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    Depression can be like an old blanket -- a smothering, sometimes comforting cloak between you and the world. Unfortunately, getting free of its symptoms is not as simple as crawling out from under the blanket. Most people experience ups and downs in the journey from depression. The fluctuations are normal, and professionals have ways of dealing with them.

    Why Don’t Antidepressants Always Work the First Time?

    “The rate of what used to be called Prozac poop-out -- the rate of relapse on an antidepressant -- is about 30% over a one-year period,” says Jonathan E. Alpert, MD, PhD, chief of clinical psychiatry at Massachusetts General Hospital in Boston.

    There are numerous explanations for this high rate of relapse, says Alpert. Most often, there’s something interfering with the effects of the antidepressant drug.

    Other medications -- such as steroids or antibiotics -- can interact with and blunt the impact of an antidepressant. So can heavy smoking or drinking.

    Stresses can also disrupt your peace of mind. Divorce, foreclosure, money problems, painful fights with one’s children -- all can generate the wrong brain chemicals just as surely as a pill can. Even changes like the birth of a child or a new job can create jagged levels of stress.

    Sometimes, though, the drug just stops working. Perhaps receptors in the brain become less sensitive to the effect of antidepressants over time, leading to a kind of tolerance. The biochemistry of this effect hasn’t been well studied, but it seems to be real enough in some patients who have no other explanations for a drug’s waning effect.

    What’s Wrong With Taking a Vacation From Medication?

    Sometimes, people stop taking their antidepressant medication because of aggravating side effects. Or they may try to deal with the side effect by taking the medication intermittently.

    “Impaired sexual responses -- impotence in men, inability to reach orgasm in women, and lack of libido in both sexes -- are among the side effects most likely to lead patients to stop taking a medication,” says Myrna Weissman, PhD, professor of epidemiology and psychiatry at Columbia University.

    Another problem that causes people not to comply with their treatment routine is weight gain. Weissman says that if you are having difficulty dealing with problems like these, it can help to talk with your doctor about using a different antidepressant. Changing medications, she says, may be appropriate if such symptoms persist.

    Gabrielle Melin, MD, MS, a clinical psychiatrist at the Mayo Clinic in Rochester, Minnesota, says that relapse is most common in people who are not taking their medications properly. “They’ll say they are, but if you press they admit, ‘Oh I miss it three or four times a week.’ That makes it ineffective because the drug takes some time to work into your system."

    Is Your Antidepressant Working?

    How long does it take? What should you expect?
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