When Depression Or Anxiety Treatment Is Not Working

Dr. Gray: "Thank you for sharing with me the details of this recent depressive episode. It sounds like the depression has really made life difficult for the last year. Tell me how long you have been on the max dose of Lexapro at 20mg."

Patient: "My provider started it three years ago at 10mg, and I felt really good for a couple of years. But when I got depressed a year ago, we increased it to 20mg."

Dr. Gray: "Any medication changes during this last year, since the depression increased?"

Patient: "No. I just don't understand why I am not feeling better on the Lexapro."

This hypothetical conversation reflects a common situation for new patients who present to our psychiatric practice. Many people seeking depression or anxiety treatment in Richmond and Henrico come in feeling discouraged or confused because the medication they are taking is no longer helping enough, or perhaps it never helped. Sometimes a person is taking a medication at a low dose. Other times, they are already at the maximum dose, but there has been no recent adjustment, no new treatment strategy discussed, and no clear next step despite ongoing symptoms.

I call it a treatment stall.

What Is Treatment Stall?

A treatment stall happens when someone is still struggling with symptoms, but the treatment plan is no longer moving forward in a meaningful way. The person continues taking medication that is no longer working well, or never worked optimally, while depression, anxiety, OCD symptoms, or emotional distress continue to interfere with daily life.

Treatment stalls are more common than many people realize.

It is important to recognize when progress has stalled and understand that additional improvement may still be possible with thoughtful, expert psychiatric care.

Why Does Treatment Stall?

In psychiatry, as in all of medicine, we do not always know exactly why a medication stops working for a patient or why it may not work effectively for another patient. What we do know is that when someone continues to feel significantly depressed, anxious, or hopeless, it is often a sign that the treatment plan should be re-evaluated.

That may mean:

• Adjusting the dose

• Changing medications

• Adding another medication

• Revisiting the diagnosis

• Considering whether another condition may be contributing to symptoms

• Looking more closely at side effects, life stressors, sleep, or other patterns that may be affecting recovery

What To Do If You Feel Your Treatment Is Not Working

If you think you may be in a treatment stall, a few steps can help.

Bring it up directly. Tell your doctor clearly that you are still not feeling well. Be specific about what has not improved.

Ask what is the next step. It is reasonable to ask whether a dose adjustment, medication change, or different treatment approach should be considered.

Ask whether a specialist would be helpful. If symptoms have continued despite treatment, it may be worth seeking care from a psychiatrist or seeking a second opinion.

A More Active, Thoughtful Approach to Psychiatric Care

At Gray MD Psychiatry, we offer personalized psychiatric care in a comfortable, private setting where patients receive close attention and thoughtful follow-up. Regular visits and longer than average appointments help us monitor symptoms carefully, make timely treatment adjustments, and keep care moving forward.

For adults looking for a psychiatrist in Richmond or Henrico, VA, or any county in Virginia, we provide expert care for depression, anxiety, OCD, insomnia, and related concerns with a focus on meaningful progress.

If your current treatment is no longer working—or never truly got you where you hoped to be—it may be time for a fresh evaluation.