The reality is that medication is limited, and a person might need to try three different medications before they get better, according to Jonathan E. Alpert, M.D., Ph.D, the associate director of the Massachusetts General Hospital Depression Clinical and Research Program.
There are many reasons why the first treatment may not work. For instance, medications, such as steroids or hormones, can hinder the effectiveness of antidepressants. Even having a glass of wine can mess with your medicine. If you’re steeped in stress or having sleep problems, your depression might not lift, even if your medication is working.
Adherence is another big issue (“adherence” refers to how well a patient is sticking to the treatment plan agreed-upon). Some people forget to take their medication or stop taking it because of bothersome side effects (or even improvement). People struggling with moderate to severe depression may need to take additional medications and work with a therapist.
Individuals may be incorrectly diagnosed. Many illnesses mimic depression’s symptoms, such as hypothyroidism, which also causes fatigue and melancholy. Some people diagnosed with depression actually have bipolar disorder.
It’s incredibly frustrating and upsetting when your first treatment doesn’t work. But it’s important to be patient and stick with it.
“Depression treatment is not a one-size-fits-all approach,” according to Deborah Serani, PsyD, a clinical psychologist who specializes in depression. It can take time to find the best treatment for you. “[B]ut it will be worth it.”
Serani views recovery as a collaborative effort. “I like to huddle with the psychiatrist, the client, the family and other health professionals so we can make a game plan, so to speak, as to what will happen next and what to aim for.”
Below, Serani shared other strategies that can help:
- Be an active participant in your treatment.
“Speak up and often,” Serani said. “[Y]ou know yourself better than anyone.” And knowing yourself can help you figure out the type of therapy that works for you. For instance, if you need extra work to get things done, you might prefer cognitive-behavioral therapy. If you’re more of a deep thinker and need answers to your questions, you might prefer psychodynamic therapy, she said. If you’re taking medication, it’s also vital to inform your doctor about side effects and track your symptoms.
- Don’t hesitate to disagree with your treatment team.
“Some of the best moments in my clinical work are when a client tells me ‘I don’t think that’s really how I do things’ or ‘I don’t think you understand what I’m saying,’” said Serani, also author of two books on depression. “Being assertive or expressive can help therapy move forward in powerful ways.”
- Consider your treatment goals.
What do you want from treatment? A reduction in symptoms? Help in other areas of your life? “Asking yourself these big questions will help you gauge how therapy helps you,” she said.
- Understand that treatment takes time.
Antidepressants take about six to eight weeks to start working fully. With therapy, replacing deeply held negative beliefs and learning new coping skills requires more than several sessions. Serani expects to see a significant improvement in serious symptoms, such as suicidal thoughts, hopelessness and fatigue, within a month. “From there, it usually takes three to six months to begin shifting negative thinking into more positive belief systems.” If her clients haven’t profoundly improved at six months, she suggests exploring medication as well.
- Take time to reflect.
Living with depression is tough. “Be proud of the gains you’ve made and the strengths you’ve uncovered along the way,” Serani said. Practice self-compassion.
- Feed your senses.
“Depression depletes you, often creating a colorless, flat and bland world, literally and figuratively,” Serani said. Feeding your senses is a simple but powerful way to feel better. For instance, go outside and feel the sun against your skin and take in the fresh air, she said. “I do this all the time, and it truly helps me refuel and renew myself.”
When you find a treatment plan that works, stick with it. Serani, who struggled with depression for many years, understands firsthand how difficult this can be.
“There were many times I wanted to skip sessions with my therapist, or not refill my medication prescription. I felt better and didn’t think I needed to do ‘this whole therapy thing anymore.’”
“But in the long run, if you work your treatment plan, you really can find a way to live with depression without it completely over-running your life.”
For more information on what doctors do when the first depression treatment doesn’t work and what you can do, see this piece.