How does my Doctor choose my Antidepressant ?

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How does my Doctor choose my Antidepressant ?

I can only really comment on what I think about when deciding to start a patient on these medications, based on my experience and studies. This is not medical advice, more my opinion on the thought process behind the science. I have made it quite simple so if you have specific questions you can comment below/email me or ask your treating doctor.

I try and match up my patients with the medication I’m prescribing. This helps them stay on the medication if they experience minimal side effects and benefit from the meds. This is not always an easy thing to do, since I don’t exactly know how the patient sitting in front of me will respond.

I look at

  • medical history (i.e. kidney issues could be an issue with some medications)
  • whether you are on any other medications (some meds interact)
  • what symptoms you have – current sleep pattern, weight, sex drive, mood, anxiety level etc
  • mood instability patterns (is this in-fact Bipolar depression?)
  • previous response to meds
  • previous side effects to meds
  • obviously what the textbooks and pharmacology books say about each medication and diagnosis

The most common question I am faced with when starting a medication is ‘ Will this make me gain weight?’. Not all antidepressants cause weight gain, but a fair amount do and its important to chat to the patient about this. Patients starting antidepressants are by default often prone to weight gain (and have already gained weight), just by virtue of their depressive symptoms (eating too much/not exercising).

Its useful to weigh yourself when starting a new medication so that we know exactly what the starting weight is. This is a huge topic though which I will look at later in another post since it is not that simple.

If you are particularly anxious I may start an antidepressant which is less anxiety provoking, or at a low dose to decrease the initial increased anxiety you may feel when starting meds.

Certain types of antidepressants which are given at night promote sleep and are great for people with insomnia, others are more ‘energy’ producing and can be given to people who are sluggish and slow, but these may cause insomnia initially.

Ask your Doctor why they chose that specific medication for you, there is generally a thought process behind it – it helps you to understand why you need to take it if you know why they chose that medication for you.