Unhappy With Your Antidepressant?

Maybe it’s time for a change.

From the WebMD Archives

If you’ve ever taken an antidepressant, you know that the first several days or even weeks can be rough. Antidepressants take time to work and some can cause unpleasant side effects like dizziness, nausea, sweaty palms, and diarrhea. When you put all that together, you may start to doubt the value of a medication that takes a month to make you feel better.

Chances are good that you will feel better, eventually. If your response to medication is inadequate after 6-8 weeks, talk with your doctor about modifying your treatment. If after six weeks you are not noticing a change in mood on an antidepressant, it may not be right for you. First, make sure you are taking the drug as directed. Then talk with the doctor about how you feel. The doctor can suggest a variety of combined and alternative treatments, as well as various types of talk therapy that can help improve your depression.

The important thing is to get consistent care from a physician or therapist who is attentive to your responses, says psychiatrist Myrna Weissman, PhD, a professor of epidemiology and psychiatry at Columbia University.

Allow Time to Find the Right Antidepressant

Antidepressants work. So does cognitive therapy. But finding the right antidepressant and the right combination of treatments takes time.

In one large study of the effectiveness of antidepressants, only about 30% of the patients became symptom free within four months of taking the first antidepressant prescribed, says Bradley Gaynes, MD, MPH, an associate professor of psychiatry at the University of North Carolina.

Gaynes says that another 20% of people gained relief after switching antidepressants or adding cognitive therapy or another medication to their treatment. And by the time the remaining people had switched antidepressants two more times, 70% no longer described themselves as depressed.

Talk to a Depression Specialist

The important thing, Gaynes tells WebMD, is not to give up too fast. Often, he says, patients get their first prescription for an antidepressant from their regular doctor. But many require a psychiatrist to sort out all the options. This is especially true if you feel symptoms of panic or anxiety that either start or continue while you’re taking an antidepressant.

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One key to knowing whether you are taking the right drug, Gaynes says, is to make sure you’re getting a strong enough dose.

“Under dosing,” he says, “may be a bigger problem than which drug you choose,” says Gaines. “Primary care physicians are more likely to under dose out of caution or lack of familiarity with a drug.” A psychiatrist can look at the drug you’re taking and let you know whether the dose you’ve been prescribed is adequate for treating your depression.

Check on Underlying Issues That May Interfere With Antidepressants

Some people may have underlying issues such as panic disorder or anxiety that need to be addressed before an antidepressant can work well. (Both jitteriness and anxiety can be side effects of antidepressants.)

“Most people can ride out the first few days and the symptoms go away -- they feel calmer, and the frequency of panic attacks goes down. But for some people, the side effect of increased anxiety gets worse and continues to build,” says Jonathan E. Alpert, MD, PhD, clinical director of psychiatry at Massachusetts General Hospital in Boston. They need treatment for anxiety as well as depression. Some antidepressants are approved to treat both conditions. Doctors may also prescribe one medicine for the depression and a second medicine for anxiety.

It’s also possible that person was misdiagnosed, and actually has bipolar disorder. “In these patients, the antidepressant can trigger manic symptoms,” Alpert says. In these cases, prescribing a more appropriate antipsychotic medication will significantly improve treatment.

Look Closely at Your Habits and Moods

Sometimes a drug’s benefits seem to wane after a long period in which it has effectively relieved symptoms of depression. Psychiatrists call it “Prozac poop-out.”

But according to Gaynes, such episodes frequently have an external cause. Alcohol or drug use could be interfering with the medication’s effectiveness. Or the dose may not be high enough.

Then, too, symptoms can intensify with the ebbs and flows of day-to-day life. Some people ask for a stronger dose of the medication they’re taking to master the darkening moods. But for many, a few months of cognitive or talk therapy is often the best way to regain equilibrium.

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Consider Talk Therapy for Depression

Research shows most people recover from depression best when they combine medication and an effective course of talk therapy, says Weissman, a professor of epidemiology and psychiatry at Columbia University. Weissman helped create Interpersonal Psychotherapy, a goal-oriented, term-limited therapy that helps patients examine triggers of depression and focus on them differently. It’s one of the few forms of talk therapy that has proven in scientific trials to be as effective in treating depression as drugs in many patients.

Assess Your Comfort Level With Depression Treatments

“Patient preference is important,” Weissman says. “The patient might say, ‘I don’t want to take any of those [drugs],’ or the patient might say, ‘I don’t want to talk about my problems with a stranger.’ In those cases, the path is pretty clear. But if a patient has [serious] signs and symptoms -- she’s not eating or sleeping well -- that’s usually an indication for medication.”

“Our understanding of these problems has grown, and we know that it’s pretty complicated,” she adds. “Everything is chemical, in a sense, but it’s triggered by life events. You usually can’t change somebody’s biology or genes immediately, but you can help them deal with their life events better. In some cases, if you improve a person’s mood, they get hopeful and more energetic and that helps with their relationships, their job, their whole outlook.”

WebMD Feature Reviewed by Brunilda Nazario, MD on April 29, 2011

Sources

SOURCES:

Myrna Weissman, PhD, professor of epidemiology and psychiatry at Columbia University. 

American College of Physician PIER Review: "Depression."

Bradley N. Gaynes, MD, MPH, associate professor of psychiatry at the University of North Carolina.

Jonathan E. Alpert, MD, PhD, clinical director of psychiatry at Massachusetts General Hospital in Boston.

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