Depression is common and treatable.
Related condition guide: Depression

But for a significant number of people, the journey doesn’t go as planned.

Many patients stop or switch medications not because the antidepressant failed to help, but because side effects make it hard to stay on treatment long enough to see benefit.

In 2025, we have:

• clear evidence that SSRI and SNRI antidepressants remain the first-line backbone of major depressive disorder treatment, and that over 80% of patients on antidepressants are taking agents in these classes.
• growing appreciation of treatment-resistant depression (TRD) estimated to affect over 100 million people globally.

One key lesson: tolerability and personalization matter as much as “choosing the right drug.”

This article focuses on what to do when side effects, not lack of effect, are the main barrier and where personalized medication, including compounding, may have a responsible role.

This is educational content, not a substitute for professional diagnosis or treatment.
Caregiver/patient resources: Help Hub

When “It Didn’t Work” Actually Means “I Couldn’t Tolerate It”

Common side effects of antidepressants include:

• nausea, GI upset, or diarrhea
• sleep changes (insomnia or excessive sleepiness)
• sexual dysfunction
• headache
• increased anxiety or agitation early in treatment
• weight changes

These can:

• appear within days,
• precede any mood improvement (which may take weeks),
• and lead patients to stop early, sometimes without telling their clinician.

In some studies, early discontinuation rates can be as high as 30–40% with certain agents, especially when started at doses that are too high for the individual.

First Steps Before Changing How a Medication Is Made

Before considering compounding or personalized formulations, clinicians usually adjust more basic variables:

1. Dose and Titration

• starting at a lower dose
• titrating more slowly
• using “start-low, go-slow” strategies

2. Timing

• moving a dose from morning to evening or vice versa
• splitting doses in some cases (when clinically appropriate)

3: Switching Within or Between Classes

• trying a different SSRI or SNRI
• considering other agents (mirtazapine, bupropion, etc.) depending on the symptom profile

Guidelines emphasize structured trials and adequate duration before labeling depression as “treatment-resistant.”

When Personalization of the Medication Itself Becomes Relevant

After optimizing dose, timing, and drug selection, some patients still face challenges that relate to how the medication is formulated:

• severe GI irritation with certain tablets
• difficulty swallowing pills (especially in older adults, patients with neurological disorders or severe anxiety)
• reactions to dyes or excipients
• the need for intermediate strengths not commercially available

This is where personalized compounding can become part of a broader strategy.

How Compounding Can Support Depression Treatment (Without Replacing Good Psychiatry)

A 503A compounding pharmacy like AllMedRx works on the formulation side always under clinician guidance.

Possible uses include:

1. Custom strengths for sensitive patients

• providing doses between standard strengths (e.g., 7.5 mg, 12.5 mg) to allow finer titration
• helping patients who are very sensitive to side effects, so they can “climb the ladder” more gradually

2. Alternative dosage forms

• liquid formulations for people who cannot swallow tablets or capsules
• in select cases, other delivery forms when clinically appropriate

3. Excipient-adjusted formulations

• removing certain dyes or non-essential excipients when these are suspected of contributing to GI or dermatologic reactions
• simplifying ingredient lists when possible

More on this approach: Dye-Free & Gluten-Free Medicines

What Compounding Does Not Do in Depression

It is important to be very clear:

• Compounding does not turn an ineffective medication into an effective one.
• It does not replace the need for therapy, lifestyle interventions, or advanced treatments (e.g., TMS, ketamine, ECT) in true treatment-resistant depression.
• It is not a shortcut to bypass standard titration or monitoring.

Instead, it is a tool to remove practical barriers (swallowing, intolerances, fine-tuning doses) that stand between a patient and a medication choice their clinician believes in.

Support resources: Help Hub

Questions to Discuss With Your Clinician

• “Are my side effects likely to get better with time, or do we need a different approach?”
• “Have we tried adjusting dose and timing optimally?”
• “Could a different formulation for example, a liquid or lower dose improve tolerability?”
• “Is compounding an appropriate option for my situation?”

You and your clinician can decide if personalized formulations are justified, or if another medication or treatment strategy is better.

Final Thoughts – Personalization as a Bridge, Not an Endpoint

In 2025, depression care is evolving:

• we better understand treatment resistance,
• we have emerging interventional options,
• and we recognize that sticking with treatment is often the hardest part.

Personalizing how medications are delivered can be the difference between:

• stopping too soon,
• or staying on an otherwise appropriate therapy long enough for it to help.

AllMedRx’s role is to:

• support prescribers with safe, customized formulations when needed,
• stay aligned with current evidence and safety standards,
• and help patients and clinicians navigate complex treatment paths with clarity.

For questions about personalized antidepressant formulations, clinicians and patients can contact:
intake@allmedrx.org