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March 15, 2023

Why Does my Doctor Want to Start Me on an Antidepressant?


The short answer is….many reasons! BUT I am writing this post today to give you a little insider tip from someone who has had some experience in primary care as a Nurse Practitioner 🙂 Try to stick with me, this is really helpful information for so many people and I promise its worth the read!

So let's just say you walk into your primary care doctor’s office for an annual visit. You tell him/her that you feel SO low energy and maybe have difficulty sleeping and aren’t sure why! From just these two symptoms your doctor will likely work in a series of questions into the conversation. What they are doing is completing a questionnaire on you called the PHQ-9without you even realizing it! This is standard practice, and any good doctor will do this for you.

What is the PHQ-9?

It is a highly validated tool made up of 9 questions put out by the AmericanPsychological Association that helps clinicians screen for, diagnose, and monitor major depression in adults. The questionnaire is scored from 0-27 and depending on how you score, your clinician will use their discretion to either watch and wait, recommend counseling, or recommend a pharmacologic agent (AKA an antidepressant).

Don't get me wrong, this tool is a very helpful one and I used in on almost every patient that walked into the clinic because so many people have at least SOME of the symptoms that are present on the questionnaire! BUT, according to a recent meta-analysis, approximately 50% of people who had a positive screening on thePHQ-9 did not actually have depression…


What about those people who were put on an antidepressant who dont actually have depression? Well, they are often left feeling frustrated and helpless.So if it isn't depression, what is it?Well, this is what I would consider pandoras box, there are many reasons you can have certain symptoms, and it can be tricky to get the right diagnosis if you aren’t careful! But for times sake, we are just going to focus on the possibility of a hormone imbalance causing these symptoms.

Enter in testosterone, estrogen, progesterone, and thyroid hormone (and vitamin D, and vitamin B12). An imbalance in any of these hormones can mimic symptoms of depression that would land you a positive result on the PHQ-9 and send you on a one way ticket to antidepressant land.But do not fear, there are ways we can check to see if you fall into that 50% of people who aren't depressed. First we do a health assessment questionnaire (see below), get a full health history on you, then send you for a very specific set of blood tests that help us determine if you are a candidate for hormone replacement therapy

(Notice how similar the symptoms on the PHQ-9 look compared to the hormone imbalance questionnaire!)

And the best part is that you may not ever need to take an antidepressant after your hormones are optimized.Many are even able to get off antidepressants after hormone optimization! However, do not EVER wean yourself or cold turkey stop your antidepressant medications without being advised to do so by a licensed health care professional.So if you have been told in the past by a doctor that you would benefit from an antidepressant, have even tried taking an antidepressant, or are still on an antidepressant and it isNOT HELPING, lets consider another cause. . it is not always due to a hormonal issue, but lets do our due diligence. You owe it to yourself to find out about your own body, how it works, and what it needs! And if you are one of those people who truly does struggle with depression and have found mental freedom by taking an antidepressant, KEEP TAKING IT! This is not a bash session for antidepressants. If you are thriving with medications, that friend is a WIN! Remember: the goal is for you to feel your best and function as best as you can! However you get there is up to you🙂Whatever your journey has been, we are here for you cheering you on every step of the way!