Depression and Anxiety Medications Helped for Four Years But Then Stopped Working

Reader’s Question

I’ve been suffering from anxiety and depression since 1993. It has costs me many jobs in my career and I just lost another one last week. I don’t know what to do. Since 2002 to present I have been taking Paxil and Klonopin. They seemed to work fine until 2006, but since then nothing seems to help.

Our Consulting Clinical Psychologist’s Reply

In situations like you’ve described, several factors may be present. For example:

• In treatment-resistant depression/anxiety, it is extremely important that your treatment be provided by a psychiatrist. It’s estimated that 85% of antidepressants are prescribed by nonpsychiatrists, typically family MDs or OB/GYN. While this works well in most cases, complicated cases and treatment resistant depression should be treated by a psychiatrist. If you are not being seen by a psychiatrist, that would be recommendation #1.
• You may have experienced what psychiatrists call “poop out” with your medications. Some antidepressants lose their effectiveness over time and gradually “poop out” (yes, that’s what it’s called!). This is especially true of the earlier SSRI’s such as Prozac and Paxil. When this happens, a medication adjustment is needed.
• You may be adding a complication to your medication and treatment program. Additional medications used for various medical conditions can influence the neurotransmitters associated with depression and anxiety. The use of herbal or other nontraditional remedies can disrupt your medication effectiveness. Frequent use of alcohol or other substances can also interfere with your medication effectiveness. When talking with your physician, honestly list everything you are using and taking.
• Are you losing jobs for reasons unrelated to depression and anxiety? In some cases, individuals may have problems with personality, attitude, and/or behavior. When depression and anxiety increase, so do those behaviors, prompting a job loss due to temper tantrums, resistance to supervision, etc. If this seems likely, you’ll need to address those issues with a counselor or therapist.
• Medications are often prescribed for a specific time and mood. As time passes however, additional stressors may change the situation to the point that the origional dosage is no longer effective. It’s like taking aspirin for knee pain for several years, then you begin an excercise program that involves walking ten miles per day on that bad knee. Suddenly, aspirin isn’t enough. Review your stressors and see if there has been a sudden increase in your level of stress, responsibility or obligation.

Overall, I’d first move to a psychiatric consultation and consider a medication change. If you are not working at this time, you may be a candidate for a “clean sweep” strategy where all medications are discontinued in an attempt to identify the actual level of your symptoms — then reapply meds.

Your situation is very treatable. The fact that medications worked well for a long period of time tells us that it’s a medication issue.