Is This as Good as It Gets?

How to Know If Your Antidepressant Is Working

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How should you feel while taking an antidepressant? I hear this question from many of my patients, whether they are just starting an antidepressant or have been taking one for some time. Many people struggle with the decision to take antidepressants; and, once they do, hope that they will have one of those dramatic, life-altering experiences shown in expertly-crafted, pharmaceutical-sponsored antidepressant advertisements seen online or on television.

You may even hear or read about someone that did have that kind of remarkable response. Others will share with you that either they didn’t get better or that the side effects outweighed the benefits.

Most peoples’ experience though is that the antidepressants help, but don’t magically transform you to some place of perpetual peace and tranquility. In other words, antidepressants are intended to make you “not depressed.” They are not happy pills. So how do you know if you are getting the most out of your medication?

We are now bombarded with new drug company advertisements telling us to ask your doctor to change you to their “better” antidepressant or add another medication to your current treatment to make it more effective. It is true that many people on antidepressants are not doing as well as they could. Research has shown that less than 50% of those under a doctor’s care for depression are getting adequate treatment.

On the other hand, being sad, anxious, or angry can be normal reactions to stressful life events. If something is happening in your life that is making you feel this way, antidepressants should not stop you from feeling those feelings. However, when your reaction is out of proportion to those life events, or you find yourself in bed with the sheets pulled over your head, that may be another story.

Here are some questions you can ask yourself to determine whether your antidepressant is working like it should:

  1. Am I overreacting emotionally to the events around me?

  2. Am I sad, angry, or anxious most the time, even without good reason?

  3. Am I sleeping, eating, and able to focus like I normally do when I’m feeling well?

  4. Are my energy, interest, and motivation levels normal for me?

  5. Am I withdrawing more from friends, family, and work obligations?

  6. I am turning to old, bad habits like drugs, alcohol, unhealthy eating, not exercising, or (fill in the blank).

When antidepressants are being developed, the standard for acceptable improvement is 50% or better. This is called response. Most antidepressants have about a 50-70% response rate. Remission, which occurs in less than one-third of people taking one antidepressant, means that virtually all your symptoms have resolved. In other words, expect some things to not go away completely with medication alone. And nearly all antidepressant research studies only look at the benefit of medicine alone, without other interventions.

So if you are still having symptoms, before assuming you need more of a medicine, a new medicine, or an additional medicine, try the following proven strategies to see if you feel better.

  1. Make sure you are eating healthy and getting physical activity. Just power walking in the neighborhood and eliminating fast food and sodas can make a huge difference.

  2. Cut out alcohol, drugs, and any other short-term “feel good” behaviors that you know are bad for you.

  3. Get enough sleep and recharge with healthy, fun activities or hobbies.

  4. Get into counseling if there are issues (past or present) that are affecting how you feel and react to people or events around you.

  5. Re-engage with family and friends.

  6. Find something meaningful to do, such as spiritual pursuits, volunteer work, or just helping out someone in need.

In some cases, however, even after taking these positive lifestyle steps, you may still feel some ongoing symptoms of depression. This could indicate any one of the following:

  1. The medicine dose is inadequate and may need to be raised

  2. The medicine you are taking may have lost its effectiveness (the phenomenon doctors call “poop out”)

  3. The medicine you are on may need a booster. It is becoming more common for doctors to add another mood medicine with your existing antidepressant to target other chemicals in the brain that could be preventing you from feeling better.

  4. There is another issue going on that could be making you feel worse, such as another medicine you are taking or other medical condition. Make sure your primary care doctor has recently checked you out thoroughly for other health issues.

The good news is that there are so many new options for antidepressant therapy, such as medications with more favorable side-effects profiles, different mechanism of actions that may work better for you, and new add-on therapies that can make your current medicine work better. Make sure you are seeing a doctor comfortable and knowledge about all the available depression therapies and be as forthright and honest as possible with him or her. Depression can be one of most easily treated medical conditions if your doctor has all the information he or she needs need to make the right decision to get you back on the road to recovery.


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Kessler RC, Berglund P, Demler O, et al. "The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R)." JAMA. 289 (203):3095–105.

Ruhé HG, Huyser J, Swinkels JA, Schene AH. "Switching Antidepressants After a First Selective Serotonin Reuptake Inhibitor in Major Depressive Disorder". The Journal of Clinical Psychiatry. 67.12 (2006): 1836–55.

Sinyor M, Schaffer A, Levitt A. "The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review". The Canadian Journal of Psychiatry. 55.3 (2010): 126–135.

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