10 reasons your antidepressant isn’t working

Dr. Melissa Shepard Smiling in white lab coat

By Dr. Melissa Shepard

Please note: this information is for educational purposes only. It is not intended to be medical advice and should not replace the advice of your doctor, therapist, or other mental health professionals. Never stop or adjust the dose of any medication without talking to your doctor first.

 
 
 

Antidepressants can help with many different psychiatric conditions, including major depressive disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, panic disorder, PTSD, etc.

 

But sometimes, an antidepressant doesn’t make you feel better. Here are a couple of different reasons why that might happen. This is not an exhaustive list, but if you still aren’t feeling well despite being on an antidepressant, hopefully, this list will serve as a jumping-off point for discussion with your doctor.

 
 
 

1. The dose isn’t high enough.

 

Many times an antidepressant isn’t effective simply because the dose isn’t high enough. Most experts in the United States consider a full trial of a psychiatric medication to be at (or in some cases, even above) the FDA maximum dose unless you develop side effects. Please note: you should never increase (or otherwise change) the dose of your medication on your own without consulting your doctor first.

 

2. You haven’t been on it long enough.

 

While some may start working faster, most antidepressants take 4-8 weeks to kick in fully. If you aren’t feeling well but haven’t been on the current dose of your medication that long, it may simply need more time to work.

 
 

3. You need therapy.

 

Medications can be beneficial on their own, but many research studies show that they are even more helpful when used in conjunction with therapy. When you are depressed, you have to change your perspective and learn new ways of coping. Medications can make this learning easier, but it can help to have someone guide you through that process.

 

4. You need a different antidepressant.

 

Unfortunately, we don’t understand the brain well enough to know which antidepressant will work for which person. Even with the newest genetic testing and imaging studies, we may not know if a medication will work for someone. Thankfully, many people do respond well to the first one or two antidepressants that they try. But if not, most experts will recommend switching to an alternative antidepressant (or even a different class of antidepressant altogether).

 
 

5. You’re missing too many doses.

 

Antidepressants have to be taken regularly in order to work properly. Some people may get a slight mood boost fairly quickly, but the bulk of the benefit from antidepressants comes after taking the medications regularly for several weeks. It’s common for people to miss a dose here and there, but if you are missing more than a dose or two a week you probably aren’t getting the full benefit of the medication. Even worse, by taking the medication irregularly you may even be causing your body to experience intermittent withdrawal symptoms (things like increased anxiety, low mood, irritability, and various physical symptoms).

 
 

6. You’re using drugs or alcohol.

 

It’s a vicious cycle: depression makes you more likely to abuse drugs or alcohol, and abusing drugs and alcohol makes you more depressed. This includes regular use of more commonly accepted substances like alcohol and marijuana. These substances may make you feel better in the short term, but they can make your depression much more difficult to treat in the long term.

 
 

7. You have an underlying medical issue.

 

The mind and the body are intricately connected, and many physical health conditions can cause depression, anxiety, and other mood problems. These can include thyroid, heart, and lung problems or even side effects from other medications.

 

Before starting an antidepressant, your doctor should take a careful history to look for any of these other health problems. They may also do a physical exam and some bloodwork to look for medical issues contributing to your depression. They may repeat this testing if you aren’t improving as expected.

 
 
 

8. It’s not depression (or it is more than just depression).

 

Several other mental health problems can look like depression and may not improve with an antidepressant. Bipolar disorder, for example, is commonly misdiagnosed as depression.

 

Even if the diagnosis of depression is accurate, another mental health problem may still be getting in the way. Untreated ADHD or OCD, for example, can make it much more difficult for someone to recover from depression.

 
 
 

9. You need another medicine.

 

Sometimes people with depression need more than one medication to pull them out of their depressive episode. This strategy is often used when a patient improves on an antidepressant but still isn’t back to their usual self. In those cases, we may continue their antidepressant and add a second antidepressant, mood stabilizer, antipsychotic, or stimulant medication to get them feeling 100%. Some people with depression may not respond to medications at all and may require procedural treatments like ECT or TMS.

 

10. There are situational factors.

 

If you are in the midst of a very toxic or difficult situation, medications may help. Still, you may not feel completely better until you are out of that problematic situation. A good therapist can help you identify any social or environmental factors that may be keeping you stuck.

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