If you have depression, antidepressants and talk therapy could be part of your treatment plan. Antidepressants modify levels of serotonin and other chemicals in your brain. They can be an effective way to relieve sadness and other depression symptoms, but only if you take them.
Talk therapy can help you work through what's troubling you and keep you from running things in your mind over and over.
The most effective treatment plan will combine medication and therapy. But it will work that way only if you keep doing both things.
Not everyone sticks with their depression treatment plan. Studies find that about half of people stop taking their medication or skip doses. Worries about side effects, beliefs that the medicine isn't helping, and stigma are a few of the reasons why people go off their meds before they’re ready.
There are many reasons that people may stop going to therapy. Some start to see it as a sign of weakness. Others think it doesn't help because they don't see the benefit. Still more are overtaken by the stigma.
Risks of Stopping Meds Too Soon
“What often happens is [people] just stop taking their medication. They don’t refill their prescription,” says Jo Anne Sirey, PhD, a professor of clinical psychology in psychiatry at Weill Cornell Medicine. “And they don’t think to come back.”
Going cold turkey could cause problems. Your brain gets used to having higher amounts of serotonin when you take antidepressants. Stopping the medicine too quickly leads to a drop in this brain chemical, which can cause withdrawal symptoms like:
- Trouble sleeping
- Mood changes
Without the medicine, your depression could come back. Leaving depression untreated could make a hospital stay or other serious complications more likely. If you’re thinking of going off your medicine, talk to your doctor first to make sure that it’s the right time and that you do it safely.
Reasons Why People Stop Taking Antidepressants
There are some common reasons people give for going off their antidepressants, including:
I have side effects. Like other medicines you take, antidepressants can cause side effects. Research says about 40% of people have side effects from selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed type of antidepressant.
Side effects vary based on which drug you take, but the most likely ones from antidepressants are:
- Weight gain
- Dry mouth
- Weight gain
- Loss of sex drive or trouble reaching orgasm
Some side effects are more bothersome than others, especially sexual ones, says Jessi Gold, MD, an assistant professor and director of wellness, engagement, and outreach in the Washington University in St. Louis Department of Psychiatry.
“[People] don’t like what it does to their self-esteem. They don’t like what it does to their relationships.”
You might wait it out for a few months to see if the side effect goes away -- especially if the drug is helping with your depression. If you can’t wait, your doctor can lower your dose or switch you to another antidepressant that doesn't have the same side effect.
If sleepiness is a problem, taking the medicine at a different time of day might work. Sexual side effects sometimes get better when you add another drug like bupropion (Wellbutrin).
Finding the right depression medication isn’t one and done, the way some other conditions are treated.
“We like to think of depression like pneumonia. You take a medication and you get better,” Sirey says. Instead, it involves some trial and error. “You have to find the right medication, and sometimes that takes more than one attempt.”
I don't need medication -- I feel fine. If you feel better while on your antidepressant, you might get the impression that you didn't need the drug in the first place. The point of taking antidepressants is to boost your mood. When your depression symptoms improve, it means the medicine is doing its job.
The risk in stopping is that your depression will return. At least half of people who have one depression episode will have one or more episodes in the future. Your depression might not come back right away. It could reappear after you have a fight with your partner or a tough day at work.
“Now they don’t have the buffer that was helping them,” Gold says.
The medication doesn’t work. Waiting for your symptoms to improve can feel like forever, but you need to give the medication time to work, Gold says. Antidepressants aren't like antibiotics. You won't feel better in a couple of days. It can take 4 to 8 weeks for you to start seeing any effects from a new drug.
If you still don’t see any improvement after a few weeks, then ask your doctor if it’s time to make a change.
I worry what people will think. Our understanding of mental illness has come a long way, but there’s still a lot of stigma surrounding depression. That can keep some people from getting the treatment they need.
Sometimes the stigma comes from inside.
“People see themselves as potentially flawed, as potentially failing, as there’s something wrong with them,” Sirey says. In her research, she found that stigma was a real factor that caused some people to stop taking their medication.
Others face outside pressure from family and friends.
“I work with college students, and I have had people who have gone home over break and their parents threw away their medications,” Gold says.
Sirey says education helps fight stigma. She recommends that you and your loved ones read up on depression and its treatments from reliable sources.
What to Do When Treatment Isn't Working
If your doctor has tried increasing the dose of your antidepressant, prescribing a different medication, or adding another antidepressant and your depression still hasn't improved, you do have other options to try along with talk therapy.
Transcranial magnetic stimulation (TMS) is another option your doctor might suggest. TMS applies pulses of magnetic energy to your brain through your scalp to relieve depression. You would do this 5 days a week for 4-6 weeks. About 50% of people with major depression who try TMS see their symptoms improve, and about one-third go into remission.
Electroconvulsive therapy (ECT) is for people with severe depression who haven't improved on antidepressants or talk therapy. While you're under general anesthesia, small electric currents are passed through your brain to trigger a seizure. You have this treatment three times a week for 2 to 4 weeks. ECT isn't painful and is safe. But it can cause temporary side effects such as confusion and memory loss.
Talk to Your Doctor
If you've thought about stopping your treatment, no matter what the reason, pause before you do it.
"Call up the person who is prescribing and have a conversation with them," Sirey says.
It’s important to find a doctor and therapist you trust, so you’re comfortable talking about how you feel and what you want. If you and your doctor decide that it’s the right time to get off your medication, the doctor will taper you off slowly. Every few weeks, you’ll drop to a lower dose until you’ve weaned yourself off the medicine without triggering withdrawal symptoms.
Going off your medication can be a good thing if it’s the right time, Gold says. What’s important is that your depression is under control, and you involve your doctor in the decision.
American Journal of Psychiatry: “Perceived Stigma as a Predictor of Treatment Discontinuation in Young and Older Outpatients with Depression.”
American Psychological Association: “How Hard is It to Stop Antidepressants?”
Brazilian Journal of Psychiatry: “How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations.”
Clinical Psychology Review: “Risk for Recurrence in Depression.”
Community Mental Health Journal: “Utilizing Education and Perspective Taking to Remediate the Stigma of Taking Antidepressants.”
InformedHealth.org: “Depression: How Effective Are Antidepressants?” “Depression: Major depressive disorder.”
Innovations in Clinical Neuroscience: “Antidepressant adherence: Are patients taking their medications?”
Jessi Gold, MD, assistant professor; director, wellness, engagement, and outreach, Department of Psychiatry, Washington University School of Medicine, St. Louis.
Jo Anne Sirey, PhD, professor of clinical psychology in psychiatry, Weill Cornell Medicine.
Mayo Clinic: “Antidepressants: Selecting One That’s Right for You,” “Selective Serotonin Reuptake Inhibitors (SSRIs).”
MIT Medical: “FAQ Antidepressants.”
PLOS One: “Barriers and facilitators of adherence to antidepressants among outpatients with major depressive disorder: A qualitative study.”
Psychiatry: “Real-World Data on SSRI Antidepressant Side Effects.”
The Centre for Addiction and Mental Health (CAMH): “Antidepressant Medications.”