Giving Antidepressants a Chance

Medical Reviewer

I rarely spend much time in support of antidepressants. I know they have a place in the effective treatment of major depression and I know many people feel they help with less severe forms of depression, although the reasons for this may be complex and there are just as effective, or better, alternatives. But, I think if you've engaged in an informed discussion with your doctor and you've reached a decision that antidepressants are worth a shot, then there's a case to be made for giving them a chance to work.

In their defense, most family doctors have a limited palate of treatment options when it comes to depression. Putting to one side the person who simply churns out a prescription and leaves you to it, there are plenty who don't. They are however dealing with a disease process that isn't fully understood and using tools, usually in the form of drugs that may or may not help. These same drugs can't change the social circumstances or stressors that may contribute to the depression and they aren't designed to make people happier. I say this because I believe some people set very high expectations from antidepressants that simply won't be met.

Relief from symptoms, or at least the worst of them, is not an unreasonable thing to ask from something claiming to do just that. There is however a trade off. If you want to find out whether antidepressants work for you, then there are things you must be prepared to do, for example:

Give Them Time: When you introduce an antidepressant into your system one of the first things you may notice is that you feel worse. It seems counter-intuitive, but the claimed beneficial effects of antidepressants may take as long as six weeks. Side effects are worse to start with and they then tend to subside. If however you can't get on with your antidepressant don't just stop. Go back, report your symptoms, and ask about alternatives. You may be offered a different drug, or the dosage may be altered.

The Dosage: Your first prescription is really a shot in the dark. There's no blood test or scan that can tell your doctor what drug or dosage might be best for you. They will usually begin with a recommended starter dose, which is often fairly modest. Once you've got past the side effects (everyone's experiences are different) you may still find you feel no or very little improvement. When you go back to your doctor and report this, he or she won't be surprised, and that's because around 50 percent of people who tolerate an antidepressant need a boost in the dose a few weeks into treatment.

Staying The Course: Once you've committed to antidepressants you must stay the course. You mustn't stop abruptly or the potential for withdrawal symptoms and 'mood crash' is increased. The minimum period for antidepressant use is six months. This is a long time, and keep in mind it's the minimum. You also shouldn't stop based on the fact you are feeling better. The worst-case scenario is that you'll join the 60 percent of people who relapse because they've used the same indicator. Basically, the longer you stay the course the better your odds of avoiding a relapse. So at three months your relapse odds improve to around 35 percent, at six months 15 percent and at a year 10 percent.