Why Antidepressants stop working

Q: I've taken different antidepressants over the years, and now my body seems to reject medications that helped before.  Any suggestions?

A:  We certainly know that antidepressant medications sometimes seem to stop working. Clinicians started to describe the “Prozac poop out” more than a decade ago, and it seems that the same thing can happen with any antidepressant. For some type of medications (like narcotic pain medication or benzodiazepine anxiety medications) we understand the chemistry of tolerance. For those drugs, long term use causes brain cells to adapt so that the same amount of medication has less and less effect over time. That tolerance and dependence process is pretty similar from person to person. Developing a “tolerance” to antidepressant drugs is very unpredictable from person to person, and we haven’t found any chemical change that explains it.

But the more we study this problem, the better we understand that we don’t really understand it. 

For example, we used to believe that whenever one antidepressant medication seemed to stop working, it was best to try switching to a medication of a different chemical type or class. 

We now know that the chemical type of class isn’t a useful guide. If one medication stops working, it’d definitely worth trying a different one—but the odds of success seem about equal if the new medication is similar to or different from the one that’s no longer helping.
Even if we don’t have a lot of science to guide us, we can still come up with some practical advice. If your antidepressant medication doesn’t seem to be helping:
  • Consider whether other substances (alcohol, street drugs, or changes in prescription medication) might be making depression worse.
  • Ask whether the dose of the medication is at the most effective level.
  • If it’s time to try something different, changing to a different medication or adding a second “booster” medication seem about equally likely to help.
  • How you respond to one medication doesn’t really predict how you will respond to a different one (even a different medication from the same family).
  • When trying a different medication, it’s important to be patient enough (sticking with it long enough to know if it will really help) but not too patient (sticking with it past the point of futility). Be sure to ask your doctor how and when you will assess whether any new treatment is right for you.
By. Greg Simon, MD, MPH, is a psychiatrist and researcher at Group Health Cooperative at the Center for Health Studies in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

Changing your perception

Change Perception and the Experience Changes:

You can easily change your perception when you recognise the fact that you made it up in the first instance based on your beliefs and past experiences. In a relaxed state with your eyes closed, create a mental image in your mind of a negative experience you wish to neutralize. Neutrally observe yourself experiencing the specific event, how it started, how you felt, where it took place, why it was negative for you and how you reacted. As you continue to neutrally observe the scene unfolding through to its end, see how your beliefs about life and yourself made you perceive the experience as negative.

Have Fun with Your Mental Image:

Have fun with the scenes in your mind as you change your perceptions. Keep it light. Allow yourself to sense how differently you would have felt or reacted had your beliefs about yourself and life been different. For instance, had you had more self-love, self-esteem and self-confidence when an important relationship ended; or had you had no attachment to money and no fear of failure when your business was in trouble; how would your perception of that experience be different? When you change your perception so does the experience.

Whatever the negative belief you had at the time, see yourself believing its opposite. Sense how your experience changes from one of disempowerment to one of empowerment as your beliefs change. Feel how the experience doesn't matter as much anymore or how you even feel stronger for it. From this place of strength, take a deep breath and as you exhale release the experience, seeing the image gently float away. Enjoy the lightness you feel as you mentally count upwards and slowly open your eyes. Knowing what you know now, what would you do differently?

Mind your Reality

Helping someone with Depression

About Depression

What can you do to help?
For people affected by depression, discussing their condition with family and friends, and asking them for their help, can be very daunting. They may feel too scared, ashamed or overwhelmed to admit how they are feeling. Tackling depression may seem an impossible challenge. This is when the encouragement and support of a friend is vital to help them feel less isolated and more motivated to actively work on overcoming depression.

By being a supportive friend, you can encourage someone affected by depression to seek help, receive a correct diagnosis and agree on a treatment with their doctor. But how do you approach this subject with them? You may feel that you need some advice to take the first step. Here are some top tips to start the communication:

Talking about depression with your friend
Some of the symptoms of depression (low mood, irritability and fatigue) can make it difficult for someone affected by depression to maintain friendships. Often someone affected by depression may withdraw from social contacts and may not actively seek to address their problem with their friends. And as mental health conditions are still often associated with a stigma in society, both parties may feel uncomfortable addressing the issue. This is why you as a friend may have to take the first step.

If you suspect your friend may be affected by depression, then you should seek positive ways to show your support and reassure them that you will take them seriously and that you will be there for them to lean on.

You could do this by saying:
You are important to me
You're not alone in this and I'm here for you
You don't have to feel guilty or ashamed, this isn't your fault
I can't really understand what you are feeling, but I can offer my compassion and be a friend to you
I'm going to be there for you to lean on. I'm not going to leave you or abandon you
When all this is over, I'll still be here for you
I'm sorry that you're in so much pain. I am going to take care of myself, so you don't need to worry that your pain might hurt me. You're not alone and neither am I
I love you (if you mean it)
Also consider offering them a hug if you feel comfortable with this.

Try to avoid saying negative things such as:
  • Pull yourself together.
  • No one ever said that life was easy.
  • Stop feeling sorry for yourself. Get a grip.
  • So, you're depressed. Aren't you always?
  • There's always someone worse off than you are.
  • Just try not to be so depressed.
  • It's your own fault.

Believe me, I know how you feel. I feel depressed sometimes too.
Once you have approached the subject with your friend, encourage them to visit their doctor (if they haven't done this yet), and ensure that they take any prescribed medication as directed and follow any other therapies recommended by their doctor. Besides the professional support your friend will need, there are also ways in which you as a friend can help them get better.

Some lifestyle changes can help people cope with depression. You can help by encouraging your friend to:
Go outside for some fresh air and sunlight every day – why not invite them for a walk or do some gardening if they don't feel like facing the world?

Take regular moderate exercise – you can suggest you do the exercise together. Encourage them to participate in the exercise by reminding them how good they usually feel afterwards.
Avoid being self-critical – you can help by recognising their accomplishments, however small, and making positive comments whenever possible, e.g. remind them that last week they had three good days and the week before they had two – they're getting better all the time.
Eat a healthy, balanced diet – suggest cooking together or invite your friend over for a meal.
Be aware that your friend may just need to rest – offer practical support like shopping and cleaning the house. Try to balance motivating them without asking them to do more than they are ready for. If your friend has stopped taking care of themselves you could try bringing round some nice soap or bubble bath. It will help them relax and improve their self-esteem.

You can also help them by:
Staying in touch on the phone and/or by e-mail.
Avoiding activities where too much alcohol is consumed as drinking can make symptoms worse.
Making time for activities that you can enjoy together.
Generally, you should motivate your friend to learn about depression and depression treatments. This will encourage them to follow their course of treatment as instructed by their doctor and seek help if something doesn't work for them. They will also see that recovery is possible. You may find it useful to learn about depression together as your friend's concentration and memory might be affected. Audio books are a great way to absorb information if your friend finds it difficult to concentrate on written information.

If your friend is talking about or has attempted suicide
Thoughts of suicide and death can be a major symptom of depression, and should be taken very seriously. If a friend expresses suicidal ideas, reassure them that their life is important to you and many other people and that the appropriate treatment will help them to get better. No matter how hard it may seem to look after someone with suicidal thoughts, it is important to show that you care.

If your friend has suicidal thoughts, talk to other professionals (e.g. GP, emergency services, social services) for advice on how you can help them to stay safe, and encourage your friend to access help and support too. Keeping contact details for support helplines close to hand is also important e.g. Aware loCall Helpline 1890 303 302; Samaritans 1850 60 90 90; 1Life 1800 24 7 100.

Mental Health Awareness Week

Mental Health Ireland celebrates World Mental Health Day with local events for the whole community to enjoy
Plan to Protect Your Mental Health & Wellbeing 

World Mental Health Day is celebrated worldwide on the 10th of October. It is an opportunity to bring awareness to mental health on an international, national and local scale, informing and educating people about mental health and to work towards ending the stigma and create a non-judgemental space for people struggling with their mental health to open up and talk. If you would like to plan an event during Mental Health Week please download our Toolkit Here!
Mental Health Ireland’s vision is for an Ireland where mental health is valued as being an essential part of personal wellbeing and the health of the nation.  Rather than focusing on mental and emotional pain as something to be eradicated, we need to promote the message that it is normal and indeed natural to feel down at times, and that feeling vulnerable is an inherent part of being human. 
Mental Health Ireland will launch their ‘Plan to Protect your Mental Wellbeing’ campaign this Mental Health Week. It encourages everyone to become aware of their wellbeing by following five simple steps. These include Connecting with others, being Active on a daily basis, Taking Notice of what’s happening around you, to Keep Learning and to Give back to your community, friends or family. By monitoring our activities and actions in these areas of our daily lives we can see which areas we are doing well in and others we may need to concentrate on. 
Mental Health Ireland have 103 Mental Health Associations in communities all over Ireland. Each Association has developed a number of activities and events to celebrate World Mental Health Week between the 5th-12th October. Some of these activities include:

National Choral Singing Week in association with Mental Health Ireland. 
Laois Connects in association with Mental Health Ireland – full week of events can be found in this link 
Limerick Mental Health Association awareness week are compiling their events and information can be found on their facebook page
Mensana Fest with Carlow Mental Health Association will be revealing their events on their facebook page 
The Longford Mental Health Association are hosting a musical evening in the Longford Arms Hotel on the 9th October 

More information and events will be uploaded so please keep an eye on this page for events taking place in your locality and please support Mental Health Ireland. If you would like to organise your own event please see this link for our World Mental Health Week Toolkit  

Text MHI to 50300 to donate €4 to Mental Health Ireland
100% of text goes to MHI across most network providers. Some providers apply vat which means that a minimum of €3.26 will go to MHI. Service provider: likecharity. Helpline 01 4433890