Although therapy may be adequate alone for mild cases of depression, it's most optimal to be in therapy when taking medication. Research indicates that therapy and medication together have the best efficacy. Although medication can treat your depression independently of therapy, it will not change environmental circumstances, won't change your coping skills, and will not change your personality or improve your self-esteem.
Keeping in mind that depression is typically the result of a culmination of biological, psychological, and social factors, it makes good sense that addressing the psychological and social underpinnings of your depressive episode is warranted. Although you cannot change your "biology" or genes, you can use therapy to change other contributors to depression.
Ideally, the risk then of future episodes can be reduced, as medication is generally not considered a life-long solution for managing depression, except in cases of more severe or chronic illness. Once in remission, an attempt to remove the medication is typically made. This really is apt to be more successful when therapy has been or currently is in place.
It can be disheartening when you do not feel better after a medication has been started. The pharmaceutical companies advertise their antidepressant medications in ways that suggest almost "miraculous" recovery. The reality is that the response rate to any given antidepressant tends to be approximately 60% to 70% in clinical trials.
What this means is a good portion of individuals (more than 30%!) wouldn't be expected to see improvement on the first medication tried. However, if a medicine is no longer working, several factors first need to be considered: How long has the medicine been taken? Is the dose high enough? Is the medication being taken as prescribed?
It requires from 4 to 6 weeks (sometimes as much as 8 weeks) for that full effect of the antidepressant to take place (after a sufficient dose continues to be prescribed). Oftentimes, the dose of medication has not been optimized. So long as there are few or tolerable side effects, the dose can be pushed to the maximum recommended dosage.
Your doctor might want to go past the typical maximum dose if you don't have any unwanted effects and have partially taken care of immediately the treatment. However, in general, once the most dose has been prescribed for approximately 6 weeks, and you've got been taking it as prescribed, a sufficient medication trial has occurred. When there is no improvement, a change to another medication should be made. The change can even be inside a class; for example, a lack of reaction to one SSRI does not mean the same is going to be true for an additional SSRI. When there is a partial response, your doctor might want to augment with another medication.
Augmentation strategies generally involve utilizing a medication with a different mechanism of action so that different neurotransmitter systems may come into play to help, similar to what cardiologists do once they prescribe antihypertensive medication to patients whose blood pressure remains elevated after an initial antihypertensive continues to be prescribed. Thus, if treatment having a given agent fails, management techniques include switches inside a class, switches to a different class, augmentation, using medications other than antidepressants, and ECT for more refractory depression.
It is very important to become open with your doctor about your degree of compliance having a given medication. It's not unusual for people to forget doses or skip doses for specific reasons. People often do not want to admit this to their doctor, as they think she or he will end up upset with them.
If you are experiencing issues with taking your medication, it is very important for your doctor to understand so that the pair of you can discuss some from the barriers to taking it, such as side effects. Deficiencies in efficacy is often because of regularly missed doses, and without this knowledge, other medications trials may be suggested unnecessarily.
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