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What Can You Do If Your Antidepressant Isn’t Helping?

by Dr. Sharon Orrange on October 24, 2017 at 1:39 pm

If you have depression that hasn’t responded to a single antidepressant, switching to another one or adding a second medication is your next step. New evidence is guiding what to do next if you aren’t much better after 6 – 12 weeks of treatment.

When your antidepressant isn’t working to improve or relieve your depressive symptoms, what’s your next step?

  • Don’t stop and switch. In adults with mild to moderate depression, augment (add to) your initial antidepressant with a second drug and/or psychotherapy rather than stopping and switching antidepressants. Adding a second med is where the benefit appears to be the strongest.
  • Don’t stop and try therapy alone. It is also recommended you add a second medication to your first medication instead of stopping meds altogether and trying therapy alone.
  • What’s the new info? In a recent study with 1500 patients with treatment-resistant depression, adding Abilify (aripiprazole) to their antidepressant led to more remission of symptoms than switching antidepressants. In this case, the original antidepressant was Wellbutrin (bupropion). It’s also important to know that most patients in this study were also receiving psychotherapy.
  • Which one should you add as a second medication? Ok, here’s where it gets fuzzy. For patients with treatment-resistant depression, there has been little comparative evidence to guide the choice for add-on therapy with a second medication. Basically, there isn’t yet good evidence to support one option over another.
  • Choices of second medications to add to your first antidepressant: Response (reduction of depression symptoms by 50 percent or more) or remission occurred more often with these 6 add-on medications, compared with placebo: Abilify (aripiprazole), lithium, Zyprexa (olanzapine), Seroquel (quetiapine), Risperdal (risperidone), or thyroid hormone (Cytomel, Synthroid, or levothyroxine). The benefits of each of these medications as a second choice were the same, so one has not been proven to be superior.
  • Downsides: Side effects are more common with two medications for depression instead of one: akathisia (crawling out of your skin feeling), sleepiness and weight gain were more commonly reported.
  • Take home message: Recent studies have shown that for patients who do not respond to a single antidepressant, add-on therapy may be modestly superior to switching antidepressants.

What has your experience been?

Dr O.

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