What to do when antidepressants don't work for you (and why)
Antidepressants often bring additional side effects for patients with little or no improvement to the depression disorder. Even if no major side effects are noticed, the pharmacological treatment of depression doesn't work for many people.
The goal of treating depression is remission-the absence of symptoms. Patients who do not achieve remission have quality of life ratings significantly lower than patients who have remitted and are at an increased risk of full relapse.
The likelihood of achieving remission decreases rapidly with each subsequent medication trial failure. After a patient has three failed trials of antidepressants, the likelihood of achieving remission with additional medication trials is only about 10%. Also, the likelihood of side effects increases with each subsequent medication trial. The below graph is based on data from STAR*D, the largest systematic antidepressant study ever done (NIMH, 2006).
When you realize antidepressants aren't working
What do you do when you realize drugs aren't helping improve your depression symptoms? First, let your doctor know the side effects and lack of effectiveness you are experiencing with the medicine. After all, your doctor can't help if he doesn't know a treatment isn't working.
It is common practice for doctors to try three or four different antidepressant medications to treat depression. For some, the second, third, or fourth prescription can have a positive impact on the symptoms of depression. However, many don't experience any improvement or remission during the course of any of the prescribed medications.
If you've given at least three different prescription drugs a full course of treatment and aren't getting the results you need, ask your doctor about alternative treatments for depression, like transcranial magnetic stimulation (TMS).
In naturalistic studies, patients who have experienced up to four failed adequate antidepressant medication trials in the current episode will have about a 60% chance of experiencing significant improvement and about a 35% chance of achieving remission with TMS (Carpenter et al. 2012).
TMS should be considered for all patients with treatment resistant depression and not as a last resort, because it is even more effective when used earlier in the course of illness before severe treatment resistance emerges. If you have received some benefit from medication but are not in remission, TMS can be an excellent treatment to help you achieve remission.
There are alternatives to antidepressants for depression
Maybe you are exhausted by the side effects of depression medication. It's possible you don't like the prospect of relying on taking drugs for the long term. Or even worse, the different antidepressants you've tried may not be working well or at all.
The good news is that in all these scenarios, there is hope. An effective alternative to treating depression with medicine is the breakthrough TMS therapy we offer at TMS Center of New Orleans.
How to start depression treatment without medication
When evaluating an alternative treatment method, you'll want to compare the impact each treatment would have:
- With traditional drug treatments for depression, the risks for side effects are much higher than with TMS therapy.
- Long-term, a course of TMS therapy can be effective for a very long time, with only the potential for occasionally "maintenance" visits—where antidepressants can be a lifetime prescription.
- The effectiveness of both can depend on the person, but the remission rates with TMS therapy—particularly in those with which medication couldn't help—are very encouraging.
If you are looking to stop medication treatment, ask your doctor if there are any alternatives, like TMS, they would recommend.