Finding the best depression treatment for you can seem like a series of scientific experiments with no positive results.
Even after trying my first antidepressant for two months, I still feel exhausted, “brain foggy,” hopeless, and restless. Therefore, medical experts suggest switching to another option. This still does not resolve the symptoms sufficiently, so the treatment plan is changed again.
“Different people respond to different drugs and treatments. No one knows why one treatment works for one person but not another,” says the Mayo Clinic. says Simon Kuhn, MD, associate professor of psychiatry in the College of Medical Sciences.
This process of trial and error can take many months to find the depression treatment, or combination of treatments, that works for you. To reduce frustration while waiting, it helps to know what to expect.
Antidepressants: What happens in the first month?
During the first few days of taking a new depression medication, you may notice side effects such as nausea, headache, dry mouth, insomnia, and loose stools. According to Dr. Kuhn, most, if not all, of these problems may go away on their own as the body adapts to the medication.
If severe side effects persist after a few days, contact your health care professional. Together, you may decide to continue a lower dose of the drug for a longer period of time to give your body more time to get used to it.
When taking full doses of antidepressants, it can take several weeks or more for the brain to respond to the medication. You may see some improvement in your symptoms within the first month, and the full effect may be felt by the end of the second month.
Time to try a new antidepressant
If side effects persist or symptoms of depression do not go away within 2 months, your health care professional may recommend adjusting your medication.
If side effects are not a problem, but antidepressants are not working as well, taking a higher dose of the drug than normally prescribed may help. If that doesn’t work, your health care professional may suggest switching to a different antidepressant.
“There are many different types of medications, and it’s always worth trying different medications,” says Dr. Kuhn. “Continue taking each drug at the appropriate dosage for at least two months. Be careful not to give up on new drugs too soon.”
Standard medical classes include:
Selective serotonin reuptake inhibitors (SSRIs): These drugs treat depression by increasing the levels of serotonin in the brain. Examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs): These antidepressants relieve depression by increasing serotonin and norepinephrine in the brain. Examples include venlafaxine (Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and levomilnacipran (Fetzima).
Atypical antidepressants. These antidepressants are called atypical because they do not fit neatly into the category of other antidepressants. Examples include bupropion (Forfivo XL, Wellbutrin SR), mirtazapine (Remeron), vilazodone (Viibryd), and vortioxetine (Trintellix).
read more: Antidepressants: choose the right one for you.
Your health care professional may recommend that you try a second drug in the same class first. For example, if escitalopram doesn’t work, you may want to try sertraline next.
Or your health care provider may suggest switching you to a medication that affects your brain differently. For example, instead of trying yet another SSRI, you might switch to an SNRI or an atypical antidepressant.
To switch, gradually reduce the dose of your current medication. Once you stop taking the first medication, you can start taking the new medication and gradually increase the dose.
This slow transition from one drug to another often takes two to three months. Talk to your health care professional or therapist about managing your symptoms of depression while your new antidepressant takes effect.
When to add a booster drug
If you’ve tried two or three antidepressants without success, it may be time to consider combination therapy, says Dr. Kuhn. This may involve combining two antidepressants, or an antidepressant and another drug not typically used to treat depression, such as an antipsychotic.
Add a second antidepressant
Combining two different classes of antidepressants may be able to affect a wide range of brain chemicals associated with mood. For example, your health care professional may recommend a combination of an SSRI, such as fluoxetine, and an atypical antidepressant, such as bupropion.
add other drugs
Some drugs are thought to enhance or potentiate the effects of antidepressants. These include antipsychotics, mood stabilizers, and the thyroid hormone liothyronine (Cytomel).
When to try other depression treatments
For some people, the search for an effective antidepressant can take months or even years.
“That’s why we have so many frustrated patients,” says Dr. Kuhn.
However, some treatments may reduce your wait time.
If several medications have failed to bring your depression into remission, Dr. Kuhn recommends talking to a medical professional about whether the following options make sense for you.
Ketamine
Intravenous (IV) ketamine is an FDA-approved anesthetic for surgical and medical procedures. In recent years, ketamine has been increasingly used off-label as an antidepressant for treatment-resistant depression (TRD). It is thought to work by increasing glutamate in the brain. “Like serotonin, the glutamate system is another important set of brain chemicals involved in depression,” says Dr. Kuhn. This treatment may also help create more connections, also called synapses, between brain cells.
A typical treatment takes 1.5 to 2 hours, including preparation time, injection, and post-injection recovery.
“People can feel confused during the IV,” says Dr. Kuhn. “They may have some dissociation and see color.”
About 60% of people experience immediate relief of symptoms within 1 to 2 days. The drug’s effects wear off, so it must be repeated every few weeks.
Transcranial magnetic stimulation (TMS)
This procedure uses a magnetic field to stimulate nerve cells in the brain. During the session, a medical professional applies an electromagnetic coil to your scalp. This coil sends out magnetic pulses that are thought to change areas of the brain associated with depression.
People receiving TMS receive five treatments each week for four to six weeks. The duration of each treatment varies depending on the machine, but ranges from 3.5 to 37 minutes. Similar to ketamine, these treatments make about 60% of people feel better, and symptoms usually decrease after a few weeks.
Electroconvulsive therapy (ECT)
This procedure, performed under general anesthesia, uses electricity to induce a generalized seizure. It causes chemical changes in the brain and can quickly improve symptoms of depression. Used in patients with severe TRD.
Much of the stigma against ECT is based on the initial treatment, in which high doses of electricity are administered without anesthesia, causing memory loss and other serious side effects. ECT is now performed using lower doses and advanced anesthesia techniques, making it safer.
ECT treatment is usually given two to three times a week for three to four weeks. Many people see improvement within six treatments.
read more: What happens during electroconvulsive therapy.
For best results, combine medication with lifestyle changes
If you’ve tried many medications and treatments over the years to no avail, the problem may not be entirely due to your brain chemicals. Instead, larger behavioral or environmental factors may be present.
Consider the following:
- Follow your therapist’s advice consistently.
- Get enough sleep, exercise regularly, manage stress, participate in social activities, and eat a balanced diet.
- Avoid alcohol, marijuana, and other drugs.
It also addresses toxic relationships, work stress, or other situations that may contribute to depression.
The search for effective treatments can take time, but know that there are many treatments for depression. With time, effort, and patience, you may be able to find a treatment that works for you.
