say “no”. So, why is it so difficult to commit to a medication for your mood? The answers are complicated.

There are lots of message boards, books, blogs, and general discussions about antidepressants. If I google Zoloft, I am inundated with information about it. Some of the information is accurate and scientific but most is anecdoctal, meaning it is based on someone’s experience. If I had a dollar for every time one patient had a great experience with a medication, while another patient did not, then I would be writing this from my villa in France. Everyone has a different body chemistry and physical make up. Sometimes, we can share a genetic response to medication. For example, if your mom is taking an antidepressant and doing well with it, there is a chance you could also do well with that same medication. Regardless, it is important to do your research when thinking about taking an antidepressant. Specifically, looking at medical and scientific information about them.

There are several types of antidepressants. Some only target serotonin (SSRIs and TCA), while some target serotonin and norepinephrine (SNRIs). Then there are those that don’t target serotonin at all, but focus on dopamine and norepinephrine (Aminoketones). It can be confusing when determining what medication is going to work. As a provider, I am looking at each person’s medical and emotional history, current symptoms, family history. This gives me a good guideline for choosing an antidepressant. However, it is “not perfect” and sometimes we need to try more than one medication. Its also important to consider dosage. In most instances, we start off at the lowest dose and then possibly move up depending on response. An unfortunate knee jerk reaction in psychiatry is to take someone off a medication if they don’t have a marked response and try a different one. It might be more beneficial to increase or maximize the dose first. Its necessary to discuss side effects, since all medications have them. With most serotonin based antidepressants, the main side effects can be low libido or inability to climax, weight gain, and a flattening effect (ie, feeling numb). Sometimes patients can have fatigue, HA, nausea, and difficulty with sleep. Of course, untreated depression can have major side effects on your body as well. So, it’s a trade off and important to discuss with your provider if concern about side effects is keeping you from trying an antidepressant.

Most of my patients have tried lifestyle changes (such as diet and exercise), psychotherapy, meditation, and supplements before coming to see me. Management with an antidepressant is sometimes seen as a “last resort”. Research indicates that medication combined with therapy and lifestyle changes is the best way to treat depression.