When To Switch or Adjust Your Antidepressant for Better Results

If you are taking antidepressants but are still experiencing symptoms of depression, your healthcare provider can help you take steps to get a better response. It may take some trial and error, but adjusting the dose, adding a second medication, or switching to a new medication entirely are all possible solutions.

Aim for Remission

Psychiatrists talk about a "response" to an antidepressant, which means at least some improvement, and "remission," which means that the symptoms subside substantially or completely.

For most people, remission is a realistic goal. If one antidepressant doesn't do the trick, your healthcare provider may consider the following options:

• Increasing the dose of the antidepressant you're taking
• Continuing at the same dose and adding a second drug, either another antidepressant (combination therapy) or a different type of drug (augmentation therapy)
• Switching, which involves gradually stopping the medication you're taking and starting a second one
• Starting psychotherapy, if you're not already attending sessions

Tolerability, Time, and Improvement

"My hope for every patient is that major depression remits as soon as possible with few side effects," George I. Papakostas, MD, an assistant professor of psychiatry at Harvard Medical School, told Health.

Dr. Papakostas listed three factors to consider when deciding whether to discontinue a particular drug or continue using it and adding another treatment

• Tolerability: How severe are the side effects, and how much trouble are they causing?
  
• Time: How long have you been on medication?
• Degree of improvement: Have the depression symptoms improved in proportion to how long you've been on medication?

Reasons To Switch

If you've seen only a slight improvement in symptoms, but the side effects are burdensome, your provider may switch you to something else altogether. A total switch may be recommended if you're experiencing little or no improvement, even if side effects aren't a problem.

Most psychiatrists agree, said Dr. Papakostas, that if an SSRI hasn't worked for you, switching to an atypical antidepressant—Wellbutrin (bupropion), Cymbalta (duloxetine), Remeron (mirtazapine), or Effexor (venlafaxine)—may be a good idea.

Reasons To Increase the Dose or Add an Additional Medication

If you're doing well with an antidepressant but there's room for improvement, increasing the dosage may be a smart move, especially if you're not experiencing side effects.

If you don't notice a significant response after six weeks at a higher dosage, switching to another antidepressant may be an appropriate therapeutic intervention, Kenneth Robbins, MD, clinical associate professor of psychiatry at the University of Wisconsin–Madison, told Health.

Your healthcare provider may add another drug to the one you're already taking. Some of the medications providers may prescribe include Wellbutrin, lithium, thyroid hormone, or Provigil (modafinil).

Options for Boosting Effectiveness

Depending on a patient's exact diagnosis and tolerance for side effects, psychiatrists sometimes prescribe an atypical antipsychotic, a class of drugs used in bipolar disorder and schizophrenia that includes Zyprexa (olanzapine), Risperdal (risperidone), Clozaril (clozapine), and Seroquel (quetiapine).

Some evidence suggests that these drugs may boost the effectiveness of antidepressants, according to a 2013 study in PLoS Medicine. Some of the drugs in this category, such as Abilify (aripiprazole) and Seroquel XR (quetiapine), have been approved as add-on treatments for people already taking antidepressants, whereas Zyprexa (olanzapine) is approved specifically for use in combination with Prozac (fluoxetine), which can be taken in a combo pill called Symbyax.

Psychiatrists may prescribe other atypical antipsychotics—such as Risperdal and Clozaril—off-label, meaning the U.S. Food and Drug Administration (FDA) has not approved the drugs for depression.

Suicide Prevention Considerations

Patients who want to stop taking antidepressants should do so gradually, with guidance from their healthcare provider or psychiatrist. Though there has been some evidence that antidepressants may sometimes be linked to suicidal thoughts, clinicians caution that the connection should not discourage anyone from taking antipressants, and they are not linked to an increase in the act of suicide, but thoughts of it.

Dr. Papakostas said that getting proper treatment for depression is far more likely to prevent suicide attempts than increase them.

And a 2020 article in Psychiatric Review in Clinical Practice documented an increase in suicide after the FDA issued a black box warning in 2003 about the connection. The authors suspected that the warning and the news coverage surrounding the decision had the unintended harmful consequence of discouraging treatment and called for a reworded warning and other communication to minimize the effect.

Withdrawal Considerations

Some people may be concerned about becoming dependent on antidepressants, but most people are able to discontinue them when needed without withdrawal symptoms. While abruptly stopping antidepressants can result in discontinuation symptoms (such as nausea, insomnia, and agitation) for a week or two, most patients are able to ease off the drugs gradually without suffering from withdrawal, said Dr. Papakostas.