Many apparent treatment failures are not failures of the drug. Before switching, confirm that the patient has taken an adequate dose for long enough, and that something else is not working against it.
This takes a few minutes and often changes the plan: a dose increase, a different time of day, a stopped interacting drug, or a fresh look at the diagnosis.
- Ask how many doses were actually taken in the last week — adherence is the commonest gap.
- Confirm an adequate dose for at least four to six weeks before judging response.
- Review co-prescribed drugs and alcohol that may lower levels or worsen mood.
- Re-check the diagnosis: bipolar depression, substance use, thyroid disease and anaemia all mimic non-response.
- Ask whether side-effects, rather than lack of benefit, are the real reason for stopping.
Why it matters
A switch made for the wrong reason costs another six weeks of illness.
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