When Depression Medication Isn't Working: Next Steps for Treatment-Resistant Depression

By Kelly Burch

Starting an antidepressant to treat symptoms of depression can require persistence and strength. You've taken control of your life and have made the important decision that you won't settle for how you've been feeling. You might envision yourself sleeping more soundly at night or having the energy to reach out to your loved ones more once symptoms are reduced. But what happens when depression medication isn't working?

In general, it's common to not see any improvements right away; it takes time for many medications to take effect. Sometimes though, this can be a sign of treatment-resistant depression, or depression that doesn't respond well to medication. Even if that's the case, there's still hope. There are plenty of treatment-resistant depression options that can provide the relief you're looking for.

If you feel your medication isn't working, read on for help deciding if it's time to reach out to your doctor about other solutions.

How Long Does Medication Take to Work?

When you start taking medication for depression, you might expect to feel better within days. Some people will have that experience, but others will have to wait weeks for the medication to begin working. Many depression medications can take from two to four weeks to begin addressing symptoms, and up to 12 weeks before taking full effect, according to the National Alliance on Mental Illness.

Scientists don't fully understand why, but they believe that depression medications such as SSRIs (selective serotonin reuptake inhibitors, the most common type of antidepressants) set off a chain reaction in the brain, which takes weeks to fully occur.

It can be frustrating to take pills every day and still not feel better. However, to really evaluate whether a medication is working, you need to take it as prescribed until your doctor tells you to stop. If the depression medication isn't working, schedule an appointment to discuss it with your doctor. They'll be able to let you know how long you should stay on the medication before trying a different treatment. Oftentimes, it's safest to gradually reduce the dosage of your depression medications, so never stop suddenly: always consult with your doctor first.

In some cases, your doctor may want you to try a depression medication for months to see if it can work for you. They might also want you to try a second medication—perhaps in a different category of antidepressants. Because everyone reacts to and metabolizes medications differently, it can be difficult to predict whether a particular prescription is right for you. Although this can feel like a long process, treating depression effectively takes some trial and error.

What Are Next Steps for Treatment-Resistant Depression?

Many people find relief with antidepressants, but one in three people continue to have symptoms  of depression after trying two medications. These people have treatment-resistant depression. Unfortunately, the only way to find out whether depression is resistant to treatment is to try at least two medications, giving them enough time to have a chance to work.

It can be disheartening and even scary to find out that depression medication isn't working for you. You might feel like you'll never get better, or that something is wrong with you because medications aren't as effective as you'd like. But you're not alone. And there are several treatment-resistant depression options out there that are effective for many people. If you think you may have treatment-resistant depression, ask your doctor to guide you to other treatment options that are safe and effective for your specific medical history.

So, with medication off the table, what's left? Many patients with treatment-resistant depression turn to brain stimulation therapies, including the following:

  • TMS: Transcranial Magnetic Stimulation (TMS) is a therapy that uses magnetic pulses to stimulate the brain. TMS is non-invasive, usually pain-free, and delivered during a short office visit. Further, patients are able to drive themselves home from the appointment. It's a good option for those who want to try a brain stimulation therapy that is minimally invasive and allows them to maximize their independence getting to and from appointments.
  • ECT: Electroconvulsive therapy (ECT) is a treatment that uses electrical pulses to stimulate a seizure. ECT is delivered while a patient is under general anesthesia, and often requires hospitalization.  Temporary memory problems are a common consequence of ECT.  This option is often reserved for patients who have tried many other therapies or those who are very ill.
  • VNS: Vagus nerve stimulation (VNS) involves a small device surgically implanted in the chest. Every five minutes, the device sends a 30-second electrical pulse to the vagus nerve, which sends the pulse to the brain. This can help relieve depression symptoms. VNS treatment remains rare and is usually reserved for those who have tried other brain stimulation treatments and not found relief.

When your depression medication isn't working, you might feel angry, sad, or scared. It's important to remember that there's hope for treating depression, even if medication didn't work for you. You don't have to settle for feeling bad. If you're not seeing results from medication, don't hesitate to look into alternative treatments or talk with your doctor about possible next steps.

If Covid-19 and social isolation are heightening your symptoms of depression, Greenbrook TMS therapy may be able to help. At Greenbrook, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. See if TMS therapy is right for you by clicking here to take a brief assessment:

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