If you're doing well with an antidepressant but there's room for improvement, increasing the dosage may be a smart move, especially if you're not experiencing side effects. If you don't notice a significant response after six weeks at a higher dosage, switching to another antidepressant is probably the most appropriate therapeutic intervention, says Kenneth Robbins, MD, clinical associate professor of psychiatry at the University of Wisconsin–Madison.
Adding another drug to the one you're already taking may also help.
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Depending on a patient's exact diagnosis and tolerance for side effects, doctors sometimes prescribe an atypical antipsychotic, a class of drugs used in bipolar disorder and schizophrenia that includes olanzapine (Zyprexa), risperidone (Risperdal), clozapine (Clozaril), and quetiapine (Seroquel).
Mounting evidence suggests that these drugs may boost the effectiveness of antidepressants. Some of the drugs in this category, such as aripiprazole (Abilify) and quetiapine (Seroquel XR), have been approved as add-on treatments for people already taking antidepressants, whereas olanzapine (Zyprexa) is approved specifically for use in combination with fluoxetine (Prozac), which can be taken in a combo pill called Symbyax.
Doctors prescribe other atypical antipsychotics—such as risperidone (Risperdal) and clozapine (Clozaril)—off-label, meaning the U.S. Food and Drug Administration (FDA) has not approved the drugs for depression.
When not to quit antidepressants
Patients who want to stop taking antidepressants should do so gradually, with their doctor or psychologist's guidance. However, fear of suicidal tendencies and fear of addiction should not be factors.
News reports have linked antidepressant use to a higher risk of suicide, but the research actually shows the drugs may increase thoughts of suicide. No studies have linked the medications to the act itself. A far greater number of patients experience a decrease in thoughts of suicide. And only 1% to 4% of patients—children and adults—appear to be at risk. "Of the patients we see, 30% to 40% have already thought about suicide before they even get treatment," says Maurizio Fava, MD, professor of psychiatry at Harvard Medical School. Dr. Papakostas says numbers like these suggest that getting proper treatment for depression is far more likely to prevent suicide attempts than increase them.
For people concerned about becoming dependent on antidepressants, relax. According to Dr. Papakostas, abruptly stopping antidepressants can result in discontinuation symptoms (such as nausea, insomnia, and agitation) for a week or two, but most patients are able to ease off the drugs gradually without suffering from withdrawal.
