When Your First Antidepressant Does Not Help

This is common, and it is not a failure

MedlinePlus says one antidepressant will not work for everyone, and that you may need to try two or more before you find one that works for you. The National Institute of Mental Health (NIMH) says finding the best treatment may take trial and error. So a medicine that has not helped is information your prescriber can use. It does not mean you are beyond help.

Timing is part of the picture. NIMH says antidepressants usually take 4 to 8 weeks to work, so it is worth telling your prescriber how long you have been taking the medicine and whether you have missed doses. MedlinePlus also notes that sometimes a medicine helps at first and then symptoms return while you are still taking it.

Options a prescriber may discuss

These are general possibilities, not advice about what you should do. Which of them applies, if any, depends on you, and any change is a decision for you and your prescriber.

• Reviewing the current medicine. Your prescriber may look at how long you have taken it, how you have been taking it and the dose. Any change is their decision with you.
• Trying a different medicine. MedlinePlus says that if side effects bother you too much, you may need to change antidepressants, and that there is usually another one to try. A different group may be discussed, such as an SSRI, SNRI, atypical antidepressant or an older type.
• Combining medicines. MedlinePlus says a provider may suggest combining two antidepressants or using another kind of medicine with an antidepressant.
• Adding therapy. MedlinePlus also lists talk therapy as a way to get more relief. NIMH says cognitive behavioral therapy and interpersonal therapy are evidence-based therapies for depression.

What an add-on medicine is

NIMH says one option for treatment-resistant depression is to combine an antidepressant with a different type of medicine that may make it more effective, such as an antipsychotic or anticonvulsant. For example, the aripiprazole label approves it as an add-on to antidepressants for major depressive disorder in adults.

Add-on medicines have their own risks. The aripiprazole label has a boxed warning that older adults with dementia-related psychosis who take antipsychotics are at increased risk of death, and that it is not approved for that use. It also carries the antidepressant boxed warning about suicidal thoughts and behaviors in children, teens and young adults. Its common side effects in depression studies include restlessness, an inner urge to keep moving called akathisia, insomnia, constipation, fatigue and blurred vision. Not every add-on use is FDA-approved, and our medicine library says which uses are approved and which are off-label.

If two antidepressants have not helped

NIMH says treatment-resistant depression occurs when a person does not get better after trying at least two antidepressants. It is a specific term, and having it does not mean nothing can help. There are other treatments, though some are not available online.

The esketamine label approves it for treatment-resistant depression in adults, alone or with an oral antidepressant. It is only available through a restricted program, given in a certified healthcare setting and monitored for at least two hours, so it is not something an online visit can provide. NIMH also describes brain stimulation therapy as an option when other treatments have not worked. Brain stimulation is not something an online visit can provide either.

Useful things to bring to the conversation

Good notes can make this conversation much easier. Tell your prescriber plainly what has and has not changed. If you see signs that are new or getting worse, contact them right away and do not wait for the next visit.

What comes next with us

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine with more than three decades of practice, offers online depression treatment by secure video for people physically located in Pennsylvania or New York during each visit. Ask us whether our psychiatrist can help, using our medication care contact form. A visit may not end in a prescription.

Our therapists do not prescribe. They offer depression therapy in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.