You've been going to therapy, taking your antidepressants as directed, and following all of your doctor's advice. But you still don't feel like your old self.
What's taking so long? It can be frustrating to wait for your depression treatment to start to work.
Antidepressants: Know Your Options
There are many drugs to choose from to treat depression. The initial choice is usually based on which symptoms are most troublesome and potential side effects, says Bryan Bruno, MD. He is the acting chairman of psychiatry at Lenox Hill Hospital, New York City. For example, your doctor may opt for a medication that has sedative effects if your depression is interfering with your ability to get good sleep.
The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- vortioxetine (Brintellix)
These drugs work by increasing the availability of serotonin, a brain chemical known to affect moods. If one drug in this class does not work for you or has unacceptable side effects, others may work. SSRI side effects may include headache, nausea, sleeplessness or drowsiness, agitation, and decreased sexual desire.
Other types of antidepressants work on both serotonin and another brain chemical called norepinephrine. These are known as serotonin and norepinephrine reuptake inhibitors (SNRIs). They include:
- desvenlafaxine (Khedezla, Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran ( (Fetzima,
- venlafaxine (Effexor)
Older antidepressants include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). These tend to have more side effects than some of the newer depression drugs, but are still used.
Action Plan Step #1: Talk About Your Treatment Options
Discuss with your doctor all the available options, their pros and cons, and which ones can safely be used together.
Make a list of questions that you have for your doctor. You may want to ask your doctor the following questions about your medication options:
- How long will it take for the medication to work?
- When should I take the medication?
- Should I take the medication with food?
- What are the side effects?
- What can I do to manage side effects?
- Are there options besides medications?
Action Plan Step #2: Give Your Medication Time to Work
Antidepressant medications do not work overnight. It can take several weeks for the drug or drugs to start affecting your mood. Some depression drugs may start to work sooner than others, but in general it takes time for certain brain chemicals involved in mood to rise. Select depression medications are started at lower doses to see if there are any unacceptable side effects. They are then slowly increased to get to a therapeutic dose if no side effects occur.
Be realistic about when you can expect to start feeling better. But "stay in close contact with your doctor when starting or changing your depression medications," Bruno says.
It's also important to know when to call in a psychiatrist or other mental health specialist. "Most antidepressants are prescribed by primary care doctors today," he says. "If you haven't gotten any better after a reasonable drug trial, seek out a referral to a psychiatrist." Some trial and error may also be involved in drug choice and dosing issues.
Action Plan Step #3: Recognize When Treatment Isn't Working
Know when to consult a mental health professional. Experts share with WebMD the importance of not stopping any medication without first discussing it with your doctor.
"If you are still having significant symptoms after four to six weeks, that is when we will try to maximize the dose, augment, or change medications," says John L. Beyer, MD. He is an assistant professor of psychiatry and behavioral sciences at Duke University Medical Center and the director of the Duke Mood and Anxiety Disorder Clinic in Durham, N.C.
"The goal of treating depression is remission," he says. What does remission look like for people who are depressed? "We want you feeling and functioning at the level you were at prior to the episode of depression."
Research shows that people with difficult-to-treat depression who don't get better with a first medication are likely to improve by trying a new drug or adding a second medication.
Your doctor may offer other treatment options in effort to get your depression into remission. The FDA has approved the use of the internasal ketamine medication esketamine (Spravato) to treat those who do not respond to antidepressants.
For severe, life threatening depression, there are several treatment options using either external devices or procedures
- TMS (transcranial magnetic stimulation) - the TMS device is held above the head to induce a small electric current to a part of the brain
- ECT (electroconvulsive therapy) – an electrical impulse is used to trigger a brief controlled seizure in the brain while the patient is asleep under general anesthesia.
- VNS (vagus nerve stimulation) – through surgery, a pacemaker like device is implanted under the collarbone to deliver regular impulses to the brain.
The best way to reach remission is to work closely with your doctor, and make sure to let them know how you are feeling as well as what side effects, if any, you are experiencing. If one antidepressant or even several antidepressants don't work, don't get discouraged, he says.
Action Plan Step #4: Talk to Your Doctor About Your Treatment Plan
Work with your doctor to find the best drug or drug choices for your depression. Don't settle for anything less than remission.
But treating depression involves more than just taking a pill. Lifestyle changes including regular exercise, healthy eating habits, and social support are also part of the treatment plan, he says. When you're depressed, it is often difficult to reach out and ask for help. Talk to your doctor about lifestyle changes that can help you feel better until your medication kicks in.
Action Plan Step #5: Manage Depression Symptoms
It may take a while before you start to feel better, which is a normal part of learning how to manage your depression. Use these tips -- along with support from your doctor and therapist -- to help you manage your depression symptoms and feel better.