Major depressive disorder, commonly known as depression, is a prevalent mood disorder affecting one in 15 adults (or 6.7%) of the world’s adult population, amounting to some 350 million individuals. In the US alone, 17.3 million adults (7.1%) have experienced one or more depressive episodes across their lifetime, with reported figures believed to mask higher rates in reality.
The World Health Organization (WHO) cites depression as the leading cause for years lost to disability, resulting in a shorter lifespan for those contending with it. WHO also ranks depression as third in its global burden of disease, and expects it to rank first by 2030. With its widespread severe effects one patients’ quality of life, tried-and-true treatments for depression, namely psychopharmacology, have been promoted as a safe and effective way to alleviate its symptoms. But what happens when antidepressants stop working? Why do antidepressants stop working, if this is the case? And is such an occurrence likely? Read on to find out.
Finding It Hard to See the Light: The Central Symptoms of Major Depression
According to the American Psychiatric Association (APA), depression is composed of a number of possible symptom types, and therefore can take on a variety of manifestations. Some cases of depression may be shaped by a multi-sided sense of lacking, and include a significant depletion of energy, a lack of hope, fatigue, psychomotor retardation (or a slowing down of one’s movement), or weight loss when not dieting. Other cases may present themselves through more erratic symptoms, such as an increase in appetite and weight, fluctuating pangs of guilt and worthlessness, psychomotor agitation (jumpiness), or difficulty concentrating.
Yet despite the fact that no single profile for depression exists, the APA stresses that at least one of the following, definitive symptoms must be consistently present for a major depressive disorder diagnosis to be considered:
Depressed mood.
Loss of pleasure.
As such, depression is centrally diagnosed through its effects on one’s mood, and how it leaves the patient feeling deeply saddened, to the point of changing their previous way of living their life. It is this unrelenting sorrow or prevention of feeling any joy, that has underscored the adverse repercussions depression can have on an individual’s well-being, and why treating it can offer a life-changing alternative to the way they have been existing.
Helping Lift You Up: Recognized Treatments for Depression
The US Food and Drug Administration (FDA) has recognized several mental health treatment options for depression, due to their proven safety and efficacy: in essence, this means the following treatments have been found to offer depression significant symptom relief, while still being gentle enough to allow patients to continue with the treatment, and not quit due to intolerable side effects.
Three such depression treatments are:
Selective Serotonin Reuptake Inhibitors. Ushering in second-generation antidepressants, SSRIs prolong the effect of the neurotransmitter serotonin within the brain. Unlike first-generation antidepressants, whose side effects include increased heart rate and blurred vision, SSRIs are considered much more tolerable. The most common SSRI side effects are weight gain and sexual dysfunction. While they are often alleviated over time, many patients nevertheless find them to be continually adverse, and as a result, stop taking them. Additionally, over 40% of patients with depression are considered treatment-resistant, meaning they have not responded well to at least two types of antidepressants.
Psychodynamic Therapy. Focusing on the patient’s past, formative relationships, their view of themselves, those around them, and the world, are all themes within psychodynamic therapy. Those who choose to take part in the treatment tend to delve deeply into their personal experiences, in an attempt to better understand the interplay between different aspects of their life, and how it has shaped the challenges they face at present, particularly in regard to any mental health disorders, such as depression. While found to be effective, not all patients wish to discuss the painful or threatening issues that often arise in psychodynamics, and as such may prefer a more medicinal approach.
Deep Transcranial Magnetic Stimulation. Non-invasive and FDA-cleared, Deep TMS is a medical device treatment that utilizes electromagnetic fields to safely and effectively regulate the neural activity of brain structures found to be associated with depression. It does not require the use of anesthesia or necessitate an extended recovery period. It is considered rather tolerable and does not tend to cause any long-lasting or significant side effects, beyond a passing headache.
When an Antidepressant Stops Working
In addition to the above-mentioned treatment resistance, certain patients find that their antidepressant’s efficacy has waned over time, driving patients to ask, “Why do antidepressants stop working?”
In their search to better understand what happens when antidepressants stop working, it is crucial to examine the particulars that may have contributed to the decrease in a drug’s ability to offer patients the same level of symptom relief. To that end, patient and practitioner should address a number of important concerns:
Has Their Depression Become More Severe
Life is seldom static, and many factors can change an individual’s well-being at any given period. It stands to reason, then, that a set dosage of an antidepressant would have a different effect at different moments in one’s life.
To better understand a patient’s current mental state, their mental health practitioner should ask them to describe their present concerns, whether any major changes have recently taken place, and what might be contributing to their depression.
Has a New Medication or Medical Condition Been Introduced
Medical issues, such as hyperthyroidism, can deepen or even bring about depression. Additional medical issues, be they a life-threatening illness or the introduction of a medication with adverse side effects, can hinder the patient’s general well-being, eventually leading them to develop symptoms of depression.
Should Bipolar Disorder have been Diagnosed Instead of Depression
A bipolar disorder diagnosis requires the occurrence of at least one manic episode, which is marked by an extremely elevated mood, high distractibility, inflated self-esteem or an increased involvement in potentially dangerous activities, to the point where one’s life is severely impaired due to said manic episode.
Though depression is not a necessary part of an official bipolar disorder, many bipolar cases cite the existence of a depressive episode, either before or after a recorded manic episode. As such, if a manic episode is missed (or has yet to take place), and a depressive episode is identified, an individual may be erroneously diagnosed with major depression, instead of bipolar disorder.
The distinction between the two diagnoses can be crucial to the patient’s treatment. While SSRIs are considered a first-line treatment for depression, the FDA has approved antipsychotic medications, such as seroquel and lithium, for the treatment of bipolar disorder. For this reason, antipsychotics (in addition to first-line antidepressants such as SSRIs) are often an essential part of an effective treatment regimen for bipolar disorder.
Has Age Become a Factor
Certain medications have been shown to become less effective with age, as neurological changes within the brain begin affecting the way they are processed and used. Accounting for the patient’s age is therefore another relevant aspect to consider when addressing a decrease in an antidepressant’s efficacy, as patients and healthcare providers aim to respond to cases when antidepressants stop working after years of effective use.
A General Word of Caution
Adjusting one’s mental health medication, under the supervision of a licensed professional, can certainly help ease their discomfort, address relevant health concerns and improve their well-being.
That said, it is important to note that like all other forms of mental health treatment, antidepressants are not meant to remove all traces of pain from a patient’s life. Emotional hardships that involve sadness or mourning are part of the human experience, and it is through therapy, medication or other forms of treatment that many individuals are able to process them, come to terms with their existence, and give them a place in their life story, without being overwhelmed by their severity.
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