How Can I Tell If My Antidepressants Are Working?  - Explainers (2022)

Prescription drugs used to treat mental health conditions are called psychotropic drugs; about 16 percent of American adults have taken them, according to a 2020 report from the Centers for Disease Control and Prevention.

The two mental health conditions most commonly treated with medication are mood disorders, depression and anxiety, says Dr. Alex Dimitriu, founder of Menlo Park Psychiatry and Sleep Medicine. Antidepressants, one of the five main categories of psychotropic drugs, are a first-line treatment for both depression and anxiety. “Antidepressants don’t make problems disappear,” says Dimitriu, “but they can make things hurt a little less so people can do the work in therapy.”

The efficacy of antidepressants is mixed. In one 2020 report, 40 to 60 percent of people said they benefited from taking them. On the flip side, that means antidepressants didn’t work for about half of respondents, a finding that’s consistent with one 2012 review.

Even when antidepressants are effective, they can take a while to kick in. While the precise timeline depends on the medication, it can take up to eight weeks for an antidepressant to work. But what does “working” even mean? Carmen Kosicek, a psychiatric nurse practitioner and founder of Alay Health Team, says the answer varies, and that it’s important for patients and providers to establish a shared definition of success.

Here’s a guide to help you understand when an antidepressant is (or isn’t) doing its job and how to discuss your progress with your provider.

Why medications work for some people and not others

Chemistry. There are several types of antidepressants, and they target a few different neurotransmitters, says Dr. Holly MacKenna, an integrative psychiatrist and founder of Dara Wellness in New Orleans. Three of the most common types are:

  • Selective serotonin reuptake inhibitors: SSRIs increase the available supply of the mood-regulating hormone serotonin.
  • Serotonin and norepinephrine reuptake inhibitors: SNRIs stop cells from reabsorbing serotonin and norepinephrine, a neurotransmitter that affects energy levels.
  • Atypical antidepressants: These medications don’t neatly fit into one category because they don’t all act on the same brain chemicals. Bupropion (aka Wellbutrin), for example, prevents the body from reabsorbing feel-good chemical dopamine.

If a patient isn’t responding to one medication, it may be because they need one that affects a different neurotransmitter.

Biology. Though medications can alter brain chemistry to improve mood, innate biological differences appear to influence the efficacy of some psychotropic medications. “People’s [bodies] metabolize medications differently,” says MacKenna. Also, one2019 study found that SSRIs were less likely to alleviate depression in people with abnormally shaped serotonergic neurons (which produce serotonin).

Interference. Alcohol and other medications can affect your brain and mood in a way that counteracts the medication’s effects. Some of these interactions can also be dangerous to your physical health. Speak with your provider about any other medications you are taking and your drinking habits.

Signs medication is working

Someone in your life notices that you seem different. “Oftentimes, when one is in a state of depression or anxiety, that [sadness or anxiousness] becomes the go-to feeling,” MacKenna says.

But medications can change the brain over time. Though it may take several weeks for you to notice significant changes, a loved one may pick up on more understated differences sooner.

“Once our brain starts to adjust to the medication, our behaviors and facial expressions will begin to subtly change,” says MacKenna. “Those who see us every day will pick up on these changes before we realize we are beginning to feel better.”

(Video) How to tell if your meds are working

You start sleeping well. Studies suggest the relationship between healthy sleep and mental wellbeing is bidirectional. That means getting enough high-quality sleep leads to lower levels of depression and anxiety, and not feeling anxious or depressed leads to more restful nights.

“I don’t usually hear people saying, ‘I’m running through fields of daisies,’” Kosicek says. “They usually say, ‘I’m sleeping better.’”

Your work performance improves. Mood disorders can affect your ability to perform well at work. The World Health Organization estimates that depression and anxiety cost the global economy $1 trillion each year in lost productivity. But some research links antidepressants to enhanced work productivity.

“For many people with depression and anxiety, there is a lot of wasted brain energy thinking about things that are not productive,” says Dimitriu. “Medications make it easier for people to let go of the past and direct that energy into the future.”

You notice a change in your energy. Mood disorders can have a negative impact on your energy, both how much you have and how it feels. Medications may help.

Dimitriu says patients with depression will often come in and note they have more motivation and energy to do the things they love, such as watching a baseball game. Meanwhile, patients with anxiety often report having a bit less negative energy: “People will say, ‘Wow, there’s actually peace and stillness. That’s a wonderful feeling.’”

Signs medication isn’t working

You feel apathetic. When you bang your knee, you might numb the pain with ice. But medication for mental health doesn’t serve the same purpose.

“You need to feel things to be able to deal with life,” Kosicek says. “Feeling numb is not what we are looking for.”

(Video) What I wish I knew about antidepressants *before* starting

You notice the opposite of any of the above. If you find that symptoms worsen four to eight weeks after starting the meds, that’s a flag. But Dimitriu advises that patients give it that amount of time, as early side effects like fatigue are common.

“There can be a wobble,” Dimitriu says. “Things can get a little bit worse before they get better.”

That said, MacKenna emphasizes medication shouldn’t make it impossible for you to participate in day-to-day life. Call your provider if it is or if you are unsure.

What to ask and tell your provider about medication

Ask questions. Experts recommend asking your provider some questions before you start taking medication and as you go along. For starters, you should understand their reason for prescribing it.

“Ask, ‘Why do you think this is the medication for me?’” Kosicek suggests. “The prescriber should say, ‘You said this is the problem, and that is what this medication is for.’”

It’s also beneficial to ask about side effects before starting and as you experience them.

“Transparency can prevent you from going down a Google rabbit hole,” MacKenna says, adding that your provider can help you understand what is and isn’t normal.

Label feelings differently. We often think of our feelings as “good” or “bad,” Dimitriu says. He suggests delving deeper.

(Video) Inside the Tripper's Brain | National Geographic

Break it down into overall mood states,” he says. “Overall, how happy or sad do you feel? Overall, how anxious do you feel? I also like to look at motivation and sleep.”

As you continue treatment, this granular level of thinking can help you and your provider examine progress.

Collect and discuss data. Dimitriu says that his patients sometimes have difficulty recalling how they felt before taking the medication. But if you confuse your pre-medication feelings with your current ones, it’s challenging to evaluate efficacy. Journaling can help.

“I encourage my patients to take careful notes on how they felt before an intervention and how they felt after 15, 30 and 60 days,” Dimitriu says.

Before sessions, MacKenna suggests using your journal to make a list. At an appointment, tell your provider how many days or weeks you’ve experienced issues or improvements.

“Data is hard to argue against,” she says. “It gives you information so you and your doctor can have a more targeted conversation rather than talking in generalities.”

Medication isn’t magic

Even medication that works isn’t a cure-all. Dimitriu suggests a holistic treatment approach that includes strategies like talk therapy, exercise and meditation.

“Don’t just sit back and wait for the medicine to work,” he says. “It’s usually more than just the medicine that makes people better.”

(Video) 2-Minute Neuroscience: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Even if other, non-pharmacological treatments didn’t have a measurable impact on your mental health prior to medication, they may be more effective in conjunction with it. Your provider can help you put together a well-rounded treatment plan.

FAQs

How long should you take an antidepressant to see if it works? ›

Antidepressants may take a while to kick in. You may feel some depression symptoms improve within the first couple weeks, but it can often take 4 to 8 weeks to feel the full effects of your medication. If you've taken your antidepressant for at least 4 weeks with no improvement, let your healthcare provider know.

What stops antidepressants from working? ›

New stressors. A new stressful situation at home or work can result in a mood response for which the antidepressant can't compensate. Other medications. Interactions between antidepressants and medications for other health conditions can affect how well an antidepressant works.

Are you supposed to feel different on antidepressants? ›

On antidepressant medication, it is possible that you might experience a sense of feeling numb and less like yourself. Though the symptoms of depression have decreased, there may be a sense that other emotional responses – laughing or crying, for example – are more difficult to experience.

How do you know if your antidepressant is too strong? ›

Your Mood or Energy Improve Too Much

If you're taking antidepressant medication and you either feel unusually elated, or you become very terse with your loved ones, feel noticeably more irritable, or have an uncharacteristic bout of rage, then it's likely that your antidepressant dose is too high.

Can you stay on antidepressants for life? ›

And luckily, as long as the benefits of the medication outweigh the potential side effects, there's no strong evidence that long-term use of SSRIs poses any major problems. “These medications have been around for decades,” says Dr. Jin Hee Yoon-Hudman, a psychiatrist and medical advisor at Minded.

How quickly do antidepressants help anxiety? ›

Most antidepressants take one to two weeks to start working. But you might feel some benefits sooner than this, such as improved sleep. Speak to your doctor if you don't feel any benefit after taking an antidepressant regularly for two to four weeks, or if you feel worse.

How do you know if your antidepressant is not working? ›

Your Depression Worsens

“If your depression symptoms get worse as soon as you start taking an antidepressant, or they get better and then very suddenly get worse, it's a sign that the depression medication isn't working properly, and you should see your healthcare professional right away,” Hullett says.

How do you know if antidepressants aren't working? ›

Signs Your Antidepressant Stopped Working
  1. You experience no relief from your depressive symptoms. ...
  2. Your depression gets worse. ...
  3. You experience a sudden surge of energy—while still battling the blues. ...
  4. You are overwhelmed by the drug's side effects. ...
  5. You start suffering from violent mood swings.
16 Nov 2015

What is emotional blunting? ›

Emotional blunting is a term sometimes used to describe a person's limited emotional reactivity. They may not even be experiencing any emotions to feel, and people with emotional blunting may report feeling an unpleasant numbness instead of emotions. There are many reasons a person might experience emotional blunting.

Can you still feel emotions on antidepressants? ›

Nearly half of patients on all types of monoaminergic antidepressants report emotional blunting,6 and it is associated with serotonin reuptake inhibitor (SSRI) therapy as follows: among 161 patients, 46% reported a narrowed range of affect, 21% reported an inability to cry, and 19% reported apathy.

How do you know if antidepressants are making you worse? ›

Nausea, constipation, or diarrhea. Gaining or losing weight. Feeling the opposite of how the medication is supposed to make you feel—like feeling more depressed when you take an antidepressant, or more anxious when you take an anti-anxiety med. If a medication makes you feel suicidal, tell your doctor right away.

Can you feel normal on antidepressants? ›

Fact: When taken correctly, antidepressants will not change your personality. They will help you feel like yourself again and return to your previous level of functioning.

What are considered strong antidepressants? ›

6 most effective antidepressants sold in the United States
  • Amitriptyline.
  • Effexor (venlafaxine)
  • Lexapro (escitalopram)
  • Paxil (paroxetine)
  • Remeron (mirtazapine)
  • Trintellix (vortioxetine)
8 Feb 2022

When should I increase my antidepressant? ›

Contact your doctor if you have not noticed any improvement after 4 weeks, as they may recommend increasing your dose or trying a different antidepressant. It's usually recommended that a course of antidepressants continues for at least 6 months after you feel better, to prevent your condition recurring when you stop.

What does too much antidepressants feel like? ›

If a person takes too many antidepressants, they can overdose. Some of the symptoms of an antidepressant overdose may include nausea, vomiting, and blurred vision. In this article, learn more about how to spot an antidepressant overdose, and what to do to keep a person who has overdosed safe.

How long does the average person stay on antidepressants? ›

A course of treatment usually lasts for at least 6 months after you start to feel better. Some people with recurrent depression may be advised to take them indefinitely. Read more about antidepressant dosages.

What happens if you take antidepressants for years? ›

Specifically, weight gain seems to be a common long-term risk, especially the medications that affect serotonin levels. This could be due to the fact that serotonin is associated with an increase in appetite. There is also a risk of higher blood sugar levels and diabetes with taking antidepressants long-term.

Are antidepressants meant to be taken forever? ›

Do I have to take antidepressants forever is a question that some ask as they struggle with depression. This is one of the more common myths associated with the condition. You do not need to take antidepressants forever nor do you need to get a prescription from a counselor or therapist.

What does it feel like when antidepressants start working? ›

According to Pennsylvania-based psychiatrist Thomas Wind, D.O., you may feel some benefits sooner. “[Patients] tend to feel a little more energy, sometimes they sleep better and sometimes their appetite improves and that happens usually within the first two weeks,” Dr.

Which SSRI is the most calming? ›

Paroxetine—the most sedating of the SSRIs and often prescribed to assist anxious patients with sleep—produces significant declines in total sleep time, sleep efficiency, and total REM time, and increases awakenings and REM latency, and, may have the worst sleep profile of all SSRI's.

What is the main symptoms of anxiety? ›

Common anxiety signs and symptoms include:
  • Feeling nervous, restless or tense.
  • Having a sense of impending danger, panic or doom.
  • Having an increased heart rate.
  • Breathing rapidly (hyperventilation)
  • Sweating.
  • Trembling.
  • Feeling weak or tired.
  • Trouble concentrating or thinking about anything other than the present worry.

How do I know if my anti anxiety meds are working? ›

“Once our brain starts to adjust to the medication, our behaviors and facial expressions will begin to subtly change,” says MacKenna. “Those who see us every day will pick up on these changes before we realize we are beginning to feel better.” You start sleeping well.

How should you feel on antidepressants? ›

When first starting antidepressants, some people have mild stomach upset, headache or fatigue, but these side effects often diminish in the first few weeks as the body adjusts. Some people gain weight, though many stay “weight neutral,” and some even lose weight, Dr. Cox says.

Can antidepressants work without therapy? ›

While antidepressants can treat your symptoms without therapy, taking them without therapy may not be the best option for your mental health in the long run.

What is breakthrough depression? ›

ADT tachyphylaxis (also known as antidepressant tolerance, antidepressant “poop-out,” or “breakthrough” depression) describes a recurrent depressive episode that is a form of relapse.

Which antidepressants cause the most emotional blunting? ›

Antidepressants that commonly cause emotional blunting include:
  • selective serotonin reuptake inhibitors (SSRIs) escitalopram (Lexapro) paroxetine (Paxil) fluoxetine (Prozac) sertraline (Zoloft)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine (Cymbalta) venlafaxine (Effexor XR) desvenlafaxine (Pristiq)

Do antidepressants make you less empathetic? ›

After three months of antidepressant treatment, the research revealed relevant differences: patients reported their level of empathy to be lower, and brain activation was reduced in areas previously associated with empathy.

What is a major depression? ›

Major depressive disorder isn't something that eventually “passes.” While most people feel sad at times in their lives, major depression is when a person is in a depressed mood most of the day, nearly every day, for at least two weeks. Some people feel depressed without knowing why.

Do antidepressants take away joy? ›

The majority of people taking the most commonly prescribed antidepressants—selective serotonin reuptake inhibitors (SSRIs)—improve substantially. But sometimes, SSRIs go beyond improving mood and make a person feel too little emotion.

Can antidepressants make you distant? ›

"Feeling distant or detached" was a close second at 70%, while "not feeling" like yourself was third with 66.2%. 5 The study didn't specify which types of antidepressants were used. All three of the most commonly reported negative side effects of antidepressants can be considered forms of emotional blunting.

Do antidepressants Make Love numb? ›

Emotional blunting is a side effect of some antidepressants, including SSRIs. People who experience this side effect may feel that their emotions are dulled or that they can no longer feel strong emotions or intense romantic love.

What does it mean when antidepressants make you more depressed? ›

Antidepressants can make you feel tired, cause concentration problems, and lead to changes in sleep and appetite. These side effects can make you feel like your depression is getting worse, instead of getting better.

What is the most common side effect of antidepressants? ›

Common side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) can include: feeling agitated, shaky or anxious. feeling and being sick. indigestion and stomach aches.

Can increasing antidepressants make anxiety worse? ›

More than 100 million people worldwide take selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, to treat depression, anxiety and related conditions, but these drugs have a common and mysterious side effect: they can worsen anxiety in the first few weeks of use, which leads many patients to stop ...

What are the positive effects of antidepressants? ›

Antidepressants are prescribed to relieve symptoms and reduce the chance that they'll come back. They help with emotional balance and reduce symptoms like restlessness, anxiety and suicidal thoughts. As antidepressants work to help treat your depression, they, in turn, can help you sleep better.

What happens if you take antidepressants and you aren't depressed? ›

Although this is beneficial for someone who's depressed, for someone who does not have depression, taking antidepressant medication can cause serotonin to build up in the body, resulting in serotonin syndrome. When serotonin levels are too high, the person may experience symptoms like: Agitation or restlessness.

What is the number 1 prescribed antidepressant? ›

Sertraline hydrochloride, used for multiple mental health and mood disorders, is the most prescribed antidepressant on the list with more than 18 million prescriptions in 2021.

What is the most successful antidepressant? ›

All antidepressants are similarly effective for treating depression, but some cause more side effects than others.
...
1. SSRIs
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
24 Sept 2021

What is the most prescribed antidepressant in the world? ›

Perhaps the most recognizable among them is Prozac (fluoxetine). It's still the best option for many people, but since it was approved by the Food and Drug Administration (FDA) in 1987, Prozac has been joined by a variety of other antidepressant medications.

How can I make my antidepressant more effective? ›

Here are the agents that when added to antidepressants result in improvement of depression symptoms that is better than just the antidepressant alone.
  1. S-adenosylmethionine (SAMe) ...
  2. Methylfolate and Folinic Acid. ...
  3. Omega-3. ...
  4. Vitamin D.
21 Sept 2017

How do I know if I need more anxiety medication? ›

Signs It's Time to Adjust Mental Health Medications
  1. You Have Severe Side Effects. Like all medications, psychiatric drugs can cause unwanted side effects. ...
  2. Your Symptoms Get Worse. ...
  3. You Experience Apathy. ...
  4. The Medication Only Helps a Little Bit. ...
  5. You Have Completely New Symptoms.
27 Jan 2020

Can it take a year for antidepressants to work? ›

MD. The timing of a drug's antidepressant effects depends on many factors including the patient's symptoms, biological individuality, and life stressors. Overall, a person can expect an antidepressant to work anywhere from four to eight weeks after the first dose.

What happens if antidepressants are too strong? ›

Because antidepressants attempt to regulate a chemical imbalance by adjusting the levels of certain neurotransmitters – such as serotonin – someone who takes too high of a dose may experience mood swings and emotional side effects like agitation and confusion.

How can I raise serotonin levels? ›

Read on to learn about different ways to increase serotonin naturally.
  1. Adjust your diet. ...
  2. Get more exercise. ...
  3. Bring in the bright light. ...
  4. Take certain supplements. ...
  5. Try massage therapy. ...
  6. Try mood induction. ...
  7. Manage emotions and stress levels. ...
  8. Think about sleep deprivation.

What causes low serotonin? ›

Prolonged periods of stress can deplete serotonin levels. Our fast-paced, fast food society greatly contributes to these imbalances. Genetic factors, faulty metabolism, and digestive issues can impair the absorption and breakdown of our food which reduces our ability to build serotonin.

How should I feel if my antidepressant is working? ›

1. You Feel Better Right Away, but It Doesn't Last. Exactly how antidepressants work is still a mystery. The effects are thought to be related to changes in neurochemicals in your brain, such as serotonin, dopamine, and norepinephrine — changes that usually take 2 to 12 weeks to set in, with a peak at 6 to 8 weeks.

How do I know if anxiety medication is working? ›

“Once our brain starts to adjust to the medication, our behaviors and facial expressions will begin to subtly change,” says MacKenna. “Those who see us every day will pick up on these changes before we realize we are beginning to feel better.” You start sleeping well.

What is the most prescribed antidepressant? ›

What are the most common antidepressants? Sertraline hydrochloride, used for multiple mental health and mood disorders, is the most prescribed antidepressant on the list with more than 18 million prescriptions in 2021.

What do antidepressants do to a normal person? ›

Antidepressants reduce symptoms of depression by balancing chemicals in the brain called neurotransmitters, which affect mood and emotions, particularly dopamine and serotonin. These depression medications can improve your mood, concentration, sleep, and increase your appetite.

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