Why isn’t my antidepressant working?
You’ve taken the first step towards treating your depression by starting an antidepressant medication- but nothing seems to be happening. What gives? Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL, shares some common reasons why you may not be seeing the results you’re hoping for.
This post is provided for educational purposes only, and does not constitute medical advice. If you have questions about your antidepressant medications, reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth. Request an appointment today to start your journey to better mental health.
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You’re experiencing side effects
It’s too early
Mental health conditions like depression, anxiety, and OCD can have a serious impact on your quality of life, interfering with your ability to function throughout the day. Once you make the decision to begin treatment by starting an antidepressant medication, it’s totally understandable to want to see improvements as soon as possible. Unfortunately, when it comes to antidepressants, expecting an immediate fix is usually unrealistic.
Medications vary in terms of how quickly they take effect and show us the results we’re hoping for. Some medications may start working immediately, while others can take some time. If you’re experiencing indigestion after eating a heavy meal and take an antacid, you may start to feel relief within minutes as the antacid quickly neutralizes the acid in your stomach. Antidepressants are different in that they can take a few weeks from the time you start taking the medication until you begin to see an improvement in your mental health symptoms.
Antidepressants aren’t one size fits all, so the exact amount of time it may take to see a response can vary from one medication to the next. If you’re unsure about whether you should be expecting to see an improvement yet, don’t hesitate to reach out to your doctor!
You’re taking it incorrectly
It’s important to make sure that you are taking your antidepressant exactly as prescribed by your doctor for optimal effectiveness. Sometimes patients struggle to remember to take their medications on a regular basis, and find themselves missing doses. If this has been a problem for you, consider using a pill organizer or setting a reminder on your phone. If you have questions about how you are supposed to be taking your medication, reach out to your doctor.
The dose is too low
When psychiatrists are deciding about the best dosing strategy for their patients, there are many factors to consider.
In the outpatient setting, such as the doctor’s office or clinic, many psychiatrists prefer to “start low and go slow” when it comes to starting a new medication. When prescribing medications, it’s generally preferable to aim for the lowest dose of medication that is effective at alleviating the patient’s symptoms. In other words, we want to avoid patients receiving more medication than they need to, as this often increases the risk of side effects.
So, what does “start low and go slow” mean?
Start the medication at a low dose
Continue taking the medication for the amount of time that is usually needed to start to see a response. For many antidepressants, this could be about four to six weeks, but varies from one medication to the next.
If the patient’s symptoms have improved, great! If the patient is still experiencing symptoms, a dose increase may be needed.
By increasing the dose of the medication gradually rather than immediately jumping to a high dose, your body has more time to adjust to the medication, which can sometimes reduce the chances that you will experience side effects.
It’s also important to keep in mind that our bodies are unique, and we each respond to medications differently. There are many different reasons for this, but one important factor is that our bodies differ in terms of how quickly they break down the medication in our body. One person may break down a given medication rapidly, meaning that they may need a higher dose than average to see a response. Another person may break down a medication more slowly, meaning that they may see improvement (or side effects!) at a lower dose than average. It can take some time to figure out the best dose for you as a unique individual.
There are certain situations where a “start low and go slow” strategy may not be appropriate. As an example, if a patient is experiencing symptoms that are so severe that they have been hospitalized, doctors may want to get the medication up to the target dose as quickly as it is safely possible to do so in order to provide the fastest relief. An example of a situation in which this dosing strategy may be preferred could be a patient who has been hospitalized for severe depression and suicidal thoughts, which can be a life or death matter. In a hospital setting, patients are under 24/7 monitoring by medical providers, making it easier to catch and quickly treat any adverse reactions to medications, or make quick adjustments to dosing. This may be less feasible in the office setting, where patients may see their doctor only once per month. Rapidly increasing the dose of a medication could present a higher risk of potential side effects, but in the hospital setting, this risk may be outweighed by the need to address a life-threatening psychiatric emergency as quickly as possible.
Change can be gradual
Many people expect that when they take an antidepressant medication, the response will be like turning on a light switch, where one day you are struggling under the weight of depression, and the next day you wake up back to your old self. Unfortunately, the response to antidepressants is generally much more gradual, with small improvements that add up over time until you get to where you want to be.
It can be hard for us to notice gradual changes in ourselves over time, but it doesn’t necessarily mean that they aren’t happening. Oftentimes psychiatrists utilize tools to track symptom severity from one visit to the next in order to monitor changes over time.
You’re experiencing side effects
Every medication carries a risk of side effects. Some antidepressant medications can cause an increase in feelings of jitteriness or anxiety. These effects may be more likely to occur at the beginning of treatment as your body is adjusting to the medication, and may go away with time. Because of this, some patients do feel worse before they feel better when starting an antidepressant medication.
With that said, if you feel that your symptoms are worsening after starting a new medication, you should always reach out to your doctor and let them know!
Your other medications or supplements are interfering
Medications can interact with one another, whether this be prescription medications, over-the-counter medications, supplements, or even certain types of foods. Sometimes these interactions can cause your antidepressant to be broken down by your body more rapidly than usual, which may prevent it from working effectively.
It’s extremely important to let your psychiatrist know about everything that you are taking so that they can help you to avoid any potential interactions. While an interaction that makes your antidepressant ineffective can be frustrating, other interactions can be life threatening! Additionally, if you are thinking about taking a new medication or supplement, it’s a good idea to check in with your psychiatrist first about any potential safety concerns.
It’s not the best medication for you
Everyone responds differently to medications. Unfortunately, while one person may find a medication to be effective at treating their mental health symptoms, another may have a more disappointing response, with only a partial improvement in symptoms, or even no improvement at all.
If your antidepressant turns out to be a dud, talk with your psychiatrist to see what other treatment options may be available. There are many different antidepressant medications to choose from, and it can take some time to figure out the one that works best for you. Additionally, antidepressant medications aren’t the only treatment options that have been shown to be effective- your options will depend on your unique health circumstances, but could include therapy or non-medication interventions.
