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  • Q&A with Australian Health Practitioners

    How do psychologists/psychiatrists select the "best" anti-depressant for someone when there are so many different kinds?

    Related Topics
    Depression Mental Health
    Is the right anti-depressant based on someone's symptoms? severity of depression? How do therapists select the appropriate one?
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  • 1

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    Anthony Merritt

    Clinical Psychologist, Health Psychologist, Psychologist

    I have been a Clinical Psychologist for ten years. I initially specialised in health psychology with a focus on pain management. More recently my focus … View Profile

    Psychologists are not qualified to give advice on medications or prescribe them. So you'll need to ask a psychiatrist! :> 

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    *Important disclaimer*

    I am not a psychiatrist but have been on an anti-depressant for a while now and (thanks to my day job) understand their underlying molecular pharmacology fairly well.

    The different anti-depressants are targetted to different neurotransmitter receptors in the brain (the serotonin and norepinephrine receptors are the most common targets though there are others.

    Neurotransmitter receptors are proteins whose job it is to “send a message” from one neuron to another in the brain thanks to their ability to recognise specific neurotransmitters. There is good evidence that abnormalities in the way in which the brain “uses” neurotransmitters like serotonin and norepinephrine are linked to depression.

    For more information see http://en.wikipedia.org/wiki/Antidepressant and links/references therein.

    A good psychiatrist will have the clinical skills and experience to match the “right” anti-depressant to the “right” person. This can take some time (it is sometimes called “being on the medi-go-round”). Partly this is because most anti-depressants take a while (weeks-months) to kick in fully.

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    norseman

    HealthShare Member

    I ask the same question. I ‘was’ on Effexor for over a year but stopped taking it a few months ago on my own. I felt
    A: drugs are totally useless without any sort of follow up
    B: Effexor is good if you are good! It doesn't stop your thoughts of suicide or stop you feeling down, hence refer to A.
    I have seen GP's and Therapists. Gp's are fine if you have a cold, Therapists likewise if you want to give up smoking or lose weight.
    The problem is to see a psychiatrist you need to wait for ages and they refer you back to a GP.
    So you live in a circle.

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    cathy

    HealthShare Member

    I would like to say that I have been on antidressants now for many years. About 5 years ago I decided to go on a trial for a new antidepressant for people with Bipolar type 2. To change medications you need to slowly come off then slowly increase them. The trial medication worked very well but it was going to take great effort every month to get it as it was only available at a particular hospital - the one doing the trial. As a result I spent a few days with no antidepressant in me and I then resumed the antidressant I had been on. It reacted badly with me and for the next few weeks I was very ill - telling me I needed the antidepressant. My GP spent time consulting with a collegue while I waited and she prescribed another and I have been on it since then. Thant was late 2008.
    Both before and when I stablesed after I have been cared for very comptenly by my GP. After the Trial she organised a couple of sessions with a psychiatrist in our clinic who concured with her decissions and told her to continue as she was doing and also said if she needed any further help with me to contact him.
    I agree medications don't stop thoughts of suicide. The cause of the thoughts needs to be addressed.
    As I have said I now have a very good GP and that has been through trial and error. She attends not only my physical needs but also my psychological needs as well. She is able to tell if I am bluffing or not. 
    I have also found a great therapist. Not only is she great, but she bulk bills. All that is needed is a mental health review from a GP.
    iI am saddened your experience has not been a good one but if you need help persist. 

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    Agree

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    Dr Zhuang Miao

    Psychiatrist

    Dr Zhuang Miao is a general adult psychiatrist and a Fellow of The Royal Australian and New Zealand College of Psychiatrists. Dr Miao works as … View Profile

    As psychiatrists, we follow clinical guidelines for treatment of depression which is evidence based. We also consider other factors, for example, previous trial of medication, other medical conditions, medication interactions with other medication patient is taking, side effect profile in individual case, etc.  

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