When the First Treatment for Depression Doesn’t Work
What You Can Do
According to Alpert, you can enhance your treatment by participating in healthy habits, such as exercising, eating nutrient-rich foods and keeping a consistent sleep-wake cycle. (Here’s more on doing things when you’re depressed.)
However, it’s important not to set high expectations, create a long list or be critical. If patients can do one thing, Hyland said, it’s to practice mindfulness. “That’s one of the best things I can help patients do.” This doesn’t mean meditating (unless you’d like to). Simply practice being an observer, she said. Observe your thoughts and feelings without judgment. Be patient and compassionate with yourself.
Hyland also suggested getting more support. “A doctor is rarely enough.” This could be asking your friend to accompany you to a doctor’s appointment or attending a support group, she said.
If you have a hard time remembering to take your medication, incorporate it into your routine, Alpert said. For instance, “take your medication when you brush your teeth in the morning or at night.” Keep the medication in the same place on the bathroom counter, or use a pillbox, he said.
Hyland creates a treatment plan for all her patients. She recommended individuals do the same for themselves. For instance, on your plan, you might write that if your energy doesn’t increase in four weeks, you’ll make a follow-up appointment; if you start having suicidal thoughts, you’ll see your practitioner immediately; when you’re feeling upset, you’ll talk to your pastor. This way, when you’re having an especially tough time, you don’t have to rely on your brain to make a wise decision. It’s already been made for you.
It’s also important to remember that if a treatment doesn’t work it’s not your fault. According to Alpert, “people will think they’ve failed, aren’t a good patient or their depression can’t be treated. The reality is that our medications are limited. Antidepressants don’t work nearly as well as we wish they did.” A person may need to try three medications before finding the right one.
Communication is Key
The other key factor in making the most of your treatment is to communicate regularly with your providers. Many people view doctors as all-knowing authorities, and they’re afraid to speak up, ask questions or voice their concerns.
But you’re more likely to get the best treatment when you keep the communication lines open. Be honest with your prescribing physician, and ask questions. Both Alpert and Hyland suggested several critical questions to ask.
- What symptoms are we targeting with this medication? Knowing what symptoms the medication is supposed to improve will help you keep track of your progress, Hyland said.
- When can I expect to improve? Similarly, she suggested asking your doctor about the time frame.
- Should I keep a mood or sleep diary? This helps you keep track of your symptoms and stressors, spot patterns and gives you a better idea of whether the medication is working, Hyland said. “Many medications work really slowly.”
- What other habits do you suggest I work on? If I notice improvement, how can I build on that? Hyland always asks her patients to engage in one behavior – something they love or loved to do – to bolster the treatment. For instance, she might ask a patient to walk their dog for 10 minutes two or three times a week. If you’re just starting out, ask your practitioner, “What can I do that will give me the most bang for my buck?” she said.
- Can I see you in 2 to 4 weeks for 10 minutes? Many doctors, Hyland said, will schedule your next appointment in 6 to 8 weeks. But you need to check in and let the doctor know how you’re feeling and if you’re experiencing troublesome side effects.
- Am I taking an optimal dose of this antidepressant? It’s common to start a patient on a low dose. (It might be a fourth of the max dose, Alpert said.) So if your first treatment doesn’t work, you might need a higher dose. It’s important to know what dose you’re taking, whether it’s the maximum and what the plans are for increasing the dose, Alpert said.
- What can be done about my side effects? While side effects come with all medications, you can minimize them. This might mean adjusting the dose, switching medications, adding another medication or taking the medication at a different time, among other techniques. Again, this is why it’s crucial to be candid with your doctor.
- Do I need other tests? According to Alpert, physicians may order additional tests when the patient has the textbook definition of depression but hasn’t responded to the first or second treatment. Depending on the particular symptoms, they might check a person’s thyroid, blood sugar, calcium, vitamin B12 or D or folate levels; evaluate the person for anemia, or refer them for a sleep study, he said.
Also, if a particular medication has been helpful for a relative, mention it to your doctor, Hyland said. “A lot of times a medication that works for a family member will work for the patient.”
It takes time and effort to find an effective treatment. “Perseverance is key,” Alpert said. He acknowledged that it’s tough to have hope when you’re already depressed and pessimistic. “The reality is that our treatments don’t work well enough for the first [intervention] to be effective.” But, as the research shows, people who stick with treatment improve and can even fully recover.
Tartakovsky, M. (2013). When the First Treatment for Depression Doesn’t Work. Psych Central. Retrieved on October 8, 2015, from http://psychcentral.com/lib/when-the-first-treatment-for-depression-doesnt-work/