Signs Your Antidepressant Isn't Working

Antidepressants are a type of medication prescribed to treat depression, as well as certain other health issues such as anxiety, insomnia, and chronic pain.

While antidepressants can’t cure these conditions, they can help reduce your symptoms. These medications work by improving the balance of chemicals, known as neurotransmitters, in the brain.

In fact, a 2016 study notes that up to two-thirds of people who have depression don’t respond to the first antidepressant drug they are prescribed, and need to change their medication before they see results.

Furthermore, approximately one-third of people with depression who have been taking a particular antidepressant medication for a long period of time may start to experience symptoms again, either because the medication stops working for them or because they have a new episode of depression that’s not responding to the medication. This antidepressant tolerance is known as tachyphylaxis.

This article explores some signs that can indicate your antidepressant isn’t working, reasons why this can happen, and what steps you can take if this happens to you.

Reasons Why Your Antidepressant May Not Work

These are some of the reasons why your antidepressant medication may not work, according to Jeffrey Zabinski, MD, a psychiatrist at Columbia University Medical Center:

• You might need a higher dose: Your psychiatrist may start you at a low dose with a plan to increase from there, which can help avoid side effects. The dosage of some medications can be increased quickly whereas with others it needs to be more gradual, so it’s important to consult your psychiatrist and work together to determine the appropriate dosage for you.
• You might need to be on a different kind of medication: There are many types of antidepressants that work in different ways. The right medication for one person is not necessarily right for someone else. Finding the right one does not always happen on the first try. However, the good thing is there are lots of options, so you should eventually be able to find the right one for you.
• You might not have taken it long enough yet: One important thing to remember is that antidepressants can take weeks or even months to get to their full effect, so it may be that more time is required before you start to feel an improvement.
• You might have a medication interaction: Some medications can interact with each other and either cause side effects or prevent each other from working effectively. It is always important to make sure your psychiatrist has an updated list of all the medications you are taking, because it may help you and your psychiatrist select a different medication with fewer interactions from the start.
• You might have missed doses of your medication: It can be easy to forget to take your medication every day. Missing doses can reduce the efficacy of your treatment and affect you in unexpected ways.
• You may need something in addition to, or instead of, an antidepressant: For example, if you have had multiple major stressors in your life recently, therapy can be extremely helpful. Or, if your symptoms of depression are connected with heavy alcohol or drug use, getting treatment for substance abuse can make a huge difference. Lastly, there are medical conditions such as thyroid problems, anemia, or vitamin deficiencies that can cause depression and low mood symptoms. Having basic blood work can help reveal other things that, when treated, may lead to an improvement in depression. 

Signs Your Antidepressant Isn't Working

These are some of the signs that your antidepressant may not be working, says Dr. Zabinski:

• Worsening sleep
• Changes in appetite
• Decreased energy
• Increased fatigue
• Lower motivation
• Apathy (the feeling of not caring about anything) 
• Difficulty concentrating
• Having to call out of work
• Canceling social engagements
  

What to Do If Your Antidepressant Isn't Working

Below, Dr. Zabinski suggests some steps you can take if you feel your antidepressant medication isn’t working.

Take Your Medication Regularly

One of the most important things to do is also one of the easiest. Since it is easy to forget to take medications every day, having a pillbox and taking your antidepressant at the same time every day can help you get into a good routine.

It may even be helpful to take your medication at a time that you do another daily task, such as brushing your teeth.

Contact Your Healthcare Provider

Call your psychiatrist or schedule a follow-up appointment. Report your symptoms and any side effects to them. There are standard symptom scales that your doctor may use, in addition to your description of symptoms, to monitor how things have changed over time. 

If you have been taking an antidepressant every day for more than a month and have increased the dose with guidance from your psychiatrist, but your symptoms have not changed or have gotten worse, your antidepressant may not be working.

Maintain a Healthy Routine

Developing a schedule can be hard since decreased motivation and low energy are symptoms of depression, but even gradual changes and improvements in sleep, nutrition, hydration, and exercise can help.

A Word From Verywell

There are several reasons why your antidepressant medication may stop working. If you’re experiencing symptoms or side effects, it’s important to stay in touch with your healthcare provider and work with them to adjust your medication accordingly.