6 Questions to Ask Your Doctor Before Starting a Mental-Health Drug

The prospect of starting a new drug to treat a mental-health condition can feel both hopeful and daunting. On the upside, you may feel encouraged about the possibility of finding a treatment that will help you feel and function better. But you may also be concerned about whether it will actually work for you or whether you’ll experience unpleasant side effects.

“For a lot of people dealing with mental-health-related concerns, it can be helpful to have discussions about these issues up front,” says Dr. Alexsandra Kovacevich, a neuropsychiatrist at University Hospitals and Case Western Reserve University. “It’s important to have realistic expectations.”

After all, people can have different responses to mental-health medications, according to the National Institute of Mental Health. And sometimes people may need to try more than one drug to find one that effectively treats symptoms without causing major side effects.

Whether you’re considering taking an antidepressant, an anti-anxiety medication, a stimulant to treat attention deficit/hyperactivity disorder, an antipsychotic medication, or a mood stabilizer, here are six questions that are important to ask your  provider. 

What is the medication supposed to do—and how does it work?

Different drugs have different mechanisms of action for treating symptoms. “In the case of mental-health medications, these are generally impacting receptors and neurotransmitters of the brain to help alleviate symptoms related to conditions such as depression and anxiety,” explains Dr. Douglas Misquitta, a psychiatrist at The Ohio State University Wexner Medical Center.

Given that there are multiple medications in various classes to treat depression, anxiety, and other mental-health conditions, Nausheen Hossain, a clinical pharmacist for Vanderbilt Behavioral Health, also suggests asking: Why do you feel this particular medication is appropriate for me and my symptoms?

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How soon can I expect results?

The timeline for improvements in symptoms can vary widely. “Stimulants work super quickly, so you will know within a day or two if it helps you,” says Kovacevich.

By contrast, the effects from antidepressants often take four to eight weeks to fully kick in. Keep in mind: Antidepressant and anti-anxiety medications don’t always eliminate those feelings entirely. The medications “take the edge off anxiety or depression, making it easier to move through your symptoms or manage them,” says Kovacevich. “You may still have some anxiety or depressive symptoms, but you may feel less stuck and have improvements in your energy, sleep, and appetite.” To get the best results, she adds, it often helps to add in  therapy and lifestyle changes alongside medication.

“Having the right expectations and patience are important to give the medication the appropriate time to have its effect,” says Misquitta. “Sometimes there may be a need for the physician to increase a medication dose.”

How long will I need to take this medication?

“Some people have hesitations about committing to something that may be a lifelong treatment,” says Kovacevich. “The length of treatment can vary depending on how long the symptoms have been going on or how many episodes they’ve had.” Be honest with your provider about these concerns while also trying to be flexible about the timeframe.

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What are the possible side effects?

Side effects—such as gastrointestinal distress, sleep disruptions, and more—can occur with many mental-health medications, says Dr. Manish Jha, a psychiatrist at UT Southwestern Medical Center’s O’Donnell Brain Institute. They often subside as your body adjusts to the medication.

If selective serotonin reuptake inhibitor (SSRI) drugs—such as Prozac, Lexapro, or Zoloft—are prescribed for anxiety, people may experience increases in anxiety at first, says Hossain. This typically eases up within a matter of days or weeks.

It’s good to find out ahead of time what the possible negative effects are and how to handle them, says Misquitta. “If side effects do come up, there may be ways to lessen or eliminate them.” Ask your doctor about this, as well as what side effects should prompt a call to the office or a higher level of care, Hossain advises. Severe side effects—such as worrisome changes in mood, irregular heartbeat, seizures, or hallucinations—may require immediate medical attention.

Even if they aren’t severe, there may come a point for some people where persistent negative side effects outweigh the benefits of the drug, in which case it may make sense to discontinue the medication, says Misquitta.

Should I avoid any medications while taking this drug?

Some mental-health drugs can interact with other medications or supplements. For example, SSRI antidepressants can have risky interactions with other antidepressants (such as monoamine oxidase inhibitors, called MAOIs), opioids, and triptans (which are used to treat migraines), among other drugs. The supplement St. John’s wort can also interact with SSRIs, increasing the risk of serotonin syndrome, a potentially life-threatening reaction caused by excessive accumulation of serotonin in the body, says Kovacevich.

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It’s important to know about risks like these ahead of time. Be sure to tell your health-care practitioner about all the medications and supplements you take. Remember that your use of “alcohol and marijuana should also be discussed with the prescriber, as these can cause additive side effects” with some mental-health drugs, Jha says. 

What happens if I miss a dose?

“Every medication is a little different, depending on how long the medication’s half-life is,” says Kovacevich. (The half-life of a drug refers to how long it takes for the concentration of that drug to decrease in the body by 50%.) “The half-life for Prozac is four to six days,” Kovacevich says, whereas “the half-life of Effexor is approximately five hours, and Zoloft is somewhere in the middle, around 26 hours.”

For some medications, missing a dose isn’t a big deal, but for others, it could be. The only way to find out is to ask the prescribing physician what you should do.

Correction, May 5

The original version of this story misspelled Nausheen Hossain’s last name. It is Hossain, not Hossein.