By Kayt Sukel
You’ve been diagnosed with depression and prescribed an antidepressant medication. You’ve been taking your prescription for a few weeks—but are unsure whether or not it is working. It can be frustrating when your antidepressant is not working. It’s important to note that antidepressant medications usually take two to 12 weeks to start working, with an apex around six to eight weeks. It may be that you just need to give the regimen more time. But if you are still questioning your treatment, there are a few clues that can help you decide whether to wait it out or head back to the clinic.
1. You experience no relief from your depressive symptoms. Jonathan Stevens, M.D., M.P.H., Clinical Director of Outpatient Services at the Menninger Clinic in Houston, Texas, says that the goal of antidepressant treatment is to put depressive symptoms in remission—though sometimes that is a lofty goal. But the drug should be helping to alleviate your blues. “If you are going on six weeks and see no effect, or only a very small effect when it comes to helping those symptoms, that’s usually a sign that you need to switch to a different antidepressant,” he says. “It’s worth talking to your doctor.”
2. Your depression gets worse. Sometimes, it’s not a matter of little or no relief. Sometimes, antidepressant medications can make a depressive episode even worse. Stevens says that if your depression is getting worse, if you are feeling agitated, “uncomfortable in your own skin,” or unable to get out of bed in the morning, you need to see your physician immediately. “We’re still at the state where the medicines we choose have a lot to do with the individual provider’s preference. It’s not always chosen to fit a patient’s biology, so we don’t always get it right the first time,” he says. “But we can now do some genetic testing to determine which medicines might respond better to your personal biology based on your metabolism. That can be a big help.”
3. You experience a sudden surge of energy—while still battling the blues. Some have speculated that this new-found energy, often experienced when starting on an antidepressant and while still suffering from depressive symptoms, can cause patients to behave in dangerous ways. Stevens says this is a significant concern. He recommends returning to your doctor if you feel this way.
4. You are overwhelmed by the drug’s side effects. Stevens cautions that side effects are fairly common—which is why it’s so important that clinicians try to educate patients about what to expect before starting a new medication. “All drugs have side effects. And, unfortunately, sometimes those side effects come on before the beneficial effects,” he says. “But if you are feeling wild mood swings, you aren’t sleeping, or feel like you’re crawling out of your skin, or have other unpredictable side effects, those are things your doctor needs to be aware of right away.” Genetic testing can also call out which medications are likely to cause significant side effects for a particular patient.
5. You start suffering from violent mood swings. This is a significant red flag, says Stevens. “Depression and bipolar disorder are not the same disease. Sometimes people with bipolar disorder come in reporting a significant depression. But antidepressant medications are much riskier for this population,” he says. “If you are feeling excess feelings of restlessness, silly giggling, seething irritability or anger—really out of character behaviors—you need to go back to your doctor.”