Taking Antidepressants:  Start to Finish

Starting antidepressant medications is a big decision.

Taking psychiatric medications often requires a great deal of consideration as to the best time to start medication, the right medication to choose, what to expect, and also how to know if and when it is time to taper. These are questions that are best discussed with a medical professional, such as a psychiatrist or your primary care physician. Here are some initial factors to keep in mind when taking anti-depressant medications in particular.

How Do I Know When It’s Time to Start Medication? 

If you have been diagnosed with a mental health disorder such as depression or anxiety, you may consider taking medication as part of your treatment plan. Medications can be especially helpful if your symptoms are in the moderate to severe range, and interventions such as therapy and lifestyle modification haven’t helped. Also, if you find yourself turning to poor coping strategies such as drugs or alcohol, or have underlying medical conditions that may be affecting your mental health, medications may be helpful for you. 

Which Medication is Right For Me? 

Choosing a medication can be a complex process that is best discussed with your doctor. But here are some questions your doctor may ask, or factors for you to reflect upon when thinking about having a conversation regarding medications with your physician. Often the choice of medication begins with whether a particular medication has worked well for you in the past, or if you have had a poor response or intolerable side effects to prior medication trials. It can also be helpful to know whether a particular medication was helpful for closely related family members. 

Other considerations include co-occurring psychiatric and medical conditions that you have, as well as any past or present substance abuse. Having this information close at hand will help you and your doctor choose the best medication for your particular symptoms and diagnosis. 

What Should I Expect When Starting an Antidepressant? 

Each person responds differently to antidepressant medications. It can be helpful to keep certain things in mind. Side effects vary and can range from mild gastrointestinal side effects to insomnia, feeling tired, a possible worsening of anxiety, and sexual side effects, depending on the medicine. 

Often side effects begin within the first few days of starting a medicine or increasing the dose. Starting the dose low and increasing the dose gradually, under the supervision of your doctor, can help minimize side effects and many resolve on their own within seven to ten days. Most antidepressants (which are often used for both depression as well as anxiety) take anywhere from four to eight weeks to work after you have reached a therapeutic dose of the medicine. It is important to discuss how you are feeling with your doctor so that they can make appropriate medication and dosage adjustments. 

How Do I Know When It Is Time to Stop My Anti-Depressant Medication? 

Just like knowing when to start medication can be a complex decision that is different for each individual, so is knowing how and when to stop the medication. All medication changes–whether a dosage increase, decrease, or change in timing–should be discussed with your doctor. 

Many people ask, “How long will I have to stay on medication for?” The answer is: it depends. Some people don’t have a prior history of depression or anxiety, don’t have a family history of mental health disorders, don’t have a significant medical history, and end up needing medication due to a stressful or severe life situation. In these cases, they may consider tapering medicine in conjunction with their doctor, after a nine to twelve month period of stability. 

Others may have a history of multiple recurring episodes of depression or anxiety, a strong family history of mental illness, or other factors that make them vulnerable to future episodes. For these individuals, they may decide to stay on medication long term. Of course, personal preference and comfort also play a big role in how long to stay on medication. If and when you decide to come off of antidepressants, it is important to do so slowly and under the supervision of your doctor. This is to minimize the risk of withdrawal symptoms, as well as to monitor closely for a return of any symptoms of depression or anxiety. 

It is best to have an ongoing dialogue about your thoughts and feelings regarding coming off of medication with your prescribing physician so that they can make appropriate recommendations while supporting you in your goals. 

The process of starting, taking, and stopping antidepressant medication is different for each and every individual. There is no one right or wrong way. It is most important to have a collaborative and honest relationship with your prescribing physician so that they know how to best support you in your recovery.

If you, or someone you love, is struggling with a mental health disorder, the Mental Health Collective, located in Orange County, 

When is it Time to Consider Depression or Anxiety Medication?

It is normal for all of us to experience ups and downs as part of life, and as part of being human. Some of us may also experience periods of depression or anxiety as well. So how do we know when to seek professional treatment, and also when to consider medications? It can be a complex and complicated question, and the right answer is different for each person. But here are some initial considerations.

MILD SYMPTOMS OF DEPRESSION OR ANXIETY

When symptoms are mild, lifestyle modifications may be helpful. For example, addressing acute or chronic stressors in your life, getting more exercise, improving your nutrition, meditating, getting regular sunlight exposure, and practicing good sleep hygiene can all go a long way. Sometimes, however, we may try these things and discover that we still don’t feel significantly better. 

A period of depression or anxiety begins to meet the criteria for a clinically diagnosable mental health condition when symptoms become persistent, pervasive, or severe enough to affect your day to day functioning. For example, if depression or anxiety persists for at least a couple of weeks, and begins to affect other parts of your life such as appetite, sleep, energy, focus, hopefulness, self esteem, and even willingness to live, then you may meet the criteria for a disorder such as Major Depressive Disorder, Generalized Anxiety Disorder, amongst many other possibilities. 

There are many starting points to seeking help if you believe you may be struggling with a mental illness that is affecting your day to day functioning. Many individuals begin with psychotherapy, often with a counselor, social worker, psychologist, or another type of psychotherapist. If your symptoms are in the mild range, and especially if you are dealing with the effects of prior trauma or current day stress, psychotherapy alone may be sufficient to relieve your symptoms.

MODERATE TO SEVERE LEVELS OF DEPRESSION OR ANXIETY

For some individuals, symptoms are already in the moderate to severe range at the time of seeking help. In those instances, the severity of symptoms may make it difficult for you to even engage meaningfully in therapy. Or symptoms such as sleep, appetite, and energy disturbance make it difficult to do the types of things that you know may help you feel better. In other situations, you may wonder if you have an underlying medical condition that may also be impacting your mental health. In these situations, medication is often indicated. 

WHO PRESCRIBES DEPRESSION AND ANXIETY MEDICATIONS?

There are a few different options. Some people feel comfortable with their primary care doctors, or in some cases, an OB/Gyn. These physicians are often comfortable prescribing psychiatric medications. Alternatively, you can seek the help of a psychiatrist, who is a physician trained in the diagnosis and treatment of mental health disorders.

Primary care physicians or psychiatrists can prescribe and monitor your medications. Often once you are stabilized and your symptoms have improved, they may then refer you for therapy as well. It is usually the combination of medications, therapy, and lifestyle modification that is the most powerful intervention for mental health conditions.  How long to stay on medications, and how and when to taper, require careful consideration, and are best discussed with your prescribing physician.

Depression and anxiety are difficult conditions to experience, and it can be hard to know where to begin when seeking help. If you or someone you know is struggling, The Mental Health Collective, located in Orange County, 

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