More than half the patients I see arrive with strong opinions about psychiatric medication, almost always shaped by something other than evidence. Some are terrified of dependence. Others want a tablet today. Both deserve a clearer picture.

SSRIs and SNRIs — the most commonly prescribed class for depression and anxiety — do not produce happiness. They lower the volume on the noise floor: the racing thoughts, the ruminative loops, the early-morning dread. That space is what allows therapy and behavioural change to land. They are not addictive in the addiction-medicine sense, though stopping them needs to be tapered.

'They change who I am' — they don't; they reduce symptoms so the real you can show up. 'I'll be on them forever' — most courses are 9–18 months. 'They're a crutch' — so are reading glasses; we still use them. 'Therapy alone should work' — for moderate-to-severe depression, the evidence is unambiguous that combined treatment outperforms either alone.

Severity, duration, functional impact, prior response, and patient preference. Mild distress — therapy and CR first. Moderate-to-severe with sleep collapse, suicidal thinking or work breakdown — combined treatment from week one. I explain my reasoning in plain English and the decision is shared.

If this is on your mind, take the PHQ-9 and GAD-7 here, and let's discuss it properly.