Tuesday, September 13, 2011


While I wrote these articles for the psychology and counseling student and clinicians, present and prospective clients can glean much useful and important information from them as well.

Do you know someone who is considering taking anti-depressant medication?  The information below is important to know.


Buelow et al. (2000) state that 60% of prescriptions written for SSRIs are from medical doctors. Due to the stigmatization of going to psychiatrists, clients are more likely to go to their family doctors for depression medication. Therefore, therapists commonly treat clients whose SSRI prescriptions were “…obtained from family physicians and other doctors not extensively trained in psychiatry” potentially complicating the therapeutic process.

When confronted with clients’ questions regarding their doctors’ SSRI prescription, therapists need to consider many important aspects of protocol and communication to insure full and proper client treatment. Clinicians help clients more adequately by fully answering client questions and educating them about the side effects and contraindications of their medication. 

In an effort to secure effective relief for clients, therapists need to inform them about uses and indications of SSRIs as well as precautions they need to take. However, asking pertinent and specific questions surrounding their clients’ SSRI use is also imperative if therapists hope to make accurate conclusions and recommendations for their clients.


According to Rankin (2000), over-distribution of SSRIs is common. Therefore, therapists need to ask clients the right questions to help determine if using an SSRI is appropriate for them. Clinicians need to explore reasons for clients’ going to a regular doctor instead of a psychiatrist to better understand if possible issues of shame or embarrassment may be posing obstacles to treatment. 

Skillful questioning can also draw out information regarding client symptoms, attitudes, and beliefs surrounding their SSRI prescription. Therapists can then challenge any myths or misconceptions clients may have about medications or disorders helping to insure continued use and facilitating more effective therapeutic treatment.

To better establish the appropriateness of SSRI use, therapists also need to ask clients questions about their symptoms both before and after taking SSRIs. Prescribing SSRIs for depression symptoms without considering other psychological aspects of clients can be damaging. 

For example, Lithium is also commonly prescribed to mitigate the manic phases of bipolar clients. If clients with bipolar depression take SSRIs without mood stabilizing medication (e.g., antimanics, benzodiazepines, and anticonvulsants), they may be put at risk for suicide. In addition, medications for the depressive phases of bipolar depression are usually different from those prescribed for unipolar depression. 

Risk of suicide is also an important consideration because antidepressant medication helps some clients feel more capable of carrying out their suicide plans. Therefore, support during the initial phases of SSRI use is crucial.

Clients need to be aware of the possibilities of depression relapse when discontinuing SSRIs. Reinecke and Davison (2002) cite Angst (1990) and Kupfer (1994) in stating that the recurrence of depression is 70% after two episodes of depression and 90% after three episodes.

For some clients, therefore, encouragement for continued use of SSRIs is important for avoiding risky behavior and failure in therapy. In addition, if therapists ask questions to examine client cognitions, they can challenge thinking that may lead clients to poor drug compliance. Ultimately, however, “Physicians should aggressively pursue recognition and treatment of depression and suicidality but not put their entire faith in medication” (Sakinofsky, 2007, Abstract).

SSRIs are commonly prescribed for symptoms such as “…pain, headaches, fibromyalgia, premenstrual syndrome, peptic ulcer, and chronic fatigue syndrome” (Rankin, 2000, p. 77). If therapists ask questions about the indications for their clients’ prescriptions, they can better understand and address therapeutic needs and underlying client issues. Furthermore, because secondary depression is often caused by physical disease processes, examining the possibility of the link between pain, fatigue, fibromyalgia, depression, and other illnesses helps therapists determine the correct causes of clients’ depression.

Therapists who assume that SSRIs are being given only for depression may miss other diagnoses for which they are prescribed such as anxiety, eating, and sleep disorders, attention deficit hyperactivity disorder, and substance abuse. Clinicians also need to consider that some depression drugs work better for some disorders than others. Therefore, therapists need to ask the right questions to help them ascertain if the use of SSRIs drugs is appropriate for their clients.

When therapists ask questions they can also determine the level of understanding of their clients leading them to use appropriate language when conveying information about clients’ prescriptions. Rather than using technical terms such as “monoamines,” “inhibitors,” “pharmacokinetics,” and “antagonist,” clinicians should use lay terms to convey SSRI concepts to uneducated or lower functioning clients.

If clients’ functioning and education indicate, clinicians may decide to use more technical terms that explain the effect of serotonin re-absorption on neurotransmitters and possibly include diagrams of brain functioning to better facilitate client understanding.

If clients obtain their SSRI prescriptions from doctors because they were uncomfortable with the stigma of mental disorders, therapists may want to impress on clients the biological explanation of depression to help clients understand that depression is not a result of moral weakness, thereby reducing self-blame.



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