Signs You May Need To Switch or Adjust Your Antidepressant To Get Better Results

If you and your healthcare provider are unsatisfied with the amount of improvement you've had while on an antidepressant, there are steps you can take to get a better response.

If you are taking antidepressants but still experiencing symptoms of depression, your healthcare provider can help you take steps to get a better response. It may take some trial and error, but adjusting the dose, adding a second medication, or switching to a new medication entirely are all possible solutions.

01 of 07

Aim for Remission

Psyciatrists talk about a "response" to an antidepressant, which means at least some improvement, and "remission," which means that the symptoms subside altogether or substantially.

For most people, remission is a realistic goal. If one antidepressant doesn't do the trick, your healthcare provider may consider the following options:

  • Increasing the dose of the antidepressant you're on
  • Continuing at the same dose and adding a second drug, either another antidepressant (combination therapy) or add another type of drug (augmentation therapy)
  • Switching, which involves gradually stopping the first drug and starting a second
  • Starting psychotherapy, if you're not already attending sessions
02 of 07

Tolerability, Time, and Improvement

"My hope for every patient is that major depression remits as soon as possible with few side effects," said George I. Papakostas, MD, an assistant professor of psychiatry at Harvard Medical School.

Papakostas listed three factors to consider when deciding whether discontinue a particular drug or to continue using it and add something else.

  • Tolerability: How severe are the side effects, and how much trouble are they causing?
  • Time: How long have you been on medication?
  • Degree of improvement: Have the depression symptoms improved in proportion to how long you've been on medication?
03 of 07

Reasons To Switch

If you've seen only a slight improvement in symptoms but the side effects are burdensome, your provider will switch you to something else altogether. They may also recommend a total switch if you're experiencing little or no improvement, even if side effects aren't a problem.

Dr. Papakostas said most psychiatrists agree that if an SSRI hasn't worked for you, switching to an atypical antidepressant—Wellbutrin (bupropion), Cymbalta (duloxetine), Remeron (mirtazapine), or Effexor (venlafaxine)—may be a good idea.

04 of 07

Reasons To Increase the Dose or Add an Additional Medication

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, said 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. Some of the medications providers may prescribe include Wellbutrin, lithium, thyroid hormone, or Provigil (modafinil).

05 of 07

Options for Boosting Effectiveness

Depending on a patient's exact diagnosis and tolerance for side effects, psychiatrists sometimes prescribe an atypical antipsychotic, a class of drugs used in bipolar disorder and schizophrenia that includes Zyprexa (olanzapine), Risperdal (risperidone), Clozaril (clozapine), and Seroquel (quetiapine).

Some evidence suggests that these drugs may boost the effectiveness of antidepressants, according to a 2013 study in PLoS Medicine. Some of the drugs in this category, such as Abilify (aripiprazole) and Seroquel XR (quetiapine), have been approved as add-on treatments for people already taking antidepressants, whereas Zyprexa (olanzapine) is approved specifically for use in combination with Prozac (fluoxetine), which can be taken in a combo pill called Symbyax.

Psyciatrists may prescribe other atypical antipsychotics—such as Risperdal and Clozaril—off-label, meaning the U.S. Food and Drug Administration (FDA) has not approved the drugs for depression.

06 of 07

Suicide Prevention Considerations

Patients who want to stop taking antidepressants should do so gradually, with their healthcare provider 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," said 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.

07 of 07

Addiction Considerations

Some people may be concerned about becoming dependent on antidepressants, but most people are able to discontinue them when needed without withdrawal symptoms. While abruptly stopping antidepressants can result in discontinuation symptoms (such as nausea, insomnia, and agitation) for a week or two, most patients are able to ease off the drugs gradually without suffering from withdrawal, said Dr. Papakostas.

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