How should I ask my psychologist/therapist for antidepressants?
December 25, 2010 9:40 PM   Subscribe

How should I ask my psychologist/therapist for antidepressants?

I’ve been having weekly appointments with my new psychologist for about 4 months. I made the decision to acquire mental help soon after I experienced sharp changes in circumstances that had once made my life very happy. My mother’s health, my PhD degree, and the deep connection I had with my best friend and finance all are failing simultaneously because of circumstantial reasons that I can do nothing about. My Mother has a rare and aggressive form of cancer with which her doctors are not too sure what to do about. I’ve decided to leave my PhD program after concluding that I don’t want/need the degree. My finance is making the decision to prioritize his relationship with another person over me. This is especially hurtful because we both committed to hold each other as the most significant member in each other’s lives, and though I still hold onto that promise, he has shown that he no longer is doing so. I feel like such a fool.

I had a very successful therapy cycle about a year prior to my current psychologist, so I feel that I could get through my extreme anxious feelings and lacking thoughts of self worth by talking it out with someone regularly. However, this time around none of my problems are going to get better because they really are out of my hands. My mother is not going to live much longer, many people are going to be let down by my decision to leave my PhD program, and I can never have back the powerful relationship I once had with my boyfriend. I’m working with my therapist on how I can manage the way I’m thinking about these situations in my life because we both acknowledge there’s nothing that can change what’s happening. The day of my therapy sessions I feel as though I’m making progress, but every other day I feel guilty about my feelings and that I just want to walk away from everybody and be left alone and not handle anything. I feel that this time around with therapy, I really need to make these sessions count and I want to be able to manage my life better so badly, but I always revert to sadness and guilt and I don’t know why, especially since I want to “snap out of it”.

Should I ask my therapist if antidepressants or some other drug would help me progress? If so, how should I ask her? I don’t know what procedure is for asking for this or even if I’m a candidate for drugs. Do all clinical psychologists have the ability to prescribe drugs
posted by Zebra130 to Health & Fitness (11 answers total) 1 user marked this as a favorite
I don't think it could hurt to ask.
posted by delmoi at 9:44 PM on December 25, 2010

I think typically psychologists don't write prescriptions, and you'd have to see a psychologist for that. However, I'm sure there are exceptions, and anyway, your GP might be OK prescribing them to you. That's what I do.
posted by two lights above the sea at 9:49 PM on December 25, 2010

Best answer: If your therapist is a psychologist then you'd need to either visit your primary care provider (like a general practitioner or family doctor) or you could ask your psychologist to refer you to a psychiatrist for the prescription. The difference is that a psychologist has a ph.d. (doctor of philosophy) in psychology and a psychiatrist has an m.d. with a specialization in psychiatry. The m.d. (medical doctor) is the one who prescribes medications. There are some few exceptions to this depending on where you live (for example, nurse practitioners can prescribe many medications in most places in America).
I can't tell from your profile where you live. If you're in a country other than the U.S., then you'd want to find out what the laws are in your location - your psychologist should be able to help with this.
In general, it sounds like you're going through some difficult things right now. Antidepressants can be really helpful for some people - especially when used in conjunction with therapy. That said, they aren't magical and they're not for everyone.
Whatever you decide, I wish you the best of luck as you find your strengths in this trying time.
posted by Quizicalcoatl at 10:10 PM on December 25, 2010 [2 favorites]

Just lay it out for her exactly the way you're laying it out here - simple and direct. If she agrees, she will likely need to refer you to a doctor/psychiatrist for a prescription - only Louisiana and New Mexico allow Ph.D. psychologists to prescribe meds, normally you have to be an M.D. to do that.
posted by facetious at 10:15 PM on December 25, 2010

At least some states in the U.S. allow at least some psychologists to prescribe psych meds, and my understanding is that this is pretty common. If yours can't, she should make some kind of referral or recommendation.

I would say, as you have here, "Can antidepressants or some other drug help me progress? Can you tell me more about my options? What should I expect if we go that route?"
posted by J. Wilson at 10:20 PM on December 25, 2010

Describe your worst periods of depression ("there was one time, I just didn't want to get up off the couch for two weeks,") your past with it, "it's always been a part of my life, other people have noticed,") your family history, "my grandmother was hospitalized with affective disorder, and my niece is having problems."

Then say: "I don't want it to get any worse, and I'd like to try drug therapy. What antidepressant would you recommend?"

If there is any reluctance, without some kind of contraindication in your health record, simply say that if they are not comfortable with drug therapy, you will get another opinion. You are the customer.
posted by StickyCarpet at 10:22 PM on December 25, 2010

If so, how should I ask her? I don’t know what procedure is for asking for this or even if I’m a candidate for drugs.

Getting antidepressants really isn't that much different from getting antibiotics or prescription zit cream or any other kind of drug. You don't need to know in advance "Should I take this?" or "Am I a candidate for this?" Figuring that stuff out is what the doctor is for — it's their job. Go explain your situation to a doctor and see what they suggest. They'll ask some questions and then say "No, I don't think antidepressants will help you" or "Well, let's try one and see if it helps."

As other folks have mentioned, the usual thing to do is to see a psychiatrist, but your regular counselor can tell you how to make that happen. Anyway, there's no special procedure. Psychiatrists work just like any other kind of medical specialist. You call their office, ask if they're taking new patients — and if they say yes, you set up an appointment.
posted by nebulawindphone at 10:22 PM on December 25, 2010

I remember agonizing about how to ask, too. It felt like a big deal and I ended up asking in a very roundabout way, but it was totally not a big deal in the end.

You can say something like "I'm interested in supplementing our therapy with antidepressants to see if they will help me make progress more easily and/or to help out while I'm trying to work through all of this stuff I'm dealing with. Can you recommend a doctor who can prescribe them?"

In the US, psychologists aren't usually the ones to prescribe drugs, but you may need to bring it up with them - for example, if you're at some sort of health clinic, you may have to be seeing a therapist there before they will let you make an appointment with one of their psychiatrists or med-management people to be evaluated for antidepressants. Or your insurance company may require a referral. It's probably good to bring it up with your psychologist even if none of these is the case.
posted by needs more cowbell at 10:41 PM on December 25, 2010

Regarding your question about asking your therapist about antidepressants: Don't worry. It's common. Describe the above situation, if she's not already aware of each and every part. Ask her if she thinks antidepressants can help you. She will probably refer you to a psychiatrist who can prescribe you the drugs.

On the psychiatrist: Tread cautiously, stand your ground, and get a new psychiatrist if you end up with a pill pusher. My current psychiatrist doesn't listen to what I say and just routinely writes scripts for drugs that drug reps pressure him to prescribe me. I'm finding a new one.

My take on your situation:
I'm transitioning off antidepressants, myself, after 10 years. This is a very personal journey. For me, drugs are not the answer.

This is going to sound like the usual spiel, but bear with me, if you so choose. Treat yourself well. Buy fancy shampoo, conditioner, and hand cream. Take nightly baths with relaxing bath salts. Eat what makes you feel good (not fast food, except every once in a while), exercise (walk vigorously every day at least), find a hobby (mine is teaching myself guitar), reach out to your friends or join a meetup group. I know how hard it can be to ask for help, especially when the person you thought was your rock is shearing off, leaving you in a precipitous situation high up a mountain you didn't want to climb in the first place. I felt for a while like I had no friends when I was going through tough times with my significant other. Sometimes I still feel too dependent on him. I deal with problems not unlike your own every day, and you really have to depend on YOU at the end of the day. I know you are struggling, but to quote some excellent advice I recently saw in Eat, Pray, Love (5.1? really? okay, I saw it on a plane, but still...maybe read the book instead):
While sitting with Ketut, Liz says she learned a more simple type of meditation. "He said, 'Why do they make it so complicated in India with the meditation?' He said, 'I'll give you a meditation. ... Sit and smile,' he said. Even smile in your liver," Liz says. "Smile all the way through. Sit there and smile all the way through and see if that doesn't work a little bit to start to change your life and cause a little revolution in your mind."1
Some recommended reading:
First off, if you're not already a member, join paperbackswap. You get a free credit to start out with, and then an additional one for every book you post and media mail ($2.75, usually, option to print postage from home) out to some other happy reader in the U.S.
Now, the books.When Panic Attacks by David Burns (it's really about managing stress yourself, not necessarily panic attacks as the title implies). Getting the Love You Want by Harville Hendrix (you'll learn a lot about yourself here, and it's not just for married people, but anyone who seeks to give and receive love).

MeMail me if you want. My proverbial door is open to you :o) Good luck, and stay strong - you've got it in you.

1Cite: Liz's Remarkable Journey
posted by xiaolongbao at 11:33 PM on December 25, 2010 [3 favorites]

If your sessions with this current therapist are going to be fruitful in any way, you'll have to bring yourself to open right up as you have here and simply ask. Don't be afraid of what they'll have to say because you are, in large part, paying them for their professional assessment of you and your situation. If they don't think a prescription is the solution then they'll tell you and suggest some alternatives. If you still feel differently, then explain this and let them know how you'd like to proceed. At the end of the day, it is your psyche.
posted by braemar at 6:49 AM on December 26, 2010 [3 favorites]

Here's how you do it:

"Do you think that medication might be helpful to me? Because I'm interested in exploring that possibility for {your reasons go here}."

Every therapist has heard this question a million different times from clients. As others have said, psychologists don't prescribe medication, but yours will certainly have thoughts about whether to see a psychiatrist or work with your primary care physician.
posted by Sidhedevil at 4:05 PM on December 26, 2010

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