What to do when your treatment for depression doesn’t work
You have undergone therapy, taken your antidepressants as directed and followed all of your doctor’s advice. But you still don’t feel like you used to.
What is taking so long? It can be frustrating to wait for your treatment for depression to start working.
Be patient, but not passive, when managing your depression, experts tell WebMD. This five-step action plan can help you get the most from your treatment for depression:
Antidepressants: Know Your Options
There are many medications to choose from for treating depression. The initial choice is usually based on the most troublesome symptoms and potential side effects, says Bryan Bruno, MD. He is the Acting President of Psychiatry at Lenox Hill Hospital, New York. For example, your doctor may choose a drug that has sedating effects if your depression is interfering with your ability to sleep well.
The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:
These drugs work by increasing the availability of serotonin, a brain chemical known to affect mood. If one drug in this class doesn’t work for you or has unacceptable side effects, others may work. Side effects of SSRIs can include headache, nausea, insomnia or drowsiness, restlessness, and decreased sexual desire.
Other types of antidepressants work on both serotonin and another brain chemical called norepinephrine. These are known as serotonin norepinephrine reuptake inhibitors (SNRIs). They understand:
Bupropion is another class of antidepressants. Examples include:
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 in use.
Action Plan Step 1: Talk About Your Treatment Options
Talk to your doctor about all of the options available, their advantages and disadvantages, and which ones can be used safely together.
Make a list of questions 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 medicine to work?
- When should I take the medicine?
- Should I take the medicine with food?
- What are the side effects?
- What can I do to manage the side effects?
- Are there options besides medication?
Action Plan Step 2: Give Your Medicine Time to Work
Antidepressant medications don’t work overnight. It may take several weeks for the medication or medications to start affecting your mood. Some depression medications may start working sooner than others, but it usually takes time for certain brain chemicals that are involved in mood to rise. Some depression medications are started at lower doses to see if there are any unacceptable side effects. They are then slowly increased to a therapeutic dose if no side effects occur.
Be realistic about when you can expect to feel better. But “stay in close contact with your doctor when you start or change your depression medications,” Bruno says.
It is also important to know when to call a psychiatrist or other mental health specialist. âMost antidepressants today are prescribed by general practitioners,â he says. “If you haven’t improved after a reasonable drug trial, ask for a referral to a psychiatrist.” Some trial and error can also be involved in drug selection and dosing issues.
Action Plan Step 3: Recognize When Treatment Is Not Working
Know when to see a mental health professional. Experts share with WebMD the importance of not stopping any medication without first discussing it with your doctor.
âIf you are still having significant symptoms after 4-6 weeks, this is when we will try to maximize the dose, increase or modify the medications,â says John L. Beyer, MD. He is Assistant Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center and Director of the Duke Mood and Anxiety Disorder Clinic in Durham, North Carolina.
âThe goal of treatment for depression is remission,â he says. What does remission look like for people who are depressed? “We want you to feel and function at the level you were before the episode of depression.”
Research shows that people with difficult-to-treat depression who don’t get better with a first drug are likely to get better by trying a new drug or adding a second drug.
Your doctor may offer you other treatment options to help get your depression in remission. The FDA has approved the use of esketamine (Spravato), an internasal ketamine drug to treat people 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 over the head to induce a small electrical current in part of the brain
- ECT (electroconvulsive therapy): An electrical pulse 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 device similar to a pacemaker is implanted under the collarbone to deliver regular pulses to the brain.
- Esketamine nasal spray: The FDA approved this new type of antidepressant for difficult-to-treat depression in 2019. It is sold under the Spravato brand. Esketamine is a chemical cousin of ketamine, an anesthetic drug. You use the nasal spray with your antidepressant pills.
The best way to achieve remission is to work closely with your doctor and make sure you let them know how you are feeling as well as any side effects, if any, that you are feeling. If one antidepressant or even several antidepressants don’t work, don’t be discouraged, he says.
Action plan step 4: Talk to your doctor about your treatment plan
Work with your doctor to find the best medications 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’s 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 is working.
Action Plan Step 5: Manage Symptoms of Depression
Stick to a schedule that includes regular exercise, sleeping and waking hours, showering, and social activities. âStick to your schedule, and eventually these things will become enjoyable again,â he says.
It may take a while before you start to feel better, which is normal for learning to manage your depression. Use these tips, along with the support of your doctor and therapist, to help you manage your symptoms of depression and feel better.