These days it is almost too easy to get prescribed antidepressants. Book an appointment with any general practitioner, talk about the fact that you’ve been unable to shake feelings of sadness, and mention that the sadness is interfering with your quality of life. Chances are good that you’ll walk out of the practitioner’s office with a either: a sampler pack for the latest heavily-marketed antidepressant, or you’ll get a prescription to fill for an SSRI.
Either way, you’re eager to pop your first pill and get your frown turned upside down. Unfortunately you may be completely unaware of the potential drawbacks associated with taking a pharmacological approach to treat depression. If you aren’t aware of the various phases of antidepressant treatment – you may want to do some reading and learn about the potential side effects, long-term effects, withdrawals, and other pitfalls associated with a typical course of treatment.
If you have your mind made up that antidepressants are the only way to escape from your depressive feelings, you may want to learn how you can maximize your chances of success when using them. Many people end up taking antidepressants only to feel much worse than they did at a pre-treatment baseline, while others end up ingesting a drug that is at odds with their genes – leading to wicked side effects. Though taking any antidepressant is a neurophysiological gamble, there are steps you can take to increase your odds of winning (feeling better).
10 Ways To Maximize Success with Antidepressants
There are many steps you can take to maximize the likelihood that you’ll respond to antidepressants and derive lasting therapeutic relief. Though no antidepressant will work forever without side effects, some can work for many years – enough time for you to get your life back on track. Even if your antidepressant stops working after 5 or 10 years – chances are that science will have progressed to the extent that superior treatments will have hit the market.
Find a Skilled Psychiatrist
Assuming you want to take an antidepressant to improve your mood, the first step you’ll want to take is finding a highly skilled psychiatrist. Even if you have to wait a few weeks or a month to get your initial appointment, it may be well worth the wait. Although you could test your luck with a general practitioner, most general practitioners are not as well equipped to treat depression nor make psychiatric evaluations.
You will want to make sure that you are being as accurately diagnosed as possible. If you complain of some mood swings – you don’t want some minor ups and downs being interpreted as bipolar disorder. On the other hand, individuals with bipolar disorder, schizophrenia, or a personality disorder will not want to be misdiagnosed by a general practitioner. The initial diagnosis is crucial for deciding which antidepressants are most likely to treat symptoms.
Assuming you are working with a skilled psychiatrist – blood panels will be recommended after your first visit. Why on Earth would a psychiatrist recommend blood panels? Is there really anything wrong with your blood? A smart psychiatrist will recommend blood panels to make sure that you don’t have any major deficiencies in vitamins, hormonal imbalances, or other toxicities that would remain undetected.
If you have a major hormone imbalance as a result of an underactive thyroid (e.g. hypothyroidism), it would be foolish to treat symptoms with an antidepressant. Rather, a medication to treat hypothyroidism should improve your mood in relatively short-order. In addition to detecting various medical conditions, a blood panel provides a baseline reading of pre-treatment biomarkers.
These biomarkers can be helpful for comparing how certain vitamin levels and hormones have changed throughout your antidepressant treatment. If your psychiatrist doesn’t urge you to get any sort of blood testing done, you may end up treating the psychiatric symptoms of a serious medical condition (e.g. hypothyroidism) rather than correcting the root cause.
We are no longer living in the Stone Ages, and yes it is possible to get your genes tested. Although we are all “homo sapiens” (humans), not all humans have the same genes – which means we won’t all respond the same to certain antidepressants. One person may take a drug and derive significant benefit in terms of a mood boost and experience no antidepressant side effects.
Another person may take the same drug and end up feeling worse with significant side effects. Genetic testing can be done with services like GeneSight, which collect a sample of your DNA to analyze your genes. Following a genetic analysis, they are able to predict the medications that are least compatible with your neurophysiology.
This can help you avert a drug that may have caused vomiting, diarrhea, a skin rash, and a host of other unpleasant side effects. Despite the fact that this technology is relatively primitive, it is still better than blindly taking all medications. The results from genetic testing will help both you and your psychiatrist decide which antidepressants are most likely to provide benefit with minimal downside.
Strategic Neurotransmitter Targeting
Despite the fact that serotonergic drugs are commonly prescribed as first-line treatments for depression, you’ll want to understand whether it’s a smart idea to tinker with the serotonin system. Though targeting serotonin is a proven method for treating depression, not everyone with depression has low serotonin or even a neurotransmitter problem. Even among those with neurotransmitter imbalances, the cause of depression could be: low dopamine, low norepinephrine, endorphin deficiencies, orexin imbalances, etc.
To get a general idea of which neurotransmitters may be most imbalanced, you could consider taking the “Braverman Personality Type Assessment.” This assessment was developed by Eric Braverman (M.D.) to help you determine neurotransmitters that are most likely to be deficient. In addition, you could consider getting some blood work done to assess blood-levels of neurotransmitters, but this may be problematic due to the fact that blood levels of neurotransmitters do not always correlate well with brain levels.
Even if you find the neurotransmitter tests to provide no value, it’s better to take an educated guess than a completely blind guess in regards to what should be targeted. Additionally, even if a drug like an SSRI works to treat depression doesn’t mean that serotonin was the underlying issue. The highly addictive drug heroin alleviates depression rapidly, but it doesn’t mean that a person automatically was deficient in endorphins.
Sometimes it may take a bit of trial and error and working with your psychiatrist to determine which neurotransmitter targets are likely to improve your mood. A psychiatrist will consider your overt (and reported) symptoms and then troubleshoot via pharmacology. The agent prescribed may be based on primary, secondary, and possibly tertiary mechanisms of action.
You certainly should trust that a psychiatrist is more educated that you when it comes to medications and choosing optimal treatments. After all, they went through a lot of advanced schooling and know how drugs work within the brain and how they may help to treat depressive symptoms. Furthermore, psychiatrists understand which drugs are more likely to have certain side effects than others.
That said, you can still have standards in terms of what you expect not to experience on antidepressants. For example, when I sought out treatment with antidepressants – I told my psychiatrist that I wanted to start with a medication that was unlikely to cause weight gain or sexual dysfunction. At the time I was in a relationship and in good shape so I didn’t want to sabotage my efforts at the gym nor intimate pleasures.
He was still able to come up with several viable medications that were unlikely to yield both of these side effects. If you don’t communicate your standards to a psychiatrist, it is likely that you may end up on a drug that causes your weight to balloon or your sex life to diminish. Only if you fail to respond to several options should you consider adjusting your standards – there are many antidepressants besides SSRIs including: SNRIs, atypicals, TCAs, MAOIs.
Minimal Effective Dose
In preclinical rodent studies, nearly every antidepressant is administered based on bodyweight. However, in humans the drug companies have devised “one-size-fits-all” type dosage guidelines. They’ve done this by suggesting a range of dosages that are likely to be effective for everyone.
What is known is that there are always outliers and people that respond to a much lower (subtherapeutic) dose than the norm, and also others that respond to a much higher (supratherapeutic) dose than the norm. It is important to avoid automatically assume that you’ll fit within the guidelines of the norm. While it is necessary to derive benefit from an antidepressant as soon as possible and avoid starting at a nonsensically low dose, immediately jumping to a high dose may be doing yourself a disservice.
Most quality psychiatrists will gradually titrate the dosage upwards from a low dose until an individual responds. This dose is considered the “minimal effective dose” or lowest amount necessary for therapeutic benefit. By starting low and working your way up to this minimal effective amount, you minimize the likelihood of side effects associated with greater doses.
Starting at a high dose is inherently problematic for a multitude of reasons. Firstly, you are shocking your nervous system with a large quantity of an exogenous chemical – leading to initial tolerability issues and side effects. Secondly, assuming you start with a moderate or high dose, your nervous system will quickly adapt to the drug’s effect.
Thirdly, many drugs have completely different binding profiles and mechanistic effects at lower doses than high doses. Therefore it may be beneficial to determine whether an individual responds to the lower dose before immediately taking a moderate or high dose. Assuming you want to prolong the drug’s benefits and minimize likelihood of side effects – starting with a low dose is usually a great strategy (especially for those who’ve never used an antidepressant).
Should you find that a subtherapeutic dose alleviates your depressive symptoms, you can avert many unwanted side effects associated with higher dosages. Although there is no biological free lunch in regards to side effects at any dose, the lower doses aren’t associated with as significant of a biological toll nor neurotransmitter “debt” following treatment. Since all antidepressants eventually stop working due to tolerance, if you started low, it is easy to increase while still avoiding many side effects.
Even if you increase from a subtherapeutic dose to a standard low dose, the side effects won’t be as bad as if you had started at a moderate dose and had to increase to a high one. There is more potential for dose progression if you start low, whereas if you start high – you may quickly hit a ceiling or end up on a supratherapeutic dose. Higher doses result in exogenous chemicals exerting more control over your neurophysiology whereas lower doses don’t.
Eating fish several times per week is linked to significantly better outcomes with antidepressant treatment. In other words, the nutrients provided by the fish may be working synergistically with medication to facilitate mood boost. Specifically, it is possible that omega-3 fatty acids (DHA and EPA) within fish may be working to strengthen connections, ramp up levels of monoamines, and decrease neuroinflammation.
Should neuroinflammation decrease and levels of beneficial neurotransmitters increase, eating fish could bolster the efficacy of an antidepressant. While correlation (between eating fish and enhanced antidepressant efficacy) doesn’t equal causation, the possibility of causation cannot be ruled out. One tip for those who are attempting to eat fish several times per week is to avoid fish with high mercury and make sure the fish is “wild-caught” rather than factory farmed.
Mercury is a potent neurotoxin and may exacerbate your depression and/or cause brain fog. If you don’t like eating fish or want to consider an alternative, you could try fish oil or krill oil supplements. Both fish oil and krill oil contain healthy omega-3 fatty acids that can improve brain function and may act as antidepressants. Read up: Fish oil for depression.
Consider Natural Adjuncts
Many people believe that they’ve done everything in their power to treat depression naturally via lifestyle changes, supplements, etc. However, just because you are on an antidepressant doesn’t automatically give you a license to be unhealthy and think you can get away with it. Eating a suboptimal diet, avoiding exercise, not getting enough sleep, etc. – can (and will) detrimentally affect your mood.
On the other hand, if you are eating an optimal diet for depression, exercising hard 5 times per week, maintaining low stress, and getting proper restorative sleep – your mood can be naturally elevated. A person’s lifestyle will always either enhance or reduce the efficacy of their antidepressant medication. Therefore, it is always important to make healthy choices to ensure that you maintain a happier mood.
In addition to lifestyle interventions, you may want to get consider some high tech ways to treat depression such as: neurofeedback, brainwave entrainment, emWave2, or transcranial magnetic stimulation. These therapies all can alter neurophysiological functions for the better and may work synergistically with antidepressants. If you haven’t already, consider pursuing natural and high-tech, non-pharmacological adjuncts.
Throughout your treatment with antidepressants, it is recommended to track your body’s reaction to the drug over time by using data. I’ve written an article about improving psychiatric treatment outcomes with variable tracking, and essentially, what you may want to consider, is tracking neurophysiological changes throughout treatment. These changes will help give you clues as to how the drug is affecting brain functioning, biomarker levels, etc.
If you notice any potentially detrimental trends emerging as a result of an antidepressant, you’ll be able to discontinue treatment and/or correct these alterations. For example, if levels of a certain hormone plummeted following antidepressant treatment, you may need to consider using bioidentical hormones to increase deficiencies. By keeping an eye on personal data, you can quickly detect ominous irregularities associated with treatment.
Furthermore, data tracking may be beneficial for comparing your “depressed” (pre-treatment) physiology to your “non-depressed” physiology (during treatment). Certain elements of the “non-depressed” physiology may be beneficial for the future in determining whether a certain drug, therapy, or intervention is improving mood. For example, if you notice that brain activation has shifted significantly from the right PFC (baseline) to left PFC (treatment) – you know that activation of the left PFC is likely beneficial for your mood.
Should you notice that the efficacy of a drug has decreased over time, and brain activity has shifted back to the right PFC – a relapse could be prevented via dosage increase, adjuncts, etc. In addition to tracking valuable objective neurophysiological data, you’ll want to record subjective data. In other words, you’ll want to evaluate your mood and track the specifics of your experience throughout treatment.
It is recommended to conduct a general cost-benefit analysis of your antidepressant treatment every so often. A cost-benefit analysis will help you organize your thoughts and determine whether the therapeutic antidepressant benefits outweigh any drawbacks (e.g. side effects). If your mood improved significantly from “rock bottom” to “feeling good” and you don’t experience any side effects – a cost-benefit analysis may not yet be necessary.
However, if an antidepressant seems to be working “just alright” and you’ve experienced a weight gain of 20 lbs. and sexual dysfunction, you may want to reevaluate the treatment. Cost-benefit analyses need not be conducted on a daily basis, but you may want to evaluate your treatment once per week, once every couple weeks, or even once a month. Monthly evaluations will help you determine whether a drug is worth taking.
To help track the costs and benefits of your experience on a medication, I recommend writing in a daily journal. You can then review these journal entries at the end of each month and create a systematic review of the “pros” and “cons” you’ve faced throughout treatment. If your treatment is no longer helping, a cost-benefit analysis can make it an easier decision to stop treatment – rather than second guessing yourself and continuing to take a drug that isn’t helping or making things worse.
How have you maximized your success with antidepressants?
While some people manage to derive benefit from antidepressants for years (or even decades) without any major side effects, these individuals are in the minority. Most people will experience some unwanted side effects or notice that a drug stops working. Fortunately with the aforementioned tips, you can maximize the likelihood that you can sustain a long-term mood boost with antidepressant treatment.
If you’ve made a concentrated effort to maximize the longevity of efficacy for your antidepressant treatment, mention what steps you’ve personally taken and whether they’ve worked. Do you believe that there are things that can be done to enhance the likelihood of a favorable antidepressant treatment experience? Or is everyone simply rolling the dice – with some patients hitting the long-term neurophysiological antidepressant compatibility jackpot? Share your thoughts in the comments section below.