Do antidepressants work?

6. I stopped my antidepressant without telling my doctor. When my depression returned, the medicine no longer worked. Why is this?
It is not clear why this happens. I have had patients who were on a medication for years. They might have stopped it for a variety of reasons. However, when they restarted it, it just did not work. Although this type of occurrence is uncommon, it is one more reason why it is so important for patients to consult with their doctor before making any alterations to recommended treatments.

7. What happens if an antidepressant doesn't work for me?
It is not unusual for your first antidepressant to fail. This is called treatment-resistant depression, which means that your depression continues despite treatment. At this point, there are various approaches, depending on your condition, side effects, and any other medical conditions you have. Generally, there is a gradual switch to another antidepressant. Sometimes the replacement antidepressant is in the same class as the first one (for example another SSRI); at other times the replacement is from a different class. Alternatively, if the first antidepressant works partially, a second one may be added.

8. What happens if the second antidepressant doesn't work?
In such cases, it is important to reassess your depression with your doctor. Sometimes, a depressive episode is diagnosed as major depressive disorder, when it is actually a part of bipolar disorder. This can be difficult to determine since you may never have had any indication that you have bipolar disorder. However, if bipolar disorder is the correct diagnosis, then a type of medication called a mood stabilizer may help you.

9. What if no medications work for me?
If you have undergone treatment with different antidepressants and you took the maximum amount of medication in each case, you should discuss your options with your doctor. You may need adjunctive medication such as thyroid hormone or an antipsychotic medication. In cases where medication does not work in depression, electroconvulsive therapy (ECT) is a very viable alternative; its success rate in depressed patients is close to nine in 10. ECT often works where medication does not.

10. Myth: Antidepressants cure all kinds of depression
Truth: Antidepressants can cure major depressive episodes, but they do not always work. In addition, antidepressants do not cure reactive depressions most of the time. Other treatments, such as psychotherapy, are better for reactive depressions -- that is, depression caused by the reaction to a stressful event, as opposed to depression that is more biological in origin.

11. I felt better after four weeks of antidepressant treatment -- then I crashed. What could have happened?
You have had a relapse. When a depression lifts, the benefits of antidepressants have not yet had a chance to consolidate. If stress occurs -- especially one similar to the one that triggered your depression -- you will feel depressed again. Your doctor should prepare you for a relapse when you begin to take antidepressants. As time passes in antidepressant treatment, your gains will become more solid. As is the case with a newly healed fracture, time makes the healing stronger.

12. My doctor said my antidepressant was successful, but why do I still have trouble sleeping?
If many of your depressive symptoms have lifted, your treatment can be said to be successful. However, some symptoms can take longer to go away than others (some take weeks while others take months). Technically, during this time, you are in partial or substantial remission, but not full remission. Disordered sleep is a very useful indicator for depression. Because it occurs during the night, when many other extraneous factors are not present, it can be perceived even when other symptoms appear to have resolved. If sleep problems remain, one should probably not stop antidepressants.

13. Is it possible that I may need to stay on antidepressants permanently?
Yes, it is. Some people become chronically depressed after several episodes of major depression. In such cases they need to take antidepressants indefinitely to control their depression. The only way to tell if your condition is chronic is to taper your antidepressant use (with your doctor's help) and see if you stay free of depression. If not, you would need to go back on medication another few months and try to come off it later. After a few attempts, it might become clear that your depression has become chronic and will last the rest of your life without treatment.

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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.