9 Questions to Ask Your Psychiatrist When Antidepressants Aren’t Working

The most useful question is simple: have I actually had two full antidepressant trials? The answer decides everything that follows, because two adequate trials is the threshold for treatments like TMS and Spravato.

Here are nine questions worth bringing.

About the medication you are on

• Am I on a full therapeutic dose, or still on a starting dose? Many people sit on the lowest dose for months.
• How long should I stay on this before we judge it? Usually six to eight weeks at a full dose.
• Could a side effect be limiting my dose, and can we address it?

About the diagnosis

• Has anything else been ruled out? Thyroid problems, sleep apnea, low iron, and low vitamin D are simple tests.
• Could bipolar disorder, ADHD, PTSD, or OCD also be part of this? These change what works, and are commonly identified late.

About what comes next

• Do I meet criteria for treatment-resistant depression? This is the question that unlocks the rest.
• Am I a candidate for TMS or Spravato? Both are FDA-approved for exactly this situation.
• What would my insurance require before approving either? Usually documented failed trials. See fees and insurance.
• If we try one more medication and it does not work, what then? Asking for the plan beyond the next step is reasonable.

Bring one piece of paper

A written list of every antidepressant, the highest dose, how long you took it, and why it stopped. This does more work than any question on the list, because it turns a vague history into a clear picture.

If you feel dismissed

Ask what would need to change for a different approach to be considered. That is a fair question and it usually produces a concrete answer.

If you still feel unheard, a second opinion is reasonable. Bring the same list.

Say the hard part out loud

If you have been feeling hopeless or thinking about hurting yourself, say it directly at the appointment. It changes what gets recommended and how quickly. If you are in danger now, call or text 988.

Common questions

What should I ask if my antidepressant is not working?

Whether you are on a full dose, whether you have had two adequate trials, what else has been ruled out, and whether you qualify for TMS or Spravato.

How do I ask about TMS or Spravato without seeming difficult?

Ask whether you meet criteria for treatment-resistant depression. It is a normal clinical question.

Should I bring a list?

Yes. Medication, dose, duration, and why it stopped.

What if I feel dismissed?

Ask what would need to change for a different approach. A second opinion is reasonable.

References

• Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917. PubMed
• Smith DJ, Griffiths E, Kelly M, et al. Unrecognised bipolar disorder in primary care patients with depression. Br J Psychiatry. 2011;199(1):49-56. PubMed

Medically reviewed by Nefretiri Abat, J.D., PMHNP-BC, board-certified Psychiatric-Mental Health Nurse Practitioner.