I personally am a big hypochondriac with my MI and I see my p-doc probably too often, so I might not be the best person to answer this question. However, I can tell you when my p-doc would probably consider it time to try a new antidepressant or medication helping with depression. He generally looks at my sleep patterns, eating patterns, and relationships. If there is a disturbance there, he would definitely consider a change. Also, the other obvious signs: s******* thoughts, being depressed most of the time, spending too much time in bed, frequent anxiety attacks, etc. I would write a list of your current symptoms so you can be prepared to tell your p-doc exactly what is going on and how often your symptoms happen. Now, if you're depressed half the time, and the other times you are either normal or hypomanic, make sure you include that info as well. That may be cause for your p-doc to want to prescribe something different than an antidepressant (e.g. Latuda for bipolar depression). Best wishes! I hope you get relief ASAP!!