This Op Ed piece, SSRIs – Nightmares by the Dozen, is filled with anecdotal stories about the horror’s of anti-depressant medication.

The first problem I see is the nature of stories: for every one horror story of a person committing suicide or homicide, I could tell dozens of stories where people credited anti-depressant medication with saving their lives.

The second problem with this piece is that in every tale, the medications were either prescribed improperly (in my opinion) or the directions were not followed. Or, people simply took the medication without educating themselves about it. In none of the stories, was the person also seeing a counselor/therapist.

In the Op Ed piece, a family member of teen who had been prescribed anti-depressants was quoted as saying, “The question is why are we handing these drugs out like candy”. Good question. Another good question is why would anybody take, or allow their child to take, medication (any medication) “like candy”. Maybe I’m just a skeptic, but I always insist on knowing about the medication I am on (and the meds my children are on).

SSRI’s are powerful medications. But then, so is nearly everything your physician prescribes.

I thought the days of blindly placing yourself in the hands of a doctor were over. Apparently not. I teach my clients that health care is a collaboration between the patient and the provider: learn to be assertive about your own health care.

(A disclaimer: I am not a physician and cannot prescribe any medications. But I collaborate with doctors on a regular basis regarding the patients we are mutually treating and I have no shortage of opinions on the subject.)

I think the best way to take any psychotropic medication is in conjunction with therapy.

My sessions are the traditional “50 minute hour” (which is now 53 minutes due to insurance driven ideas of how long a session should be). I have time to adequately diagnosis my clients. Most physicians spend 15 minutes or less actually in the same room with their patients. I also have the time to talk with my clients about their understanding of the medication they have been prescribed.

I shouldn’t have to. It’s not my job: that is the job of the treating physician and of the pharmacist. But I get paid to listen and explain; they get paid to prescribe and fill prescriptions. So, we go over the handout’s from the pharmacy. I provide material from NIMH and links to sites with patient information for the particular medication they are on.

I’m not blaming individual physicians. I see 25 to 30 people each week; they see that many people in a day. It is simply easier for a therapist to stay in touch with a client/patient than it is for a doctor.

And, research is clear that the most effective treatment for clinical depression is a combination of medication and counseling/therapy. One without the other just isn’t as helpful as both.

SSRI’s can take two to four weeks to build up to a therapeutic level. And then another two to four weeks before the full anti-depressant effect kicks in. Assuming the patient is on the right medication (brand) at the proper dose, it can still take four to eight weeks before significant change is brought to bear.

So here are the guidelines I give my clients when taking an SSRI:

1. Always follow the physician’s prescription. If you decide to make any changes to the regime: don’t. At least, not without contacting your doctor first.

2. Be in therapy with a licensed and experienced therapist while starting a SSRI or when making adjustments to the dosage.

3. Educate yourself and your family members about the possible side effects of the medication.

4. Call or see your physician at least every two weeks until you both are satisfied you are on the right SSRI at the correct dose. Don’t let him or her give you a prescription and tell you to come back in 30 days. (I saw a new client the other day who had been given one years worth of refills and no follow up appointment.)

5. Prevent relapse by staying on the medication six months to one year after the cessation of depressive symptoms.

6. Don’t just stop taking the SSRI cold turkey; just as you built up to the therapeutic dose, you will need to wean yourself off the medication. Follow your doctor’s protocol for stopping an anti-depressant.

7. Remember, treatment of depression is a collaborative effort between your doctor, your therapist, and you. And of the three, YOU may be the most important member of the team.