Whether you’re dealing with treatment resistance or you’re taking antidepressants for the first time, it’s possible to get your progress back on track, says Nabil Siddiqi, MD, a psychiatrist with Orlando Health Medical Group Behavioral Health in Longwood, Florida. That starts with a meaningful conversation with your doctor, he says.
“Patients should feel comfortable asking as many questions as they need to in order to understand their specific diagnosis, why a certain treatment was recommended, and what the factors might be if symptoms aren’t resolving,” he says.
With that in mind, here are four questions to ask your doctor when it seems like your depression treatment has stalled.
1. Do My Symptoms Mean the Treatment Doesn’t Work?
Sometimes, what feels like a plateau — or even going backward — simply means you haven’t waited long enough for an antidepressant to start working. Although there can be some improvements like better sleep or sustained energy throughout the day within the first couple of weeks, most antidepressants typically take between four to eight weeks for full therapeutic effect.
And even if you do respond to a particular treatment, it’s common to have lingering symptoms, such as:
- Feelings of hopelessness and emptiness
- Getting angry, irritated, anxious, or frustrated more easily than usual
- Lack of interest in activities you once enjoyed
- Sleep difficulties, such as oversleeping, frequently disrupted sleep, or insomnia
- Low energy no matter how much you sleep
- Difficulty concentrating
- Reduced appetite or weight changes
- Unexplained, nagging pain such as headaches or backaches
- Desire to isolate and skip social gatherings
That doesn’t necessarily mean your treatment has stopped working, but it may need to be adjusted. To help your doctor figure out what’s going on, it’s a good idea to keep track of your symptoms, says Alex Dimitriu, MD, a psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine in California and a medical reviewer for Everyday Health. Include what symptoms you’re having, how often you have them, and how long they last.
2. What Other Factors May Be Affecting Medication Effectiveness?
A treatment that worked well for you at first can lose effectiveness for many different reasons. Among them:
- Drug or alcohol use, which can lead to mood changes
- Stressful situations at work or home, especially if those are new stressors
- Pregnancy, since that affects body weight and blood volume, which can change the dose you need
- Interactions with other medications
- Poor sleep, which can reduce the effects of an antidepressant
- Underlying medical conditions like chronic pain or hypothyroidism
Even age can be a factor. As you get older, your brain experiences subtle shifts in how it processes medications, and hormone changes related to menopause may play a role as well.
3. Should We Adjust My Medication?
Once you’ve determined that you’ve waited long enough for an antidepressant to start working and there are no other factors at play, then adjusting your medication may be an option, say Nissa Keyashian, MD, a psychiatrist in private practice in San Jose, California.
That might mean increasing your current dose, or adding a “booster” or secondary medication that’s designed to help the primary antidepressant work more effectively.
“Adding another antidepressant with a complementary mechanism of action is often a first step if it seems symptoms aren’t improving,” she explains. “Lithium is an extremely effective adjuvant medication for major depression, and we can also add buspirone, atypical antipsychotics, or other mood stabilizers.”
After that, the next step would likely be to switch antidepressants if you’ve had minimal response, she adds.
4. Are There Other Strategies I Should Try?
In addition to antidepressant troubleshooting, talk with your healthcare provider about other options that can go along with a medication approach, suggests Dr. Siddiqi.
For example, more frequent psychotherapy might help you get a better outcome, he says. Research indicates that the combination of psychotherapy and medication for moderate to severe depression tends to work better than just one of these treatments on its own.
Some people may also be candidates for treatments like transcranial magnetic stimulation — a noninvasive option that uses focused magnetic pulses to stimulate specific areas of the brain — or ketamine, which has an entirely different mechanism of action than antidepressants, says Siddiqi.
You can also try lifestyle interventions, he adds, such as stress reduction techniques, sleep behavior strategies, and regular physical activity. For instance, exercise like walking, yoga, and strength training has been linked to improvement in depression symptoms.
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