By Dr. David Woo - November 27, 2020

Many people delay seeking help for depression because of the stigma of mental health illness and antidepressants. But antidepressants have helped many patients find relief from depression, especially patients with moderate to severe depression. (1,2)  

Getting help and starting treatment early-on increases the probability of achieving remission and reduces the risk of relapse. (3) How can patients struggling with depression determine if an antidepressant might help them?

You Have Severe Symptoms That Interfere With Daily Life

The most notable and common symptoms of depression include low mood, sadness, and feelings of despair that last for at least two weeks, but typically can last as long as months or even years. However, not everyone experiences this symptom, or the same symptoms of depression. To better understand if depression is affecting your daily life, ask yourself if you:

• Have lost interest in activities and hobbies.
• Are struggling with your relationships.
• Are sleeping too much or too little.
• Have trouble remembering appointments, concentrating, or multitasking.
• Struggle to maintain good hygiene (do you find it difficult to brush your teeth or shower on a daily basis?)
• Have experienced changes in your weight.
• Have had thoughts of suicide or have ever attempted suicide.

You’ve Tried Counseling and it Hasn’t Worked

Talk therapy may be recommended as the first step of treatment for patients with depression.  Therapy can help patients learn skills and gain valuable insight that can help them feel better and reduce the risk of or even prevent depression relapse. Initial research shows that one type of therapy, called cognitive-behavioral therapy, can be just as effective as antidepressant medication for certain patients. (4) However, some patients, including those with moderate to severe depression, may need an antidepressant in conjunction with talk therapy in order to see results. 

Finding the Right Antidepressant, and Depression Treatment, Can Take Time

Physicians know that finding the right depression treatment is a trial-and-error process because patients respond differently to different treatments. The first antidepressant won’t necessarily work (only 33% of patients will find relief from the first antidepressant they try) and successful treatment may involve a combination of two treatments. (5) For example, lifestyle changes and talk therapy, in combination with an antidepressant, may provide greater relief of depressive symptoms than an antidepressant alone. (6)

What if You’ve Tried Antidepressants and They Don’t Work?

Although antidepressants have helped many people with depression, they don’t work for everyone. As many as one-third of patients who try antidepressants won’t see results. (7) An important study, called the STAR*D study, illustrates the effectiveness of different depression treatments in patients who did not see symptom relief when given an antidepressant as their first treatment option. Learn more about the STAR*D study here.

If antidepressants don’t work for you, there is still hope. Alternative treatments, like transcranial magnetic stimulation (TMS), offer hope for people with treatment-resistant depression. TMS is proven to help patients when antidepressants don’t. (8,9,10) For patients who feel nervous about leaving their antidepressants behind, TMS can also be used in conjunction with certain antidepressants and may even augment the effects of their antidepressant medication. (11)

If you believe you’re struggling with depression and would like to learn more about antidepressants and other depression treatment options, contact us online or call us at 212.731.2033.

Resources:

1. Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103(5):777-780. Link. Accessed November 17, 2020.

2. Depression: How effective are antidepressants? InformedHealth.org — Institute for Quality and Efficiency in Health Care (IQWiG). Published January 28, 2015. Updated June 18, 2020. Link. Accessed November 16, 2020.

3. Halfin A. Depression: The Benefits of Early and Appropriate Treatment. Am J Manag Care. 2007;13(4):S92-S97. Link. Accessed November 17, 2020.

4. Driessen E, Hollon SD. Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. Psychiatr Clin North Am. 2010;33(3):537-555. Link. Accessed November 18, 2020.

5. Gaynes BM, Rush AJ, Madhukar HT, Wisniewski SR, Spencer D, Maurizio F. The STAR*D study: Treating depression in the real world. Cleve Clin J Med. Jan 2008;75(1):57-66. Link. Accessed November 16, 2020.

6. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67. Link. Accessed November 17, 2020.

7. Ionescu DF, Rosenbaum JF, Alpert JE. Pharmacological approaches to the challenge of treatment-resistant depression. Dialogues Clin Neurosci. 2015;17(2):111-126. Link. Accessed November 18, 2020. 

8. Berman RM, Narasimhan M, Sanacora G, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry. 2000;47(4):332–337. Link. Accessed November 17, 2020

9. Garcia-Toro M, Mayol A, Arnillas H, et al. Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression. J Affect Disord. 2001;64:271–275. Link. Accessed November 17, 2020. 

10. Somani A, Kar SK. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr. 2019;32(4):e100074. Link. Accessed November 17, 2020. 

11. Rumi DO, Gattaz WF, Rigonatti SP, Rosa MA, Fregni F, Rosa MO, Mansur C, Myczkowski ML, Moreno RA, Marcolin MA. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry. 2005 Jan 15;57(2):162-166. Link. November 16, 2020.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.