The Antidepressant Choice: Getting it Right

Although individual patient variability certainly plays a role in whether or not an antidepressant works, other issues are also at work here. For one, said Dr. Dunn, formulary and contract manager with SelectHealth, in Salt Lake City, Utah, doctors often don't use depression questionnaires to see if the depression drug treatment is working before giving up. They also don't give the antidepressant medication enough time to work. The STAR*D study, for instance, found it took, on average, about seven weeks of antidepressant medication for patients to reach full remission, with about 40 percent requiring eight or more weeks.^iv

Download copies of these depression and antidepressant self-monitoring charts and share the results with your doctor:

• Antidepressant Side-Effect Monitoring Chart
• Depression Symptoms Monitoring Chart

Second, patients often stop taking a drug once they start feeling better. Studies find that only 60 percent of people are still taking an antidepressant after three months; only 40 percent after six months. Yet clinical guidelines recommend continuing depression medication treatment after remission for at least six months, preferably 12. This is called depression maintenance treatment and studies find it can reduce the risk of relapse up to 70 percent.^vii

That's important because the ultimate goal of treatment is not just feeling better, or "responding" to the medication; but a complete cure, also called "remission." The reason? If you quit taking your antidepressant too soon, you're more likely to have a recurrence. In fact, studies show a relapse rate of 76 percent in people who quit treatment but still have some depressive symptoms compared to 25 percent of those who reach full remission. The danger here is that the more relapses you have, the more relapses you're likely to have.^viii,ix,x

When the First Depression Drug Doesn't Work

So if the first drug for depression doesn't work, what's a doctor to do? The first option is to increase the dosage, generally about four weeks after starting. Unfortunately, several studies find that doctors not only don't keep their patients on an antidepressant long enough, but also don't increase the dosages to levels shown to have the greatest benefit.^xi,xii,xiii

For example, say your doctor increased your dosage a couple of times and kept you on the antidepressant medication for seven or eight weeks. You're feeling better, but you're not in remission. Your doctor has several options:

• Add psychotherapy to the antidepressant
• Add another antidepressant
• Switch to a different antidepressant
• Add another medication, called "augmentation"