Getting my hands on the magical happy pill.

August 5, 2005 1:01 PM

Will your regular doctor prescribe you depression medication, or will they just send you to a psychiatrist?

I have a very long history of depression, and after a few months of being content, this week's blindsided me with deep feelings of sadness and worthlessness along with crying spells. I know I'm at the beginning of yet another months-long bout, and I need to get a handle on this as soon as possible. Hurrah for the new health insurance, I can actually get treated this time, but I've tried calling around for psychiatrists, and none have openings till October or aren't available. I've scheduled an appointment with my GP for next week. What's the likelihood that she'll prescribe me medication right away? My job and life depend on me not hiding in my bedroom for weeks weeping constantly.

posted by lychee to health & fitness (29 comments total)

My regular doctor was happy to prescribe antidepressants (he even had samples), but I have heard of other doctors who prefer to send you to a psychiatrist.
posted by goatdog at 1:05 PM on August 5, 2005

These days most GPs that I know of are more than willing to prescribe anti-depressants. I'm not sure it's altogether a good thing, as I personally believe it's good to get evaluated for therapy as well, but anti-depressants are definitely marketed to GPs as a medicine that they can prescribe as part of their regular practice..

But rather than wait, why not call your doc and ask her the question? BTW, these meds typically take some time (a few weeks) to kick in, but I would imagine there's a reassurance factor that goes with just getting started with them.
posted by jasper411 at 1:13 PM on August 5, 2005

I've almost always had my antidepressant RXs from my regular (primary care) physician, and then been referred to a psychiatrist for "maintenance" visits to make sure the dosage is correct. I think with a history of depression and the fact that you're obviously going through a down cycle right now makes it very likely that your doc will be willing to prescribe next week. (In the meantime, do what you can to take good care of yourself, lychee. I've been there, and I'm sorry you're going through it right now. Good for you for seeking treatment!)
posted by scody at 1:17 PM on August 5, 2005

I'd definitely see the regular doctor first - not only will he probably prescribe the meds, he might be able to refer you to a psychiatrist. I know with many types of doctor referrals I've had, you got on a different scheduling list than the cold callers. I haven't gotten a psychiatrist this way, but it's happened with a dermatologist, an internal medicine guy and my current oncologist. Perhaps psychiatrists work the same way?

Another referral thought - if you can get the meds now from your regular doc, maybe you could get in to see a psychologist sooner, to at least start the therapy. They can't prescribe medication, but they're trained on the talking side of things, and again, could probably refer you to a psychiatrist colleague. That's how I wound up with my last psychiatrist back in Boston.

Man, I've seen a lotta doctors recently...
posted by Moondoggie at 1:31 PM on August 5, 2005

It's going to be okay. GPs pretty commonly dispense prescriptions for depression meds these days; I'd be very shocked if you weren't able to have a prescription in your hands when you left your doctor's office.

Take care of yourself and remember that all this crap will pass.
posted by stefanie at 1:31 PM on August 5, 2005

Your regular, primary care doctor can prescribe antidepressants.

If all of the psychiatrist are full until October, maybe look for a good psychologist or counselor. Often they work in the same office with psychiatrists and do the same sort of therapy, they just can't prescribe medication.
posted by gus at 1:33 PM on August 5, 2005

Oh, and incidentally, I got my current anti-depressants from my GP (living in CT now, away from my head shrinker), then refilled by my internal medicine guy who's soon to become my new GP. YMMV though, as part of my waves of depression come from the cancer battle, so they might just be prescribing it for me knowing I'll "be down" about my situation from time to time. Once I'm cured and still depressed, they might push me over to a psychiatrist again :)
posted by Moondoggie at 1:34 PM on August 5, 2005

As others have already stated, your GP can prescribe an anti-depressant. However, not all AD's are created equally and different ones work for different people. The side effects can be different. And the differences can be very subtle.

Sadly, there is no lab test (as of yet) that can tell you which AD is best for you. It's trial and error. Because many AD's can take weeks to reach a desired state, and because dosages vary from person to person, this trial and error process can be long or short depending upon how quickly you use the best AD for you.

Psychiatrists or doctors who specialize in treating people for depression generally know much more about the different AD's than general practitioners do. (This includes knowing about the different withdrawal symptoms so, if you have to switch, you know what is going on.)

Psychiatrists and therapists can help you to sort out which emotional reactions are situational, which ones may be related to biochemistry, and which ones may be as a result of the drug itself. For example, some people experience an increase in anxiety symptoms when starting Zoloft than can eventually go away after a few weeks. Others may create changes in your sleep, metabolism and so on.

Start with your GP. They may start you on a common SSRI. But be sure to get a referral to a specialist or psychiatrist for follow-up. Have the GP investigate other organic conditions that may trigger depression...thyroid issues, sleep disorder, etc.

I've lived with chronic depression since my teens and live an extremely high-functioning life with the help of the right meds. (I've also taken the wrong meds and that is no fun. ) Take very good care and I hope that you feel better soon.
posted by jeanmari at 2:11 PM on August 5, 2005

What jeanmari said.

Personally I have never taken anything but prozac (which my GP perscribes but I had been originally given it by a shrink, some GPs are okay with renewing but reluctant to do initial script) and would certainly recommend it. It's dirt cheap and since it has a long persistence in the body you can taper down your dose with no see-saw effect. I take it M/W/F and that's usually enough for me.
posted by phearlez at 2:23 PM on August 5, 2005

Many people have said the same things here. It is possible that your GP won't prescribe, but I find it unlikely if you go in and make your case that they won't at least float you until you get to a psychiatrist. If you've previously been on meds and know the type and dosage, that's really good information to go in with. I would also suggest making an appointment with a therapist. 80% of people who see therapists improve versus an untreated sample. Therapy definitely works.
posted by OmieWise at 2:47 PM on August 5, 2005

And, even though you feel like it is the LAST thing you want to do, exercise definitely helps as much as meds (sometimes more, depending on your personal biochemistry).
posted by jeanmari at 2:55 PM on August 5, 2005

jeanmari: in my personal case, exercise doesn't "definitely help as much as meds". exercise sometimes lessens associated anxiety, but it has little effect on my overall spirits. despite my father's constant assertion that all my depression will be cured by simply exercising.
posted by Bear at 3:13 PM on August 5, 2005

First, I agree with jeanmari that if you can force yourself to move vigorously with some kind of exercise, you might feel a little better before getting in to see the GP.

I can shed a little light on the AD medications and prescriptions by the GP versus a psychiatrist. Almost all GPs in private practice prescribe AD medication. However, if the doctor is in a "Doc-In-A-Box" type of clinic that accepts walk-ins (with names like QuickMed, FastMed, MedPlus, UrgentCare, 24-Care, etc.), he or she will be less likely (in fact, most likely will not) to prescribe anti-depressants.

With that said, there are a very few GPs who simply believe that psychiatrists are the only doctors that keep up with these things enough to have the knowledge to prescribe correctly - and refer based on this belief. But, maybe sadly, they are few and far between.

Best of luck and hope you feel much better - and soon!
posted by Independent Scholarship at 3:21 PM on August 5, 2005

Thanks everyone. It really helps to know people have had similar experiences. Hopefully knowing this will pull me through the week till my appointment. I've only been to a doctor a handful of times in my life, so I had no idea what to expect in this situation.
posted by lychee at 3:23 PM on August 5, 2005

As stated--PCP can and probably will prescribe--hopefully they will take a brief history, explore feelings about possible weight gain, associated anxiety--and most importantly--any past history of being responsive/nonresponsive to certain ADs--while the SSRIs are all related they have different profiles regarding possible side effects and some are more responsive to mixed anxiety and depression--remember--the dose is very important and do not be hesitant to encourage you physician to play around with the dosing after the first 14-21 days if it is not working--for some of the drugs, and some of us, there appears to be a trigger for the therapeutic level--ie--it does not work and then the dose is increased a bit and suddenly it works--if the symptoms remain after thirty days push for a consult with a psychiatrist--some of the best plans include a combination of drugs that effect different neurotransmitters--best of luck
posted by rmhsinc at 4:07 PM on August 5, 2005

I have had GPs who would give me a short scrip or samples to get me through. The last one however said that crying through the new Fantastic Four movie wasn't quite compelling enough.
posted by mischief at 4:30 PM on August 5, 2005

My GP almost gave me anti-depressents.. until we concluded that my ~6 months of fairly severe depression were caused by my brand of contraceptive pill.
posted by Lotto at 4:41 PM on August 5, 2005

try street drugs; same premise; much cheaper
posted by Satapher at 7:01 PM on August 5, 2005

Bear: I should have clarified my statement. Exercise does NOT cure depression. However, there are studies that suggest it does help to manage symptoms of depression.

Meds do not cure depression, they help to manage the symptoms. Some people have short depressive episodes. Some have chronic or recurring depressive episodes. How long you take meds depends upon how long and how frequently your own depressive episodes last.

I have "hard to treat" depression and most meds do not work for me. SSRI's, tricyclics, SNRI's, Bupropion, nothing. Even a misdiagnosis in 1994 led to a course of Lithium that did more harm than good. Only when I reached the point of trying an MAOI did I experience any relief (though I have had to switch temporarily for other reasons). I also am being treated for hypothyroidism, even though my T4 and T3 levels are within the "official guidelines". This has also greatly helped and was not easy to diagnose.

I did not mean to suggest that exercise alone could "cure" a depression. And I did not mean to belittle your depression or offend you. Depression is a very serious condition, worthy of much attention and concern. It not only can affect one emotionally, but physically as well.

I don't, however, believe that there is a "magic pill" that will "cure" me. And I really, really wish that there was. I think that my meds are useful for managing the symptoms so that I take better care of myself and my life in general.
posted by jeanmari at 8:54 PM on August 5, 2005

I just want to second jeanmari's point about hypothyroidism. I'd been on Zoloft for two years when a doctor finally got around to testing my TSH: it was so high, at first they assumed it was a lab error. I went on big doses of synthetic thyroxine immediately, and I have never felt so well.

Working theory now is that I've been hypothyroid my entire life. The Zoloft helped a lot, but the thyroxine helped more. I might try weaning myself off Zoloft at some stage, but I'm in no hurry; unlike Prozac it doesn't persist in the body very long, and withdrawal's a bitch. Besides, after struggling with bouts of depression for as long as I remember, I now feel cheerful and confident and my ability to cope with stressors has multiplied a thousandfold. Hang in there. There is hope.
posted by rdc at 11:40 PM on August 5, 2005

I've been on depression meds since October and I've gone in several times to get the scripts renewed. Not once has my GP mentioned therapy (can't afford it even if he did).

Good luck, lychee.
posted by deborah at 12:28 PM on August 6, 2005

jeanmarie--contrary to your statement "meds do not cure depression" in fact, for some persons meds do cure depression--some depression is strictly a biochemical event and the medication reestablishes normal levels of neurotransmitters--just a synthroid cures hypothyroidism--meds do not cure unhappiness, existential angst, stress,etc. BTW--other than meds (where appropriate) there is no better treatment than regular aerobic exercise--you are right
posted by rmhsinc at 2:13 PM on August 6, 2005

My GP prescribed Lexapro for me, but he seemed to be handing it out like candy. About six months into it, I went ahead (after moving to Houston) and saw a psych; she increased my dosage and things are MUCH better.

Your GP *can* do it, but I'd talk to a psych first, or at least after you've been on the medication for a while. They're much more qualified to analyze what's going on.
posted by mrbill at 3:25 PM on August 6, 2005

rmhsinc, I think the "meds don't cure depression" idea comes from the fact that you have to continue taking them. Cures are generally considered something that eliminates the disease; if you have to keep taking it, it's treating the symprom.
posted by dagnyscott at 5:53 PM on August 6, 2005

symptom. aargh.
posted by dagnyscott at 5:53 PM on August 6, 2005

Sometimes you get "situational depression." You're in some horrible situation that seems huge and beyond resolving. Once you are not depressed anymore, it's a lot easier to change the situation, because it doesn't seem so huge, but the situation (and your procrastination in dealing with it) is in itself depressing, so it's a bit of a Catch-22. Meds can help a lot with this kind of problem -- they sure did for me. A few months of Paxil and I'd got my finances in order and established a plan for paying off my crushing debt, and a few months after that I left Detroit. Situation changed, depression gone, meds no longer needed.
posted by kindall at 7:02 PM on August 6, 2005

If you have a long history of depression, does this include previous periods of being on meds? If so, and if you can accurately report that history to the GP and if there was one drug that worked well for you in the past (especially if you remember the dosage) this will give her (why is everyone on this thread referring to the doc generically as "he?") a lot to go on. If you haven't, well, this sounds a little serious froma lay perspective, and in my experience if you feel up against a wall and are assertive about it with a psychiatrist's office staff you will get seen sooner. The magic words are that you think you are "in (or close to) crisis." Insist on an earlier appointment, or a referral to someone who can see you sooner. Being depressed to the point where you fail at work and avoid social contact is serious business, as you apparently know. If you were bleeding from a wound, you wouldn't take a month from now for an answer and a doctor who wouldn't work you in would be committing malpractice. It works the same way with mental illness.
posted by realcountrymusic at 9:41 PM on August 6, 2005

rmhsinc -- as dagnyscott points out, meds TREAT the symptoms of depression, they do not CURE depression. By cure, I mean that there is not a med that currently exists which, when taken, will restore you to a state where--without changing ANYTHING ELSE--you will never experience depression again.

Even in kindall's example, meds helped to manage the symptoms during a situational depression so the cause of the situational depression could be addressed.

There is no cure for diabetes. There is no cure for the common cold. There are treatments for the symptoms of these conditions.

We don't understand completely and in a detailed way what causes biochemical depression, although depression can be a symptom of other health problems. Doctors are not even entirely sure how these antidepressants work. (Some are drugs developed for some other medical purpose where it was noticed that it also had a reliable effect on some forms of depression.) But we have them and, for many people, they do seem to work. So we've come a long way from the recurring shock treatments that my grandmother was forced to endure. And that is wonderful.

lychee--back to your questions. Here is a list of antidepressants and the types of depression that they are commonly prescribed for. (Click on this link and then scroll down to the Depression/Anxiety/Insomnia section.) Their common side effects will also determine which a doctor will prefer to try. For example, MAOI's are not generally recommended for people who are depressed and have high blood pressure. Users of MAOI's have to be careful of the drug's effect on their blood pressure (therefore the MAOI diet.)

I have often asked my doctors to explain their decision to give one AD over another. It's a fair question and helps you to understand how they pick and chose which AD's to try. If finding the right treatment for depression is not quick or easy, this can exacerbate feelings of helplessness and discouragement. Anything that helps you to feel like you are exerting more control over your treatment and getting all of the information you can may help to keep this counterproductive feelings at bay.

Best of luck.
posted by jeanmari at 9:59 PM on August 6, 2005

OK, I give--you are right--meds do not cure depression--they make it a manageable illness--it is the "treat symptoms" piece that bothers me--this harkens back to the days of benzodiazepams, the early anti psychotics, barbituates, amphetamines etc. What most of them did was mask the symptoms with out actually treating the cause. The newer ones actually target specific neurotransmitters and fill chemical holes--Thanks and take care
posted by rmhsinc at 1:40 PM on August 8, 2005