Should I give up on antidepressants?
April 23, 2011 7:06 PM   Subscribe

Do antidepressants just not work for some people?

I've been suffering from depression for years, but it has gotten much worse over the past year due to some pretty serious losses (death of someone close to me, and unemployment). I have tried many SSRIs over the course of the past year and nothing has made any improvement in the depression. My psychiatrist finally put me on Imipramine 4 weeks ago, stating that this is often a drug that works for treatment-resistant depression. It hasn't worked, but yesterday when I saw him he said that my dosage of 125mg was not a therapeutic dose and to up it to 200mg for the next several weeks before giving up on it. His next suggestion is to try Adderall or Ritalin (which sounds strange to me, but he claims this sometimes works for depression), and given that I haven't responded to anything else, it may work.

I am not suicidal, but I have lost hope that any drug will work for me. Lifestyle changes have been difficult because I find it so hard to function, let alone take care of myself better. Does anyone have any experience similar to mine? The kind where nothing was working and suddenly a drug kicked in and allowed you to at least start making some positive improvements in your life? Help!
posted by anonymous to Health & Fitness (27 answers total) 7 users marked this as a favorite
Have you ever tried Wellbutrin? (buproprion) It's not an SSRI and gets some people going when SSRIs don't.

I think the answer to your question is that an enormous percentage of people don't respond well to SSRIs.

(I'm not a medical doctor etc.)

Are you in psychotherapy as you are taking these drugs? You know that's highly recommended. (I am not your therapist, still not a medical doctor, etc.)
posted by DMelanogaster at 7:20 PM on April 23, 2011 [2 favorites]

To the overall question, yes. Treatment-resistant depression is, according to Wikipedia, at least, "a term used in clinical psychiatry to describe cases of major depressive disorder that do not respond to adequate courses of at least two antidepressants." I've come across this term many times when reading about "off label" uses of various other pharmaceuticals (I seem to recall modafinil has been effectively against treatment-resistant depression for some people, for example).
posted by wackybrit at 7:26 PM on April 23, 2011

a person i'm close to didn't respond to medicine and so he gets "zapped" once a week, as he likes to phrase it, which is shock therapy treatment. its been several months that he has been on this treatment. its is not at all pleasant for him, and i think its a last resort kind of thing. i've heard welbutrin works miracles for some, and is hard to take for others but you may want to try that. i also want to add that for the person i know who is receiving shock therapy, we (his family) have seen no improvement unfortunately. the best i had ever seen him was when he was exercising routinely - running like 30 miles a week - which i wish he'd go back to doing. moderate to lots of exercise may help, if that is an option for you.
posted by dmbfan93 at 7:36 PM on April 23, 2011

Are you habitually drinking, smoking pot, or anything else? Because it will counter act SSRIs.
posted by thylacine at 7:46 PM on April 23, 2011

It would be best if you combined your medication with talk therapy and exercise. Drugs alone are seldom wholly effective. You also need other changes.
posted by five fresh fish at 7:47 PM on April 23, 2011 [1 favorite]

They didn't work for me. What did work was removing toxic people from my life. It took the right therapist and a couple years of difficult discussions to get there.

Most of the drugs that I took are no longer in use, so I can only comment on Wellbutrin. Within two days, I couldn't sleep. So Ambien was prescribed and I started sleepwalking.
posted by Mr. Yuck at 7:49 PM on April 23, 2011 [1 favorite]

I have heard of adderall/ritalin being used to kick-start someone out of a depression -- partially on the thought process that exercise helps but if you're depressed then you are too tired and sad to exercise, so the adderall will give you the energy to get started . . .
I like the fact that your doc didn't jump to it early, but does know enough or is able to think out of the box enough to try it.

Also, I think 4 weeks is awfully early to judge an antidepressant.

And I've learned from my own recent experiences that being depressive and getting depressed is a whole different monster from being depressive and having a bunch of bad things actually happen to you. Suffering the loss of a loved one and unemployment are pretty depressing things in their own right, and you started behind the curve. A 'happy' person would take a good 6-9 months to recover from either of them, y'know? But both? That's really hard.

It generally takes average of three different meds before they find the one that works for a particular person's depression. Sometimes it's a mix of 2 or 3 meds.

Lastly, the people over at are really knowledgeable and very kind -- you should check with them, too.
posted by MeiraV at 7:50 PM on April 23, 2011

Just based on the experiences of several close friends, my anecdata is that psychiatric drugs in general only seem to work on about 30% of the people, but it's a different 30% for each drug. So it seems to be quite common to have to try several different ones before finding one that works, and then maybe trying quite a few more (or various combinations of drugs) to end up with a set of side effects you can accept.
posted by FishBike at 7:54 PM on April 23, 2011

In short, kinda, more or less. I'm hesitant to recommend any drugs - as you know by now, everybody reacts differently - but I know folks where it's taken eighteen months or more to ramp up and down and figure out an effective regimen of what to take.

And seconding crazymeds, who are excellent.
posted by The Bridge on the River Kai Ryssdal at 7:57 PM on April 23, 2011

Every individual has an individual experience. For me, several meds did not work and then years later a new med did (together with other life improvements). I don't know if this new cocktail will work for you, but I hope you are able to find a way to live and love with your depression/condition.
posted by ClaudiaCenter at 7:57 PM on April 23, 2011


In the last 20 years, I've tried... *counts* about 15 drugs for depression/anxiety. None of them really helped in any significant way, so I'd just come to accept that I was resistant to antidepressants. I'm also like the person mentioned above who seemed to improve a bit with a lot of running (30 to 40 miles per week), but I kept getting injured and couldn't keep that up.

Then this January, in a frustrated last-ditch attempt to feel better, I asked my doctor for Effexor. In short, it's changed my life. It is not hyperbole for me to say that I feel better about every aspect of my life now. I'm terrified that it will stop working because it really feels miraculous.

So yes, there are others out there like you. And there is hope.
posted by hollisimo at 8:51 PM on April 23, 2011 [1 favorite]

Nthing Mr. Yuck.
posted by jbenben at 9:12 PM on April 23, 2011

Are you habitually drinking, smoking pot, or anything else? Because it will counter act SSRIs.

This x 1000

You don't really give much information, so all we can do is shoot in the dark.

Have you tried lamictal?
posted by TheBones at 10:18 PM on April 23, 2011

One other possible reason could be bipolar disorder. On a down swing, it appears and functions very much like depression. Treatment for bipolar involves entirely different medicines and behavior alterations.

thylacine also brings up a great point. Alcohol, marijuana, even tobacco or caffeine can hinder treatment. I would mention both of these things. Your psychiatrist will definitely be the one to decide, but the more information you can provide, the more informed their decision will be.
posted by Saydur at 10:22 PM on April 23, 2011 [1 favorite]

I have to say that if Effexor isn't one you have tried, you might want to give it a shot. I wouldn't have believed any meds could help my mom and her various mood problems (depression, anxiety, etc). She was on antidepressants (regular SSRIs), antipsychotics, Lithium, anti-anxiety meds, various cocktails and mixtures of all of the above, and nothing really improved. Then the doctor gave her Effexor and it actually *works* (for her, that is, your story might be different, but since hollisimo mentioned Effexor as well I though I'd chime in).
posted by rainygrl716 at 10:29 PM on April 23, 2011

Also, if there is a possibility of bipolar then adderall/ritalin and welbutrin can trigger hypomanic episodes. I am not saying that you have bipolar, or even hinting it, but this is just more stuff for you to consider.
posted by TheBones at 10:29 PM on April 23, 2011

Occasionally, they stop working, as well. As someone who is been on a number of ssris and other pills, and had the side effects be too difficult, or had them lose effectiveness, or just never work, its quite common.

The pysch I consulted about possible ECT said about 25 per cent.
posted by PinkMoose at 10:48 PM on April 23, 2011

Regarding antidepressants, over the years I've been on SSRIs, an SNRI, and Wellbutrin, taking them both alone, and in various combinations. Some have not worked. Some have worked like gangbusters, but stopped working over time (Wellbutrin, I'm looking at you).

That said, MeiraV's comment is really worth noting: Mourning and depression are related, but in my experience, they're not entirely the same. You may need to take time to be sad, and sort through your thoughts and feelings. Antidepressants can take the edge off, but at the risk of sounding grossly touchy-feely, grieving is a healthy and normal process. I put it off for a long time, and I kind of wish I hadn't. It was taxing and intense—hello, random-ass crying jags!—but ultimately, it enabled me to feel some sense of closure.

Unemployment probably doesn't help. In addition to strained finances and the stress of looking for a job, you're probably alone with your own thoughts for most of the day. The sort-of-good news is that unemployment causes absolutely normal, not-depressed people to feel stressed and stir-crazy. Is there somewhere you can go during the day, so you're not trapped at home? Do you have any friends who are free during business hours? I find that spending time with someone makes a huge difference. In addition to giving the day some structure, and getting me out of the house (Exercise! Sunlight!), the simple act of hanging out with friends makes a big difference.

tl;dr: Some antidepressants work for some people, sometimes. But it sounds you're going through a lot, including things that throw non-depressive people for a loop. It could be a matter of finding the right medicine, but behavioral strategies might be just as, or more, important right now.
posted by evidenceofabsence at 12:17 AM on April 24, 2011

Do antidepressants just not work for some people?

You bet--they didn't work for me. Over the years I tried various combinations of various SSRIs, Effexor, Wellbutrin, and even Provigil. I also tried several different therapists and psychiatrists. None of it ever helped me at all. I really wish providers would be more upfront about this, because it is tremendously frustrating to someone who already feels awful to keep hearing that you will get better when you don't.

Realistically I suppose we shouldn't expect that everyone should be able to be cured of depression any more than everyone should be able to be cured of any other disease, but you'd never know it given that the overriding message seems to be that if you do all the right things--take your pills, see your therapist, go to your psychiatrist, exercise--you'll improve. Providers owe it to patients to give statistics in advance about what percent of people actually get relief from antidepressants so that patients don't feel betrayed if they don't work.
posted by Violet Hour at 1:39 AM on April 24, 2011 [1 favorite]

Yes. Yes. Yes.

The only thing that finally kicked the butt of my treatment resistant depression (complicated by PTSD) was a combo of a couple ADs, a mood stabilizer, a benzo, an antipsychotic and a thyroid drug (even though my thyroid function was fine).

After years off, I've had to go back on. I'm on Lexapro, 3 tricyclics and a benzo. It's helping some. I hate being on the med-go-round. But I can see a small difference. I see my p-doc again tomorrow (I see him weekly, FWIW) and we'll evaluate where I am.
posted by kathrynm at 3:45 AM on April 24, 2011

Four weeks isn't a long time to judge an anti-depressant. But really, you haven't tried a whole lot of anti-depressants - you've tried a lot of different 'flavours' of similar anti-depressants. Imipramine is a very different one, and you should both give it time to work and know that there are other types of anti-depressants out there.
posted by Coobeastie at 5:06 AM on April 24, 2011

There can also be a difference in effectiveness between the brand and the generics. Wellbutrin/buproprion, in my personal experience, is certainly guilty of this, depending on the manufacturer.
posted by Thorzdad at 7:19 AM on April 24, 2011


I have faced the same problem and have been doing a lot of research into the neurobiological forces (as well as social and environmental and lifestyle) forces that go into despressive symptomology.

A lot of REALLY cool research is being done, but we still need light years more. Have you got your liver enzymes checked? If you're being put on a lot of different meds, your doctor should be requiring this periodically. I would request a copy of those results and discuss them with a doctor who understands liver issues and also a nutritionist. Another thing you can do is get your neurotransmitters assessed.

This isn't fool proof, but it seems to work fairly well and they use it in a lot of experiments I've been looking at. Some people really do have low seratonin and some people have depressive symptoms that don't have anything to do with serotonin. For examply, my serotonin levels were fine.

Which would mean that SSRIs would likely not do a darn thing for you other than cause side affects and make your liver toxic. Liver toxicity can cause fatigue and affect a host of other molecular processes in your body since the liver is responsible for producing a lot of necessary enzymes in the body.

I compleely understand where you're coming from with how to make lifestyle changes happen with a ravaged system that is completely burnt out. If you'd like to memail me I can "talk" your ear off some more about it. : )
posted by xarnop at 9:12 AM on April 24, 2011 [1 favorite]

According to what I've read in this thread, I was/am absolutely treatment resistant. I really don't know how many different anti-depressants I shoved into my head and got nothing except side effects. Oh, goodie. And as noted upthread, a person with this manic depressive illness (also known, rather inaccurately, as bipolar disorder, inaccurately because it's not so much just two poles involved but rather a spectrum) a person with this manic depressive thing going on is looking at a different treatment than a person who is "only" depressed. (Only. Ha ha. Ha ha ha ha, he laughed, bitterly.) Anyways, I've got this manic depression thing going on, which complicated it some, but still, I know whereof you speak.

So I didn't respond to any of them and then one day I put on of them into my mouth and, amazingly, it began to work. And it began to work fast, for me, faster than they mostly do, fast as in I knew within two days or three that I'd gotten something I'd never before gotten from any of them -- help.
I intentionally didn't tell you what worked for me -- you've got to find the one that works for you and don't need to think my solution is your solution, my pill bottle the same as your pill bottle. Maybe so but maybe not; even identical twins respond differently to this stuff.

I have a friend who describes it as though the background music in his life changed. I've heard others say that the air was clearer, sounds sounded better. Myself, even my arm feels better after I scratch it when it itches, feels better than it would have before putting this stuff in my mouth, plus I'm happier as I scratch, too, it's more a sense of festive scratching somehow, I'll sometimes croon happily as I scratch...

Okay, so that last is a bunch of bull, but you maybe see what I'm saying here. I found one that works for me. After all those years (yeah, years -- hate to say it here but it's the truth) after all that time, finally I'd hit the jackpot.

I said all that to say this -- don't give up. Don't quit seeking medicinal armistice with this son-of-a-bitching illness. Yeah, it's true (probably) that there are some people who just can't be helped by these amazing docs and their amazing scrip pads but plz don't think you're one of them. There is a huge palette of medications and treatments to choose/mix/match and it sound like you've a good shrink, time is on your side, keep on plugging at it. It's so worth it, the payoff is huge if/when you do find the right pill bottle in your hand.

Last. I'm not trying to build hope where there is none -- it has been pointed out upthread that there really are some who can't be helped, and that is always a good thing to know -- you're not the only one, should this be what happens to you. What I'm saying though is that most of us can get help, that I truly do believe. And by most I mean considerably more than 51 percent.

Keep on hammering at it.

Good luck.
posted by dancestoblue at 9:34 AM on April 24, 2011

There are a whole raft of antidepressants out there, but yes, there is a certain percentage of the populace who are resistant to medication. There are alternative treatments, although they do fall into the rather extreme category and really, from what I can find online, should be used only with pretty severe depression. Electroconvulsive therapy (shock treatment) and transcranial magnetic stimulation are alternatives, although not without controversy (apparently the effectiveness of TMS isn't established for patients who have not responded to multiple antidepressants, although I'm going off of the wikipedia article for that). I'd look into exercise routines and other antidepressants before considering something as extreme as messing with the electric or magnetic fields in your brain.

so: extreme alternatives do exist, but probably not worth it unless your depression is incredibly severe. However, it is worth knowing about.
posted by Hactar at 9:34 AM on April 24, 2011

Might be worth consulting with a psychopharmacologist in addition to your psychiatrist (and letting your psychiatrist know about this, of course) These doctors specialize in treating depression with medication, and often have more knowledge than your run-of-the-mill psychiatrist. This was true for me. My psychopharmacologist got me on Wellbutrin SR, which has worked for me for over a decade. DON'T GIVE UP. THERE WILL BE A COMBINATION OF MEDICATIONS OR TREATMENTS THAT WILL HELP YOU.
posted by dudeman at 9:39 AM on April 24, 2011


My own experience: after the sixth or seventh go-round with meds, I accepted that the pharmacological approach just wasn't for me. For me, what worked (anecdote, not data) was meditation. Your Life Solution May Vary. Best of luck.
posted by SPrintF at 3:43 PM on April 24, 2011 [1 favorite]

« Older The Most Toast   |   Gift for MPH Grad Newer »
This thread is closed to new comments.