Dr. David Husted, MDBoard-certified psychiatrist for adult anxiety and depression in Jupiter, Florida

How I evaluate

I start every new evaluation with a full hour, and I use it. Before we talk about medication I want to know what the problem is costing you: the job you are struggling to hold, the mornings you cannot get out of bed, the relationship that is wearing thin. Symptoms matter, but function is what we are trying to restore, so I write down two or three concrete functional goals at the first visit and we measure against them from then on.

Alongside the history I use structured instruments, the PHQ-9 for depression and the GAD-7 for anxiety among them, and I ask about sleep, alcohol, caffeine, stimulants, thyroid disease and the medications other physicians have prescribed. A surprising number of referrals for treatment-resistant depression turn out to be something else: untreated sleep apnea, a bipolar spectrum illness that was never recognized, a medical cause nobody checked. I would rather spend the first hour ruling those out than spend six months treating the wrong diagnosis.

How I decide on medication

I prescribe when the evidence says medication is likely to help and when the patient, having heard the trade-offs, wants it. For a first episode of moderate depression or anxiety, that usually means a single SSRI or SNRI at an adequate dose for an adequate time, which is eight to twelve weeks, not three. Most medication failures I see are trials that were stopped too early or never reached a therapeutic dose.