How long do antidepressants need to be taken?
Depending on which active principles are present in the medication, eight days to three weeks can go by before the patient begins to notice the effects of an antidepressant.
Should no effect be noticed, or strong side effects appear, the physician should modify the dosage or prescribe a different medication.
After a first depressive episode has been treated successfully, the medication should still be taken for half a year even when the symptoms have subsided. Afterwards, the treatment can slowly be reduced. However, in case of severe and/or returning episodes, a lasting treatment can be necessary.
When the patient does not – or not sufficiently - respond to the medication, the physician may decide to increase the dosage or to switch to a different medication, or to combine it with another medication, or yet to recommend a psychotherapeutic treatment. Further alternatives may include for example electroconvulsive therapy, sleep deprivation, magnetic stimulation, light therapy and movement therapy.
In any case, it is crucial for the physician to establish a trust-based relationship with the patient, and for the patient to take the prescribed medication on a regular basis and with the proper dosage. Several treatments fail because the therapy is not properly observed. On the one hand, some patients refuse to take the medication from the onset. On the other hand, many patients do not notice any improvement at the beginning of the treatment, but observe several side effects, and doubt about the efficacy of the treatment. Or else because the depressive symptoms subside after some time, and the patient feels the medication is no longer needed. However, a too early cessation of the medication can increase the risk of a recurrence of the depression.
Therefore, it is important that the physician and patient should openly discuss all questions and problems, and in particular address issues of treatment duration, the effects expected, as well as possible side effects.
Antidepressants and risk factors
Two groups are particularly at risk for using antidepressants: pregnant women and elderly people.
Therapy with elderly people
Especially as regards elderly people, depression episodes usually require a longer treatment. In such a situation, the fact that older people are more susceptible to heart diseases (eg. coronary disease) must be taken into consideration, and care must be taken not to influence an existing illness negatively. Other factors, such as the way medicine metabolize in older people, or the interactions with other prescribed medication, must also be considered.
Treatment during pregnancy
Taking antidepressants during pregnancy should be discussed thoroughly with the physician. Studies show that taking SSRI does not increase miscarriage rates, however seems to have an impact on premature births. Usually, a medicine-based treatment is not the only therapeutic approach, as medication is often considered only as a “crutch”. Indeed, the real problems that lie at the root of a depression cannot be healed with medication alone. A psychotherapy treatment remains indispensable to address the underlying issues of a depression.
Most importantly, the patient must accept that the depression is an illness that must be treated, and that he must ask for help. Changing eating habits, doing more physical activities and relying on alternative approaches have also helped “miracles” to happen.
Text: Helga Grafe – 11/2015
Translation from German: MyH – 06/2016