Where to Turn When Antidepressants Don’t Work

Antidepressants are somewhat of a mystery to many people, and it’s difficult for some to process whether they’re a good thing or a bad thing, with conflicting messages on both sides. Headlines and government bodies are writing reports that prescription drugs are addictive and can cause deaths, and antidepressants contain black box warning that a potential side-effect of the drug is suicide.

Meanwhile, countless reputable sources recommend speaking to your doctor about getting a prescription for an antidepressant, not only for depression, but for various other mental health problems including generalized anxiety and eating disorders.

It’s particularly confusing when you do begin taking antidepressants, and they don’t work the way they should. Depression is a very difficult disorder to live with and manage, and the feeling of still struggling with it despite the effort to seek out treatment can be unbelievably frustrating and invites feelings of hopelessness. But it’s important not to give up – there are alternatives and understanding how antidepressants work can give you an idea of why they might not be effective.


How Antidepressants Function

Antidepressants are prescription drugs that block the reuptake of serotonin in the brain, thus increasing the amount of serotonin in the spaces between brain cells. One hypothesis as to why this works is because the increased serotonin “makes up” for the general negativity and sadness associated with depression, because among its many functions, serotonin is a neurotransmitter involved in mood regulation and “happiness”.

Because selective serotonin reuptake inhibitors (SSRIs) do not involve the neurotransmitter dopamine, they are not as potentially addictive as many other prescription medications, which rely on chemicals that affect, among other things, the release of dopamine in the brain.

This means antidepressants are not addictive in the same sense as anti-anxiety medication (benzodiazepine) and painkillers (opioids) can be, but withdrawal symptoms are nonetheless common. Serotonin is a neurotransmitter responsible for more than just an uplifted mood, which generally means that some of the potential side-effects of these drugs are the effects of changing the way they brain processes this chemical. After a certain amount of time has passed, quitting antidepressants can lead to uncomfortable symptoms including nausea and weight gain, until the brain readjusts.

Outside of these side-effects, the biggest controversy when talking about antidepressants is its black box warning – since 2003, SSRIs have had to be prescribed with the warning that they may increase the risk of suicide. However, there are a few things wrong with that assessment. The report stated that teens younger than 19 could experience an increased risk of suicide through SSRI treatment, which was later adjusted to include teens under the age of 25. However, the introduction of this label led to a sharp increase in suicides in the United States, a 14% rise over a year – the highest since the CDC began collecting data on suicides.

Furthermore, some have argued that the method by which SSRIs were determined to increase suicide ideation are flawed, as the drug alone does not account for the entirety of any given patient’s treatment, and that too many other factors may drive a patient to take their life despite going through treatment.

Still, this doesn’t mean that antidepressants are a magic bullet. It also doesn’t mean that you’re somehow abnormal for not responding to them. Antidepressants do not always work.


Why They Might Not Work

Most people don’t respond well to their first antidepressant. And up to a third of patients don’t respond even after multiple drugs were tried. Antidepressants generally have the same function within a given class (SSRIs, SNRIs, Tricyclics, etc.), but they use different compounds and chemicals to achieve said function. Some drugs might decrease depressive thoughts but lead to sexual dysfunction, while others won’t work at all. If a person has undergone treatment and does not respond to several different antidepressants, they are struggling with what is sometimes called treatment-resistant depression. The exact parameters for what counts as a treatment-resistant depression differ from expert to expert. Some suggest a person has to try at least four medications, or two medications from at least two different classes.

Why might they not work? That’s not an easy question to answer. It depends entirely on each patient, and while certain factors are obvious – such as not giving the drugs enough time to clear out of the system and try another one, and then give that drug its time to take effect – it’s possible that some people’s brains simply do not respond to reuptake inhibitors of any kind, be they inhibitors for serotonin reuptake, dopamine reuptake, norepinephrine reuptake, or all of the above. Depression does not always occur for the same reason or with the same cause, and there are other causes (thyroid issues, menstrual problems) that SSRIs and other antidepressants simply cannot affect.

When all is said and done, antidepressants can help millions manage their symptoms for a variety of mental health problems – but they still come with risks, and they don’t work for everyone. However, that doesn’t mean there is no hope. There are other treatments.


TMS and Treatment-Resistant Depression

Of the various alternatives provided by doctors for patients who struggle with treatment-resistant depression, one that has only somewhat recently been used to begin treating depression is transcranial magnetic stimulation. While it sounds completely different and quite bizarre in comparison to talk therapy or pills, transcranial magnetic stimulation is a form of depression treatment that has shown great promise, especially in patients who do not respond to other forms of medication or treatment.

It’s a non-invasive and safe procedure, and simply involves lying back in a reclining medical chair while an apparatus is attached to the head, wherein a coil sends magnetic fields into the head, a few centimeters through the scalp. One treatment program takes several weeks, split into several meetings throughout the week, usually only for about half an hour per meeting. There are no lasting side-effects to the procedure, and patients are safe to drive and work immediately after.

Transcranial magnetic stimulation affects a very specific portion of the brain, mapped out in a preliminary session using a special device. The continuous application of magnetic fields affects the mood regulating center in the brain, usually to great effect. Most patients experience relief and remission of depressive symptoms after their sessions have fully concluded, especially if other forms of treatment seem non-effective.

It’s important to understand that whatever might happen throughout your treatment period, it takes time for these things to work. It can also take time for concrete changes to occur. This can be particularly frustrating, but patience is key. It does get easier over time, and even if you may still experience your fair share of bad days, going through with the treatment and sticking to it can help you increase your overall quality of life and enjoy living without the pain of depression being a constant in your life.


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