Why antidepressants don't work for everyone?
It is no secret that sometimes doctors have to try different medications in order to find the right medication or combination of medications until they find something that works. This can be especially true of psychiatric medications. There are few, if any, tests that can be run to determine what the patient might be deficient in or which medication is the most likely to be effective. When prescribing psychiatric medications, trial and error is the only way. And even when you do find a medication that is somewhat effective, it may not be as effective as is needed or it may lose effectiveness over time. Dr McMillen discusses this further.
Sometimes You Get the Wrong Medication or Dose
Because assigning a psychiatric medication is a process of trial and error, the doctor may not choose the right medication the first time. It can be a matter of just trying a different medication. Similarly, if the dosage is not right, the doctor may need to increase or decrease it. Finding the right medication and dosage can be a process.
Constantly Changing Medications Could Be a Problem
It has been suggested that constantly changing antidepressants can make patients worse by causing resistance to those antidepressants. While there have yet to be many studies on this theory, Dr. McMullen believes there may be some merit to this theory. Instead, he believes that if a medication shows some effectiveness, even if it is not as much as the doctor or patient would like, rather than switching antidepressants, Dr. McMullen suggests adding a second medication to improve its effectiveness.
Sometimes It Can Take a While
Sometimes it can take a while for a patient to show improvement after beginning a medication. Patients may need to be patient. Improvement might take as long as a year before showing any dramatic effects.
Sometimes a Patient Can Be Given the Wrong Diagnosis
You can not give a patient the right medication if you do not first give them the right diagnosis. Sometimes a patient does not get better because he or she has been given the wrong diagnosis. If a patient with ADHD or bipolar disorder is diagnosed with simple depression, the medication will likely not improve their symptoms. It may be necessary to investigate further before assigning a diagnosis and corresponding medications.
They May Be Deficient In a Particular Vitamin or Hormone
The signs and symptoms of mental illness can be the result of a deficiency in certain hormones or vitamins. A deficiency in certain B vitamins can produce the symptoms of depression. So, too, can problems with the thyroid which is influenced by certain hormones. Either can bring about depression-like symptoms. Antidepressants may not be effective if the patient requires a different chemical or nutrient. This is a time when a blood test might be helpful in determining the cause of depression-like symptoms.
There are many possible reasons why mental illness may seem treatment resistant. If your antidepressant is not working, talk to your doctor. There are tests he can run and other options he can try to treat your depression.
Dr. Robert McMullen is a psychiatrist who was trained at Georgetown Medical School and did his residency at Columbia Presbyterian Hospital. He currently practices in New York City. If you are in New York City and have further questions or are looking for a psychiatrist, you can contact Dr. McMullen's office at 212 362-9635.