Medically Reviewed by Pat F. Bass III, MD, MPH
Getting the right depression medication is often a trial-and-error process.
A person about to begin taking depression medication more than likely won’t receive the right drug or dosage to treat all her symptoms the first time out. Figuring out which depression medication meets all the patient’s needs is an ongoing process, which involves trying various medications to see what works best. This investigation process can take weeks, months, or even years, says Melva Green, MD, a psychiatrist in Baltimore and former chair of the American Psychiatric Association’s Committee on Women. “It’s a real trial-and-error process. It’s ongoing.”
Depression Medication: Starting Your Treatment
To start you on an appropriate first medication, your physician or therapist will take a full medical history. There are many factors to consider when prescribing antidepressants, including:
- Overall health
- Current medications
- Use of alcohol or drugs
- Mental health history
At this stage, your doctor might decide depression medication would not be beneficial, and instead recommend that you seek counseling or make some other change in your life. “We rule out whether someone’s lifestyle may be contributing to their symptoms of depression,” says Dr. Green.
If depression medication is the path your doctor chooses for you, he will most likely first prescribe a selective serotonin reuptake inhibitor (SSRI). SSRIs generally are first-line drugs for depression because they are very effective and do not have as many side effects as some of the older depression drugs. They work by allowing serotonin to remain in the brain a little longer, which improves mood.
Depression Medication: Fine-Tuning Your Treatment
Doctors will watch to see how well the first prescribed drug works to tackle your symptoms. “By and large, we want to see some improvement within the first four to six weeks,” says Green. “If we don’t see anything improve, and we’ve been steadily increasing the dose, the general operating rule is to switch to a different SSRI or add something else to the SSRI.”
Additional medication your doctor might add to help antidepressants do their job includes:
- Non-SSRI antidepressants like bupropion (Wellbutrin) or mirtazapine (Remeron). These medications can bolster your first antidepressant’s efficacy by managing persistent depression symptoms.
- Mood stabilizers like lithium or valproate (Depacon), if you experience uncontrolled mood swings.
- Stimulants like methylphenidate (Ritalin), if the antidepressant causes sluggishness or sleepiness.
- Antipsychotic or anti-anxiety medication, depending on symptoms.
If you have no response to SSRIs, your doctor might have you try other types of antidepressants until you find something that works. Also, doctors will switch you to another medication if any side effects are harming your quality of life.
Once your doctor finds a medication or combination of drugs that work, he probably will increase the dosage to make sure that adequate levels of depression medication are in your bloodstream.
Depression Medication: The Importance of Staying on the Right Meds
All this drug-swapping can be frustrating for people who are trying to manage their depression. But you need to stick with it and keep taking your medication as directed. “In order for antidepressants to really work, they have to get up to and sustain a therapeutic level,” Green says. “That can’t happen if you aren’t diligent about your medications.”
If you do decide to stop taking antidepressants, talk with your doctor first so he can set up a program to wean you off the depression medication. Don’t go “cold turkey,” as that can result in a depression even deeper and more painful than what you were initially dealing with.
Keep in mind, too, that the process of tweaking depression medication most likely will never end. “The body is forever changing — we’re multidimensional beings. There are lots of things going on that you just can’t control for,” such as hormonal or metabolic changes, Green says. Instead, she notes, getting the right help for your depressionmeans having a partnership with your doctor and being able to make any necessary changes.