Greetings! I am Dr. Bruce Semon, M.D., Ph.D., a board certified psychiatrist. I’m writing today about what to do when anti-depressants aren’t working for you. This is a very common problem in my psychiatric practice.
Many patients take medications called antidepressants to beat the symptoms of clinical depression. Some of the common antidepressants are Prozac (fluoxetine), Zoloft (sertraline), Effexor (venlafaxine), Lexapro (escitalopram) and Celexa (citalopram).
For some people, these medications are wonder drugs. They help people feel much better. For other people, the medications don’t work These are the questions I hear almost every day:
“I’m on antidepressants and they don’t work. What’s wrong with me? What’s wrong with the pills? Why do I feel so bad?”
How do I answer them? In my experience, the most common reason is that people are not diagnosed accurately, so they are prescribed the wrong medicines. They may have some depression, but really are suffering from other problems. These other problems do not respond well to antidepressants, and antidepressants can even make them worse.
People commonly come to me and say they have “anxiety and depression.” Their previous doctors have tried everything, including different types of antidepressants, and nothing works. In fact, the patient may be worse, be even more irritable and not be sleeping well.
Strangely enough, all too often the other doctor has continued to prescribe antidepressants, and may have even increased the dose, thinking that the dose just isn’t high enough. So the patient continues to take a high dose of a medication that may be making them worse.
Think about it this way. You go to the doctor with a rash. Rashes can be symptoms of many types of problems. The doctor prescribes a medication, but instead of getting better, the rash becomes worse. Most doctors would say, well, this must be the wrong medicine and try something different. However, in the case of mental health treatment, many doctors just prescribe a higher dose of the same wrong medication.
In my clinical experience of over two decades, I have found that many people are often misdiagnosed with depression when they really have another disorder called “ bipolar disorder” or a tendency toward bipolar disorder. You might have heard of bipolar disorder as “manic depression,” and you may think that for someone to have bipolar disorder, they also need to go up and down with wild mood swings. You may think of mania as not sleeping for days, having a grandiose mood, and feeling the person can do anything. These same people may then cycle downwards and be very depressed, which can go on also for weeks and even months.
Although some bipolar disorder looks like this, milder forms of bipolar do not have all these dramatic symptoms. In milder cases of bipolar disorder, patients may have experienced depression and times of irritability and difficulty sleeping. Depression may be part of bipolar disorder. However, the patient may not have experienced a time of mania.
So when people with milder bipolar disorder go to the doctor for depression, they describe something that the doctor treats with antidepressants. The patient may be misdiagnosed with depression and anxiety. However, the antidepressants may work only for a short time. Within a few weeks or a few months, the antidepressants may “flip them” from depression to irritability. The patient has developed a new set of symptoms (irritability) from taking the medication. The irritability may be very significant, because the patient may be yelling at significant people in his or her life and destroying relationships. The depression is not better either.
The patient reports these symptoms to the doctor, and reports that the medication is not working, and they are correct. This is where the problem is. Instead of recognizing the new symptoms as a consequence of the medication, or of taking the wrong medication, the doctor just thinks that the antidepressant isn’t working, especially if the irritability is on the milder side, or if the depression is still present. The doctor may then recommend another antidepressant and the same “flipping” will occur. The person just stays irritable and keeps on trying antidepressants. I have seen people who are never stable after this process begins, because the medication is just making them worse. Almost none of the antidepressants will work for such people. I have seen this occur many times.
What should you when antidepressants aren’t working?
I have seen hundreds of people who are in this same situation, and I have been able to help them.
First I help them recognize that the antidepressants may not work because the patient has been improperly diagnosed. Antidepressants may be making them worse, as I explained above.
Next I try a different medication. I have found two medications that are very helpful. One is Lithium. Lithium is for people whose moods go both up and down. Lithium can help both ways. Lithium does not cause “flipping.” The others is Wellbutrin ( bupropion). Wellbutrin is an antidepressant, but can be effective. Wellbutrin is less likely to “flip” a person from depression to mania. Flipping still occurs, but is less frequent
I also have had a lot of success with treating patients in a more natural way, using diet and homeopathy. Many of my patients either do not want to take medications or want to get off medication. I recommend a special diet which is described in our book Feast Without Yeast. This is now available in Spanish (Un Banquete Sin Levadura). I explain my Feast Without Yeast diet if you click here. This is very effective for depression and mood swings. For now, you can try a small part of it by removing one food in particular. That food is malt. Malt really affects mood. Malt is in a lot of foods, and contains 20 different chemicals that put your brain to sleep. If your brain is partially asleep, you will have that much more difficulty regulating your moods. For more information about malt, click here.
Along with removing malt, you can consider treatment for the yeast Candida albicans. I explain why if you click here, but here is the brief explanation: Candida in the gut makes numerous toxic alcohols which are then absorbed and slow down the brain and the nerves again, which will affect your mood. Candida is treated with my Feast Without Yeast diet, and a non-absorbed medicine called nystatin that kills Candida in the gut. This combination is very helpful for treatment of mood problems.