Maria has been feeling depressed for at least two and a half years. About three years ago, her husband of 20 years left her for another woman. Devastated, she became despondent and tearful almost daily. Eventually, her depression got worse associated with inability to function. Her appetite, energy, concentration, and sleep became impaired. She also felt hopeless and suicidal. Her psychiatrist put her on a starting dose of antidepressant. She responded initially but after a few days, she felt just like before taking
medication.
For past two years, Maria has tried four types of antidepressants. She has taken usual adult doses of these drugs. Although she somewhat improves, she has virtually remained same — depressed and disabled.
Maria seems to be taking medications regularly. But why is she not responding to her antidepressants?
Maria is just one of many depressed individuals who don’t feel “normal” despite treatment. Depression is a treatable disease but how come some people don’t do well on medications?
There are many reasons why depressed patients like Maria don’t improve on antidepressants.
First, is diagnosis correct?
Depression can be caused by many clinical entities. Sometimes, knowing right diagnosis is a challenge. Medical disorders, medications such as beta-blockers and benzodiazepines (e.g. clonazepam), and various psychiatric disorders can cause depression and they all require different treatment. If your doctor fails to identify and treat true cause of your depression, you will remain depressed despite use of antidepressant.
Second, are there co-morbid disorders?
Depression can exist along with other psychiatric disorders such as anxiety disorder, alcohol or drug problems, personality disorder, dementia, and psychosis. Depression will persist if these co-morbid disorders are not treated. For instance, depressive disorder with psychosis cannot be adequately treated just with antidepressant alone. You need an antipsychotic drug added to an antidepressant to treat illness.
