Experiementing to find the right medicine?
Oct 2, 2003
I've had unipolar depression for the past 5 years now; I've only been receiving treatment for the past year though. I was started on Zoloft, and it helped a bit for about 5/6 months. Then it started just not working at all, and I tried Lexapro. That didn't help either, and now I'm on Wellbutrin XL 150mg and Ambien to help sleep....My questions are: 1. Is it usual for it to take a long time (even a year) to really find a medicine that works? 2. Do you think my depression is being stubborn in going away because I let it go so long untreated? Thank you, Melanie
Response from Dr. Horwath
1) Finding the right medicine can take some time. However, the real question for you is: did you receive adequate trials of treatment? Zoloft is an outstanding antidepressant, but you need to take up to 200 mg/day for up to 6 weeks before you can say you didn't respond. Similarly, Lexapro 20 mg/day for 6 weeks is a minumum trial.
In most cases, if an SSRI (sertraline, fluoxetine, paroxetine, citalopram, escitalopram) doesn't work or stops working, the next step is to augment the SSRI with Wellbutrin. It is often quite effective to add Wellbutrin to an existing treatment with an SSRI. It is not usually necessary to stop the SSRI. If augmentation of an SSRI does not work, the next course of action is usually a trial with an antidepressant from another class, such as venlafaxine (Effexor) or a tricyclic antidepressant (eg. nortriptyline, imipramine, desipramine, amitriptyline).
If you get an adequate trial of medication, the likelihood of response should be 80-90%
2) No, I don't think your depression became more stubborn or treatment resistant because of waiting. However, an episode of depression that lasts 5 years is unusually long. Episodes of major depression will often resolve spontaneously after several months. More lengthy depressions often have complicated causes, and may require a combination of medication and psychotherapy to fully resolve. Interpersonal psychotherapy and cognitive-behavioral therapy have both been studied, and are considered effective treatments for depression, especially in combination with an appropriate medication.
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