5 Reasons Your Antidepressant Is Not Working

Dr. Brett HowardMental Health

Antidepressant | Reboot Science

Are you close to flushing your antidepressant down the toilet? Have you been taking an antidepressant for weeks but feel that it is not working? In a 2011 Data Brief the US Centers for Disease Control and Prevention listed antidepressants as the most frequently used prescription medication among those aged 18-44. Despite their popularity in prescription, many who have started taking an antidepressant stop the medication prematurely due to the perception that the medication is not helping them with their symptoms.

If you or a loved one are one of the many hoping to receive relief from depression and/or anxiety through a prescription antidepressant, ask your prescriber about the following issues before you decide to stop a medication that could change or even save your life:

Reason #1: You haven’t waited long enough

The standard answer to the question, “How long will it take before this antidepressant works?” is 3 to 4 weeks AFTER the patient has been prescribed an adequate dose. However, depending on the resource and the criteria used, the time period could extend up to 8 weeks to see any results, with an adequate trial only achieved after 12 weeks on the medication. However, for those who are looking for more timely relief may wish to also pursue psychotherapy which may reduce the waiting period for symptom relief by a few weeks. Ask your doctor if you have waited long enough to see results from your medication.

Reason #2: You are not taking a high enough dose

There are many reasons why a prescriber may have started you at a lower dose of an antidepressant, such as to protect you from intolerable discomfort from side effects or because your liver and/or kidney function may be impaired and a lower dose may be all your body can handle. However, we also know that antidepressants almost always have “target” doses known to be the amount of medication that is most likely to achieve symptom relief. All too often I have accepted a new client whose depression has been “unresponsive to treatment” only to find the dose the patient is taking is below (or way below) the known target dose for that medication. Ask your doctor if you are taking the target dose of your antidepressant or if dose adjustments will be in your future.

Reason #3: You are not taking the medication as prescribed

If you keep forgetting to take your medicine, it will never work. If you find it difficult to remember to take your medication (and the cell phone reminder didn’t work), ask your doctor about an antidepressant that can stay in your system longer so missed doses are less of an issue (e.g. fluoxetine).

Reason #4: You are taking the medication for the wrong reason

Antidepressants are best at treating the kind of depression that comes from an imbalance in the biological mechanisms that govern our mood, sleep and energy. However, they are not very good at treating the kind of depression that comes from life’s stressors, disappointments, and losses. Sadness, loneliness and grief are normal variations of a healthy mood and are expected after a passing of a loved one or significant change. Antidepressants may be helpful in time if your reaction to loss includes profound grief that is prolonged or involves alterations in your sleep, energy, appetite or self-esteem.

Reason #5: The antidepressant that you have been prescribed is not going to work

One of the major scientific studies that evaluated the effectiveness of antidepressants on depression (STAR*D) concluded that only about a third (1/3) of patients achieved a remission of symptoms after an adequate trial of the first antidepressant medication. For the remaining 2/3 the solution to their depression was found through other medications, psychotherapies, or a combination of both. If you have been diligently taking your antidepressant medication as prescribed, at an adequate dose, for an adequate amount of time and for the right reason, but still have symptoms of depression and anxiety, ask your doctor about the possibility of trying another option to address your symptoms. The right solution for your depression may be closer than you think.