What to Do When an Antidepressant Stops Working Effectively

Amber Hoberg, MSN, APRN, PMHNP-BC, a member of the Steering Committee at the Psych Congress NP Institute, provides insights on identifying when antidepressants may cease to be effective and offers practical strategies for adjusting treatment. Nurse Hoberg discusses evaluation techniques for symptoms and when it is appropriate to consider alternative treatment approaches to enhance patient outcomes.

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Hi, my name is Amber Hoberg. I'm a psychiatric mental health nurse practitioner in the San Antonio, Texas area. I work for my own private practice, Morningstar Family Medicine, and I also see patients at the Baptist Health System.

Yes, I have heard from patients that they're antidepressant that they've been taking for a number of years, do quit working again. This happens quite often where sometimes the brain gets used to that particular medication, and in that case, sometimes it's not as efficacious as it used to be when they first started the medication.

My recommendation would be definitely to go to a different type of approach. An example is if maybe the patient has been on an SSRI, and that's what they've been taking for years, that only hits the serotonin neurotransmitter. If they're kind of having that 'fizzle out,' I would recommend going to a different mechanism of action like an SNRI or maybe one of the newer agents that works on a different mechanism of action; trying to get those different aspects in the brain that might be needed in order to improve their depression.

Again, the most important thing to really look at is what are the symptoms they're having and that will help guide your treatment.

What other comorbidity symptoms like psychiatric morbidity symptoms that they might be having? That also helps guide that decision as well. So for me, it really depends on what that patient's symptoms look like in order for me to make that decision. But always going with a different mechanism of action is always the best approach when they're having fizzle out from their current treatments.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from University of Texas Health Science Center San Antonio. She has been working for the past 12 years with the adult and geriatric populations, treating all types of psychiatric conditions. Her background, as a Psychiatric Advanced Practice Nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Baptist Health System and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.