12 questions to ask your doctor before starting antidepressants

There is an appointment — often fifteen minutes long — where the decision to start an antidepressant gets made. This page is a checklist for walking into it prepared.

We take no position on what you should decide. Every question below is motivated by a specific trial, label fact, or regulatory record, with the citation attached, and several link into the medication library where the studies live with their funding lines read literally. Print the list, bring it, and use the ones that fit.

This is information to bring to your prescriber, not medical advice. If you are in crisis, call or text 988 — that conversation comes before any of this.

The checklist

1. What else works for what I have, besides medication?
2. Why this drug first, and what would second choice be?
3. How does the severity of what I have change what this drug is likely to do for me?
4. How long until I can tell it's working — and what improves first?
5. What are the common side effects, including the sexual ones?
6. Before I start: what does stopping look like later?
7. How long was this drug actually tested?
8. What's our monitoring plan?
9. What does this interact with that I already take?
10. What happens if I miss doses?
11. If pregnancy is possible for me: what's the plan?
12. Who funded the evidence we're relying on?

The rest of this page is why each question earns its place.

1. What else works, besides medication?

A fair prescriber will answer this readily: psychotherapy, behavioral activation, and exercise all carry real evidence for depression, alone or combined with medication — we've walked through the exercise evidence and what peer support does and doesn't do separately. The point of asking is not to dodge medication; it's to make the choice an actual choice.

2. Why this drug first — and what's second?

Antidepressants are not interchangeable. The largest comparison ever conducted — a network meta-analysis of 21 drugs in The Lancet — found all of them beat placebo on average, with real differences in both effectiveness and tolerability between drugs [1]. "Why this one for me?" has a real answer, and hearing your prescriber give it tells you the choice was made rather than defaulted. Asking for the second choice up front also means a switch, if needed, is a plan rather than a failure.

3. How does severity change my odds?

One of the most consistent findings in this literature: the benefit of antidepressants over placebo grows with the severity of depression, and for mild-to-moderate symptoms the average drug–placebo difference can be small [2]. If your depression is severe, that cuts one way; if it's mild, it cuts the other, and alternatives from question 1 deserve more weight. This is the single most decision-relevant fact most people are never told.

4. How long until I can tell — and what improves first?

In the PANDA trial in UK primary care, sertraline improved anxiety symptoms within six weeks, while clearer effects on low mood emerged more slowly [3]. Two practical consequences: judging the drug at week two is premature by the trial data, and feeling less anxious before less flat is a recognized pattern, not a failure. The concrete ask: "can we set a specific review date now?"

5. What are the side effects — including the sexual ones?

Sexual side effects are common across SSRIs and consistently under-discussed; measured rates vary enormously depending on whether researchers wait for complaints or ask directly. And in 2019, European regulators required labels to warn that sexual dysfunction can persist after stopping an SSRI or SNRI [5] — a precautionary label change responding to a safety signal, not a statement of frequency, and a thing you deserve to know exists before you start. Every drug's tested side-effect rates and real-world reports are on its page in the medication library, caveats first.

6. Before I start: what does stopping look like?

The question almost nobody asks on day one, and the one that matters most years later. In the ANTLER trial, among people on long-term antidepressants who felt well, 56% of those who stopped relapsed within a year, versus 39% who continued [4] — read both numbers: stopping carries real relapse risk, and four in ten people who kept taking the drug relapsed anyway. Withdrawal symptoms, distinct from relapse, are common when stopping quickly — we've gone through that evidence in full. Asking "what's the exit plan?" before the first pill establishes that staying on is a decision to be revisited, not a default that hardens.

7. How long was this drug actually tested?

The pivotal trials behind most psychiatric drug approvals ran weeks — we plotted every drug in our library: three weeks for aripiprazole's longest approval trial, six to twelve for most SSRIs — while median real-world use runs years. Short trials are how approval works; they are not evidence about year five. The fair phrasing for your prescriber: "the approval trials ran a couple of months — what do we know about people who take it as long as I might?"

8. What's our monitoring plan?

"Take these and come back if there's a problem" is not a plan. A plan has a review date (question 4), a definition of working, and a definition of not-working that triggers the second choice (question 2). If the first weeks include worsening mood or new agitation — which the label itself warns about in young adults — you should know in advance who to call.

9. What does this interact with?

Every drug's FDA-label interactions section is reproduced verbatim on its page in the medication library — and a pharmacist checking your actual medication list beats any published list, including ours. Name everything: supplements and St John's wort included.

10. What happens if I miss doses?

Drugs with shorter half-lives can produce withdrawal symptoms within days of missed doses — dizziness, electric-shock sensations, irritability — which are easy to mistake for relapse or flu. Knowing your specific drug's profile turns a bad weekend into an explained one.

11. If pregnancy is possible: what's the plan?

This is a genuinely contested area — a 2025 FDA panel proposed pregnancy warnings for SSRIs while ACOG called the panel's discussion alarmingly unbalanced, and the underlying evidence has to be weighed against the documented risks of untreated depression. We won't compress that into a paragraph; the honest version is that this question needs its own conversation with your prescriber before it becomes urgent, and ideally with an obstetric provider in the loop.

12. Who funded the evidence?

Most pivotal trials are manufacturer-funded — that's how the system works, and it doesn't make them wrong. It does make funding worth seeing: funding source correlates with reported outcomes across the medical literature, which is why every study in our library carries its funding line read literally, or `UNKNOWN` when we can't establish it. The question for your prescriber isn't an accusation; it's "what independent evidence do we have?" — and a good prescriber will know.

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A prescriber who engages with even half of these is telling you something good about the next five years of that relationship. One who treats them as an affront is telling you something too.

The companion page — the questions for the appointment where you ask whether you should still be on the medication — is next in this series.