When Depression Medication Is Not Helping Enough: What Should You Discuss With Your Psychiatrist?

If your depression medication is not helping enough, what you need to do next is talk to your psychiatrist immediately, instead of quitting your medication. When you visit your online psychiatrist for depression, take notes on changes in your symptoms, any side effects you notice, how long you’ve been on the medication, and any related therapy. The psychiatrist may discuss dose adjustments, other treatment options, and related therapies, including treatment for treatment-resistant depression. 

You took the pills, you showed up for follow-up sessions, you practiced mindfulness techniques, but days after, you still feel flat, exhausted, anxious, and awkward. You might think that “this medicine is no longer working for me”, or “maybe there is something all wrong with me,” and then you quit the medicine and give up on the treatment.

This is not the solution, nor is your conclusion. You may experience partial relief from antidepressants, as it is very common; however, you simply need a dose and treatment adjustment rather than quitting altogether. In a recent study, only ⅓ of the patients remitted on their first antidepressant and needed additional follow-up for adjustments. This is why psychiatrists treat depression very carefully, as a series of carefully monitored steps rather than a simple one-time prescription.

In this blog, we will discuss what you need to tell your psychiatrist if your medication is not enough. We will also help you try to understand how online psychiatry might help you have an easier conversation.

Is It Really “Not Working”? Or Just Needs Modification?

First, you and your psychiatrist need to decide if the treatment is “not working yet” or “not working enough”. A typical antidepressant needs four to six weeks at a standard dose before it starts showing effects. Still, if you feel any of these below, you need to report them to your psychiatrist:

• You feel only a little better, and then you struggle again
• You are experiencing mood swings
• Sleep schedule, appetite, energy, and concentration levels are still low
• Side effects are more problematic than the benefits of the medicine
• You still have thoughts of hopelessness or quitting

IMPORTANT: If you are having thoughts of harming yourself or suicide, seek help right away. Call your local emergency number or the Suicide and Crisis Lifeline.

Do not stop, alter the dose, or cut off your medicine by yourself. Stopping the medicine abruptly can cause withdrawal-like symptoms or a remission of depression.

What Is Treatment-Resistant Depression?

Technically speaking, the term “treatment-resistant depression” is used when someone has no considerable improvement after trying at least two different antidepressant medicines. Each at a proper recommended dose for a recommended period. According to research, roughly 30 percent of patients with major depression experience treatment-resistant depression.

Now here is a reassuring thing. A term like this does not mean that you cannot get any better. It merely indicates that you may need a wider set of options. Another point is that people who seem to be “resistant” may have a fixable problem. It might be an undiagnosed condition or a dose that needs adjustment.

7 Things to Discuss With Your Psychiatrist

 1. Your Ongoing Symptoms

Honestly and openly tell your psychiatrist what is still wrong. Never say that you “feel okay”. Mention in detail your sleep, appetite, mood, anxiety, and irritability problems. Psychiatrists may use a short rating scale like PHQ-9 to track your progress. They assign you a number alongside your story to make assessment better.

2. How did you actually take the medicine?

This one may make you feel guilty or awkward, but be honest. Have you missed any doses? Did you stop the medicine all by yourself just because of side effects? Did you lower the dose yourself for months? A psychiatrist will surely need to know this, and don’t worry, they are not there to judge you. The more honest you are, the more helpful your session will be.

3. Side effects: all of them!

Even if you experience any side effects that you are embarrassed to discuss, you need to tell them to your psychiatrist. This means sexual issues, emotional numbness, weight gain, being sleepy at day time or any others. Instead of stopping the medication by yourself, discuss this early with your therapist. Often, a slight dose change or a different medication may solve the problem.

4. Medication History

Take notes on the medication you have already tried. Note down the dosage, the timings, and the symptoms experienced alongside. If you have used any over-the-counter medicines, list them too. This history will help assess the ongoing treatment and results and will inform the next steps to follow.

5. Other conditions which may look like depression

Sometimes, what might appear as a treatment-resistant depression might be something else. The conditions may point towards:

• Anxiety, ADHD, bipolar spectrum conditions
• Thyroid issues, Vitamin D deficiency, or Sleep apnea
• Alcohol or drug abuse
• Other medications which may impact mood

6. Lifestyle and therapeutic changes

Medication is sometimes just a part of a broader lifestyle and therapeutic changes. Evidence-based conversational therapy and cognitive behavioral therapies can make room for improvement for many people. Suggestions for regular physical activity, steady sleep, and social support groups may also help many individuals, although medication is still necessary.

7. What’s Next

Ask your psychiatrist directly. What is next, and how does he plan to move the treatment forward?

Treatment Options When Your First Medication Is Not Enough

There is no single correct path that works for everyone. Therapy and medication are tailored responses for individual needs. It all depends on your history, new symptoms, and preferences. That said, a psychiatrist might consider the following options.

1. Optimizing the dose or duration:

The first step is usually altering the dose or duration of the same medicine prescribed before.

2. Switching medication: 

Here, the psychiatrist may decide to switch the medicine within the same class or to a new one, depending on new symptoms.

3. Augmentation: 

This means adding a boost of another medicine in addition to the previous one. Some antipsychotics are prescribed at lower doses first. Each new medicine needs careful monitoring, so this is highly individualized.

4. Combining Antidepressants:

5. In some cases, two antidepressants with 2 different actions are prescribed together for a broader level of effects.

6. Psychotherapy: 

Conversation therapies or cognitive behavioral therapy (CBT) might be recommended for additional benefits and swift recovery.

7. Esketamine (Spravato). 

It is an FDA-approved nasal spray. It is especially prescribed for treatment-resistant depression, along with oral antidepressants. However, it is only prescribed under supervision at a certified treatment site like Cordial Psychiatry.

8. Neuromodulation: 

If, by chance, the medication is not enough and the symptoms persist, neuromodulation techniques are the resort. Transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) are techniques when medication is not enough. Consult your psychiatrist about these.

Frequently Asked Questions

How long should I wait before deciding my antidepressant is not working?

Most antidepressants take about four to six weeks at a moderate dose before starting to have an effect. If you still see no improvement afterwards, contact your psychiatrist.

Can an online psychiatrist prescribe depression treatment?

Yes. If he/she is a licensed and qualified online psychiatrist, he/she can evaluate, diagnose, and treat depression by prescribing antidepressants.

Is online psychiatry as effective as in-person care?

Yes. For many people with depression, studies have concluded that telepsychiatry has comparable outcomes with in-person care. However, the situation can vary for different people.

Should I stop my medication if it is not helping?

No. Stopping medication on your own can cause relapse or new symptoms. Always consult your virtual psychiatrist before making any changes.

The Bottom Line

If the medicine is not helping enough, it does not mean that there is no more solution to your problem. It simply means that your treatment plan needs some modification, or you might need additional therapy. Honest conversations about your symptoms, side effects, history, and treatment goals will help you and your psychiatrist devise an alternate strategy to help you out.

At Cordial Psychiatry, our approach to depression treatment is collaborative, evidence-based, and not rushed. If you need help, book a visit with an online psychiatrist for depression and take a step towards improving your mental health.