Antidepressants through a GP or clinic
December 29, 2007 5:50 PM   Subscribe

How can I get a prescription for an antidepressant from a GP or (preferably) a walk-in clinic, and how long would the prescription last?

--- Back story ---

I'm quite sure I've been depressed for 15+ years; I used to write "suicide notes" and "wills" at as young as 12 years old, and I've relied on suicidal ideation as a weird coping mechanism ever since (I am not suicidal now). I also have general feelings of worthlessness, crippling guilt and anxiety, uncontrollable crying, etc. Basically, I've always felt like every moment of contentment or happiness I've had is just a temporary distraction from my long-term state of sadness and self-loathing.

However, although I've thought about seeking therapy on and off for about 5 years, I can't bring myself to do so.

One reason is that I've never felt like my depression was bad enough for me to "deserve" treatment.

A second reason is that the whole process of therapy seems like it would just be a huge drain on my time, energy, and wallet (I'm in the U.S. and have health insurance).

A third reason is that I have a huge aversion to talking about my feelings, and when I start to get upset, I physically can't speak. Especially if I start to cry; I just can't make my mouth GO. Also, acts of kindness, empathy, or sympathy usually set me off into hysterical crying and I shut down further. So I have this feeling that I wouldn't make any progress because I'll never be able to communicate the depth or the range of what I feel.

Therefore, I think I need to be on an antidepressant before I can be stable enough to seek therapy.

--- The actual question ---

I've read this thread and have found it quite helpful. However, I don't understand the process of going to a GP or a walk-in clinic and getting an antidepressant prescription. I don't really have a primary care physician; I do see a great endocrinologist regularly for a hormonal issue (definitely not related to depression), but I would never feel comfortable talking to him about depression. I actually haven't been to a GP in 10+ years; if I feel unwell I just go to an urgent care/walk-in type clinic.

If I go to a walk-in clinic and tell them I'm depressed, will I really get a prescription for an antidepressant? Approximately how long would that prescription be good for (would it be a few weeks, a couple of months, etc.), and what do I do when it runs out? Or does all of that depend 100% on the doctor I see? I have always had a LOT of trouble talking to doctors, even about simple physical symptoms, so any advice on exactly what to say would be appreciated.
posted by anonymous to Health & Fitness (17 answers total) 1 user marked this as a favorite
Well, how about asking for what you want? Most GP's will consider your requests for meds in a rational manner (unless you're asking for painkillers, anti-anxiety meds, and such). Many SSRI's treat more than just depression...example: Paxil is used for depression, social anxiety, premature ejaculation, etc.
I suggest that you mention your depression to the doc, however, it would be well to describe the symptoms of your depression: racing thoughts, loss of appetite, low energy level, etc...
GP's will usually prescribe for 3 months and ask you to come back for a brief visit at that time.
posted by rockhopper at 6:06 PM on December 29, 2007

No qualified clinic will give you a prescription for antidepressants because you can't speak with a doctor about your problems.

They might give you a prescription after rather much talk with a proper clinical psychologist and a well-reasoned diagnosis. Depression is a ambiguous and misdiagnosed condition that requires discussion with a qualified professional. Although an antidepressant can be a short-term "solution" to your problems, you will only end up hurting yourself if you attempt to solve your troubles with self-prescribed medicine for a self-diagnosed disease.
posted by saeculorum at 6:09 PM on December 29, 2007

This is not a big deal and people do it all the time. Check this article out to see a list of the symptoms of depression. Just go in and tell them what you told us. Antidepressants are really commonly prescribed. They have pretty mild side effects. It may be easier to talk to a nurse practitioner. I've found they are generally very easy to talk to and listen well. The prescription will probably be for 6 months or so. If it's working for you, the doctor will probably keep you on it, no problem. There may not even be an office visit involved. Oh, and if cost is an issue, print out the list of $4 antidepressants available at walmart and tell the doctor you don't have insurance, and cost is important. Seriously, they want to help.
posted by selfmedicating at 6:15 PM on December 29, 2007

Physical symptoms of depression include some or all of: unexplained sleep disturbances, unexplained appetite changes and lack of sexual interest. These are in addition to the symptoms usually associated with depression, like general apathy and lethargy.

You might find it easier to focus on the physical symptoms (if you have them) when you talk to a doctor, especially a GP. I have found that GPs (in my experience) don't really "get" your complaints until you put them in terms of actual physical issues, rather than more nebulous terms like "I feel depressed".

Also, if you are unsuccessful with getting prescriptions, try a serious aerobic exercise program for a few weeks. That might elevate your mood enough temporarily so you feel more comfortable making that first appointment with a mental health professional, which is who you should see long-term for depression management anyway.
posted by SuperSquirrel at 6:29 PM on December 29, 2007

I went to my physician for a physical and simply told her that I thought I'd been having episodes of depression and anxiety for several years but had never brought myself to say anything about it. At the time, my anxiety was the driving force in asking about it because I had just moved to a new city and couldn't deal with many of the challenges I was facing (specifically, for me, driving in traffic and thus going out except for mandatory trips to work, grocery stores, etc.). She talked with me about it, and asked if I wanted to see a therapist or if I'd thought of meds. At that time I'd resigned myself to trying medication, which is the only reason I brought up the mental issues at all.

She did explain that sometimes there's a bit of trial and error with antidepressants, since there are so many reasons for depression/anxiety. In fact it so happened that she tried one med that gave me some icky side effects so when I went back in another month or two she gave me a prescription for a different drug.

So yeah, if you go in, tell a doctor you're depressed, she'll likely ask you some questions like you'd see on a depression screening checklist. She may suggest therapy, she may suggest seeing a psychiatrist to work out medications, or she may just prescribe a medication. You need to be very honest with them when answering questions, especially about your suicidal thoughts, even if they were years ago. Also, I find it helpful to go to a GP, just so that you know the same doctor is looking at your chart each time you go in, and it might make it easier for you to talk to someone who may not feel like a stranger. It may take a couple of visits or a couple of meds, and it's good to be comfortable with whom you're dealing.
posted by eldiem at 6:33 PM on December 29, 2007 [1 favorite]

Just so you know, and I am not suggesting this, it is totally possible (and last time I checked, completely legal) to go to a website, fill out a form about how shit you feel on a scale of 1 - 10, get an online prescription and have antidepressants mailed to you 10 days later.

This works best if you have some idea what drug you might want, as in having previously had a prescription for it, however. But no fair me knowing something you don't, so I just thought I'd mention it.
posted by DarlingBri at 6:40 PM on December 29, 2007

Yes, you can totally get an antidepressant on the first visit but you have to go to someone's office. I can't imagine a walk in clinic would do something like this. There's a period of dose-adjustment, troubleshooting side effects, maybe even a change in medication so with most reputable clinicians you should expect at least 2-3 visits over a couple months up front. Once things are totally stable and someone doesn't want to come off and they are doing well, you might be expected to come back once or twice a year. This is what I would consider a "bare minimum" for treatment of straight forward depression.

Which brings up another point. I am not so sure I would be comfortable diagnosing someone with major depression if they weren't able to sit down and talk to me about it for 30 minutes. From the clinician's standpoint, you might have bipolar or a personality disorder or something that would entail some real liability on my part if I misdiagnosed you and gave you the wrong treatment plan. Most doctors are willing to meet patients where ever they are mentally and if you are not looking for hours of therapy they won't force it on you. So I would encourage you to tell the doctor exactly what you've said here, but you should expect to have to give at least a little bit during the process if you want someone to be able to help you.
posted by Slarty Bartfast at 7:15 PM on December 29, 2007

While a GP can do a great job of screening, seeing a psychiatrist could have additional benefits of more targeted screening and specialized knowledge of treatment options, including multiple drug combinations for especially severe or atypical cases. However, know that with therapy, you've got to tear down before you build up. Good therapy is purposefully destabilizing, so that you can break old patterns and cycles and create new ones. It's not an easy path, but the more roadblocks you put in front of yourself, the harder it will be to start. Good luck!
posted by moonbird at 7:37 PM on December 29, 2007

When I finally started getting treatment for depression a few months ago I opted to see a GP instead of trying a walk-in clinic, so I can't say whether one route is better than the other. Going to the GP, though, I did end up with a year-long prescription.

When the GP came in and asked me why I was there, I said, "depression," and he started talking about how a lot of people come in saying the same thing. He generally seemed to be implying that my problem was mild and maybe not even real, but that he'd play along and give me a prescription with few side effects just to placate me and maybe work the placebo effect. I walked out of the office that day with a med sample pack; when I came back the next week and told him that I thought it was helping, he wrote a prescription for a year.

So, in order to acquire that prescription, since that was your question, what I had to do was to schedule the appointment with a doctor (that was difficult), go to the office (also difficult), separately tell the medical assistant and the doctor that I was depressed (difficult, awkward), answer a few questions and then come back a week later and say I thought I felt the medication was working.

Even though I did think I was feeling effects, I know now that a week is almost always too soon to tell, and what's more it turns out that even after two months, I actually felt just the same as before. So I went through the whole process again, this time getting a different doctor in the hope that she would be a bit more understanding. She was, and spent more time asking questions – which is really difficult and awkward, yes, but it's one of those necessary evil things, since the brain is complicated and it's worth avoiding getting a prescription that will just make things worse.

If you can, find a sympathetic friend to lean on a little while you go through this (even if it's just by accompanying you to appointments or whatever, you don't have to talk about your feelings), because it is hard. There's no point in pretending otherwise. And even though you may doubt that you're depressed enough to merit treatment, it really sounds like you are. I had the exact same doubts until the second doctor gave me a questionnaire and determined that I was in the severe range. You do deserve help, and I want you to get it.
posted by tepidmonkey at 7:43 PM on December 29, 2007 [1 favorite]

My family doctor had prescribed two family members with antidepressants (long term) without them having seen a psychologist. I believe most GP's would willing and able to help you on your first visit.
posted by Sufi at 7:45 PM on December 29, 2007

After reading your entire question I'd like to add a few things.

The visit with the doctor probably won't last more than 5 minutes. You'll get a few routine questions (they aren't psychologists and they don't pretend to be. From my experience, the questions aren't very intrusive), the doc will explain the medication and you'll be out the door.

As for the length of prescription, you'll be asked to return after a couple months (maybe 2-3) for a re-evaluation, but I've never known anyone that actually did that. I believe the prescription is good for quite some time.. hell, by the time it runs out, you may be feeling good enough to schedule an appointment with a psychologist.
posted by Sufi at 8:05 PM on December 29, 2007

My partner's regular family doctor prescribed anti-depressants when he went in complaining of fatigue, aches and pains, inability to concentrate, and a general icky malaise (luckily, the first prescribed meds did wonders in about a month). There was a hospital-sanctioned checklist for him to go through with questions like, have you felt suicidal, do you have trouble waking up in the morning, how's your sex drive, etc. However, the doctor asked him to come in at two or three week intervals for the first two months just to check up on how everything is going since this was the first anti-depressant medication he'd been on. The initial prescription he got was only for three months.
posted by sian at 12:31 AM on December 30, 2007

Oh, I forgot to add--our family doctor is a general family practitioner, but apparently is also the depression specialist at our clinic. If you don't already have a doctor and you want to make an appointment to see a new one, be sure to specify your reasons for visiting in case they can match you with an appropriate doctor. (Personally, I can name a number of physicians I've visited over the years who I would never trust with prescribing depression medication.)
posted by sian at 12:35 AM on December 30, 2007

If talking about your depression is really impossible for you, write out how you are feeling and give it to the doctor.
posted by happyturtle at 12:46 AM on December 30, 2007

(I mean, write it all out in advance and have it prepared before you go, not that you sit in the doctor's office and write while he's waiting. )
posted by happyturtle at 12:49 AM on December 30, 2007

Inspired by your question, I'm going to try this tomorrow (going to a 24hr mental health walk-in clinic, in Philadelphia), and I will tell you how it goes. I'd go today if I had the money to get there (would have to take more bus connections on a Sunday).
posted by Danila at 7:06 AM on December 30, 2007

Anonymous, I am so sorry to get back to you so late. I procrastinated of course and didn't go to the clinic until today, Friday, the busiest day of the week. My experience:

It was a 24 hour walk in clinic at a local hospital. I got there at 10am. Since the clinic is connected to a hospital, a number of the patients ended up being admitted. I just needed to talk to a doctor and get some medication. Since my case was not urgent, I didn't see the doctor until around 1pm. Then I didn't get my prescription and discharged until 4:30 pm. Please note, this was an inner city clinic and it was quite busy. You might not have to be there so long.

Because some people were there involuntarily, there was an extensive search. Metal detector, plus pat-down, plus removal of all items including shoes for the duration of the visit. I did get some cozy socks. I filled out some paperwork, nothing major, showed ID, and sat to wait. Talked to a nurse about why I was there. They didn't ask for my insurance card, although it's possible they saw me in the system since I am part of the city health program, and they did ask for my social security number. When I saw the doctor, he was young, a resident, and there was an intern with him. We spoke for maybe 10 minutes. They might not want to give you a prescription unless you let them set up an appointment for you at a regular clinic. I think I went to a crisis clinic, not a regular clinic. They have to have some way of making sure you'll be okay with any side effects. He said they'd also be okay with it if you go to your GP afterwards, so long as you give them permission to call and make sure the GP followed up. They only gave me a 2 week prescription until I can see a regular doctor. So it looks like you can't get regular prescriptions from a crisis clinic, make sure you don't make my mistake and go to a 24 hr crisis clinic. A regular clinic associated with a hospital would probably be better, although there might not always be a doctor there.
posted by Danila at 2:41 PM on January 4, 2008

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