Selecting The Right Anti-Depressant

Four out of five prescriptions for emotional problems are written by physicians who are not psychiatrists (Psychiatric Services, 2009).

Sadly, general practitioners and family doctors completely miss the diagnosis of depression for about half of their depressed patients.

Some general practitioners have conscientiously applied themselves to learn the skills to make a proper evaluation of depression, and also make time in their practice to conduct these evaluations.

Unfortunately, rushed scheduling, other medical concerns, and economics of a general medical practice often means that careful evaluation of depression is simply not done.

M.D.s who would think nothing of ordering expensive tests for other painful and complex conditions, simply do not think about referring outside of their practice for expertise in diagnosing depression.

When prescriptions are written, there is often less than 10 minutes between the initial questions about “how are your feeling” to writing the script.

While it is true that research finds anti-depressants are typically helpful, it is also true that they are not always necessary.

When they diagnose the presence of depression, there is a tendency for general practitioners to immediately prescribe a favorite or well-known anti-depressant, without regard to the exact nature of the depression. One family of anti-depressants – the SSRIs –  are most often prescribed, but an analysis of four FDA clinical trials of SSRI antidepressants found the drugs didn’t preform significantly better than placebos for mild to moderate depression, and the effects were small even for severely depressed patients (Irving Kirsh of Harvard, in PLoS Medicine, 2008).

Often depression and anxiety go together, as does depression and problems sleeping. It takes specialized expertise to properly match the correct anti-depressant to a client’s particular mix of depression, anxiety, sleep problems, and other issues.


Prescription of anti-depressants by family doctors and general practitioners:

  • rarely includes a fine-tuned evaluation of whether depression might be better treated by psychotherapy
  • is often insensitive to the fact that different varieties of depression respond differently to the scores of available anti-depressants. (For example, some anti-depressants are better at helping with sleep, some are better at targeting depression mixed with anxiety, and some better for elevating energy.)

Matching an anti-depressant with a particular depression is a job best done by a psychiatrist who specializes in this field. A psychiatrist is an M.D. who specializes in conditions like Depression.

If Dr. McConnell thinks anti-depressant medications might help you he will recommend you see a skilled psychiatrist for further evaluation.