15 December 2008

'Antidepressants are not helping me'

You've taken the responsible step to tackle your depression head-on and to seek treatment. However, it's a few weeks down the line and you are still not feeling better.

You've taken the responsible step to tackle your depression head-on and to seek treatment. However, it's a few weeks down the line and you are still not feeling better. If you are tempted to throw in the towel and give up hope, consider the following first. There may be good reasons why you are not feeling better yet.

Incorrect dosage
There is no standard, correct dosage for all people. You and your doctor need to establish the right dosage for you. If your dosage is too low, you may not be getting the therapeutic benefit of the drug. If it is too high, you may be suffering from side effects unnecessarily which may tempt you to stop taking your medication altogether. In most cases, doctors start at a low dosage to give your body a chance to get used to the medication. The dosage should be increased gradually until the right therapeutic dosage is reached. In the early days, it may be useful to keep a "mood and side effect diary". This way you could track your progress and discuss it with your doctor.

Most antidepressants don't give instant results. Some may take two to four weeks before you feel better. Others can take up to six or eight weeks before you see results. Ask your doctor what you could expect from the medication he/she prescribed and at what point you should reconsider the type or dosage of medication. Hang in there!

Drug interactions
Many types of medication (including natural remedies) interfere with antidepressants – some could reduce the effect of your medication, others could even lead to toxicity. Make sure to tell your doctor what you are taking. Read what you need to tell your doctor.

Incorrect type of medication
There are many different kinds of antidepressants and you and your doctor need to find the right one for you. If you are not seeing any results, it does not mean that antidepressants are not for you. Your doctor may try a different kind of antidepressant or may add a different type to your existing medication. Have a look at our section on antidepressants for a break-down of the different options available.

Side effects getting to you?
Most medication has side effects and antidepressants are no exception. Side effects are common during the early days of treatment and usually disappear with time. One serious side effect to be on the lookout for is unexplained euphoric mood with increased energy and decreased need for sleep. It may be helpful to keep notes on whether there are any side effects, including when you have them and when you take your medication (time of day; before or after meals). In many cases, side effects can be avoided or minimised by taking them at a different time of the day or before or after meals. If you continue to battle with side effects, discuss this with your doctor. He or she may be able to change to dosage or prescribe a different antidepressant.

Incorrect diet
What you eat and drink can interfere with your medication. Ask your doctor if there are any foods that need to be avoided. MAO Inhibitors in particular can have serious interactions with certain foods. Alcohol should be taken in moderation. Some antidepressants can make you feel drowsy and alcohol will make matters worse. Alcohol could also slow the metabolism of some antidepressants.

Stopping prematurely or without supervision
You may be tempted to skip a dose or stop taking your medication altogether. Never stop treatment or lower the dosage without discussing it with your doctor, even if you feel better. It is also important to notify your doctor if there are any changes in body weight in order to assist with fine-tuning your dosage. Stopping prematurely may lead to a relapse or discontinuation symptoms.

Not taking medication regularly
It is vitally important to take your medication at the right time and not to skip a dose. If you find it difficult to remember to take your medication, think of ways in which you can be reminded to take your medication. Some people find it helpful to take it with a specific meal of the day and some keep their medication next to their toothbrush. You may also buy a pill box which will help you to keep track of what you have taken. Star charts may be helpful for children.

The most important thing is not to give up hope. If you work closely with your doctor, you will soon reap the benefits of treatment. – (Ilse Pauw, clinical psychologist at Health24, updated July 2008)

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Reviewed by Doctor Bennie Steyn, child psychiatrist in Stellenbosch (021 883 9799).


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