While antidepressant medications generally provide significant relief from depression, 10 to 30 percent of patients find their symptoms persist. Some patients experience only minimal improvement; others find their symptoms don't subside at all or return after a brief improvement. Fortunately, with a bit of perseverance, most patients find a treatment regimen that works.
Do You Have Treatment-Resistant Depression?
Many factors contribute to treatment-resistant depression. If you answer yes to any of these questions, it may explain why your antidepressant is not working.
- Have you been taking your antidepressant for less than four to six weeks? It typical takes at least this long before you notice improvement.
- Are you on a low dose of antidepressants? Only about 11 percent of patients take an adequate dose initially, or stay on an antidepressant long enough for it to take effect. Insufficient dose and duration are the most common causes of treatment failure.
- Are you under excessive stress?
- Do you have an underlying health problem, such as hypothyroidism or anemia that might reduce the effectiveness of your medication?
- Are you also taking other drugs? Medications such as beta-blockers actually cause depression as a side effect, and others block the action of antidepressants.
- Do you have a co-existing condition, such as an eating disorder or substance abuse?
What to Do
Depression is highly treatable. If you're taking antidepressants and your depression is not improving, seek help from a professional who specializes in mental health, rather than your primary care physician.
Sometimes all it takes is switching to a different antidepressant. For example, individuals whose symptoms include low energy might respond better to an antidepressant that has a slightly stimulating effect. For those who have difficulty sleeping, an antidepressant with sedating properties might be the right choice.
For any given antidepressant, there's no absolute correct dose. The right dose varies from person to person depending upon age, weight, health status, and other co-existing conditions. You may need a higher dose than your prescription calls for.
Ask your mental health professional to evaluate you for other mental health problems, such as bipolar disorder, and have your primary care physician rule out other health conditions that may be interfering in your depression treatment.
Attend to your basic needs. Eat a healthy, balanced diet, get enough sleep, and avoid drugs, alcohol, and pain medications. Adding psychotherapy may provide the treatment boost you need.
Sources:
Thase, Michael E. and Rush, A. John. "Treatment-Resistant Depression."Psychopharmacology: The Fourth Generation of Progress. Web.
http://www.acnp.org/g4/GN401000105/Default.htm
Hall-Flavin, Daniel K., M.D. "Antidepressants: Can they stop working?" Mayo Clinic. Web. 18 March 2010. http://www.mayoclinic.com/health/antidepressants/AN01312
Mayo Clinic. "Treatment-resistant depression: Explore options when depression doesn't get better." Web. 27 April 2009. http://www.mayoclinic.com/health/treatment-resistant-depression/DN00016
Cadieux, Roger J., MD. "Practical Management of Treatment-Resistant Depression." American Family Physician (1998). Web. December 1998. http://www.aafp.org/afp/981200ap/cadieux.html
National Institutes of Health. National Institutes of Mental Health. "Subsequent Treatment Strategies for Persistent Depression Yield Modest Results." Web. 1 September 2006.
Zusky, P.M., Biederman, J., Rosenbaum, J.F., Manschreck, T.C., Gross, C.C., Weilberg, J.B., and Gastfriend, D.R. "Adjunct low dose lithium carbonate in treatment-resistant depression: a placebo-controlled study." Journal of Clinical Psychpharmacology April 8(2) 1988: 120-124. Web. http://www.ncbi.nlm.nih.gov/pubmed/3131389
