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The question was submitted 25/06/2008

Subject: Changing medications.

Hello,

I have been on the same antidepressants for 12 months now – a tricyclic. Before that I had about nine months on SSRIs. My mood has oscillated on occasions and I had a consistent improvement in mood for about 5 months and was functioning “normally” in my relationships, my career/community life, and in general. In fact I felt quite well.

Over the last few months my mood has again dipped and now it is very low. Some of this is related to external factors as was my first major episode. My question is this: if my psychiatrist suggests a change in medication or an increase in dosage how is it that it can work for a while and then cease working? I understand that my external pressures my have changed but at the time I started the course of medication I was extremely low, in fact I was in hospital in an intensive care unit of a mental health facility, and it worked then. Why does it cease working resulting in a change of medication?

I do have a psychiatrist who I am seeing regularly but wanted to be aware of this issue as I feel he may be heading down that path.

Thank you

Answer from DepNet

Hello and welcome to DepNet,
The issue you raise is an important and difficult one for many people. There is debate about whether tablets actually stop working (which appears to be the case to many patients and clinicians) or whether some other factors are contributing to make it look that way (which is how the researchers tend to look at it). There are many possible reasons why a medication may appear to stop working, although in many cases, unfortunately, it is not possible to say with any confidence. Some of the possibilities to consider include the following. Firstly, some people may have an underlying bipolar disorder and may require the addition of a mood stabilizer to achieve a full and longer lasting remission (recovery). It is also known that people who have anxiety problems in addition to their depression may have more trouble getting well (and the addition of CBT should be considered). Another factor to consider is any missed tablets – some people may be more sensitive than others to loss of effect if tablets are forgotten. In your case, you describe what may be a significant sensitivity to external factors. In such cases the addition of a psychological treatment such as cognitive behavioural therapy (CBT) or interpersonal therapy (IPT) may assist in preventing relapse. IPT may be particularly helpful if the external pressures concern relationships at home or at work. More recently, a psychological therapy known as mindfulness based cognitive therapy (MBCT) has been shown in a number of studies to be of assistance. So it may be that tablets alone are simply not enough for some people to get well and stay well.

The answer was published on DepNet 02/07/2008