• Depression
• Emotional Health

Why Antidepressants Stop Working – And What To Do

When you struggle with depression, antidepressant medications have the power to boost your mood and relieve your anxiety. But because they treat the symptoms of depression, and not the underlying cause, the effectiveness of these medications may not be lasting.

For many people with depression, medicines that have helped may, at some point, seem to stop working. This loss of effectiveness is called tachyphylaxis.

Or informally, “Prozac poop-out.”

“The natural course of chronic depression involves periods of increased symptoms and decreased symptoms,” says Wayne Anable, DO, medical director for Samaritan Behavioral Health and a board-certified psychiatrist in adult and child psychiatry. “Just like other chronic conditions, it can progress over time. If you have ups and downs, it’s not a failure. You just need an adjustment in treatment.”

Dr. Anable notes several contributing factors may lessen the effectiveness of your antidepressant. And he offers possible solutions to help you get back on track and feel good again.

What You Can Do

Try these suggestions if you find your mood slipping and depression symptoms returning, despite taking antidepressants:

• Take your medicine as prescribed. It’s common for patients to stop taking their medicine or to reduce the dosage, thinking they can get by on less, Dr. Anable says. “This is not a cold or flu that is treated and gone. It’s a lot like diabetes or high blood pressure, something you have to deal with a long time.”

  He cautions against changing your medication unless you talk with your health care provider. To get the maximum benefit from your antidepressant, he suggests, “It’s important to take your medicine at the same time every day. Either in the morning when you get up or at night when you go to bed is a good idea.” Routine makes missing a does less likely and better regulates the medicine in your system.

• Avoid excessive use of alcohol and other drugs. “Depression and substance abuse often go together and need to be treated simultaneously,” Dr. Anable says. “If you are struggling at all while taking antidepressants, try giving up alcohol.” Any type of substance abuse – alcohol or drugs – changes the chemicals in the brain, making it harder for antidepressants to work.

• Make healthy lifestyle choices. Sweets and processed foods are quick carbs that make you feel good for a short while but can leave you feeling down when they wear off, Dr. Anable says. He suggests limiting these. Instead, increase foods with omega-3 fatty acids and vitamin B12, which, as some studies suggest, work in the brain to allow better absorption of antidepressants.
  
  Dr. Anable adds, “Good exercise and getting your heart rate up can stimulate the brain and boost your mood.” Exercise also is a good stress reducer. Stressful events such as mourning the loss of a friend or family member, moving away from a familiar setting, and other life events can change the chemistry in your brain and make it more difficult for your antidepressant to work effectively. “You can reduce stress with psychotherapy, counseling, exercise, or mindfulness meditation,” Dr. Anable says.

• Pay attention to your mood. Dr. Anable says you can be depressed and not realize it. Ask yourself how well you are functioning at work, in social relationships, and with family. Are you losing enthusiasm and feeling bored with life? If you notice these things or family and friends mention them to you, talk with your psychiatrist or family physician.

How Your Doctor Can Help

If your antidepressant isn’t working as well as it did, Dr. Anable advocates lifestyle changes, stress reduction, counseling, and psychotherapy (talk therapy) as options before making medication adjustments.

“Psychotherapy, when used with medication, is the most successful way to treat depression,” he says.

Doctors also are trained to evaluate people for bipolar disorder, in which your mood swings from depression to mania. Manic symptoms can be subtle, such as having the energy to stay up all night or having a temper outburst. If mania gets worse with antidepressants, doctors can prescribe a mood stabilizer to balance the extremes of emotion.

Your physician also can help sort out whether another medical condition is contributing to your depression. Illnesses that can cause depression or make it worse include hypothyroidism (abnormally low thyroid activity), Alzheimer’s disease, Parkinson’s disease, heart disease, and arthritis.

If other contributing causes have been addressed, Dr. Anable says a small adjustment in medication dosage is the first option to get better results. Trying another medication is also an option.

“If your antidepressant isn’t working well, talk with your family doctor or psychiatrist,” Dr. Anable says. “Don’t try to figure it out on your own. Realize that it’s not a hopeless situation; it’s only a setback. It’s common to need adjustments from time to time.”

Sources: Wayne Anable, DO, Samaritan Behavioral Health; U.S. News and World Report, Everyday Health: National Institutes of Health

Wayne Anable, DO