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When Your First Antidepressant Doesn’t Work

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Major depression is one of the most common mental disorders in the U.S., affecting 14.8 million American adults. Many people think that curing depression is a simple matter of taking an antidepressant drug, but that’s a common misconception. While medication can quickly relieve symptoms for some people suffering depression, only 35 to 40 percent of depression sufferers experience complete symptom relief with the first antidepressant they try.

The majority of depression sufferers must try multiple treatment options before they find a medication that works for them. About 30 percent must combine antidepressant therapy with psychotherapy and lifestyle changes in order to achieve complete remission. An unlucky minority of depression sufferers must even resort to more invasive therapies, like electroconvulsive therapy (ECT), vagus nerve stimulation (VNS) and transcranial magnetic stimulation (rTMS).

What Is Treatment-Resistant Depression?
People who continue to struggle with depression symptoms after trying at least two treatments or drugs are said to have treatment-resistant depression, also called refractory depression. Doctors don’t understand exactly why some people fail to get better with treatment while others show improvement with the first antidepressant they’re given. Some people who appear to have treatment-resistant depression in fact have another condition, like a thyroid disorder, bipolar disorder or dysthymic disorder, a mild and lasting form of depression.

Other people suffering treatment-resistant depression also present with complicating factors, like eating disorders, substance-abuse disorders or other mental illnesses. Genetic factors may be at play in many cases of treatment-resistant depression. Because underlying lifestyle factors, like insomnia, lack of exercise or poor diet, can contribute to depression, antidepressants alone often aren’t helpful.

Don’t Give Up on Antidepressants
If you’re like many people who are prescribed antidepressants for depression, you may not realize that they can take a while to have an effect on your symptoms. It can take one to two months for antidepressants to begin to take effect. If a new medication doesn’t work right away, give it time.

If you do give it time and it still doesn’t work, you may want to try a higher dose before switching to another medication. However, many people respond better to some antidepressant drugs than others, so trying different drugs is an option. Your doctor may also suggest augmenting your medication with another drug, such as an anti-anxiety medication, a mood stabilizer or a beta blocker.

woman receiving counselingSeek Counseling
Psychotherapy, especially when combined with antidepressant prescriptions, is one of the best treatments for depression. There are specific types of psychotherapy that have been proven effective for depression, such as:
Interpersonal psychotherapy. This type of therapy helps you work through relationship issues.
Cognitive-behavioral therapy or CBT. CBT can help you learn to recognize unrealistic patterns of thinking that are contributing to your depressed mood.
Family therapy. Strained relationships can contribute to depression, and family therapy can heal them.
Psychodynamic therapy. This type of therapy helps you address the issues behind your depression.
Group therapy. A therapist will work with you and other depression sufferers in a group setting.

If one type of therapy isn’t working for you, try another kind. You may need to try several psychotherapeutic approaches to find depression relief.

Make Lifestyle Changes
Lifestyle changes are a big part of treating many conditions, including depression. Overwhelming stress, poor sleep quality and a bad diet can really exacerbate your depression symptoms. Make sure you get eight hours of sleep each night — and talk to your doctor if you’re having trouble sleeping. Exercise regularly — research has shown that strenuous exercise at least three times a week helps with depression symptoms. If you are using substances, stop. Take steps to manage your stress, like yoga, journaling, meditation or deep breathing exercises.

When Nothing Else Works
If you have tried multiple antidepressants, lifestyle changes and psychotherapy and still haven’t found any relief from depression, you may want to try some more invasive treatments. Perhaps the most reliable one is ECT, a procedure that involves administering an electric current to the brain. Don’t worry — the ECT practiced today is totally different from the scary procedure you probably remember from watching “One Flew Over the Cuckoo’s Nest.” ECT is now administered under general anesthesia, and uses a significantly reduced voltage.
rTMS is an entirely different kind of procedure that relies on a magnetic field to stimulate a specific part of the brain. VNS is a treatment similar to a cardiac pacemaker. A small implant is attached to the vagus nerve in the neck. It delivers a pulse to the nerve every 30 seconds. VNS has long been used to treat epilepsy, but can be beneficial for some people suffering depression.

When the first antidepressant your doctor prescribes doesn’t relieve your depression symptoms, it can be tempting to give up on treatment altogether. Don’t. There are many options for depression treatment — you may just need to experiment a bit to find the one that works for you.

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