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What to Do If Your Antidepressants Stopped Working
Erika Krull, MSEd, LMHP
You can feel them creeping back into your life: sadness, negative thoughts, sleepless nights, and other familiar depression symptoms. You're worried your antidepressants stopped working, even though you've been feeling better for a while. Now what?
Finding an effective antidepressant can be a challenge, so this situation can be frustrating and disheartening. But there could be more to the story—your old symptoms may be more noticeable again for many reasons, and not all of them are directly related to your medication. So if you think the effects of your antidepressants are wearing off, your next step is to gain a better understanding of your overall health. Here's what you need to know.
Assessing If—and Why—Your Antidepressants Stopped Working
Before your doctor can make any changes to your treatment plan, be sure to do the following. First, keep taking your medication exactly as it was prescribed. Second, observe your symptoms for about a week to see how things develop. Describe what they were like when your medication was working and how things have changed recently.
Having more noticeable symptoms once in a while doesn't mean your medication is failing you. However, feeling worse for several days in a row could be meaningful. Consider how the following three factors can help you determine your next step.
1. Your Diagnosis and Other Conditions
Your doctor makes your depression diagnosis with the best information they have at the time. At some point, you may need to revisit your diagnosis and examine how other issues could be part of the picture.
Start by reviewing the original diagnosis. You may have bipolar depression instead of major depressive disorder, for example, or perhaps a new mental health issue is developing. You may also have a new or undiagnosed medical condition that's interfering with your ability to navigate your symptoms. Sometimes issues like thyroid disease or diabetes cause imbalances in your body that can affect your mood.
At the same time, if you've gone through a period of significant weight loss or have a medical condition affecting your digestive system, your body may not be able to absorb medication as well as it did previously. Inflammatory bowel disease, Crohn's disease, or gastric bypass surgery could have this effect on antidepressants.
Finally, simple aging can affect the way your body responds to medications. Changes to your blood-brain barrier, the density of your nerve cell receptors, and a slower response to medication can all make a difference. What worked for you at age 25 may not work the same way at 55 or 60.
2. The Medication Itself
Do the effects of antidepressants wear off? Your medication can become less effective for several reasons, even if it's helped for a while. Talk with your doctor about whether your medication is being absorbed into your body correctly. Again, absorption can be impacted by medical issues and the effects of aging, and another medication may work better for your body now.
Next, look closely at how you're using your medication. Has anything changed your ability to take it as prescribed, even just a few times? This could explain why its effectiveness has changed, and your doctor can help you find a regimen that fits with your current schedule.
Finally, check to see if your pharmacy switched to a generic version of your medication. Even when the active ingredient is the same, some variations in generic medications can change how they work in your body.
3. Your Life Circumstances
If you've recently gone through a life transition or a period of grief, your symptoms may be part of a normal but temporary reaction. You may feel better with more emotional support from others or lifestyle changes. A short-term adjustment to your treatment may be appropriate if you're not functioning well.
What If You Need to Change Your Depression Treatment?
Depending on what you discover by exploring these factors, it may be time to change your depression treatment plan. Consider these possibilities to get your journey back on track.
Try a Different Antidepressant
Less than half of all adults using antidepressants find success on the first try. So, if you need to choose something different, it may take some trial and error. The good news is that you have many safe and effective choices to work with.
Add Another Medication
If your antidepressant relieves most of your symptoms, your doctor might add a second medication to fill in the gap. Called augmentation, this strategy can improve your symptoms without switching medications. While you may have more potential side effects to consider, a combination approach may give you the best relief.
Seek Counseling
Medication and counseling (also called therapy, or psychotherapy) can be an effective combination for depression symptom relief, often better than either treatment alone. If you're currently in therapy, talk to your therapist about improving your symptoms. You may consider a different approach or more frequent sessions. And if you're not in counseling right now, then this may be a good time to start.
Look into TMS
Even after trying two antidepressants, one-third of people don't find relief from depression. If you find yourself in this situation, it may be wise to consider transcranial magnetic stimulation (TMS) therapy. FDA-cleared for treatment-resistant depression, TMS is a non-invasive treatment that could help you start feeling better within a few weeks. With TMS, a handheld device delivers magnetic pulses to specific areas of the brain that regulate emotion and mood. Treatment sessions are short and can be safely scheduled into your regular routine. In some cases, the combination of partially effective medications and TMS is enough to bring complete relief.
It's important to take the time to observe and understand how helpful your current antidepressant treatment is before making a change, but it's possible that TMS is an effective way to treat your symptoms. To learn more about whether TMS is right for you, schedule a no-cost consultation.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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