What to Do When Treatment Does Not Seem to Be Helping Enough

What should I do first?

Tell the person treating you, and be specific. The National Institute of Mental Health (NIMH) says to call a health care provider right away if you have problems with a medication or worry that it might be doing more harm than good. It also says that if therapy has gone on for what feels like a reasonable amount of time and you are not getting better, talk to your therapist.

Please do not stop or change a medication on your own, even if you feel it is doing nothing. NIMH warns that stopping too soon may cause unpleasant or harmful side effects, and a provider can lower a dose slowly and safely if that is the right step. Finding what helps often takes more than one try, and that does not mean you failed.

How long is long enough to judge a treatment?

It depends on the treatment, so ask directly. NIMH says antidepressants usually take 4 to 8 weeks to work, and that problems with sleep, appetite and concentration often improve before mood lifts. Smaller early changes can count, even when you do not feel better overall.

Improvement does not always last, either. NIMH notes that a medication can help for a while and then symptoms return. Therapy has no set clock either, though it is fair to ask how progress will be measured and what happens if you are not starting to improve. If something feels wrong sooner, call. You do not need to wait out a time frame to raise a concern.

What should I track before the conversation?

Specifics make a review more useful than a general sense that things are not better. NIMH suggests being specific about when symptoms started, how severe they are and how often they occur. A few notes each week can cover:

• Your main symptoms, rated in whatever simple way makes sense to you
• Sleep, appetite, energy and concentration, even if mood has not changed
• Side effects, and when they happen
• Missed doses or therapy sessions, without judging yourself
• Alcohol, drug use, supplements and new medications from any provider
• Big stressors or life changes at home, school or work
• What you hoped would change, and what has changed so far

What might a review look at?

When progress stalls, a provider usually looks for reasons that can be addressed. This table shows common areas and why they come up. The answer may be one of these, a combination, or something else.

Why might a diagnosis be reviewed?

A diagnosis is a working understanding, and new information can change it. Depression is one example. NIMH notes that some people with bipolar disorder seek help only for depressive episodes while hypomanic episodes go unnoticed, and that it is important to consider the course of symptoms rather than only current ones. Our guide on why bipolar disorder can look like depression explains this.

A review is not an accusation, and it does not always lead to a new label. Sometimes it confirms what you already knew and shifts attention to something else. A fresh psychiatric evaluation takes the same kind of history from the beginning, which can be useful when care has been spread across several providers.

What options might come up?

Options depend on the condition, your history and your own preferences, so nothing here is a promise that one will suit you. For depression, NIMH describes options such as trying a different antidepressant, combining an antidepressant with another type of medication that may make it more effective, adding psychotherapy, and brain stimulation therapy when other treatments have not worked. Your own list may look quite different.

Some treatments are provided elsewhere, so a referral may be part of the plan, for example to a dedicated therapist or a center that offers brain stimulation therapy. Medication decisions here are made after an evaluation. Not every medication can be prescribed at every kind of visit, some may require an in-person appointment, and we explain what applies to you and how medication management works.

Is it okay to ask for a second opinion?

Yes. NIMH's guide to talking with a provider says you may want to consider another opinion from a different health care provider, and that you may need to talk to a few providers to find someone you are comfortable with. A good provider should not be offended. You can simply say that you would like another view.

Ask for copies of your records or a treatment summary, and bring your medication list and notes. Keep following your current plan until you have a new one, so there is no gap. If you decide to move your care, our guide on switching psychiatric providers covers the practical steps. If you want to know whether a one-time second opinion is possible at our clinic, ask us.

What does this look like at DanShalom Behavioral Clinic?

New patients start with a first evaluation of about 60 minutes with Victor Onodjacha, MSN, PMHNP-BC, and follow-ups are about 30 minutes with the same provider. Visits are at our Sugar Land office or by secure video if you are physically in Texas, Idaho, Arizona or Maryland. Messages are answered within 2 hours during office hours, Monday to Friday, though they are not for emergencies.

To begin, you can request an appointment and read about coverage on our insurance page. If you are in crisis, call or text 988, or call 911 if there is immediate danger. DanShalom Behavioral Clinic is not an emergency service, and our crisis resources page lists more places to turn.