Patients ask me all the time “What to do when your anti-depressant stops working?” For example you have depression and have been on Zoloft for seven years and done well, but the past six months you feel more depressed.

First thing to ask is “are you using alcohol?” That’s the worst thing you could do. Alcohol is a depressant and maybe interfering with the efficacy of the antidepressant. Marijuana, Opiates, Benzodiazepines and Antihistamines aren’t much better either.

For example drugs like Roxycodone, Oxycodone, Oxycontin, Oxycodone, Loritabs, Hydrocodone, Xanax, Alprazolam, Ativan Lorazepram, Benadryl, and Diphenhydramine these drugs have a similar effect and may function as depressants.

Substance dependency usually results in depression, whether it is a physical or psychological affect. Often times an antidepressant isn’t working the first thing people do is self medicate. Don’t do that because it makes matters worst.

The first thing I tell people to do is exercise. Take a walk, ride a bike, go for a run. Do something, the best exercise is the one you do. Move your body everyday for an hour; get your heart going, break a sweat. Studies indicate exercise is as beneficial as anti-depressants in healthy depression.

The second thing I tell people is to eat right. Lose the candy, cakes, cookies, muffins, cupcakes, pastries, etc. Avoid canned, packaged and processed foods. Avoid anything with white flour, sugar or salt. Don’t eat pizza, French fries and hamburgers.

You should eat vegetable, nuts, lean meats, chicken, fish and pork. Eat a diet high in fiber. Drink lots of water. Eat four little meals throughout the day. Ok, now we have talked about no drugs, exercising and eating right.

Start seeing a psychotherapist. That individual helps supports you differently. For example rescheduling your thinking and offers you practical advice.

The next strategy would be to change your medication. There are many possibilities. Depending on what you have taken in the past, what family member experience with medication and how your current medication is working.

In the example of the individual who was taking Zoloft and a new direction may be indicated. The drop in efficacy after seven years means the use of that drug is done. A reasonable thing to do is to start the person on an antidepressant from a different family of antidepressants. Wellbutrin comes to mind. This medication is a different class of antidepressants and works on a different group of neurotransmitters in the brain. This medication is energizing, has no sexual side effects, may actually cause some weight loss, has no withdrawal symptoms and works very well for most people. No medication is perfect though and some people get anxious, headaches, irritability and trouble sleeping. You can start Wellbutrin while you taper of the Zoloft over a three to four week period. (Note: Zoloft has a withdrawal syndrome which can mimic the flu.)

Let’s say the Zoloft didn’t lose its total effectiveness and all it is needed was a boost. Abilify can do that as well as small doses of Lamictal, Zyprexa, or Lithium. Other drugs or supplements that can be helpful are Buspar, Deplin, or Thyroid extract. Antidepressants from another class like Effexor, Remeron, and Pamelor can work. Amphetamines and other activating medications like Provigil and Nuvigil can help. The semi synthetic opiate Burpenorphine can help as well.

The management of depression is an ongoing progress. The illness changes, the body changes and individual life circumstances change. This is why the approach to treatment must evolve and include education, exercise, nutrition, therapy and medication management.

Reducing stress, socializing, getting plenty of sunshine and staying active with positive activities will help improve your mood.

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