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You’ve entered treatment for depression. You’re working hard in therapy. You are taking an antidepressant that was prescribed to you. But you haven’t yet achieved the benefits you’ve expected. Could the problem be that the medication isn’t helping? Are you ready to ask your treatment provider “Why are my antidepressants not working?”

If you ever have any questions or concerns about your mental health, it is never a bad idea to consult with a professional who is familiar with your treatment plan. But if you’re not able to do so at the moment, or if you want to learn a bit more about antidepressants before you have this conversation, this post may be of value to you. 

What Are Antidepressants?

Antidepressants are a category of medications that can alleviate some symptoms of depressive disorders. Some over-the-counter (OTC) medications may offer certain benefits for people who are struggling with symptoms of depression, but the term antidepressants is typically reserved for prescription medications.

Within the general category of antidepressants, these medications are also organized into subcategories based on how they interact with the central nervous system. Three of the most common subcategories of antidepressants are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. 

Here are a few examples of medications from each of these subcategories, with the trade or brand name listed first, followed by the generic name in parentheses:

• SSRIs: Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline), 
• SNRIs: Cymbalta (duloxetine), Effexor (venlafaxine), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine)
• Atypical antidepressants: Oleptro (trazodone), Remeron (mirtazapine), Spravato (esketamine), and Wellbutrin (bupropion)

Some doctors may also prescribe monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants. These are older types of antidepressants that, in most cases, aren’t used unless a person has not been helped by medications from the categories listed above.

How Do Antidepressants Work?

To determine why your antidepressants are not working, it can be helpful to understand how they are supposed to work.

The medications from the categories listed in the previous section work in different ways. For example, SSRIs are designed to prevent nerve cells from absorbing a neurotransmitter called serotonin. Serotonin has been associated with elevated mood and healthy sleep patterns. By preventing the absorption of serotonin, SSRIs ensure that a greater amount of the neurotransmitter is available to be shared among cells in the central nervous system.

SNRIs function somewhat similarly to SSRIs, except they prevent the absorption of two neurotransmitters: serotonin and norepinephrine. Norepinephrine is a hormone that is linked to alertness, stress response, and healthy sleep. Norepinephrine is made from dopamine, a hormone that influences sensations such as pleasure and motivation.

Atypical antidepressants can work in a variety of ways:

• Oleptro promotes increased production of serotonin. 
• Remeron triggers the production of additional serotonin and noradrenaline, which can influence the body’s “fight or flight” response.
• Spravato helps create additional synapses in the central nervous system, which improves communication among nerve cells.
• Wellbutrin prevents the absorption of norepinephrine and dopamine.

Of course, these are just brief overviews of how certain antidepressants work. To get a more detailed understanding of their functioning, speak with your pharmacist or the doctor who prescribed the medication to you.

Why Do Antidepressants Work for Some and Not Others? 

Antidepressants are not “one size fits all” solutions. When you first begin to take antidepressants, it can take some time for you and your doctor to identify the right medication and determine the optimal dosage level.

Here are a few possible reasons why antidepressants may work for some people, but not for others:

• The symptoms that the individual has been experiencing are not caused by the specific neurotransmitters or other brain chemicals that are targeted by their antidepressant. 
• The person has been drinking, abusing other drugs, or taking other prescription medications that can negatively interact with the antidepressants.
• The individual’s symptoms aren’t related solely to depression. They may have a different or co-occurring mental health disorder.
• The patient has not been taking their antidepressant as directed. Taking too much or not enough (or failing to take the medication on a regular schedule) can undermine its effectiveness.

More: The Effects of Taking Antidepressants When Not Depressed
More: Can You Overdose on Antidepressants?

Signs Your Antidepressants are Working

When you’re given a prescription for antidepressants, your doctor should inform you that it will probably take a few weeks before you start to notice improvements. 

After you’ve been taking the medication for an appropriate amount of time, here are a few signs that your antidepressants are working:

• You seem to have a bit more energy and motivation than usual.
• Your mood and attitude seem to have stabilized. You no longer experience dramatic changes or descents into deep depression.
• You’re better able to manage stress. Challenging situations and personal setbacks can still be difficult, of course, but they’re not as devastating to you as they used to be.
• Your eating and sleeping habits have become less extreme and more predictable. 
• You’ve noticed improvements in your ability to concentrate and focus.

Here’s an important (and perhaps surprising) reminder: If you took an antidepressant and felt better right away, this is not a sign that the medication is working. Most antidepressants take several weeks to begin working, and their initial benefits are felt gradually. If you felt rapid improvements almost instantaneously, it’s highly unlikely that the antidepressant is responsible.

Signs Your Antidepressants Aren’t Working

Taking antidepressants won’t immediately cause all your symptoms to disappear. But within a reasonable amount of time, they should begin to make a noticeable positive difference. 

Since antidepressants take a while before they begin to have an effect – and since the type of effect they have can vary significantly from one person to another – it can sometimes be difficult to be sure if they are working. 

Here are some common signs that your antidepressants aren’t working:

• You’ve noticed no change in your mood, attitude, and energy levels, even after you’ve been taking the antidepressant for several weeks.
• Some of your symptoms seem to have become more severe since you have begun to take the antidepressant.
• You have begun to experience drastic swings in mood, attitude, or energy. Some days, you are enthusiastic and motivated. Other days, you struggle with overwhelming sadness and fatigue.
• Your sleep patterns are off. This may involve sleeping much more than necessary (hypersomnia) or having trouble getting to sleep (insomnia).
• You continue to experience dizziness, nausea, and other persistent unpleasant psychical symptoms.

Why Are My Antidepressants Not Working?

The question, “Why are my antidepressants not working?” isn’t as straightforward as it might initially appear to be. When you ask this question, you might actually be inquiring about concerns such as the following:

• You’re not feeling the types of effects that you expected.
• The effects aren’t as strong as you had hoped.
• The effects aren’t occurring as quickly as you want them to.
• You are having unexpected side effects.

The speed with which antidepressants work is often a concern among people who are taking these medications for the first time. Some antidepressants need to be taken for one or two weeks before they can begin to have a discernable effect. In other cases, you may need to take the medication for a month or longer before your mood improves or certain symptoms begin to subside.

If you are concerned about the way an antidepressant is making you feel, or the strength of its effects, you may first want to make sure that you understand the stated purpose of the medication. Is the problem that the medication isn’t working as intended, or are you expecting an effect that it isn’t designed to provide?

Also, remember that every medication has side effects. In some cases, these effects subside as your body adapts to the presence of the medication. Of course, if this doesn’t happen, or if your side effects are particularly distressing, this is a problem that needs to be resolved.

If you believe that your antidepressant isn’t working, or is working improperly, your first step should be to consult with a professional. This can include a therapist or counselor, a pharmacist, or the doctor who prescribed the medication. This person can assess the situation and make an appropriate recommendation.

To improve your experience with antidepressants, possible options can include waiting a bit longer for the medication to take effect, adjusting your dosage, choosing a different medication, or prescribing an additional one. What is most important is making sure that any actions you take are done with the guidance and supervision of a trained professional. You should never stop taking a medication, start taking another one, or adjust your dosage on your own.

Treatment Options for Depression

When you are seeking depression treatment, it is important to understand the range of options that are available to you. 

A comprehensive, holistic approach to depression treatment typically combines prescription medication with therapy. Depending on how you have been impacted by depression and any co-occurring mental health disorders, the following therapies may be beneficial for you:

• Individual and group therapy
• Cognitive-behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Eye movement desensitization and reprocessing (EMDR) therapy
• Neurofeedback therapy
• Red light therapy
• Biosound therapy

Depression treatment can be provided on either a residential or outpatient basis. Some people take part in treatment at only one level of care, while others begin with residential treatment then step down to an outpatient program for additional support. There is no single treatment path that works for every person. The goal is to find the services that align most closely with your needs and expectations.

Find Depression Treatment in Nashville, TN

Arbor Wellness provides quality clinical services and comprehensive, personalized support for adults who have depression and other mental health concerns. Our treatment center in Nashville, Tennessee, is a safe space where adults can receive life-changing care at the residential, partial hospitalization, intensive outpatient, and outpatient levels. If your life has been disrupted by symptoms of a depressive disorder, the Arbor Wellness team is here for you. Contact us today to learn how we can help.