My Antidepressant Medication Doesn’t Work, So Now What?

Reader’s Question

I’m 17 1/2 years old and have been on citalopram on and off for four years. It’s not working. I get so upset, and feel like life isn’t worth living. What should I do?

Psychologist’s Reply

It’s unclear from your letter whether the medication ever did help, and whether you were ever on it consistently enough to find out. Antidepressant medications have to be taken regularly, at an effective dose, even when feeling better. Some people seem to be under the mistaken impression that antidepressants can be taken like aspirin: only on those days when it feels like it’s needed.

Regardless of the issues mentioned above, the rest of what I have to say is the same. Although we are fortunate to live in this period of history in which we have better psychiatric medications than ever before, their use is far from an exact science. Eventually we’ll have not only more effective medications, but we’ll know much more about matching medications to individuals. In the meantime, prescribing antidepressant medication remains a trial-and-error process.

A physician typically starts with prescribing a particular medication based on the symptoms and physical health of the patient, but even then, there are usually multiple options for each patient. So, frequently physicians start with the medication they feel most comfortable with, and optimistic about, based on their experience. If that antidepressant doesn’t seem to work after having attained a sufficient dose over several weeks, the physician usually discontinues that medication and tries another. This process is common.

Although any one particular antidepressant medication may have high rates of success, there are always individual differences. Also, people may respond best at different dosages, and some people only experience relief when a particular balance of combined medications is reached. Unfortunately, this process may take considerable time and patience, physician expertise, as well as an open and trusting relationship with the physician prescribing the medications.

Most people who take antidepressant medications receive the prescriptions from their family or primary care physicians. That’s certainly preferable to not being treated at all. However, when a person does not experience a good result, perhaps because of side-effects or simply not having a response to the medications, it’s time to consult a specialist. When it comes to understanding brain chemistry and cases of difficult-to-treat depression and anxiety, psychiatrists are those specialists. Because of their training and experience, psychiatrists are much more likely to be aware of the latest research, trends, and options in prescribing antidepressants. Similarly, psychiatrists are most likely to know how to best combine medications with patients who do not respond to typical treatments.

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Having said all that, my suggestion would be to make an appointment with a psychiatrist. If it was a psychiatrist who prescribed the citalopram, it’s time to go back and explain that it’s not working. That’s an unfortunately common problem psychiatrists face, so you won’t be unusual. Also, consider combining medication with regular meetings with a counselor with whom you feel comfortable. Finding such a counselor takes a bit of effort, but establishing a relationship with a good one can make all the difference between “some” response and excellent response to treatment. Given the options for both medication and counseling, continuing to suffer from depression (or anxiety) is needless. Don’t suffer any longer. And in the meantime, if you need immediate support and guidance, there are free resources such as Lifeline for talking or texting with someone.