Depression is a really common mental health problem affecting about one in every six people at some stage in their lives. There are a variety of treatment options to help manage depression and medications often are prescribed. Here are some important things to know about antidepressant medication treatment:
1. If antidepressants are going to work, you should feel better fairly quickly.
It is now well established that most people who are going to respond to antidepressant medication will start to feel better within the first couple of weeks. On the other hand, you don’t need to try a medication for too long if it is not working, three to six weeks is enough. Some doctors will leave patients on medication for much longer than this, even when nothing has changed, but this is just really a waste of time: for most people you are better off moving on to try something else if an individual medication has not made a significant difference – at a therapeutic dose – by then.
2. Taking antidepressant medications is a process.
Antidepressant medications can work but many individuals need to try multiple drugs to find one that works, and there is a considerable portion of patients for whom medication just is not the answer. It has long been thought by psychiatrists that about two out of three patients will do well with medication, and one in three will struggle to get better. Recent research suggests that even after trying 3 or 4 medications, an even smaller proportion of patients than this, perhaps less than 40%, may be fully recovered.
3. Antidepressant medication is one step and should never be the only step.
If you do get better with medication, patients need to plan carefully and proactively, with everyone helping them, what they’re going to do to maintain their mental health in the long term. Evidence suggests that antidepressant medication reduces the likelihood of depression returning in the 12 months after it has been started, but there is really very limited research exploring its effects in the longer term. There are clearly types of psychological treatment, such as mindfulness based cognitive behavioural therapy, that can reduce the likelihood of depression coming back, and these should be considered as part of a broad preventative strategy.
4. Antidepressant medication can be challenging to start, and to stop.
All antidepressant medications have side effects and a significant proportion of people will just not tolerate each individual drug. Notably, the most commonly prescribed antidepressants, the selective serotonin reuptake inhibitors (SSRIs), have a number of significant side effects – such as nausea and dizziness – that are prominent when someone first starts taking them, but can lessen over time if you persist. These drugs can also bring on or worsen thoughts of suicide, especially in young people, early in treatment. SSRIs, and some other antidepressants, can also produce a ‘discontinuation syndrome’: a series of nasty symptoms in some people when being stopped.
5. Although medications can help some people, it is important to remember that there are other treatment options to help those with depression.
Many patients will benefit from forms of psychological treatment such as cognitive behavioural therapy and there are an increasing range of other more biomedical treatments that have been shown to be effective in depression such as transcranial magnetic stimulation (TMS). Although not considered traditional antidepressants, there are also a series of new medication based therapies that may be helpful such as the use of the drug ketamine, which can produce antidepressant effects quite quickly.
Paul Fitzgerald, PhD, MBBS is Director of the School of Medicine and Psychology and a Professor of Psychiatry at the Australian National University in Canberra, Australia. He completed his Medical Degree at Monash University followed by a Masters of Psychological Medicine and professional training in Psychiatry leading to membership of the Royal Australian and New Zealand College of Psychiatrists. After a fellowship at the University of Toronto, he completed a research PhD in Psychiatry. Paul has conducted extensive research developing new treatments for depression and other conditions while continuing to practice as a psychiatrist and has established multiple clinical services in the provision of new treatment methods. He is the author of Curing Stubborn Depression: Emerging & Breakthrough Therapies for Treatment-Resistant Depression.
