My Antidepressant Isn't Working. What Are My Options?

By

Michael Craig Miller, M.D.

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What to Ask About Depression

Michael Craig Miller, M.D.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Question:

My antidepressant isn't working. What are my options?

Answer:

Antidepressants often don't work well enough. Or fast enough. Only about a third of people taking any given medicine for depression will get complete relief. I can't list all your options. But here are two:

  • If the first treatment fails, try a second one.

  • If one treatment fails, try a combination of treatments.

No doctor can make one recommendation that is best for everyone. Here are two reasons why:

  • No two depressions are alike.

  • There are dozens of treatment options and hundreds of potential combinations.

I'll give you a few examples. But remember — there are many, many more.

If you are taking an antidepressant, consider psychotherapy. Psychotherapy and drugs are about equally effective. The combination is often better than either alone.

Many doctors suggest boosting an antidepressant with a second drug. That usually involves prescribing a drug that affects the brain differently than the first one. The idea is to target two different brain pathways at the same time.

Let's say you are taking fluoxetine (Prozac). It boosts the chemical messenger in your brain called serotonin. Your doctor may suggest adding bupropion. This antidepressant acts on different chemical messengers, dopamine and norepinephrine.

Other possibilities: your doctor might suggest adding an anti-anxiety drug (such as buspirone) instead of a second antidepressant. Or perhaps he or she may consider adding an antipsychotic (such as aripiprazole or olanzapine) .

Lithium, best known for treating bipolar disorder, can be a helpful addition to depression treatment. Thyroid hormone, which is needed to regulate mood, can help depressed people too.

Patience is the key. No one can predict which treatment combination is best. The process is trial and error.

But you can help your doctor help you. Record what treatments you've tried, at what dose, for how long. Note how you felt — better or worse. Did you have side effects?

This kind of diligence is your best weapon against a persistent depression.

Last Review Date: Apr 13, 2013

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