Episode 1: Why Don’t Antidepressants Work for Me?

Why do anti-depressants seem to work well for some and not at all for others? In this episode of Ask a Psychiatrist, Dr. Erik Messamore takes on this question, offering practical information about the multi-faceted nature of depression and factors to consider in choosing from a range of treatment options.

A clinician has more than half a dozen pathways to think about the cause of high blood pressure, each with its own family of medications available as possible treatments. But when it comes to depression? It’s treated as a one-size-fits-all monolith – as if there are no variants or factors specific to the affected individual. Dr. Messamore has a different take, explaining the range of biological, environmental, social, and even spiritual variables that are relevant to mood.

As a first step, Dr. Messamore underscores how important it is for patients, their families and most of all clinicians to put on a Detective’s Hat: Keep track of symptoms and the progression of treatment; consider having a personality assessment done to better understand the individual’s unique psychological landscape and tendencies; take a pro-active approach to researching and considering alternatives to a bio-chemical approach. When it comes to treatment options, they are as diverse as the nature of depression itself, which is why this episode of Ask a Psychiatrist not only describes some common types of depression but also an array of clinical strategies to augment or replace anti-depressant medications.

Dr. Messamore also breaks down how drugs affect particular neurotransmitters and why Evidence-Based Psychotherapy can be a highly effective tool for responding to depression – especially those that are not genetically based. With the incidence of depression on the rise nationally, generation over generation, it’s very likely that you or someone you love will encounter the complex and constantly evolving field of psychiatry. Dr. Messamore is here to answer questions and provide information about mental illness and general wellness.*

*Advice provided by the host is not addressed to any specific person or personal situation. If you are experiencing a health emergency, please consult a physician. Click here to view a relevant video in which Dr. Messamore offers additional thoughts on this topic. Click here if you’d like to ask a question or suggest a topic to address in a future episode. If you’ve found this information helpful, please share it with your network!

KEY TAKEAWAYS:

• (01:40) – Depression is not a single disease as defined by one set of symptoms or a single remedy. It’s has many causes, and many treatment options.
• (06:31) – Some people respond to anti-depressants because they’re experiencing a genetic deficiency in one of their neurotransmitters, but anti-depressants might also be curative because they increase a general feeling of well-being that encourages resilience.
• (10:10) – Why is it that – even with all the enhanced treatment options – the rates of depression keep going up and up?
• (13:34) – Dr. Messamore cites some of the many contributory components of depression and some of the interventions available, such as: Anti-depressants targeting specific neurotransmitters such as serotonin, norepinephrine and glutamate. Transcranial Magnetic Stimulation Electro-Convulsive Therapy
• (15:50) – It’s very important for people to know that serotonin isn’t the only treatment option out there.
• (16:20) – Anti-depressants given at the right dose for the right period of time should lead to improvement. If the overall trendline is not towards relief, it’s worthwhile to revisit the treatment with your provider.
• (18:28) – About Evidence-Based Psychotherapy and the use of personality or temperamental assessments in pinpointing/responding to depression.
• (20:35) – Two symptom clusters that are typical in depression and can help guide bio-chemical treatment approaches: Melancholic Depression: Loss of appetite, sleep disturbance, mood variation that tends to improve as the day goes on. A-Typical Depression: Tendency to sleep a lot, eat a lot (especially carbs) and respond with unusual sensitivity to relationship stressors.
• (25:11) – Dr. Messamore highlights some of the factors that can trigger a biological response and also play a role in the failure of bio-chemical treatments.
• (29:29) – Some strategies to consider if you’re not getting the results you’d like from your anti-depressant medication: Establish what you’re looking for in terms of quality of life and track your moods to determine if progress is being made. If multiple treatment options have failed, assess which drugs have been tried, to what degree they’ve been effective and whether there are external environmental factors that might be affecting outcomes. Consider undergoing an assessment to see whether you’re one of a large subset of people whose personality or temperamental make-up undermines the efficacy of anti-depressants.  

QUOTABLE:

• “We’re living in a time where we have more medication treatment options for depression than ever before … yet depression rates are growing. They’re going up and up.” “It’s important if you’re not getting good results from Treatment A or Treatment B to press the pause button with your doctor and talk about all the options.”
• “The specific symptom cluster that we call Melancholic Depression might tip the scales in favor of assuming that biological factors are more relevant.” 
• “The thing about perfectionism is that you can never achieve it. You can always envision something better than what you’ve currently got.”
• “It’s really important for everybody involved – patients, their families and especially clinicians – to put on a Detective Hat as well as a Doctor Hat.”

About the Host: Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.