Understanding Why SSRIs Stop Working and the Challenge in Treating Depression

Major depression affects more than 264 million people worldwide. It is a debilitating condition that affects an individual's ability to function daily. Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressants prescribed to treat mild to severe cases of depression, anxiety disorders, and borderline personality disorder (BPD). However, some patients who responded well to SSRIs suddenly stop responding to their treatment over time, causing their depression to relapse. In this blog, we will explore the reasons why SSRIs stop working and why treating depression is a challenging task.

Patrick M. DeCarlo successfully treats clients frustrated with their results achieved from SSRIs.

Tolerance to SSRIs:

One reason why SSRIs stop working is the patients develop tolerance to their medication over time. This means that the drug's effectiveness gradually diminishes as the body adapts to the drug's presence. As a result, the patient may require a higher dosage or a different medication to manage their symptoms. Tolerance is more prevalent in patients with long-term medication usage or those with severe forms of depression.

Individual Differences:

Another reason why SSRIs stop working is because of individual differences in patients' brain chemistry. Serotonin, the neurotransmitter targeted by SSRIs, affects mood and emotions. Some people naturally produce more serotonin than others, making it easier for them to recover from depression compared to someone who produces serotonin in lower quantities. Also, some people have different serotonin receptor genes that can interfere with their response to SSRIs.

Drug Interactions:

SSRIs' effectiveness may reduce when co-administered with other drugs that can interfere with their metabolism or function. For instance, SSRIs can increase the concentration of the anticoagulant medication warfarin, leading to bleeding complications. Patients must inform their healthcare providers about any other medication or supplements they use, including herbal remedies, before starting any SSRI therapy.

Compliance:

Patients who do not adhere to their medication regimen as prescribed are more likely to experience medication failure. This includes forgetting to take their medication or taking them erratically, stopping medication abruptly, or self-medicating with other substances, like alcohol. To ensure medication effectiveness, patients must follow their healthcare providers' instructions when taking antidepressant medication.

Resistance to Treatment:

Despite undergoing several rounds of antidepressant treatment, some patients may still remain unresponsive to therapy. This is known as treatment-resistant depression (TRD). TRD is challenging to manage and may require other types of therapies, such as electroconvulsive therapy (ECT), ketamine infusion therapy or transcranial magnetic stimulation (TMS).

SSRI therapy has revolutionized treating depression and other mood disorders. However, it is crucial to realize that not all patients respond to the medication the same way. SSRIs' effectiveness reduces over time in some patients, mainly due to tolerance, individual differences, drug interactions, and compliance issues. To address these challenges and improve the effectiveness of depression treatment, patients and their healthcare providers should work together to develop a comprehensive treatment plan. This plan should include psychotherapy, regular monitoring of medication side-effects, lifestyle changes, and adherence to medication instructions. With these measures in place, treating depression and other mood disorders could be more effective in the future.