Signs Your Antidepressant Isn't Working for You

You might consider switching antidepressants if you are still experiencing depression symptoms. Signs your antidepressant isn't working include developing unpleasant side effects, having worsening symptoms, and not getting enough sleep. This might happen if you develop a tolerance to the medication.

The best antidepressant is one that helps improve your mood, reduces depression symptoms, and leads to remission. No improvement in symptoms can occur if your antidepressant dose is too low. Overdose can happen if your dose is too high or too strong.

It may take some trial and error, but adjusting the dose, adding a second medication, or switching to a new medication entirely are all possible solutions. Here are some common signs that your antidepressant medication isn't working well and when to contact a healthcare provider.

1. You Develop a Tolerance

People typically take antidepressants for six to 12 months or longer. You might have developed a tolerance to an antidepressant if it no longer works as efficiently as before. This is known as antidepressant tachyphylaxis, or a decreased response to a medication.

Research has shown that people who take selective serotonin reuptake inhibitors (SSRIs) are likely to develop a tolerance. SSRIs are a commonly prescribed class of antidepressants that boost levels of serotonin, a hormone that controls mood.

2. You Develop Serotonin Syndrome

Serotonin syndrome is a rare reaction to antidepressants. Some people develop serotonin syndrome if an antidepressant interacts with other medications or if an overdose occurs.

Symptoms include:

• Agitation
• Confusion
• Fast heart rate
• Flushed skin
• Increased anxiety
• Nausea and vomiting
• Restlessness
• Sweating 

These symptoms typically develop within 24 hours and resolve after stopping the antidepressant. A healthcare provider might decrease the dose and switch the medication.

3. You Do Not Get Enough Sleep

Antidepressants can affect the quality of your sleep. Some of the most common side effects of antidepressants are insomnia (trouble falling or staying asleep) and sleepiness. Sleeping too much or too little might affect your mental health and worsen depression symptoms.

A healthcare provider can advise ways to manage these side effects, such as:

• Avoid caffeine in the late afternoon and evening.
• Avoid napping after 3 p.m.
• Exercise regularly.
• Go to bed and wake up at the same time each day.
• Take time to unwind before bed by reading a book or taking a bath.

4. You Have Side Effects

You might develop unpleasant side effects on antidepressants. Some of the most common side effects include:

• Blurry vision
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Increased anxiety
• Insomnia
• Low or no sexual desire
• Nausea
• Weight gain

Let a healthcare provider know if you develop side effects that impact your quality of life.  The risks of not treating depression may or may not outweigh the risks of side effects. They can discuss different options with you, including switching the medication.

5. You Skip Doses

You might forget a dose now and then or take the medication at different times each day. It's important to consistently take antidepressants as a healthcare provider prescribes. The medication might not work completely if you do not use it as directed.

6. Your Symptoms Are Not Improving

It's normal for eating and sleeping habits to improve before mood does after you start an antidepressant. It usually takes about four to eight weeks to see improvements in mental health.

A healthcare provider may switch you to a different antidepressant, however, if you see little to no improvement in symptoms after a couple of months. Every person is different, so it might take some trial and error before you find an antidepressant that works for you.

7. Your Symptoms Get Worse

An antidepressant is not working properly if depression symptoms worsen after you start the medication. Let a healthcare provider know if you develop worsening symptoms like:

• Aches or pains
• Appetite changes
• Digestive problems
• Feeling anxious, hopeless, irritable, or sad
• Loss of interest in hobbies
• Sleeping too much or too little
• Thoughts of self-harm 
• Tiredness

When To Contact a Healthcare Provider

Always contact a healthcare provider if you are thinking about switching antidepressants or stopping altogether. It's important to gradually go off of antidepressants with the guidance of a healthcare provider. Abruptly stopping antidepressants can result in discontinuation symptoms like agitation, brain zaps, insomnia, and nausea.

Changing Your Depression Medications 

Psychiatrists talk about a "response" to an antidepressant and "remission." Response means at least some improvement, while remission means symptoms have subsided substantially or completely. Remission is a realistic goal for most people.

A healthcare provider might consider other options if one antidepressant does not do the trick. They might advise continuing at the same dose and adding a second drug, either another antidepressant (combination therapy) or a different type of drug (augmentation therapy). A healthcare provider might increase the dose of the antidepressant you are taking or recommend psychotherapy.

You might consider switching antidepressants, which involves gradually stopping the medication and starting a second one. Antidepressants include:

• Atypical antidepressants: These work differently than other classes of antidepressants. The drugs generally assist your brain in using hormones that control mood. Examples include Remeron (mirtazapine) and Wellbutrin (bupropion).
• Atypical antipsychotic: Psychiatrists sometimes prescribe an atypical antipsychotic, depending on your exact diagnosis and tolerance for side effects. This class of drugs typically treats bipolar disorder and schizophrenia. Examples include Clozaril (clozapine), Risperdal (risperidone), and Zyprexa (olanzapine).
• Monoamine oxidase inhibitors (MAOIs): A healthcare provider might advise MAOIs if other drugs have failed. These drugs have been linked to several unpleasant side effects. Examples include Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine).
• Selective serotonin reuptake inhibitors (SSRIs): These boost levels of serotonin, a hormone that controls mood. Examples include Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), and Zoloft (sertraline).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): These increase levels of serotonin and norepinephrine, which helps regulate mood. Examples include Cymbalta (duloxetine), Effexor XR (venlafaxine), and Khedezla (desvenlafaxine).
• Tricyclic antidepressants (TCAs): These work similarly to SSRIs but generally have more side effects. Examples include Anafranil (clomipramine), Surmontil (trimipramine), and Tofranil (imipramine).
  

A Quick Review

Your antidepressant might stop working if you develop unpleasant side effects, notice worsening symptoms, and are not getting enough sleep. Your dose may be too low, too high, or too strong. A healthcare provider can adjust your dose, add a second medication, or switch the drug altogether. Always talk to a healthcare provider before changing or stopping antidepressants.