Even if you’ve had significant relief from depression symptoms since you started treatment, you can still experience a plateau. If at least two different antidepressants aren’t able to control your symptoms, that’s considered treatment-resistant depression, and the plateau may seem particularly daunting to navigate.
Whether you're dealing with treatment resistance or you're taking antidepressants for the first time, it’s possible to get your progress back on track, says Nabil Siddiqi, MD, a psychiatrist with Orlando Health Medical Group Behavioral Health in Longwood, Florida. That starts with a meaningful conversation with your doctor, he says.
"Patients should feel comfortable asking as many questions as they need to in order to understand their specific diagnosis, why a certain treatment was recommended, and what the factors might be if symptoms aren't resolving," he says.
With that in mind, here are four questions to ask your doctor when it seems like your depression treatment has stalled.
1. Do My Symptoms Mean the Treatment Doesn’t Work?
Sometimes, what feels like a plateau — or even going backward — simply means you haven't waited long enough for an antidepressant to start working. Although there can be some improvements like better sleep or sustained energy throughout the day within the first couple of weeks, most antidepressants typically take between four to eight weeks for full therapeutic effect.
And even if you do respond to a particular treatment, it’s common to have lingering symptoms, such as:
Feelings of hopelessness and emptiness
Getting angry, irritated, anxious, or frustrated more easily than usual
Lack of interest in activities you once enjoyed
Sleep difficulties, such as oversleeping, frequently disrupted sleep, or insomnia
Low energy no matter how much you sleep
Difficulty concentrating
Reduced appetite or weight changes
Unexplained, nagging pain such as headaches or backaches
Desire to isolate and skip social gatherings
That doesn’t necessarily mean your treatment has stopped working, but it may need to be adjusted. To help your doctor figure out what’s going on, it’s a good idea to keep track of your symptoms, says Alex Dimitriu, MD, a psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine in California and a medical reviewer for Everyday Health. Include what symptoms you’re having, how often you have them, and how long they last.
2. What Other Factors May Be Affecting Medication Effectiveness?
A treatment that worked well for you at first can lose effectiveness for many different reasons. Among them:
Drug or alcohol use, which can lead to mood changes
Stressful situations at work or home, especially if those are new stressors
Pregnancy, since that affects body weight and blood volume, which can change the dose you need
Interactions with other medications
Poor sleep, which can reduce the effects of an antidepressant
Underlying medical conditions like chronic pain or hypothyroidism
Even age can be a factor. As you get older, your brain experiences subtle shifts in how it processes medications, and hormone changes related to menopause may play a role as well.
3. Should We Adjust My Medication?
Once you’ve determined that you've waited long enough for an antidepressant to start working and there are no other factors at play, then adjusting your medication may be an option, say Nissa Keyashian, MD, a psychiatrist in private practice in San Jose, California.
That might mean increasing your current dose, or adding a "booster" or secondary medication that's designed to help the primary antidepressant work more effectively.
"Adding another antidepressant with a complementary mechanism of action is often a first step if it seems symptoms aren't improving," she explains. "Lithium is an extremely effective adjuvant medication for major depression, and we can also add buspirone, atypical antipsychotics, or other mood stabilizers."
After that, the next step would likely be to switch antidepressants if you’ve had minimal response, she adds.
4. Are There Other Strategies I Should Try?
In addition to antidepressant troubleshooting, talk with your healthcare provider about other options that can go along with a medication approach, suggests Dr. Siddiqi.
For example, more frequent psychotherapy might help you get a better outcome, he says. Research indicates that the combination of psychotherapy and medication for moderate to severe depression tends to work better than just one of these treatments on its own.
Some people may also be candidates for treatments like transcranial magnetic stimulation — a noninvasive option that uses focused magnetic pulses to stimulate specific areas of the brain — or ketamine, which has an entirely different mechanism of action than antidepressants, says Siddiqi.
You can also try lifestyle interventions, he adds, such as stress reduction techniques, sleep behavior strategies, and regular physical activity. For instance, exercise like walking, yoga, and strength training has been linked to improvement in depression symptoms.
What's most important is to start this conversation with your doctor when it seems like you've hit a plateau, Siddiqi says, rather than waiting to see if symptoms improve on their own.
The Takeaway
When you’re being treated for major depressive disorder, it’s not uncommon to feel that your recovery has stalled.
Antidepressants typically take four to eight weeks to become fully effective, and many factors impact how well they work, including stress, alcohol use, and medication interactions.
Talk to your doctor if it seems like your symptoms aren't resolving; there are different strategies that may help, including adjusting dosage and adding a booster medication.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Noetel M et al. Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. February 14, 2024.
Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.
A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.
Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.
Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.
She and her husband are avid travelers and have been to over 55 countries and territories.
Elizabeth Millard is a Minnesota-based freelance health writer. Her work has appeared in national outlets and medical institutions including Time, Women‘s Health, Self, Runner‘s World, Prevention, and more. She is an ACE Certified Personal Trainer and a Yoga Alliance Registered Yoga Teacher, and is trained in obesity management.
