I'm Keri Wiginton, and I live with major depressive disorder (MDD). Let me guide you through your visit to learn more about your treatment options.
Before your visit
Do some research ahead of time. You may feel more comfortable starting treatment if you have a good understanding of your choices and what your doctor may suggest first. Here are some tips to prepare for your appointment:
Read up on depression medication.
Learn about commonly used antidepressants and their side effects, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, and serotonin modulators.
Learn about different kinds of talk therapy.
Cognitive behavioral therapy (CBT) is one of the most effective ways to treat depression, and I can’t recommend it enough. But there’s also interpersonal therapy, mindfulness-based cognitive therapy (MBCT), family and couples therapy, problem-solving therapy, supportive therapy, and others.
Set goals.
Think about what you want to get out of your appointment. Do you want to leave with a prescription for an antidepressant? Do you need help finding a therapist? Do you want more info about lifestyle changes and other nondrug ways to manage depression?
Learn who treats depression.
My primary care doctor prescribes my antidepressant, and the most helpful therapist I’ve ever seen is a social worker. But psychologists have special training in talk therapy. And a psychiatrist (a medical doctor trained in mental health) is your best bet if you want to know more about brain stimulation and other techniques used to treat serious or difficult depression.
Consider making an appointment with your regular doctor first.
I usually have to wait 6 months or longer to see a psychologist or psychiatrist, at least one who’s covered by my health insurance. That’s why the last time I was depressed, I met with my primary care provider first. And I’m glad I did. She’s the first doctor to help me get to and stay in complete remission.
Talk to other people who get treatment for depression.
Only take medical advice from a health professional. With that said, many of my friends know I’ve tried multiple forms of therapy and medication and made a lot of lifestyle changes to ease my depression. And I’m happy to discuss the ins and outs of my 25-year treatment journey with them.
Find your depression community.
I don’t know where I’d be without my depression and anxiety friends, the folks in my life who understand what it’s like to manage a lifelong mental illness. If you don’t have a community, groups like Mental Health America and the Anxiety and Depression Association of America may be able to connect you with in-person or virtual peer support that meets your specific needs.
During your visit
You probably want to leave this appointment with a plan for how to manage your depression, and also a general time frame for starting to feel better.To guide your visit, here are some questions to ask your doctor and some they may ask you:
WHAT TO ASK YOUR DOCTOR:
What’s the most common treatment for depression?
My doctors suggest I pair talk therapy with an antidepressant, usually a selective serotonin reuptake inhibitor (SSRI). These widely used drugs include escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). I’ve tried all three. They don’t ease depression fully for everyone (including me), but they’re generally considered safe and well-tolerated, even for people who are pregnant.
What are my treatment options?
Ask about the pros and cons of talk therapy, medication, lifestyle changes, and other treatments. If you have severe depression, a psychiatrist can tell you more about when you might need things like brain stimulation, including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), or newer treatments like ketamine infusions or esketamine nasal spray.
How long does it take for treatment to work?
This depends on which treatment you get. But antidepressants usually take at least 4 to 8 weeks to fully kick in. I know that’s a long time to wait when you feel bad, but an effective medication should improve your symptoms at least a little bit within a week or two. I always tell my doctor if that doesn't happen, and she usually adjusts the dose right away.
Why are you recommending one treatment over another?
Your doctor might suggest one medication or procedure over another based on how severe your depression is, side effect concerns, or specific symptoms that you want to target. For instance, I used the SNRI duloxetine (Cymbalta) for 6 months to ease my frequent migraine attacks and nerve pain. I later switched to the mildly stimulating antidepressant bupropion (Wellbutrin) because I was still tired all the time.
What side effects should I watch for, after starting an antidepressant?
You may not notice much, but antidepressants can be activating for me. I usually feel anxious and restless for a couple of days. Sometimes I get insomnia. This adjustment period can be uncomfortable or even scary. You may stop your treatment too soon (I have in the past) if you don’t know that this feeling usually goes away as your body gets used to the medication.
What are side effects of treatment and how do I manage them?
If I’ve learned anything from talking to other people with depression, it’s that side effects vary widely. But if your doctor treats a lot of people with depression, they should be able to tell you the kinds of complaints they hear most often and what can be done to manage your symptoms.
How do you know which treatment is right for me?
Expect some trial and error. My doctor considers several key things, including how serious my symptoms are, how long I’ve been depressed, which treatments I’ve tried in the past, and whether I have other issues. For instance, the medication that works best for my depression can worsen anxiety and insomnia. I wouldn’t take it if I had those issues.
How will I know if treatment is working?
I’ve recovered from several depressive episodes, and my physical symptoms tend to get better first: I sleep better, have more energy, and think faster. Then, I’ll start to have fewer negative thoughts and a brighter outlook on life. But my doctor also asks me a set of specific questions to gauge how I’ve improved in certain areas. (Look up the PHQ-9 Patient Depression Questionnaire to find out more.)
Can I ease my depression without medication?
My doctor recommends I take antidepressants if my symptoms have lasted a long time and they’re serious (if I have suicidal thoughts, for example). That’s because meds tend to help me recover faster and more completely. But I can usually manage mild depression with cognitive behavioral therapy, mindfulness meditation, and daily exercise.
Does increased physical activity help?
I know what it feels like to be so depressed that even getting out of bed takes effort, but research shows regular exercise can ease symptoms of depression or prevent them from coming back. That’s certainly true for me. I try to walk at least 60 minutes a day and lift weights a few times a week. Any activity is better than none. Ask your doctor what’s safe for you.
How can I increase my social connections and add more purpose to my life?
The pandemic didn’t do my social anxiety any favors. But I’m an introvert who works from home, and I live in a different state than most of my friends and family. My therapist helped me find meaningful ways to connect with my community. I volunteer once or twice a week with people who are in hospice or have dementia.
Should I quit drinking alcohol and using other substances?
Drug use is a bad idea if you have depression. Booze can change your brain in a way that worsens depression, so I gave it up. While I’ve had a depressive episode since, I recovered faster while sober. And my generalized anxiety (which I was diagnosed with in my mid-20s) went away completely a few months after I quit drinking.
Will I need depression treatment for the rest of my life?
There’s no way to know for sure. But I’ve had more than a few episodes of depression (meaning my MDD symptoms have lasted 2 weeks or longer at separate times in my life), and every doctor tells me that means there’s a good chance I’ll need lifelong treatment to prevent another one from happening.
What if the first treatment I try doesn’t help enough?
Your doctor should have a stepwise plan for what they’ll do if the first (or second or third) thing you try doesn’t ease your symptoms enough. Over the years, I’ve tried six medications from three drug classes. I’ve gone through 6 weeks of cognitive behavioral therapy (CBT) more than once.
If I start an antidepressant, is it easy to stop?
Some antidepressants are easier to quit than others, but ask your doctor how you’ll wean off meds later on. When I was first diagnosed, no one told me I could get withdrawal effects (including flu-like symptoms, wild mood swings, and brain “zaps”) if I missed a dose or stopped cold turkey. But now I know to slowly taper off.
WHAT YOUR DOCTOR MAY ASK YOU:
I’m comfortable taking antidepressants and working with a therapist. But when I see a new doctor, I’m upfront about medications I’ve tried in the past that I won’t take again, because they didn’t work or caused side effects. I’m clear that I’m mainly interested in CBT, which tackles specific goals and lasts only 4-8 weeks.
What are your ultimate goals for treatment?
I’m specific with my doctor. I say things like: I’m physically and mentally exhausted all the time, and I sleep 10 to 12 hours a night. My thoughts feel like they’re stuck in mud when I try to concentrate, which makes it hard to do my best at work. And while my mood isn’t that low, I’m having trouble with motivation. I’d like help with all those symptoms.
When it comes to antidepressants, what side effects are you most worried about?
Tell your doctor about anything that concerns you. They might choose a different drug if there’s a specific symptom you want to avoid. For example, the medication I take now doesn’t cause changes in my sex drive or lead to weight gain, which are issues I’ve had in the past on SSRIs and SNRIs.
Do you get depressed at certain times of the year?
My doctor thinks I have MDD and seasonal affective disorder (SAD), a type of depression that gets worse in the fall and winter. With her OK, sometimes I only need to take my antidepressant when it’s cold and dark for long periods.
How well do you manage your other health problems?
I discuss my other medical conditions, especially endometriosis and migraine, which are known to cause or worsen symptoms of depression. You may need to address other issues, depending on your health.
What do you do to manage your stress?
I used to think you were either born equipped to handle life's challenges or not. Now I have an array of stress management skills. I meditate, exercise, take breaks when I need them, spend time in nature, and don’t skimp on sleep.
Who do you turn to for support?
I depend on a core group of friends and health professionals. But I hid my depression for a long time, partly because I didn’t want to be a burden. I also didn’t want my loved ones or co-workers to think I couldn’t handle everyday life. But acting like I’m not depressed when I am is exhausting, and I don’t do it anymore. Instead, I ask for help when I need it.
When to speak up
You should feel like your doctor takes you seriously and has your best interests in mind. Here are some examples of when you should advocate for yourself and what to say:
When you feel like your doctor dismisses your concerns
“I may not seem that depressed, but I’m really having a hard time getting through the day. Can we go over my main concerns again and what treatments might help address the symptoms that bother me most?”
When you feel rushed into starting an antidepressant or other treatment
“I’m not ready to start medication or therapy just yet. I need a little more time to go over the pros and cons of all my options. Can we schedule an appointment for a couple weeks from now to revisit the conversation about depression treatment?”
When you have unanswered questions about side effects
“I need to know in advance what might happen with certain treatments and how long side effects might last. I’m afraid I’ll stop treatment too early if I get strange or uncomfortable symptoms I’m not prepared for.”
When you need fast help for serious symptoms
“I know that antidepressants and therapy can take weeks or months to work, and I’m open to trying them., But I’m scared because I’m having recurrent thoughts of suicide and death. Do you think something like ketamine or another kind of fast-acting treatment might be right for me?”
When you want your doctor to check for other health problems
“I know certain medical conditions can cause symptoms of depression. Do you think I should get lab tests to see if I have thyroid problems or signs of another disease that might need treatment? If not, can you tell me why?”
When you want to learn more coping skills
“I’m not managing my stress or emotions well. Can you refer me to a social worker, behavioral health counselor, or psychologist who can teach me relaxation techniques and give me the tools I need to take control of my unhelpful thoughts and behaviors?”
When you feel hopeless
“I want to recover, for myself and my loved ones. But I feel like there’s no point in starting treatment because I don’t think I’ll ever get better. I know that’s the depression talking, so do you think another mental health professional can help me overcome these negative thoughts? Can I see someone soon?”
When you can’t afford depression treatment
“I want to do what you’re telling me to, but I can’t pay for ongoing medication, talk therapy, or procedures like brain stimulation. Can I talk to a social worker or patient navigator who’ll help me find resources to help cover the costs of my treatment?”
After your visit
You may have a lot to think about when it comes to treatment options. Make sure you have all your doctor’s instructions and know who to call if you’re confused about anything.
Know what’s next for treatment.
Are you starting an antidepressant? Do you know what side effects to watch for once you start your medication? How will you remember to take your meds every day? Do you need to make an appointment with a therapist? If so, when is your first visit? How often will you meet?
Know who to go to with questions.
Ask your doctor how to get in touch if something pops up after your visit. Who do you contact if you have an emergency? My doctor responds within a day through MyChart, an app that hospital systems use to share information and connect with their patients. But I also have a number to call if I need to talk to a person right away.
Check your insurance coverage.
Health insurers are required to cover the costs of mental health treatments the same way they would for other kinds of medical care. How much you’ll pay depends on your plan. I still have to pay a copay each time I see a therapist, meet with my doctor, or fill a prescription. But I make sure all my providers are “in-network” before I make an appointment, and I get generic drugs.
Schedule a follow-up appointment.
The last time I had a major depressive episode, my regular doctor wanted me to restart my antidepressant, and she had me make an appointment with a behavioral counselor before I left the office. I checked in with someone from my care team at least once a week for about a month until we figured out my treatment plan. I still see my regular doctor once every 6 months.
Keep track of symptom changes.
Several key things happen when my depression lifts: I fall asleep easier and stop having nightmares. I get less distracted when I’m working, feel more joy in my life, and have plenty of energy to exercise. Music no longer sounds irritating, and I can concentrate long enough to finish a book.
Learn about other lifestyle changes and other self-care strategies.
I know I’ve said this before, but exercise is key to my quality of life. I also find ways to manage my stress, including spending time with my husband and other people I care about. Ask if there’s anything else you can do to feel better.
Connect with others living with depression.
A friend reached out years ago and asked if I’d talk to her about mental health. She knew I'd recovered from depression (because I talk about it openly) and wanted some advice. That one-time phone call turned into more than 5 years of weekly video chats. We discuss life in general, medication side effects, and any new or recurring depression and anxiety symptoms.
Consider getting a second opinion.
My doctor consulted with a psychiatrist and a behavioral health counselor to fine-tune my treatment plan. If you don’t already have access to those kinds of specialists, ask your doctor if they can refer you to someone.
Find more information about how to search for mental health professionals by going to the websites of the American Psychological Association, American Psychiatric Association, and National Alliance on Mental Illnesses (NAMI).
Show Sources
SOURCES:
Keri Wiginton, 42, medical writer and health journalist, Madison, WI.
John Krystal, MD, chair, Department of Psychiatry, Yale School of Medicine; chief of psychiatry, Yale-New Haven Hospital, New Haven, CT.
UpToDate: “Depression treatment options for adults.”
American Psychological Association: “Depression Treatments for Adults.”
National Institute of Mental Health: “Depression.”
Stanford Medicine: “Patient Health Questionnaire (PHQ-9).”
Harvard Health Publishing: “Exercise is an all-natural treatment to fight depression.”
Current Sports Medicine Reports: “The Role of Exercise in Preventing and Treating Depression.”
Frontiers in Psychiatry: “The Effects and Mechanisms of Exercise on the Treatment of Depression.”
The American Journal of Psychiatry: “Alcohol and the Etiology of Depression.”