Medically reviewed by psychiatrist and Timberline Knolls medical director Johnny Williamson, M.D.
You’ve been taking antidepressants for a couple of weeks now but it’s hard to tell what’s happening. Sure, maybe you notice a little extra energy, yet you’re still feeling hopeless, depressed and having trouble concentrating. Plus, you’ve been experiencing nausea right after taking the medication. If you’re asking yourself, “Is this antidepressant even working?” and feeling unsure, you’re not alone.
Antidepressants affect everyone differently and it’s not always clear if they’re helping. Not to mention, it can take up to six weeks or longer to feel the full effects and your doctor may need to increase your dose a few times. To help demystify what you should expect from your antidepressants and how to tell if they’re working or not, we asked two psychiatrists how they navigate this question with patients.
What Are Antidepressants?
There are currently more than 25 antidepressant medications used to treat mental health conditions such as depression, anxiety and obsessive-compulsive disorder (OCD). Antidepressants are generally classified in five major groups:
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Atypical antidepressants (drugs such as bupropion [brand name Wellbutrin], trazodone [brand name Oleptro] or vortioxetine [brand name Brintellix], among others)
While all antidepressants may work slightly differently — and drug companies are beginning to test completely new options like esketamine — the basic premise is the same. They increase the amount of serotonin, dopamine or norepinephrine available in your brain and body. Experts don’t know exactly how or why antidepressants work for many people, but these neurotransmitters impact everything from your mood to your memory, concentration and sleep.
What to Expect When You First Start Taking Antidepressants
Everyone responds differently when you first start taking an antidepressant. However, experts do know a few basics to get you started. What you’ve probably heard most often is it will take four to six weeks until you start to feel better. 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. Wind told The Mighty, adding:
Within the second two weeks, people start to look better to the people around them, but they’re still not necessarily feeling better. It’s really in week five and six for most antidepressants that they start to kick in, and you actually start to really feel better if you’re on the right medication, if you’re on the right dose.
Often your doctor will start you on a lower dose of antidepressants below the recommended therapeutic range of the medication. For example, the SSRI sertraline (brand name Zoloft) is most effective in doses between 50 and 200 mg a day. Your doctor may start you below this range (like 25 mg of sertraline) and then gradually increase the dose over the coming weeks and months to minimize side effects and monitor your symptoms.
How Do You Know If Your Antidepressants Are Working?
So how do you know when your antidepressants are actually working? According to Wind and New Hampshire-based psychiatrist John J. Miller, M.D., it’s very individual based on your mental health symptoms. Miller said in your first appointment, your doctor should document the symptoms that bother you the most and monitor them closely once you start antidepressants.
“Each person is going to have their own fingerprint of symptoms and so you want to revisit those symptoms with each follow-up,” Dr. Miller told The Mighty. “Some improve sooner than others, like they may start sleeping better before their depressed mood and their suicidality gets better. And maybe their anxiety gets better first and then the helplessness, hopelessness, guilt gets better.”
Wind said he may also ask patients to rate the severity of each of their main symptoms on a scale of one to 10 to help track how things are improving during follow-up appointments. The ultimate goal he said is to get people back to feeling like themselves, what is “normal” for you with minimal symptoms.
“I want a person to feel normal. To me, that’s the goal of a true antidepressant medication,” Wind said. “That requires a lot of work because … up to 70% of the people who take the medicine will feel about 50% better. And that’s good, but that’s not the goal. It’s always that they feel like a normal person.”
Here’s how members of The Mighty’s mental health community knew their antidepressants were working:
With my Wellbutrin, which I’ve been on for a little under two years, I started to want to shower more, instead of this horrible chore, and liked interacting with people better. When I started Trintellix in August, the people around me noticed I was so much less anxious and wasn’t obsessively word-vomiting, then a few weeks later I was able to drive in the rain calmly without white knuckling the steering wheel and not think I was going to crash the whole time. — Savanna
I knew it was working when I smiled spontaneously. It wasn’t until I did it that I realized I hadn’t for a long time. Other than that I had more energy to do something other than basics. I stopped falling asleep at work on my breaks, I finally was sleeping at night. — KT
For the first time in my life, I have an appetite. I have an easy time falling asleep. I’m not sure that they’re working completely though, as I haven’t overcome my OCD, but it does make it slightly easier to manage. It seems it gets better as the dosage increases. — Kevin
Is There a Placebo Effect?
There’s a lot of debate about antidepressant placebo effect and whether or not the medications really help people. It is true that antidepressants don’t work for everybody and you won’t have a good response to every type of antidepressant. In general, however, research shows that antidepressants do have a positive effect on many people. There’s nothing wrong with taking medications for your mental health.
And Miller said even if your improvement is in part related to a placebo effect, that’s not necessarily a bad thing at the beginning of treatment. Sometimes just the act of reaching out for help and starting a course of mental health treatment can make people feel a little more hopeful during the process of finding the right medication and dose.
“You always want to take advantage of the power of suggestion and expectation,” Miller said. “I say, ‘You may start to feel better within a couple of days but we can’t say that the medicine is not working until you’ve been on [an] adequate dose for at least six weeks.'”
What Should You Know About Side Effects?
Antidepressants, like most medications, can cause side effects. Some of the most common side effects include:
Increased suicidal thoughts
Often antidepressant side effects will fade or get better after two weeks, but that doesn’t make them any more pleasant to deal with in the meantime. Wind said he prepares clients with what to expect, knowing if the side effects are too severe it may be necessary to try another medication instead of waiting to see if the side effects fade.
“The problem with side effects is that most of them are going to peak within the first two weeks and you’re not going to really start feeling better until week four to six,” Wind said, adding:
It’s a balancing act. Some people are more willing to do balancing and others are not. That’s just a personal preference, but I encourage them to work through it. I also encourage them to get in touch with me for having side effects so that we can talk one-on-one directly.
Miller also emphasized it’s important to call your doctor if you’re experiencing medication side effects because they may be able to help. For example, if you’re experiencing nausea and vomiting, your doctor might suggest taking the antidepressants right after you eat instead of on an empty stomach. Anytime you’re concerned about medication side effects or even how your mood and mental health symptoms are changing, don’t hesitate to call your doctor.
What to Do If Your Antidepressants Aren’t Working
If your antidepressants aren’t working or you’re not sure, talk to your doctor. You may need your medication dosage increased or to try another drug entirely if your symptoms aren’t getting better over time. Wind said another option is adding a second medication (usually an atypical antidepressant or antipsychotic that doesn’t interact with a serotonin-related drug) to address lingering symptoms or boost the effectiveness of your antidepressant.
Your doctor will be able to determine what course of action is best based on your diagnosis, history, symptoms and side effects. Miller also said he works with clients to look at the bigger picture of their health, including social support and lifestyle concerns like diet, exercise and sleep — all factors that can make a big difference in how you feel. Check-in with a therapist too if you’re dealing with major life stressors and as a source of extra support for your mental health. Research suggests that a combination of medication and psychotherapy is often most effective for people who are struggling with their mental health.
It can be frustrating waiting weeks for an antidepressant to start working, and even more so if the first medication you try isn’t helping. Reaching out for help is a big step, and know you’re not alone.
How Long Do You Have to Take Antidepressants?
Once you’ve been on an antidepressant for a while and are feeling like yourself most of the time, you may be able to switch to a maintenance medication regimen or stop taking your antidepressant completely with the help of your doctor. This decision is often dependent on how many depressive episodes you’ve had. Your doctor may want you to stay on your antidepressant to prevent relapses.
“I’m not a take medication forever person but I am a take medication for as long as you need it. And just because you’re feeling good doesn’t mean you don’t need it,” Wind said, adding:
In a first bout of depression, where the person has not been depressed for long, the recommendation is that they feel normal for six to 18 months before you consider taking the medication away, depending on how long they’ve been feeling depressed. If it’s a second bout of depression, you want them to take the medicine for at least two to three years feeling normal before they come off of the medication and see if they still need it.
If you and your doctor start tapering the dose of your antidepressant, Miller said you might realize you still need the medication, but at a lower dose. For example, you slowly reduce from 50 mg of Zoloft to 25 and then to 12.5 mg. But at 12.5 mg, your symptoms start to come back, so your doctor may leave you at a 25 mg maintenance dose of medication. Miller said you want to find “a balance point” between less medication and staying symptom-free.
Regardless, always consult with your doctor before changing or stopping your medication to avoid discontinuation effects and other complications. Remember that antidepressants can be a really helpful tool to support your mental health, even if they don’t “fix” everything. And they work best alongside other treatments and supports, like therapy, social support and lifestyle changes to help you feel fully engaged in your life.
“Antidepressants aren’t supposed to make you happy,” Wind said. “They’re supposed to make you feel like a normal person.”
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