Pros and Cons of Self-Prescribing Antidepressant Medication

Reader’s Question

I have been taking antidepressants for a couple of years but never had a prescription. I always ordered online. But now I am seeing a therapist, and I was wondering if I would have to get a full psychiatric evaluation to get a prescription, or if I could just tell her what I am taking.

Psychologist’s Reply

Seeing a licensed therapist and providing a full account of your medical history as well as any current medications and supplements that you are taking is an excellent first step on the path to feeling better. The short answer to your question is yes, absolutely tell her what you are taking so that she can get a comprehensive picture of your symptoms and work toward an accurate diagnosis to guide your treatment. However, the issue you present is an important one that can be dangerous, and merits further discussion.

The most pressing concern to me is your report of ordering antidepressants online and taking them without a prescription. The internet can provide a wealth of information and instant gratification that can at times be helpful, but if used without proper professional guidance can actually be harmful. With so much health information available, it is very tempting to self-diagnose a mental disorder or other health issue that does not seem life-threatening. While it can be reassuring to know that a diagnosis that fits a cluster of symptoms exists, it can be dangerous to try to treat a disorder without the help of a trained, licensed health provider (or mental health professional) who uses their training to rule out other disorders and determine an accurate diagnosis before prescribing a course of treatment. Just as you would visit a physician to treat physical symptoms (like chest pains, for example, to rule out a heart attack), it is also prudent to visit a licensed mental health provider or physician to treat emotional and physical symptoms (like sadness or difficulty sleeping, for example, to rule out depression). Although you indicate that you are taking “antidepressants,” I wonder what, specifically, you are taking.

If you are taking something herbal or something that the seller claims is an antidepressant (but is not approved by an agency such as the FDA in the US), then its effectiveness is not supported by research, and you may not be getting relief from your symptoms. If it is a medication (for example, an SSRI like Prozac or Zoloft, or another class of medications to treat depression) that can only be obtained with a licensed physician’s prescription, then you and/or the distributor may be engaging in not only harmful, but illegal activity. It can be especially harmful to take a prescription medication like an SSRI or other antidepressant without a physician’s supervision, primarily because effective dosages vary widely for each individual and must be monitored and adjusted carefully by a licensed physician or physician’s assistant. Similarly, stopping an antidepressant medication without tapering it under a physician’s supervision can also be dangerous and can lead to problematic side effects or a return of bigger (and, at times, lethal) depressive symptoms.

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The other issue that confuses many people is understanding which mental health providers can prescribe medication. There are several mental health licenses, all of which have some differences in the amount and type of education and training, as well as the scope of their practice. In many countries, including the United States, psychologists have PhDs or PsyDs and are licensed as psychologists in their jurisdiction. Psychologists provide therapy and psychological testing and assessment in their practices. They do not prescribe medication unless their jurisdiction allows it and they have completed additional pharmacological training. Similarly, counselors or therapists (LPCs, LMFTs, LCSWs) are licensed in their jurisdiction and provide therapy (but not psychological assessment) in their practices. Only psychiatrists and other physicians have MDs and are licensed to prescribe medication. Many mental health professionals have psychiatrists in their referral network, or may work alongside a client’s primary care physician to prescribe medication if it is indicated in their assessment, diagnosis and treatment. Depending on the diagnosis and the severity of depressive symptoms, research shows that a course of evidence-supported therapy (such as CBT) is equally effective as medications in treating depression.

It sounds as if you have been struggling with some depressive symptoms for a while. Seeing a licensed mental health professional should help with a more accurate diagnosis, and more effective and safer treatment for your symptoms.