Richard Balon, M.D., Professor of Psychiatry, Department of Psychiatry & Behavioral Neurosciences at Wayne State University

I've been told by my doctor that, before she'll prescribe antidepressants for me, I've got to have a complete physical.  Is this really necessary; I thought the new SSRIs were harmless?

True; the new SSRIs are very safe. However, it is frequently necessary to have a physical exam. Some cases of what appears to be clinical depression are  caused by other physical conditions, such as low thyroid levels and other problems.  Additionally some medications taken for other illnesses can, themselves, trigger clinical depression.  It is important for us to rule out other possible causes in order to make a correct diagnosis and set up an appropriate and effective treatment regimen. Thus, a careful review of bodily systems, discussion of medications taken, and a physical examination may be indicated, depending on one's history.

My doctor wanted to know about any herbal and alternative medications I am taking and suggested that I stop taking them while on the medications he is prescribing for me, why?

While there's no question that some of these alternative medicines could, in fact, confer some benefits upon those taking them, there have been no good studies indicating that there are no interactions between these herbal medicines and prescription medicines.  Actually, there have been case reports of possible interactions between herbal remedies and some medications, including antidepressants (SSRIs). Some of these interactions could have serious adverse consequences, and it is likely that your doctor would rather be safe than sorry in the absence of solid information.