What if an antidepressant doesn’t work?
There are dozens of kinds of depression. That is according to genetic studies. The actual number might be much higher, in the hundreds. So it’s not surprising that an antidepressant might not work. In fact, in one study, it was found that 40 to 50% of people respond to the first anti-depressant and then of the remaining people, another 10 or 15% respond to the next two or three medications. Overall that leaves about 30% or so of people seeking help for depression, finding the anti-depressants doesn’t seem to help.
Seventy percent get help, 30 percent don’t.
Because there are many kinds of depression, it’s important to look for underlying issues. This is where it pays to work with an experience Ccinician. They have the experience to draw from tw look more carefully at what might be underlying issues.
I’ve seen anti-depressants start working when the following underlying issues got treated insomnia, anxiety, ADHD, social anxiety, sleep apnea, chronic pain, Panic, post,traumatic stress disorder, borderline, personality,traits, autistic traits, diabetes, obesity, food, addiction, nicotine,addiction, alcohol,addiction, loneliness, grieving loss of health, grieving loss of a loved one., dwelling on the past, low thyroid function, narcolepsy, obsessive self doubting, lack of stable daily routines, bad diet, lack of exercise, among other issues. In other words, they came back one month after starting an antidepressant and said, “I’m just as depressed as before the medication.” To myself I said, “We need to get to work.” Then I go down the list of “usual suspects” of issues that interfere with an antidepressant (they are not magic and many things can stop them from working.) The list is at the start of this paragraph. And then we get to work on those issues. Often there are two or three. Once those are dealt with (which can sometimes take1-2 months) then the antidepressant has a chance to work. If it still doesn’t work, then we change the antidepressant. I find this approach helps antidepressant work 80% of the time, much better than the 60% of the time in some studies. It pays to refine your life skills with a professional.
Other studies have found that after three or four antidepressants don’t work, Yyur chances are better at finding help from bipolar disorder treatments. These include praylar olanzapine, lithium, lamotrigine, Tegretol, Trileptal., and Abilify.
It’s also helpful to look at how counseling has been going. Are they learning anything? When counseling works the patient learns things, such as to not blow things out of proportion, to let go of the past, to embrace a grateful attitude. When I ask someone what they’re learning and counseling, and they say nothing, it’s just helpful, then I know ithe counseling is ot helpful. and I will ask the patient to go back to the counsellor and ask what new issue can be addressed? Often the patient Isn’t doing their homework. and will (gently) be told that, and then they will get better. In the background, I am the squeeky wheel that gets the grease! It doesn’t end there of course. Everything is a process. The therapist may talk about things the patient can practice, but homework, knowing the therapist has been assigning it, but it hasn’t been getting done. Then I write down in my chart. NThen (the psychiatrist’s secret weapon) I write a nte tin the progress note for that visit, for me to (next time) sk about thow the homework wentat the next visit. I like to cheer my patients on and show my appreciation for their hard work learning Nnw thinking strategies with the help of their therapist.
I will say that at the end of the visit so the patient knows ahead of time, that next time I will be asking about certain things. This is what patient’s get when they work with a detail oriented positive thinking psychiatrist, and there are many psychiatrists like this practicing all over the US.