Do antidepressants work?

1. How long does it take for an antidepressant to work?
Antidepressants are about the slowest of all the drugs for psychiatric conditions and take about two weeks just to show signs of working. If the starting dose fails, then a higher dose is given -- you must then wait another two weeks to see if this dose works. Given that the dosage of the most popular antidepressants can be increased three to four times before being deemed a failure, it can take a long time just to see the beginnings of a response. This can be frustrating, since most medications work much faster.

2. Will I just wake up one morning and feel better?
That happens, but it is rare. People who have this response are usually those who describe their depression as a black cloud. Some of them will know that day it lifts. For most people, however, the improvement is so slow that it is imperceptible. They might continue to feel bad, even though various signs and symptoms, such as sleep or appetite, normalize. Generally, it is only in retrospect that you can tell when an antidepressant began to work.

3. When an antidepressant works, does that mean I'm cured?
Antidepressant treatment continues even after one begins to feel normal since its benefits consolidate with time. If you encounter a stressor -- even a mild one -- right after improvement, you are likely to get depressed again, often for days, making it feel as if you are back to square one. If you were suicidal earlier, you might resume thinking about or attempting suicide. If treatment continues for another month or two, the same stressor might lead to a day of feeling down; if you continue for another two or three months, the stressor may easily be shrugged off.

4. My antidepressant worked really well, so why did I feel so down when my company was taken over?
Your response is really the rule rather than the exception. Antidepressants can't protect you against the ups and downs of life. By relieving your depressive signs and symptoms, they just bring you back to where you were before the onset of depression; you still remain vulnerable to serious stressors.

5. How long do I have to take my antidepressant?
It is important not to rush things. Generally, from the time you have a good response, you should continue with your antidepressant for six months to a year. When your medication is slowly reduced, you should start seeing your doctor more often so that he or she can increase the dose again if your depression reemerges. If this happens, your doctor can also tell you how much longer to wait before trying to discontinue medication again. Some people, especially as they get older, are unable to come off antidepressants without having a relapse. In such cases, the depression has gone from episodic to chronic. Some doctors now recommend that more elderly patients stay on antidepressants indefinitely because any side effects are likely to be outweighed by the risk, if medication is discontinued, of further episodes of depression.

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Excerpted from Depression: Your Questions Answered by Melvyn Lurie, MD. Copyright 2007 by Melvyn Lurie, MD. Excerpted by permission of Dorling Kindersley Plc P/B. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.