When starting a new antidepressant medication, people often wonder how the drug will make them feel. Will they have more energy, a better mood, and higher self-esteem, or will they feel no difference, numb, or even worse? If the medication is a good fit, you should feel less depressed, less anxious, and ready to face the world with renewed optimism.
Antidepressants for Depression
Antidepressants fall into several classes, all of which are drugs that help to reduce and manage the symptoms of depression. Antidepressant medications are typically safe and effective. As of 2018, more than 13% of American adults were currently prescribed and using at least one antidepressant medication for depression.1
Antidepressants are primarily developed and used to treat several types of depression, including major depressive disorder, premenstrual dysphoric disorder, and disruptive mood dysregulation disorder (DMDD), but they can help address other conditions, too.
Some other health concerns managed with antidepressants include:2
How Antidepressants Work to Reduce Depression
Antidepressants reduce symptoms of depression by modifying the activity of chemicals in the brain called neurotransmitters. The most popular type of antidepressants are called selective serotonin reuptake inhibitors (SSRIs), and despite the technical name, they have a simple job in the brain – to increase the levels of serotonin.2
In the brain, cells make and release serotonin so that other cells can absorb it and send appropriate chemical messages. Without enough serotonin, the messages cannot be communicated fully or efficiently.
The same cells that release serotonin also reabsorb it, so SSRIs work to inhibit or block the reabsorption of serotonin. This leaves more of the chemical available in the brain, and ensures that messages are sent.3
SSRIs account for more than 64% of all antidepressants prescribed. Over the last 20 years or so, SSRI prescription rates have been steady, tricyclic antidepressant (TCA) prescription rates have fallen, and serotonin norepinephrine reuptake inhibitors (SNRIs) prescription rates are growing.4
- TCAs represented almost 18% of all antidepressants in 1996 and only 3% in 2015
- SNRIs only represented slightly more than 3% in 1996 and about 16.5% in 2015
The following SSRIs are the most frequently prescribed antidepressants: 4
Prescribing and using medications for depression is not exact science, so there could be some trial and error involved in the process. Oftentimes, a change in dosage or a change in medication will be necessary in order to receive the least amount of side effects and the highest symptom reduction.
In general, antidepressants take approximately 6-8 weeks for full effect and as a result the most common complaint is no change in symptoms when first starting an antidepressant. When all goes well, symptoms of depression such as feelings of hopelessness or apathy will be reduced within 6-8 weeks after initiating the medication.
*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. Before starting any of these medications, you should talk with your doctor about these risks.
Benefits of Antidepressants
The benefits of antidepressants involve diminishing or eliminating all or most of your depressive symptoms. For reasons that are not fully understood, some people will note a complete and absolute reduction in depression symptoms, while others will see more subtle differences over an extended period.2
When you’re benefiting from antidepressants, you should feel:5
- A mood that is less depressed, less irritable, happier, and more content
- Excitement for and pleasure in everyday activities and events
- An ability to regulate your eating patterns without eating too much or too little
- Well-rested in the morning, energetic during the day, and ready for sleep at night
- Able to accomplish normal routines and chores
- Good about yourself, your appearance, and your abilities
- Focused, decisive, and attentive with the ability to make good choices
- Hopeful for the future and optimistic about your life
Antidepressants are not drugs of abuse, so you will never feel high or euphoric after using an antidepressant. Ideally, you will just feel like the best version of yourself. You don’t have to feel like a superhero or the most amazing person ever, but if you can like yourself, create a positive impact in the world, and look forward to tomorrow, the antidepressant is working.
You may not feel an immediate match with your antidepressant, but there are plenty of options. Continue working with your treatment team to find the one that is right for your needs.
Other Changes Antidepressants May Cause
With the inexact nature of psychiatry and mental health, there is no way to guarantee that the changes caused by antidepressants will always be positive. Some odd or unexpected changes could make you rethink the overall utility of taking the antidepressant, but hopefully the desirable effects of mood and energy improvements will overwhelm the unwanted.
Ten changes you may experience while on antidepressants include:1,2,3
1. Feeling Better
If all goes well, you will start feeling better in a month or two. This expected and desired result of antidepressants happens in many cases.
It’s important to note that antidepressants, however, do not have a fantastic overall track record. In studies of antidepressants, between 40 and 60 people out of 100 noticed an improvement in their symptoms, compared to 20 to 40 people who felt better by taking a placebo.6 As a result, depression is often treated with a combination of behavioral therapies and medication.
It seems that severity of depression is a major driving force for recovery. Those with more mild depressive symptoms tend to feel better with antidepressant medications.
2. Feeling Nothing
Some people may notice no change from taking medication for depression, while others may report feeling emotionally blunted. They may no longer report feeling the low and down feelings linked to depression, but may also have trouble feeling the happiness and comfort other people feel.
Depending on previous symptoms, this may be an acceptable state for the patient. Other times, this numb feeling, or blunted affect, shows that the antidepressant is not working to the desired level and a change is needed.
3. Feeling Too Good
Antidepressants are supposed to help you feel good, but you never want to feel “too good,” or like you’re having a manic episode. Depending on your diagnosis and overall mental health, an antidepressant can induce a state of mania. This is why antidepressants are not prescribed for individuals with bipolar disorder, and it is incredibly important to note any history of mania before starting an antidepressant.
During a manic episode, you could feel:
- An inflated sense of self
- Increased energy and drive
- Decreased need for sleep
- High impulsivity and desire to complete activities that might be dangerous
Experiencing these manic episodes could indicate the patient has bipolar disorder.
4. Feeling Worse
Some people will feel worse after starting an antidepressant. The worsening symptoms could involve increased depression, lower energy, and poorer sleep. In the worst situations, it could lead to suicidal thoughts, actions, and death.
Anyone is at risk of these unwanted side effects, but children, teens, and young adults are especially vulnerable to an increase in suicide. These risks are greatest during the first weeks of taking the medication.
5. Nausea, Diarrhea, or Vomiting
For many medications, side effects like nausea, diarrhea, and vomiting are a common experience. Antidepressants are no different.
Just because these effects happen at first does not mean that they will continue forever. Some symptoms may fade over time, while others can be relieved with a few changes. For example, taking the medication with food or moving the dose until bedtime could help relieve any nausea.
6. Sexual Side Effects
Depression often impacts sex drive and taking an antidepressant medication is supposed to lessen depressive symptoms when working, but for people who experience sexual side effects, the antidepressants may add more stress than before taking an antidepressant. The sexual side effects of antidepressants can manifest in several ways:
- Women might experience a reduction in sexual desire and difficulty reaching an orgasm
- Men could also note similar effects with the addition of being unable to achieve or maintain an erection
These symptoms of sexual dysfunction may not improve over time and often require a medication change to diminish.
7. Feeling More Anxious or Panicky
Antidepressants help by adjusting the neurochemical signaling in the brain. This change helps to reduce depression, but since these same brain chemicals are related to other mental health conditions, people could find themselves feeling more stress, more anxiety, and more panic from the antidepressant.
These side effects may be worsening the pre-existing anxiety disorder, or it could be the start of a completely new disorder.
8. Eating and Weight Changes
Appetite, eating, and weight are all very influenced by depression. They are impacted by antidepressant medications as well.
Some people may report intense and insatiable hunger from the medication, leading to substantial weight gain. Others will note that the medications result in low appetite and weight loss.
Whatever the case, it’s important for people to acknowledge and track their diet and weight to better understand the impact of the medication.
9. Serotonin Syndrome
Some side effects can cause mild discomfort, while others can be harmful and dangerous. After starting an antidepressant medication, serotonin syndrome could emerge, which happens when too much serotonin accumulates in your system.
The condition is much more likely if you are taking two or more medications that interact with serotonin.
Some side effects of serotonin syndrome may include:
- High fever
- Blood pressure changes
- Rapid heart rate
Anyone with these side effects should seek out emergency medical services immediately.
10. New Anger, Aggression, and Violence
Anger, aggression, and violence sometimes linked to antidepressant medications has the ability to affect and possibly endanger others in your life. If you are agitated while with a loved one, they could become the targets of your frustrations.
How Long Does it Take Antidepressants to Work?
Taking an antidepressant is not like taking other medications where the effects are obvious minutes or hours after consumption. You have to take the medication consistently, as prescribed, for at least four weeks before you may start to feel the benefits. In some cases, it could take additional weeks for the effects to fully take hold.2
You have to work with your prescriber to determine an appropriate dose for your symptoms and unique biology. Some people find that dose quickly, while others might have to start at a lower dosage and build a higher dosage slowly and over time.
Always work with your prescriber to communicate your needs, goals, and symptoms. Never stop taking your medication without first consulting with your treatment team.2
What to Do if Your Antidepressants Are Making You Feel Worse
Unfortunately, knowing if your antidepressant is working well isn’t always straightforward and easy to recognize.
Any time you start a medication, having open, honest communication with your prescribers and mental health treatment team is essential.3
To improve your mental health and symptoms of depression, talk to your doctor about:
- Increasing your dose
- Switching your medication
- Adding a medication to the one you are already taking
Different people need different forms of treatment for depression. Some will have depressive disorders that are more resistant to treatment and will lean on alternative treatments for assistance.
Some signs your antidepressant isn’t working include:
- Continuing or worsening depressive symptoms
- Other new or worsening mental health or physical health symptoms
- Suicidal thoughts or actions
- Homicidal or violent thoughts or actions
Questions to Ask Your Health Team
Being an educated part of your health team is a great way to increase the prospect of your care. Ask questions, understand the answers, and find a prescriber who is willing to spend time communicating with you.
Questions to ask your care team about how antidepressants make you feel include:
- What medication are you prescribing – generic and brand name?
- What made you choose this one?
- What class of antidepressant is it – SSRI, SNRI, TCA, or other?>
- Which side effects are more likely?
- When should I begin to notice results?
- What is our next step if this doesn’t work?
- Who do I contact if I’m experiencing symptoms or side effects?
It’s also valuable to understand what dangerous side effects may emerge and when you should utilize emergency care. If you ever feel suicidal, homicidal, or very physically ill, calling 9-1-1 may be the best course of action.
Many people worry about personality changes or negative feelings that may occur when they begin taking antidepressants. Remember that if you’re on the right medication, you should be feeling more like yourself rather than less. It may take a few trials and dose changes, but there is likely a medication that can help reduce your depression symptoms.