My friend Jennifer 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. Eventually, she sank into depression.
Jennifer seems to be taking the medications regularly. But why is she not responding to her antidepressants?
There are many reasons why depressed patients like Jennifer do not improve on antidepressants.
First, is the diagnosis correct?
Depression can be caused by many clinical entities. Sometimes, knowing the right diagnosis is a challenge. If your doctor fails to identify and treat the true cause of your depression, you will remain depressed despite the use of antidepressant.
Second, are there co-morbid disorders?
Depression can exist along with other psychiatric disorders such as anxiety disorder, 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 the illness.
Third, are there ongoing psychosocial issues?
Financial problems, family conflict, work-related stress could all precipitate and complicate depression. Despite adequate medication treatment, some individuals will remain depressed especially if such problems are not addressed by the therapist or psychiatrist.
The treatment of depression is frequently straightforward. Occasionally however, various factors complicate it. For antidepressant to be effective, a psychiatrist should ensure that the diagnosis is correct, that co-morbid psychiatric disorders and that psychosocial issues are adequately addressed.
