When Should You Consider an Antidepressant?

When you are struggling with depression, the decision to try an antidepressant isn’t an easy one, nor should it be. Antidepressants are a serious medication that can be accompanied by significant side effects. They are also a fantastic tool that can make a life-changing (or even lifesaving) difference when used appropriately. 

I’ve identified several questions to ask yourself and your therapist if you’re contemplating the use of antidepressants from my professional experience and observations over the years. 

It’s important to keep in mind this list is primarily about depression. You should be more cautious about medicating anxiety, PTSD, or other disorders that don’t respond as well to medication as counseling. You absolutely need medication if you’re struggling with bipolar disorder or schizophrenia. 

1. How Severe Is Your Depression?

The more serious your depression, the more you should consider using an antidepressant. In psychiatric diagnosis, we divide levels of depression into mild, moderate, and severe based on the number and intensity of symptoms. Antidepressants seem to be most effective at reducing the symptoms at the highest levels of depression. If you’re struggling with severe depression and struggling to function, it’s probably time to try an antidepressant. If your depression is on the mild end, the antidepressant may have a less meaningful impact and you may want to consider other treatments first.

2. How Long Have You Been Depressed?

The longer you’ve been depressed, the more difficult it can be to break free. The struggle with depression is also likely to be exacting a larger toll on your life and the potential side effects of medication might outweigh the damage depression is having on your life.

3. What Other Treatment Approaches Have You Tried?

If you been in counseling for a meaningful period of time and haven’t seen significant improvements, it might be time to consider adding an antidepressant. Sometimes medication can enable you to use the skills and tools you’ve been learning in counseling but may have had difficulty implementing due to the severity of your depression. If you’ve tried a well-balanced lifestyle that includes exercise, sleep, adequate nutrition, etc. and still haven’t made progress, an antidepressant might be warranted. 

4. Are You or Have You Been Suicidal?

This should probably go without saying, but if you’re actively contemplating suicide or have frequent suicidal thoughts, you should 100% take advantage of this potentially lifesaving medication. While antidepressants frequently have side effects, none of them are worse than a suicide attempt or completion.

5. How Recurrent Is Your Depression?

If you’ve struggled off and on with depression or for a long period of time, an antidepressant may help you break free of the cycle and might be helpful as a maintenance tool between periods of depression.

6. How Old Were You When Your Depression First Appeared?

An earlier onset of depression generally predicts severity and frequency of later episodes. It also suggests biological underpinnings or early developmental issues such as trauma that might make it difficult for your mind and body to obtain mood stability without a biological intervention. 

7. What’s Your Family History of Depression or other Mental Health Issues?

If you have a family history of mental health issues, you might be fighting against a significant genetic predisposition towards depression. This may suggest your depression has biological origins and a biological approach is warranted.

8. Are You Able or Willing to Try Other Treatment Options?

While this isn’t my preference in mental health, some people may be unable or unwilling to get treatment such as therapy. This could be due to financial or time restraints or you may not “believe” in counseling. While an antidepressant alone isn’t as effective as an antidepressant combined with counseling, it can still be quite helpful alone and is better than no treatment at all.

Counseling should be tried before medication unless your depression is already severe. It’s also important you continue with counseling and other treatments after you begin the antidepressant to take full advantage of whatever benefits they may confer. Keep in mind that “pills don’t teach skills”.

As a therapist, I can provide consultation about your decision. Counseling provides a place to process and reflect deeply on this choice with time and curiosity. If you do reach the decision to try medication, I can’t prescribe medication myself. I recommend you talk to a psychiatrist for an additional opinion and medication strategy, although let’s be honest, they are generally inclined to prescribe something as that’s their primary focus in treating mental health.

When I do suggest to a client it might be time to consider an antidepressant, I like to point out that I don’t make a dime if they take it or not. It’s truly only out of my care and clinical opinion that they consider adding this option to their mental health treatment.  At the end of the day, it’s a cost/benefit analysis of the side effects of an antidepressant vs. the benefit it may have on your life.

I hope this list is illuminating and invites some reflection on this important decision you may be facing!