I have treatment-resistant depression and PTSD. For me, medications have been ineffective or had side effects worse than the disease. I would like to not take medications for my mood. How can I talk to my doctor about not medicating me?

Unfortunately, your experience with medication is not uncommon. For some people, antidepressant medications have few positive effects and significant negative effects. If your doctor tries to convince you to try a different medication, she is probably trying to be helpful. But that may not feel helpful if trying another medication is not what you want.

I’d try to think of your relationship with a doctor in these terms: each of you is an expert, but about different things.

You are the expert about your own experience. You know better than a new doctor about your past experience with medications, both the positive effects (if any) and the negative effects. More importantly, you are the expert about your own preferences and values. You know how much any positive effects of medication are worth in comparison to negative effects―to you as an individual. And you know what you prefer about different kinds of treatment―traditional medications, psychotherapy, or alternative therapies. It’s your preferences and values that matter in your decision, not your doctor’s.

But your doctor is supposed to be an expert about the evidence. Evidence is about averages rather than individuals, but average information is still useful. For example, your doctor should be able to answer questions like this: “If I have tried medications A, B, and C with no benefit from any of them, what’s the chance that a fourth medication would help?” Or this: “If medication A and B both took away my sexual function, what’s the chance that some other medication would not do that?”

Exaggerated pessimism is a central part of depression. Looking at the evidence can help bring decisions back to the facts―both what we know and what we don’t know.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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