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Why Aren’t My Antidepressants Working?
If you feel like your antidepressant has stopped working, you're not alone. It's common for a medication that once worked wonders to become ineffective, especially if you've been taking it for a long time. Symptoms return for up to 33% of people using antidepressants — it's called breakthrough depression.
"Usually an antidepressant that's worked for a patient will keep working," says Paul Nestadt, M.D., psychiatrist and co-director of the Jack and Mary McGlasson Anxiety Disorders Clinic at Johns Hopkins. "But sometimes, a new episode of depression might come up that's not as responsive to that medication, or the medication might just stop working altogether."
What causes depression medications to stop working?
Multiple factors can change the way your body responds to an antidepressant, including:
- Drug or alcohol use. Illicit drug use and alcohol can cause strong mood changes, which can make antidepressants ineffective.
- Pregnancy. Your body's weight and blood volume increase when you're pregnant. Talk to your doctor about taking antidepressants while pregnant, and about potentially adjusting your dosage to continue relieving symptoms.
- New stressors. A new stressful situation at home or work can result in a mood response for which the antidepressant can't compensate.
- Other medications. Interactions between antidepressants and medications for other health conditions can affect how well an antidepressant works.
Most often, though, antidepressants stop working for what seems to be no reason. "There's no good research that shows why a medication may stop working for someone," says Nestadt. "I think it's less an issue of building up tolerance and more likely constantly changing stressors and factors in the brain."
When to See a Doctor
If your depression symptoms return for more than a few days, it's time to see your doctor. But even if you feel like your antidepressant isn't working, it's important to keep taking it until your doctor advises otherwise. You may need a dosage increase or a slow tapering off process. With many antidepressant medications, stopping their use too quickly can cause withdrawal effects such as:
- Diarrhea or constipation
- Greater anxiety
- Suicidal thoughts
Early warning signs of breakthrough depression are the symptoms you typically experience when an episode of depression is coming on, says Nestadt. Depression symptoms vary from person to person, but signs include:
- Low mood
- Changes in sleep or appetite
- Decreased socializing
- Loss of interest in previously enjoyable activities
If your symptoms return, don't worry — adjusting the dose or switching to another antidepressant often solves the problem. (Note: If you have self-harm or suicidal thoughts, see your doctor immediately, call 911 or go to an emergency room. )
Changing Your Depression Medications
If you and your doctor have ruled out factors that could interfere with your current medication, your doctor may increase the dosage, switch you to another antidepressant or recommend you take an additional medication. Drug therapies that treat depression include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRI drugs are the most commonly prescribed antidepressants and are often considered the first line of defense against depression. They increase your brain's level of a neurotransmitter (a chemical that transfers messages from brain cell to brain cell) called serotonin. This neurotransmitter is associated with feeling happy and content. SSRI side effects tend to be mild, and depression symptoms improve significantly for about 60% of people with moderate to severe depression.
Selective Serotonin Noradrenaline Reuptake Inhibitors (SSNRIs)
Both SSNRI and SSRI medications affect serotonin levels, but SSNRI drugs also impact the level of norepinephrine, another neurotransmitter that may affect mood. This type of medication is helpful for those who have extreme fatigue associated with depression, or who have had side effects or poor response to SSRI drugs.
Tricyclic Antidepressants (TCAs)
TCA drugs increase serotonin and norepinephrine in the brain, but unlike other antidepressant types, they also block acetylcholine, a neurotransmitter associated with increased stress, anxiety and depression. You may experience more side effects with TCA medications than with SSRI or SSNRI drugs.
Monoamine Oxidase Inhibitors (MAOIs)
MAOI drugs inhibit the breakdown of dopamine, norepinephrine and serotonin, which increases their concentration in the brain. Low levels of these neurotransmitters are associated with depression and anxiety. MAOI drugs have a greater number of serious side effects. People taking them have to be mindful of the medication's interactions with certain foods and other drugs.
Bupropion acts on dopamine and norepinephrine. Its main advantage is that it doesn't cause troublesome side effects such as decreased libido and weight gain like other types of antidepressants do. However, it may be less helpful for depression with anxiety features.
This newer drug provides relief from depression symptoms within hours by increasing levels of glutamate, the most abundant neurotransmitter in the brain. Esketamine comes in a nasal spray that must be administered in a clinic because it can cause hallucinations and other sensory side effects for up to two hours after treatment. It's an effective drug for those who haven't responded to other antidepressants.
If you're experiencing breakthrough depression, it's important to consult with your doctor so you can feel better again. "It's not unusual for medications to stop working," says Nestadt. "It happens with other sorts of medical treatments as well. Sometimes your blood pressure medicine is no longer effective and it has to be switched. It's just the nature of treating illness."
12 Signs Your Antidepressant Isn’t Working
For many people, finding the right depression treatment is a trial-and-error process. An antidepressant may work well for one person but not at all for someone else — and experts don’t yet have ways to predict this.
In other cases, a person may start to feel better on an antidepressant, but the side effects are too bothersome for them to keep taking it.
A review published in February 2018 in the Lancet assessed previous studies of 21 antidepressant medications and concluded that although these drugs are an effective treatment for depression, some work better than others, and some are better tolerated by the body than others.
One way to improve your chances of finding the depression medication that works best for you is to look for the following signs that your antidepressant isn’t working well enough or is no longer working the way it should.
6 Depression Symptoms You Shouldn't Ignore1. You Feel Better Right Away, but It Doesn’t Last
Exactly how antidepressants work is still a mystery. The effects are thought to be related to changes in neurochemicals in your brain, such as serotonin, dopamine, and norepinephrine — changes that usually take 2 to 12 weeks to set in, with a peak at 6 to 8 weeks. So, if you feel different immediately after starting a depression treatment, it could be a placebo effect, says the board-certified psychiatrist Joseph Hullett, MD, the senior medical director of OptumHealth Behavioral Solutions in Minnesota.
Sometimes that placebo effect wears off, and the actual effect of the antidepressant kicks in. Other times, the placebo just wears off, and the intended effects of the antidepressant are never felt. In this second case, it isn’t that the medication stopped working — it’s that the medication (beyond the placebo effect) just didn’t work for you in the first place.
RELATED: 12 Surprising Facts About Depression2. You Skipped a Dose — or Several
It’s a common situation — busy people often miss doses or take their medication at irregular intervals. The trouble is, not taking an antidepressant medication consistently can prevent it from working as well as it should — or prevent it from working at all, Dr. Hullett cautions. This can cause people to abandon what otherwise might be a very effective treatment.3. You Can’t Sleep Well
“Antidepressants can make you feel more sleepy, less sleepy, and affect your libido and sex life, which can affect your sleep,” says Karen Lim, MD, a double board-certified psychiatrist in general and child and adolescent psychiatry at Prairie Health, a telepsychiatry platform based in California.
“Some people are also surprised to know that antidepressants can cause vivid dreams, myoclonus (sudden jerking of limbs especially at night and when tired), and, rarely, seizures,” Dr. Lim adds. She says the following tweaks to your bedtime routine can be enough to correct some of these issues:
- Try relaxation techniques, such as deep breathing.
- Exercise during the day rather than at night.
- Listen to calming sounds and music, or watch calming videos.
- Talk to your doctor about taking an over-the-counter sleep aid like melatonin.
RELATED: 8 Health Problems Linked to Not Getting Enough Sleep4. Your Mood Is Still Low After a Few Months
“You should see some improvement within three months of starting an antidepressant,” explains Zinia Thomas, MD, a psychiatrist based in St. Louis. “If you have been on an adequate dose of a depression medication for three months and you don’t get results, it’s probably time to try something new.”5. You Feel More Energetic — but Still Feel Blue
“If you feel more physical energy after starting an antidepressant, but you still have depression, that’s good and bad news,” says Gabriela Cora, MD, a psychiatrist in Miami. “It means the depression medication is starting to work, but not in the right way." Increased physical energy combined with depression is a bad combination that can make you act out or increase your risk of suicide, she explains. “So, report these symptoms to your doctor right away,” urges Dr. Cora.
RELATED: 8 Depression Symptoms You Shouldn’t Ignore6. You’re Experiencing Unpleasant Side Effects
Deciding which depression medication is best for you often comes down to side effects, says Hullett. If you gain weight or have sexual problems on one antidepressant, for example, you may want to switch to one without those side effects, he advises.7. You Show Symptoms of Serotonin Syndrome
Although antidepressants are meant to help you feel better, in some cases an antidepressant may combine with other medications you are taking or foods you are eating and lead to serotonin syndrome, an uncommon condition involving an overabundance of serotonin in the body, the Cleveland Clinic states.
Symptoms to watch out for, Lim says, include fever, aches, shakes, sweats, fatigue, irritability, a bad headache, confusion, agitation, restlessness, dizziness, difficulty seeing or walking, muscle twitching, muscle tension, or jaw clenching.
Typically, serotonin syndrome happens within days or weeks of starting an antidepressant or after a dose increase, says Lim. The most common factors that affect your risk of serotonin syndrome, per the Cleveland Clinic, are:
- Too much of one medication that affects your serotonin levels
- Multiple medications that affect your serotonin levels at the same time
“If you’ve been on an antidepressant for a long time, your body may develop a tolerance,” notes Hullett. As a result, a medication that once worked well at quelling your sadness, anxiety, and other symptom no longer has that power. Sometimes, Hullett says, increasing the dose under supervision by your doctor may help. “If you’ve been taking 10 milligrams (mg) of Prozac (fluoxetine), for example, your physician may increase the dose to 20 mg,” he says. In other cases, trying a different medication or treatment is helpful.9. Your Depression Worsens
“If your depression symptoms get worse as soon as you start taking an antidepressant, or they get better and then very suddenly get worse, it’s a sign that the depression medication isn’t working properly, and you should see your healthcare professional right away,” Hullett says. Specific warning signs to watch for include feeling agitated or restless, pacing or constant movement, hand wringing, or feeling generally out of control.10. Your Mood Has Improved, but You’re Still Not Yourself
If you experience some relief on an antidepressant, but it’s not the relief you hoped for, it may be time to try something new, Dr. Thomas says. Options include another depression medication or the addition of counseling, psychotherapy, mood-boosting cardio exercise, or light therapy to your treatment regimen. The combination of medication and other mood-brightening treatments can speed your recovery and reduce your overall time on antidepressants, she says.11. Your Mood or Energy Improves — but Too Much
“Depression medications can sometimes cause mood swings, especially in people who have a tendency toward bipolar disorder — depression and mania,” Hullett says. If you feel unusually elated or you become very terse with your spouse, feel noticeably more irritable, or have an uncharacteristic bout of road rage, you probably need to change your antidepressant, he advises.
RELATED: 9 Different Types of Depression12. Your Depression Is Gone
If you’ve been taking an antidepressant for at least six months and you’ve achieved remission, it’s important to slowly taper off your depression medications with the help of your physician. “Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can produce physical symptoms of withdrawal if you stop taking them suddenly,” he says. “So, you need to reduce the dosage of depression medication slowly, usually over a few weeks.”
You may experience some depressive symptoms when discontinuing antidepressants, but this does not mean the depression is returning. Unfortunately, some people stay on their antidepressants longer than needed because the symptoms of discontinuing SSRIs can be mistaken for signs of returning depression.
Work with your doctor to distinguish between the two. You may need to go even slower than a few weeks when tapering off your antidepressant to prevent these withdrawal symptoms.The Bottom Line
While taking an antidepressant can be very helpful for managing depression, you might not find the right one for you on the first try.
If your medication isn’t meeting your expectations, don’t give up. Consider talking to a doctor who specializes in treating mood disorders if you aren’t already seeing one. And be on the lookout for any worrisome symptoms while you're taking any antidepressant, Lim advises. Manic episodes, serotonin syndrome, and seizures, for example, need to be evaluated by a doctor ASAP.
Additional reporting by Michelle Pugle.
60 years ago the USSR adopted a decree on intensifying the fight against parasites
On May 4, 1961, the USSR authorities stepped up the fight against parasitism at the legislative level. From now on, any resident of Moscow or Leningrad, who was unemployed for four months, could be prosecuted under a criminal article. Parasites were forcibly sent to corrective labor in remote regions for up to five years. Among those convicted of parasitism were the poet Joseph Brodsky and the actor Nikolai Godovikov.
On May 4, 1961, the Presidium of the Supreme Soviet of the RSFSR adopted a decree "On intensifying the fight against persons (loafers, parasites, parasites) who evade socially useful work and lead an antisocial parasitic lifestyle." The decree toughened the legal documents of the Stalin period: Article 12 of the Constitution of the USSR of 1936 "Work in the USSR is the duty and a matter of honor of every able-bodied citizen on the principle: who does not work, he does not eat," as well as the decision of the Council of People's Commissars of the USSR, the Central Committee of the All-Union Communist Party of Bolsheviks and the All-Union Central Council of Trade Unions "On measures to streamline labor discipline" dated December 28, 1938 years old
From now on, a citizen was held liable under Article 209 of the Criminal Code of the RSFSR "Parassism" if he did not work "for the good of the Motherland" for four months.
The exception was women who were raising small children.
“Adult able-bodied citizens who do not want to fulfill the most important constitutional duty - to honestly work according to their abilities, evade socially useful labor and lead an antisocial parasitic lifestyle, are involved by decision of the executive committee of the district (city) Council of Workers' Deputies in socially useful labor at enterprises (construction sites) located in the area of their permanent residence or other localities within a given region, territory, autonomous republic, ”the text of the decree followed.
Muscovites, residents of the Moscow region and Leningraders, "avoiding socially useful work and leading an anti-social parasitic lifestyle", were subject to eviction for a period of two to five years. At the same time, the property of the convict could be confiscated as acquired “dishonestly”.
The slogan “Parasites are our enemies” became very popular in the Soviet Union. Take care of the bread of labor from them!
Leaders of various levels began to criticize able-bodied citizens who did not want to "honestly work" and received unearned income from movable and immovable property (exploitation of living space, cars, land plots).
Citizens accused of parasitism were called BORZ - "without a specific occupation." Hence, the word “borzoi” appeared in the criminal jargon, that is, a person who does not want to work. Responsibilities for identifying and catching parasites were assigned to the Ministry of Internal Affairs. But there were not enough employees, so the so-called “public courts” came to the aid of the police - groups of activists, consisting of combatants, Komsomol members, party and business leaders.
The decree of May 4, 1961 equalized the "notorious loafers" and all citizens who worked, but received unearned income, including representatives of creative professions.
“In the retrospective of Soviet history, the fight against parasitism became a tool for solving various social, economic and political problems, the very discussion of which required specific reservations and Aesopian language. It is already symptomatic that in the role of the defendants under Article 209 there were persons who were charged with offenses that included alcoholism, prostitution, unearned income, hidden unemployment, private entrepreneurship, political dissent, etc. USSR (1961-1991): legal theory and social practice".
The most famous of those who did not fit into the certain framework of the CPSU was Joseph Brodsky. In 1964, a large-scale persecution of the poet was organized. In the spring of that year, a trial took place. Brodsky received the maximum - five years of forced labor. “Re-educated” he was sent to a remote state farm “Danilovsky” in the Arkhangelsk region. Brodsky's friend Yevgeny Rein recalled that in exile "parasite No. 1" was given half of the hut. At the state farm, the disgraced poet was engaged in harvesting. In his free time from working in the fields, he continued to write poetry.
A year and a half later, under pressure from the foreign public, Brodsky's term was reduced. Subsequently, he admitted that the time spent at Danilovsky was the happiest in his life.
“I was lucky in every way. Other people got much more, it was much harder than me, ”said Brodsky.
Actor Nikolai Godovikov, known for his role as the Red Army soldier Petrukha in The White Sun of the Desert, was convicted of parasitism for one year.
They tried to accuse the historian-publicist Roy Medvedev, who existed on the funds from the publication of his books abroad, the philosopher Alexander Zinoviev, who was expelled from the Union of Writers Vladimir Voinovich, for the same.
“Aren't you ashamed to accuse of parasitism a writer whose books have been published in hundreds of thousands of copies and translated into more than three dozen languages? If these books mean nothing to you, then maybe you will take into account that I wrote the songs that you, your children and almost the entire population of the Soviet Union sang! about the place of work.
In December 1980, Voinovich was expelled from the USSR and later deprived of Soviet citizenship, which was returned to him only at 1990th.
However, article 209 of the Criminal Code of the RSFSR quickly ceased to work against creative people, dissidents and other lovers of "unearned income". The bohemia has learned to avoid being held accountable by hiring in purely manual, often fictitious positions.
Thus, the physicist Yuri Mnyukh, who emigrated to the United States, worked for a long time as an elevator operator, and the linguist and human rights activist Konstantin Babitsky, after his release from prison (where he ended up for protesting against the entry of troops into Czechoslovakia), worked as a carpenter in the Kostroma region. The cult rock musician Viktor Tsoi, in order not to be considered a parasite with all the ensuing consequences, already in the late USSR worked as a fireman in a boiler room. Another icon of the genre, Yuri Shevchuk was both a stoker, a janitor, and a night watchman.
And Konstantin Kinchev, in order to escape from the article for parasitism, starred in the film "Burglar" and even received the award of the International Film Festival in Sofia as "Best Actor of the Year".
The wording of Article 209 has changed four times (in 1975, 1979, 1982, 1984). The authorities then toughened it, then softened it. In total, from 1961 to 1965, 37 thousand people were convicted under this article. It is curious that party leaders in the northern regions asked Moscow not to send them convicted of parasitism: they simply could not be provided with work and living conditions.
The expulsion of parasites ceased in 1965, but under Yuri Andropov in the early 1980s, the persecution resumed with renewed vigor. Older people remember the so-called "Andropov raids" well, when policemen could unexpectedly raid a cinema, shop or hairdresser in the middle of the day with the only question: "Why are you not at your workplace?"
The names of violators were entered into special lists of truants, which were then transferred to the management of enterprises.
The criminal article for parasitism lasted exactly 30 years - until it was adopted on April 1991 years of the law "On Employment". He abolished the criminal liability for parasitism and legalized unemployment - those who lost their jobs were paid social benefits.
In memory of the era of the persecution of parasites, propaganda posters such as the following have been preserved: “Let the earth burn under the feet of parasites!”, “Parasites and loafers, not working, themselves interfere with the work of others.”
End of the world. What does not work in the three former republics of the USSR in blackout
The regions and the largest cities of Kazakhstan, Uzbekistan and Kyrgyzstan turned out to be de-energized due to a state of emergency on a single power grid created back in the days of the USSR. Tashkent believes that the accident occurred in Kazakhstan. Kazakhstani KEGOC, in turn, speaks of an imbalance in the networks of neighboring countries. The blackout disrupted the operation of airports and the metro, subscribers complain about the lack of mobile communications, and there is no water in residential buildings.
Kazakhstan, Kyrgyzstan and Uzbekistan experienced a massive power outage. The capitals of Bishkek and Tashkent, as well as the largest Kazakh city of Almaty and the second largest city of Kyrgyzstan, Osh, were left without electricity.
Three countries of Central Asia experienced a massive power outage
Several countries of Central Asia, in particular Kyrgyzstan, Uzbekistan, and Kazakhstan, experienced problems...
January 25 14:11
According to the Uzbek Ministry of Energy, the blackout occurred due to a major accident in the power grids of Kazakhstan. Three countries are connected to the single power grid of Central Asia.
“Today at 10.57 in Almaty, Shymkent, Taras, Turkestan (regions) and adjacent regions of Kazakhstan, as a result of a major accident on the unified power grid of Central Asia, there was a power outage. As a result, power outages were observed in the energy system of Kyrgyzstan, including in Bishkek, Osh, Jalal-Abad and all other cities," the ministry said in a statement.
Tashkent TPP and Syrdarya TPP were automatically switched off. The accident also led to the shutdown of the Talimarjan and Turakurgan TPPs. Residents of the Fergana and Tashkent regions, the Ferghana Valley, Syrdarya, Jizzakh, Samarkand, Bukhara, Kashkadarya regions of Uzbekistan were left without electricity. The authorities are preparing to launch each power plant separately.
The Kazakhstani authorities, in turn, blame the power engineers of Uzbekistan and Kyrgyzstan for what happened. “Due to the significant emergency imbalance created by the energy system of Central Asia (Uzbekistan, Kyrgyzstan), there was a power surge on the 500 kV electricity transit North-East-South of Kazakhstan,” said in the Kazakhstan Electricity Grid Operating Company (KEGOC).
All airports in Uzbekistan stopped working due to a power outage. According to the Uzbekistan Airports Telegram channel, not all passengers were checked in at the Tashkent airport for a flight to Nur-Sultan, about 60 of them were “stuck” in the sterile zone. Flight HY-762 Almaty - Tashkent was sent to the alternate airfield in Navoi (the only airport in the country currently operating).
Air Astana flight KC-127 from Almaty is returning to the departure airport. There is no electricity in the airports of Namangan, Andijan, Ferghana, Termez, Karshi, Urgench, Bukhara, Nukus and Samarkand.
The Tashkent police department urged residents not to drive unless absolutely necessary due to the shutdown of traffic lights on the roads. Traffic is controlled by traffic police. The work of the metropolitan metro has been suspended.
In Primorye, due to abnormal frosts, about a thousand people were left without electricity
In Primorsky Krai, due to abnormal frosts, 850 people were left without power supply, reports...
December 26 08:21
Bishkek Airport switched to autonomous power supply, it continues to work, reports zakon.kz . “There are no problems with receiving flights. The airport operates normally, but not in full mode. Check-in for the Bishkek-Islamabad charter flight has been suspended,” the Manas airport told the publication.
Due to a power outage in Almaty , trolleybuses stopped, they remain on the route waiting for the resumption of power supply.
Almaty International Airport and the metro are operating as normal. None of the hospitals in Almaty was cut off from electricity, since medical institutions are powered by other power supply schemes, diesel generators are provided in case of failures.
The Ministry of Health of Uzbekistan also reported that all medical institutions switched to backup power sources, and the catastrophic consequences of the accident were avoided.
According to the municipal enterprise "Bishkekvodokanal", there is no cold water in the capital of Kyrgyzstan, since pumping stations are powered by electricity. Also, the supply of heating and hot water from the Bishkek thermal power plant is malfunctioning. Residents of Tashkent also report problems with heating and water supply.
In Kazakhstan, due to a large-scale blackout, Kcell subscribers had problems with communication and mobile Internet.
More than 15% of Tele2/Altel base stations were left without power. Residents of Almaty and the region, Shymkent, Taraz and Kyzylorda complained about the failure. Operators install generators at hub sites to keep the network running.
Beeline base stations in Kazakhstan operate on a diesel generator, the network is overloaded due to the lack of a Wi-Fi signal in houses and apartments.
ATMs, terminals for non-cash payment in stores do not work in Kyrgyzstan, banking operations are not carried out.
At the Kazakh ski resort Chunkurchak and at the Uzbek ski resort Amirsoy, people got stuck on cable cars. Rescuers of the Ministry of Emergency Situations have already been sent there. There were no calls from the cable car in Koktobe and the resort to Shymbulak.
The project of a unified energy system of Central Asia was created back in Soviet times.