Depression is a common mental health issue that affects teens and adults of all ages. It impacts nearly 300 million people across the globe, the World Health Organization reports.
The severity of depression can vary from person to person — some people may experience episodic depression like seasonal affective disorder (prevalent in the Pacific Northwest) while others have more severe symptoms that may lead them to withdraw from work, social circles or even contemplate suicide.
The American Psychiatric Association reports that 80% to 90% of people can find relief from depression with treatment, which frequently involves medication in addition to therapy. And with a variety of medications available to treat depression, it’s important to know if your medication is working.
Finding the right antidepressant
The first step in trying to address depression is finding the right antidepressant and this starts with a diagnosis, Dr. Misty Tu, M.D., medical director and psychiatrist at Seattle Anxiety Specialists, says. Knowing if there is a family history of depression that has been successfully addressed with a particular medication is also important.
Because there are so many medications available to treat depression, it’s important to understand how antidepressants work.
“Three types of neurochemicals are important for maintaining happiness: serotonin, norepinephrine and dopamine,” says Dr. Katharine Liang, M.D., Ph.D., consulting psychiatrist at Seattle Anxiety Specialists. “When these neurochemicals become imbalanced, patients can experience symptoms of depression and/or anxiety.”Antidepressants are prescribed based on how they can help regulate those neurochemicals.
Liang says doctors typically start a treatment plan with serotonin selective reuptake inhibitors (SSRIs) which she describes as “first-line treatment for depression and anxiety” due to the fact that there’s ample clinical evidence around their effectiveness. It’s likely that people have heard of these medications, such as Prozac, Zoloft and Lexapro.
“Choosing an antidepressant is part science, part art,” she says. “Rather than relying on formulaic demographic factors like sex or age, the choice [of medication] should rely more on the entire constellation of the patient’s symptoms because not everyone’s depression looks the same. Some antidepressants are more effective for a combination of anxiety and depression, some are more energizing, some help with sleep, some help with pain.”
How long does it take for antidepressants to work?
Before deciding your antidepressants may not be working, Liang and Tu advise exercising patience as it can take a month or longer before the medication takes full effect and you notice an improvement in symptoms. Some people may feel more immediate relief, but each person is different and should closely monitor how they’re feeling with their doctor and psychologist.
How do I know if my antidepressants are working?
A diagnosis of depression is largely reliant on being forthcoming with your doctor and mental health provider about your symptoms, which means it’s key to be transparent about how you’re feeling.
“Small changes are always hard for us as individuals to judge,” Tu says. “Most people begin to feel that things are a little bit easier. They report it’s easier to take a deep breath, or they feel less anxious. They also report they feel more motivated and find things to be fun again.”
“Because depression can alter one’s perception of their mood, sometimes patients have a tough time recognizing their depression is improving,” Liang says. “Often, patients’ loved ones recognize improvements before patients recognize it themselves. I’ll hear families comment that a patient joked around or sang along to the radio for the first time in months,” she says.
Liang says there is also the PHQ9, a standardized questionnaire that helps doctors and psychologists score the severity of someone’s depression and track it over time.
What should I do if I don’t think my antidepressants are working?
Tu cautions that if your medication isn’t working as well as it once did, it’s important to not take matters into your own hands by stopping the medication or adjusting the dosage. It’s necessary to have a plan with your doctor to understand when you should feel the benefit of the medication or if you’re starting to feel worse.
“Studies have shown that if you have one episode of major depression and are stabilized on medication for about one year, you can safely try to wean off the antidepressant” with a doctor’s help, Tu says. “But if you have more than one episode of major depression, the likelihood of having another one without medication is almost 80%. It’s important to stay on the medication for at least a year in remission from symptoms so that your brain has a chance to adjust to a new normal and equilibrium.”
There’s also a difference between side effects and the overall effectiveness of the medication you’ve been prescribed, she says. Sometimes side effects will subside and if they don’t, then it’s likely your doctor will suggest a different antidepressant.
And don’t be overly concerned if you need to try different medications to reach the desired result.
“We don’t necessarily build a tolerance to antidepressants,” Tu says. “With antidepressants and mood, we continue to change over time. We are in different environments and situations and we have different stressors.”
There can also be other reasons that you might feel your antidepressants aren’t working:
- Breakthrough depression isn’t unusual. Some people may find that, over time, the medication isn’t working as well as it once did. This could be attributed to a worsening mental health condition, new physical health issues or interference from non-antidepressant medications.
- Alcohol and drug use can impact a person’s mood and emotions and can render antidepressants ineffective.
- New stressors. Losing a job, changes at home or other situations that cause you stress can impact how effective you think your antidepressants are.
Employ a well-rounded plan to deal with depression
Medication is one avenue to treat depression, and Liang and Tu emphasize there are other things people can do to help alleviate depression.
Light therapy can be helpful for those who live in areas with limited sunlight during the winter. Exercise is always beneficial, not only for mental health but also to maintain good physical health. Don’t forget about getting enough sleep, developing healthy support systems and “healthy, anti-inflammatory diets have been shown to improve mood and cognition,” Tu says.
“A combination of medications together with therapy has the best evidence for treating depression,” Liang adds.
Keep in mind that treatment for depression has a well-established history and there is ample evidence for doctors to rely on to help individuals at different stages of their lives. Maintaining a consistent relationship with your psychiatrist and psychologist are integral to finding what works best for you.
Seattle Anxiety Specialists, PLLC is a private psychiatry and psychotherapy practice in downtown Seattle, providing evidence-based treatments and in-depth self-exploration for anxiety and conditions that create anxiety including phobias, depression, GAD, OCD, PTSD, ADHD, OCPD and bipolar.