For some people, antidepressants are a life-saving medication that restores their quality of living and makes them feel like themselves again. For others, antidepressant medications can be ineffective and sometimes even make symptoms worse.
Even if you initially find improvements with antidepressants, you might eventually feel their effects starting to wear off. Studies show that 25-50% of antidepressants can stop working after a long period of time. If you feel like your antidepressants aren’t working, or have lost their effectiveness, you’re not alone. Thankfully, there are other treatments for major depression that may work for you when antidepressants don’t.
In this guide, we explore what to do when antidepressants don’t work for you. We’ll look at signs that your antidepressants aren’t working, reasons why they may not be effective for you, and some medication strategies you can try before you give up on them entirely. We also talk about treatment-resistant depression and discuss some alternative ways to treat depression without medication.
Signs your antidepressants aren’t working
In an ideal world, antidepressants would be a magic pill with immediate results. In reality, however, a person needs to be taking them for at least six to eight weeks before effects become noticeable. Before giving up on your antidepressants, try to be patient and give them enough time to kick in. Know that you might still have some days where you feel sad and that’s completely normal.
With that said, let’s look at some signs that indicate your antidepressants aren’t working the way they should.
1. Your mood is still low, even months later
It can take some time for antidepressants to start working, but if you’re still experiencing depressive symptoms several months after starting your medication then it could be a sign that they’re not working for you.
2. You have more energy but still feel sad
If you feel an uptick in physical energy after starting your antidepressants but still feel depressed, it could mean that the medication isn’t working in the way it should be. Sometimes, this is a cause for concern as increased physical energy combined with depression can increase your risk of suicide or acting out. Be sure to speak with your healthcare provider if this is something you’re experiencing.
3. You’re having unpleasant side effects
Some people experience negative side effects when taking antidepressants, such as weight gain, nausea, or sexual problems. Even if your depression symptoms are alleviated, these side effects can be unpleasant and intolerable. If this is the case for you, you may want to try a different type of antidepressant.
4. You have signs of serotonin syndrome
Sometimes, antidepressant medications can interact with other medications or foods and lead to serotonin syndrome. This means your body is releasing too much serotonin and it’s having a negative effect.
Signs of serotonin syndrome include agitation, insomnia, heavy sweating, increased heart rate, dizziness, headaches, confusion, and muscle twitching, amongst others. You may experience these signs within a few days or weeks of starting a new antidepressant or increasing your dosage.
If you experience any of these signs, or feel unusual, be sure to speak to your healthcare provider immediately, especially if you are on other medications.
5. Your depression feels worse
It goes without saying, but if your depression symptoms feel worse after taking antidepressants for a number of months, then it’s a strong sign that they’re not working and you may need to try something else. Antidepressants should never worsen depression.
6. You experience mood swings
Sometimes, antidepressants can cause mood swings that disrupt daily life. If you find yourself feeling more irritable, manic, or angry, you may want to change your dosage or try other depression medications.
Remember that you should never stop taking your medication or change your dosage without first speaking to your healthcare provider. They have the necessary expertise to understand how to best manage your medication to get the results you need.
Things to try before you give up on antidepressants
If you feel like your antidepressants aren’t working, don’t lose hope. What works for one person might not work for you, and you may need to work with your mental health provider to find the right dose, medication, or combination of medications that works for you and your particular symptoms.
Below are some things your doctor or mental health professional might want to try when your antidepressants aren’t working:
- More time: If you haven’t been taking your antidepressants for long, they may suggest you give them more time to work. As we outlined earlier, antidepressants require anywhere from 6-8 weeks to become fully effective and for side effects to ease up.
- Change dosage: Sometimes, you may find that increasing or decreasing your dosage provides the best effects. Discuss this with your doctor first and don’t change dosage on your own as many factors need to be considered first.
- Switch medications: For some people, certain brands just don’t seem to work. Your doctor might suggest trying a different brand of the same antidepressant.
- Add another antidepressant: The two main types of antidepressant drugs are SSRIs and SNRIs. If you’ve been taking one type, your doctor might recommend adding another type of antidepressant. This can make your medication more effective.
- Try other medications: Sometimes, you might find relief by adding medication used to treat other types of mental illness. This includes antipsychotics, mood stabilizers, or anti-anxiety medications.
Reasons why antidepressants might not work for you
If antidepressants aren’t working for you, it doesn’t mean that your depression is not treatable. There are many things that can reduce the effectiveness of antidepressants or explain why they’re not working for you. Below, we outline some of the most common:
- Extra stress: Experiencing added stress to your life, such as a new job, moving house, divorce, or loss of a loved one, can lead to more severe depression symptoms. As a result, your current antidepressant dose may be unable to compensate.
- Aging: As a person ages, their body’s ability to absorb and metabolize medication can change. As a result, your antidepressant may start to lose its effectiveness.
- Medical conditions: Some medical conditions, such as thyroid disease or diabetes, mimic the symptoms of depression. If you have these conditions, it may be harder for your body to respond to antidepressants. At the same time, being diagnosed with a new medical condition can add extra stress that worsens depression symptoms and weakens the effect of your medication.
- Increased substance use: Alcohol, tobacco, and other recreational drugs can affect how well antidepressants metabolize in the body. On top of that, substance use can cause mood changes that make it appear like your medication isn’t working.
- Pregnancy: Your body goes through many changes during pregnancy, and even antidepressants that are safe to take when pregnant can be affected. You may need to change your depression medication or dosage to continue relieving symptoms throughout your pregnancy.
- Drug tolerance: Tachyphylaxis is when your body stops responding to a drug. It’s common with antidepressants – mainly selective serotonin reuptake inhibitors (SSRIs) – with an estimated 25% of people taking depression medication likely to experience tachyphylaxis.
What to do if depression medication isn’t working
The first thing to do is to reach out to your doctor or mental health provider and let them know that your antidepressants aren’t working. If you’re experiencing any negative side effects, make sure you communicate this too.
It’s likely you’ll be asked to change your medication or have your dosage adjusted. Many people are prescribed three or four different antidepressants before they find one that can improve depression symptoms.
That said, if you’ve tried at least two different prescription antidepressants, for a full course of treatment, and still haven’t found results, you may have what’s called treatment-resistant depression.
What is treatment-resistant depression?
Treatment-resistant depression (TRD) is a type of major depressive disorder (MDD) that doesn’t respond well to traditional forms of depression treatment, such as medications and psychotherapy. If you’ve tried two different classes of antidepressants, and your symptoms haven’t improved, you may have treatment-resistant depression.
TRD is more common than you think. Around 10-15% of people find that antidepressants don’t improve their symptoms. In some cases, psychotherapy can be helpful, but for others, symptoms persist despite efforts put into treating depression. Even if you find relief for some periods of time, symptoms might keep returning.
Thankfully, despite its name, there are ways to manage treatment-resistant depression. The most effective treatment is transcranial magnetic stimulation (TMS) therapy. More than half of patients with treatment-resistant depression have found TMS therapy to be helpful and a third found that their symptoms disappeared completely.
Below, we look at TMS therapy in more detail as well as other things to try if antidepressant treatment isn’t working for you.
Ways to treat depression without medication
If you’re not finding relief from antidepressants or psychotherapy, there are alternative methods to treating depression. For some people these can be as or even more effective than traditional treatment options.
Transcranial magnetic stimulation (TMS) therapy
TMS therapy is a non-invasive and non-surgical procedure that uses electromagnetic pulses to stimulate nerve cells in the brain and relieve symptoms of depression. During a TMS therapy treatment, an electromagnetic coil is placed on your scalp to activate parts of the brain involved in mood regulation and depression.
Highly concentrated magnetic pulses, like those used in an MRI machine, are transmitted through the coil and stimulate your brain’s nerve cells. These cells are thought to release neurotransmitters like serotonin, norepinephrine, and dopamine. TMS therapy lasts for around 20 minutes and full effects are felt within a few weeks. After TMS therapy, you can drive yourself home and continue your day’s activities as usual.
TMS should not be confused with electroconvulsive therapy (ECT), which is performed under anesthesia and involves using electric currents to trigger seizures in the brain.
Esketamine (SPRAVATO®)
Esketamine is an FDA-approved nasal spray medication that provides fast, temporary relief from depression symptoms. Specifically formulated to address treatment-resistant depression, esketamine works differently to other antidepressants and can provide relief to people who haven’t found traditional antidepressants effective.
Your mental health provider might suggest taking esketamine during the time it takes for your prescribed antidepressant to take effect, or alongside your current antidepressants for better relief. An esketamine treatment usually lasts around 2-3 months, with doses administered twice a week and then less frequently throughout the rest treatment period.
Esketamine must be taken under the supervision of a healthcare provider to monitor for potential side effects. You’ll also require in-office monitoring for up to two hours after treatment and should avoid driving a car and operating machinery until the next day.
Who to talk to if your antidepressants aren’t working
If your antidepressants aren’t working or you think you may have treatment-resistant depression, help is just a few clicks away. At BestMind Behavioral Health, we can support you on your journey to finding the right treatment to ease your depression symptoms.
Our depression medication management specialists can help you find the right antidepressant, the right dosage, and the right results for your symptoms. We offer our services via telehealth so anyone can seek the support they need no matter where they’re located.
If you’ve tried numerous antidepressants and feel you may be experiencing TRD, our team is well-versed in a number of therapies for treatment-resistant depression. If you live in Colorado or Oregon, you can visit one of our BestMind locations to try TMS therapy or esketamine (SPRAVATO®) treatment.
If you’re unsure what your needs are or where to go, contact our team to see how we can support you on your journey to feeling better.
