Antidepressants (SSRIs, SNRIs, tricyclics, MAOIs)

Domain IX · Biomedical, neuro & digital

What it is

What this is. Antidepressants are prescription medicines. They are prescribed and managed by a doctor or other authorised prescriber (for example a GP, psychiatrist or other prescribing clinician), not by a psychotherapist. This guide is therefore written for the psychotherapist working alongside…

Format

• There is no psychotherapist "protocol" for antidepressants. The phases below follow the course of medication treatment as the labels and NICE describe it, with the psychotherapist's task in each. Prescribing appointments run on the prescriber's schedule; psychotherapy sessions keep their own format…
• Phase A: Considering medication. Goal: the client can make an informed choice with the prescriber. NICE says people want realistic information about benefits and harms, how long the drug takes to work, how long treatment lasts, what withdrawal involves and how they will be monitored, and that for…

Who practises it, and how they are trained or regulated

• Regulatory status. In the US all four are FDA-approved prescription drugs with a class boxed warning on suicidal thoughts and behaviours in children, adolescents and young adults, plus a required Medication Guide. Paediatric approval is limited: the FDA page lists fluoxetine (Prozac) for paediatric major depression, and fluoxetine, sertraline, fluvoxamine and clomipramine for paediatric OCD; amitriptyline,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the client following through; if not, explore barriers next session.
• pressure from family, employer or you; the decision should be the client's.
• a sudden calm after agitation; giving away possessions; increased access to medicines.
• under-reporting of sexual side effects; older clients' confusion being dismissed as mood.
• information flowing both ways; avoid becoming the client's go-between for every medical question.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.