Are Antidepressants Ineffective? Medication Adjustments and Anxiety

Can antidepressants be ineffective?

Hello Doctor: I started experiencing nasal congestion in April, which led to difficulty breathing and gradually increased anxiety that affected my sleep.
Since August, I have been unable to sleep well.
A psychiatrist prescribed "0.5 mg of Mirtazapine before bed + 1 mg of Quetiapine before bed," which improved my sleep a bit, so I switched to "0.5 mg of Mirtazapine before bed + 0.5 mg of Quetiapine before bed." In early October, I began to feel shaky and unwell, so the psychiatrist changed my medication to "0.5 mg of Sertraline in the morning + 0.5 mg of Quetiapine before bed + 1 mg of Sertraline as needed." However, I experienced strong side effects from Sertraline, including generalized weakness, difficulty exerting myself while using the restroom, persistent fatigue, and blurred vision.
I then switched back to "0.5 mg of Mirtazapine before bed + 0.5 mg of Quetiapine before bed." I later discussed this with my psychiatrist, who expressed concern that the serotonin effect of Mirtazapine might be insufficient, so after discussion, we decided to change to "1 mg of Mirtazapine + 0.5 mg of Quetiapine before bed" starting on November 21.

On November 23, I suddenly experienced shortness of breath in the evening and had to go to the emergency room due to hyperventilation.
I felt fine from November 24 to 25, but on November 26, when I got busy with work, I felt short of breath again.
Since then, I have been experiencing a sensation of breathlessness almost every evening.
On November 30, around noon, I started to feel numb and shaky again, and after taking 0.5 mg of Quetiapine and sleeping, I felt better.
However, today, December 1, I started feeling numb and shaky again after noon.

Before taking 1 mg of Mirtazapine, I did not feel this uncomfortable.
Since switching to 1 mg, my condition has not been good daily.
Could it be that the effect of Mirtazapine at 1 mg is too strong for me? Or could it be that switching medications and then switching back has rendered Mirtazapine ineffective for me? I am scheduled for nasal turbinate surgery on December 12, and I am concerned that my current condition might affect the surgery, but I also need to address my nasal congestion, as it is the source of my anxiety.

Xiao Zhu, 40~49 year old female. Ask Date: 2023/12/01

Dr. Qiu Junda reply Psychiatry

Hello.
Antidepressants should not lose their effectiveness.
The condition may fluctuate (stress from preparing for surgery can also affect the condition).
It is not that the medication is ineffective.
Hyperventilation can be alleviated with anxiolytics.
I recommend that you continue to follow up with your doctor.
With proper medical care, your condition should remain stable.

Reply Date: 2023/12/01

More Info

When it comes to managing depression and anxiety, the journey often involves navigating the complexities of medication, including potential side effects and the effectiveness of various treatments. Your situation highlights a common challenge faced by many individuals dealing with mental health issues: the balance between finding relief from symptoms and managing the side effects of medications.

Antidepressants, while effective for many, can sometimes lead to adverse effects that complicate treatment. In your case, it appears that the medication adjustments made by your psychiatrist have not provided the desired relief and may have even exacerbated your symptoms. The experience of feeling weak, having blurred vision, and experiencing shortness of breath can be distressing and may lead to increased anxiety, creating a cycle that is difficult to break.

Firstly, it is essential to understand that antidepressants, such as the one you mentioned (美妥平, which is likely a reference to a medication like Mirtazapine), can have varying effects on different individuals. The dosage adjustments you have undergone may have contributed to the side effects you are experiencing. Increasing the dosage from half a pill to a full pill can sometimes lead to heightened side effects, especially if your body is sensitive to the medication. It is also possible that the combination of medications you are taking, including the sleep aid (景安寧), may interact in ways that amplify side effects.

The symptoms you describe, such as feeling weak and experiencing shortness of breath, could be related to the medications, but they could also stem from underlying anxiety or panic attacks. It's crucial to differentiate between side effects of the medication and symptoms of anxiety. The feeling of not being able to breathe, especially if it occurs during stressful situations, may indicate an anxiety response rather than a direct effect of the medication.

Given your upcoming surgery for nasal obstruction, it is understandable to be concerned about how your current health status might affect the procedure. It is vital to communicate openly with both your psychiatrist and the surgeon about your symptoms and medication regimen. They can work together to ensure that your mental health is stable leading up to the surgery, which is crucial for both your physical and emotional well-being.

In terms of managing your anxiety and depression, consider the following strategies:
1. Open Communication with Your Healthcare Providers: Keep your psychiatrist informed about all your symptoms, including any new or worsening side effects. This information is critical for making informed decisions about your treatment plan.

2. Medication Review: If you feel that the current medication is too strong or not effective, discuss the possibility of adjusting the dosage or trying a different medication. Sometimes, a lower dose of a different medication can provide better results with fewer side effects.

3. Therapeutic Support: In addition to medication, consider engaging in therapy, such as cognitive-behavioral therapy (CBT), which can help you develop coping strategies for managing anxiety and depression.

4. Lifestyle Modifications: Incorporate stress-reducing activities into your daily routine, such as mindfulness, meditation, or gentle exercise. These practices can help alleviate anxiety and improve your overall mood.

5. Monitoring Symptoms: Keep a journal of your symptoms, medication changes, and any triggers you notice. This record can be helpful for your healthcare providers in understanding your condition and making necessary adjustments.

6. Support System: Lean on friends, family, or support groups. Sharing your experiences with others who understand can provide emotional relief and practical advice.

In conclusion, while antidepressants can be effective, they are not a one-size-fits-all solution. It is essential to work closely with your healthcare providers to find the right balance that minimizes side effects while effectively managing your symptoms. Your health and well-being are paramount, and with the right support and adjustments, it is possible to find a treatment plan that works for you.

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