Can Antidepressants Stop Working
If your antidepressant is no longer working as well as it did when you first started taking it, you could have developed a tolerance for the drug. Some people refer to this as antidepressant “poop-out,” although the medical term is tachyphylaxis. It has not been determined how many people taking antidepressants experience this phenomenon, but studies show rates ranging from 9% to 57%.
While no one knows for sure why this decrease in effectiveness occurs, one theory suggests that receptors in the brain become less sensitive to the medication. Other culprits include:
- Alternative or cooccurring mental health diagnosis
- Drug interactions
Guidelines For Taking Antidepressants
The more you know about your antidepressant, the better equipped youll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.
Some suggestions:
Follow instructions. Be sure to take your antidepressant according to the doctors instructions. Dont skip or alter your dose, and dont stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates and can cause serious withdrawal symptoms.
Beware of drug interactions. Drinking alcohol can lessen the effects of some antidepressant medications. Dangerous drug interactions can also occur when SSRIs or SNRIs are taken with blood thinners, prescription painkillers, or antihistamines found in many over-the-counter cold and allergy medicines and sleep aids. Always talk to your doctor or pharmacist before combining medications.
Monitor side effects. Keep track of any physical and emotional changes youre experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression worsens or you experience an increase in suicidal thoughts. See your doctor on a regular basis.
Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately four to six weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.
How To Tell If Your Ssri Dose Is Too High: 3 Tips
Claire Imber,
10 Minute Read
Are you worried your SSRI dose is too high?
Selective serotonin reuptake inhibitors are an effective treatment when taken at the right dosage for many individuals with depression, anxiety, and other mental health conditions. Common SSRIs include citalopram , escitalopram , fluoxetine , paroxetine , and sertraline . Occasionally, however, the dose of an SSRI can be too high, and that can cause uncomfortable side effects. Its a good idea to know some of the signs of having your SSRI dosage too high, including when to talk to your psychiatric provider.
Here are a few signs to watch for if youre taking an SSRI.
Want to speak 1:1 with an expert about your anxiety & depression?
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Why Some Antidepressants Make You Feel Worse Before Better
Theres a paradoxical period when a person first starts an antidepressant: they may actually begin to feel worse before feeling better. The underlying cause of this phenomenon is a bit of a mystery, but a new study from researchers at Otto-von-Guericke University in Germany explains why this might occur.
The gap between starting an antidepressant and feeling its positive effectsa time period thats typically a couple weeks but may last up to a monthcan sometimes be characterized by an increased risk for harmful behaviors. Researchers have previously speculated that when a person starts an antidepressant, they may suddenly have a surge of energy they didnt have before. If that person is suicidal, the effect may provide enough energy to act upon their feelings.
The controversial idea caught on. A decade ago, the U.S. Food and Drug Administration issued a black box warningthe most stringent of warningson all antidepressants warning of possible suicidal thoughts and behaviors. As TIME recently reported, many psychiatrists were upset by the label, arguing that its led to a drop in antidepressant use among patients. Physicians, fearful of the risks, may also be deterred from prescribing them.
MORE: Do Depression Drugs Still Need Suicide Warnings?
Depression itselfnot an antidepressantis the greatest risk factor for suicide, and these new findings provide new insight for what patients can expect at the start of their treatment.
Questions To Ask Your Doctor
- Are there any medical conditions that could be causing my depression?
- What are the side effects and risks of the antidepressant you are recommending?
- Are there any foods or other substances I will need to avoid?
- How will this drug interact with other prescriptions Im taking?
- How long will I have to take this medication?
- Will withdrawing from the drug be difficult?
- Will my depression return when I stop taking medication?
Medication isn’t your only option for depression relief
Remember, antidepressants arent a cure. Medication may treat some symptoms of depression, but cant change the underlying issues and situations in your life that are making you depressed. Thats where exercise, therapy, mindfulness meditation, social support and other lifestyle changes come in. These non-drug treatments can produce lasting changes and long-term relief.
Read Also: What Major Depressive Disorder Feels Like
Side Effects Of Antidepressant Medications
All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.
Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.
If you are experiencing side effects, check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, it is best to continue taking your medication as prescribed but let your doctor know as soon as possible. Your doctor may:
- encourage you to wait a little longer for the side-effects to fade
- adjust your dose
- suggest you take the medication at a different time of day
- prescribe other medications to help control side-effects
- change your medication
- stop medication treatment and suggest a different type of treatment approach.
Side-effects vary depending on the type of medication. More information on side-effects is included for each type of types of antidepressant.
You can help to control possible side-effects on your own by:
Do antidepressants increase the risk of suicide?
Before starting treatment, prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
What Is An Ssri
SSRI is an acronym for Selective Serotonin Reuptake Inhibitor, a class of drugs for treating mental health conditions. It includes some of the most commonly prescribed antidepressants. SSRIs are prescribed for depression, anxiety disorders and other conditions such as Obsessive-Compulsive Disorder .
Serotonin is one of the essential chemical messengers of brain cells. It regulates mood, emotion, social behaviour, sleep, memory, learning and other functions. It is thought that people who suffer from depression have lower levels of serotonin in the brain. SSRIs work by blocking the reabsorption of serotonin, causing the level of serotonin in the brain to increase over time, enhancing communication between neural cells. In general, depression symptoms are relieved once an appropriate level of serotonin is achieved. This is why it takes several weeks before patients and their doctors can know whether or not a treatment plan is working. However, having too much serotonin in the brain also leads to significant mental health problems.
Some patients with bipolar disorder, schizophrenia, or personality disorders have elevated levels of neural transmitters in the brain, including serotonin, leading to severe mood swings and anxiety.
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How Effectively Do Antidepressants Relieve The Symptoms
There are a lot of different medications for treating . But it’s difficult to predict how well a particular medication will help an individual. So doctors often first suggest taking a drug that they consider to be effective and relatively well tolerated. If it doesn’t help as much as expected, it’s possible to switch to a different medication. Sometimes a number of different drugs have to be tried before you find one that works.
Studies show that the benefit generally depends on the severity of the : The more severe the depression, the greater the benefits will be. In other words, antidepressants are effective against chronic, moderate and severe depression. They don’t help in mild depression.
The various antidepressants have been compared in many studies. Overall, the commonly used tricyclic antidepressants were found to be equally effective. Studies involving adults with moderate or severe have shown the following:
- Without antidepressants: About 20 to 40 out of 100 people who took a placebo noticed an improvement in their symptoms within six to eight weeks.
- With antidepressants: About 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.
In other words, antidepressants improved symptoms in about an extra 20 out of 100 people.
Antidepressants can also relieve long-term symptoms of chronic depressive disorder and chronic , and help make them go away completely.
What Happens If You Take Too Many Antidepressants
People who overdose on antidepressants may experience mild to severe symptoms, depending on how much they took and whether they mixed them with any other substances.
Usually, common antidepressant overdose side effects include:
- Nausea and/or vomiting
- Uncontrollable shaking in the limbs
More severe symptoms of antidepressant overdose include:
- Increased heart rate
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Can Too Much Testosterone Cause Depression
A womans chances of developing depression can be increased by low or high testosterone levels, according to scientific evidence gathered in the 2000s. Women going through menopause appear to have higher testosterone levels than other women.
Contents
There are a number of physical and emotional symptoms that can be caused by low testosterone.
Antidepressants Take Four To Six Weeks To Reach Full Effectiveness
When you start taking an antidepressant, you probably wont feel better right away. It takes about a month and a half for the medication to build up in your body, and your doctor will increase your dose gradually, Dr. Cox says.
People sometimes get discouraged when their medication doesnt work quickly, but patience is key, she adds.
For fast-acting anxiety relief, doctors may prescribe as-needed medications that work more quickly to be used temporarily until the SSRI, SNRI or atypical antidepressant reaches full effect. These medications include benzodiazepines, such as Ativan and Klonopin.
These can be helpful when appropriate, but caution should be exercised as they can be addictive and cause sedation and falls, Dr. Cox says. Safer, nonaddictive alternatives include Vistaril or Inderal.
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What Is Serotonin Syndrome
When treated with SSRIs, people may be at risk for a serious drug reaction called Serotonin Syndrome, which can be triggered by the use of other drugs and supplements that further increase serotonin levels. Serotonin Syndrome symptoms include:
- rapid heart rate
There can be a range in the severity of symptoms. In the case of mild symptoms, the side effects are usually alleviated once the medication is stopped. Some patients, however, experience severe symptoms which can be fatal if left untreated. Interactions between SSRIs, other types of antidepressants, as well as some supplements can trigger Serotonin syndrome. When switching between different types of antidepressants, the current drug must be slowly tapered down over a few weeks, followed by a washout period before new antidepressants can be started to reduce the risk of Serotonin Syndrome. Consult with your doctor and pharmacist about the best way to start new medications safely.
Potential Mechanisms For Antidepressantinduced Suicidality
How antidepressants might induce suicidality is not definitely known . The findings of increased suicidality with antidepressants seem counterintuitive and progression of underlying depression reflecting ineffective drug treatment could be an initial consideration. However, in many clinical trials demonstrating their efficacy, antidepressants were associated with increased rates of suicidality. Thus, drug ineffectiveness is insufficient to explain an association of antidepressants with risk of suicidality compared to placebo. Several mechanisms have been postulated through which antidepressants may induce suicidal behavior . Two primary pathways were initially postulated: in one model antidepressants may energize suicidal patients to act on their impulses in the other antidepressants may produce a worsening of depressive symptoms leading to the emergence of suicidal thoughts or actions. Other pathways were subsequently proposed.
Activity of the serotonin system might also be involved in the explanation for the observation that children are more sensitive than adults to the behavioral effects of SSRIs. Serotonin function varies during human development. Susceptibility to SSRIinduced behavioral side effects may be a function of brain maturation and vary according to the age of the patient .
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You Show Symptoms Of Serotonin Syndrome
The most common signs your antidepressant dose is too strong are symptoms of serotonin syndrome. Serotonin syndrome occurs when a medication youre taking increases levels of serotonin in the body, causing it to accumulate. This can lead to symptoms like agitation, confusion, rapid heart rate, high blood pressure, muscle rigidity, loss of muscle coordination, and more.
Symptoms of serotonin syndrome are most likely to occur when someone starts taking medication or adds another medication to their regimen. If you experience any of these symptoms, speak to your doctor right away. While serotonin syndrome is curable, it can become life-threatening if left untreated.
Hows An Overdose Treated
In the case of an overdose, emergency personnel will transport you to the hospital or emergency room.
You may be given activated charcoal while en route. This can help absorb the medication and alleviate some of your symptoms.
When you arrive at the hospital or emergency room, your doctor may pump your stomach to remove any remaining medication. If youre agitated or hyperactive, they may use benzodiazepines to sedate you.
If youre displaying symptoms of serotonin syndrome, they may also administer medication to block serotonin. Intravenous fluids may also be necessary to replenish essential nutrients and prevent dehydration.
Once your symptoms have subsided, you may be required to stay in the hospital for observation.
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Starting An Antidepressant Doesnt Mean Youll Be On It Foreverbut Dont Go Off Cold Turkey
People who take antidepressants dont need to feel trapped, Dr. Cox says. Some people need medication indefinitely, but many do not. Their life circumstances change, or they make progress in therapy, and the antidepressants arent as critical anymore.
Just because youre struggling and you reach out to your doctor about medication doesnt mean youre signing up to take something for the rest of your life, she says.
If you are interested in stopping your medication, its important to do so in consultation with your doctor, who will tell you how to taper off slowly. This has two purposes, Dr. Cox says: One, it reduces the chance of withdrawal symptoms. Two, if you start to decrease your dose and your anxiety or depression worsens, you can increase back to your previous dose easily.
Think you might be dealing with depression or anxiety? Talk to your doctor or find one near you.
Selective Serotonin Reuptake Inhibitors
SSRIs affect serotonin, which is a neurotransmitter that plays a role in many things, including your mood. Neurotransmitters act as chemical messengers within your body.
When your brain releases serotonin, some of it is used to communicate with other cells, and some of it goes back into the cell that released it. SSRIs decrease the amount of serotonin that goes back into the cell that released it, leaving more available in your brain to communicate with other cells.
Experts arent completely sure about the role serotonin plays in depression. But many believe that low levels of serotonin are a contributing factor.
SSRI antidepressants include:
- weakness and fatigue
SNRIs can cause sexual side effects, but not as often as SSRIs. Some people who take SNRIs may also gain weight, but weight loss is more common.
In some cases, people taking SNRIs may notice increased blood pressure.
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What Side Effects May Be Caused By Each Type Of Antidepressant
These are the side effects that each type of antidepressant may cause. The lists go from the most common at the top to the least common at the bottom for each type of antidepressant, with links to more information below:
SSRIs and SNRIs
- rapid heartbeat and disturbed heart rhythm.
Antidepressants can make you feel less alert or able to concentrate. This can happen especially when you first start taking them. This may affect your ability to drive and to do other skilled tasks.
Diabetes
Long-term use of antidepressants over several years may increase your risk of diabetes. This is especially in people who are:
- over the age of 30
- taking SSRIs or tricyclics.
Gastrointestinal bleeding
A rare side effect of some SSRI antidepressants is bleeding inside your gastrointestinal system, which includes your stomach and intestines.
The risk of gastrointestinal bleeding is higher for older people, especially those aged over 80. If you are over 80, your doctor may prescribe you a different antidepressant to avoid this risk.
Hypomania or mania
Antidepressants may trigger in some people. This may stop if you stop taking the antidepressant. But sometimes it may be a sign of . In this case, you may be given a new diagnosis and different medication.
Our page on has tips on discussing your diagnosis with your doctor, if you feel like it doesnt match your experience of mental health.
Neuroleptic malignant syndrome
The symptoms of NMS are:
What’s the treatment for NMS?
Serotonin syndrome
When Depression Gets Worse On An Antidepressant
When depression gets worse on an antidepressant, it doesnt necessarily mean the patient has bipolar disorder or that they are sensitive to medications. Today, we detail 7 explanations for this paradoxical phenomena.
This month we featured a new study on an old controversy: Can antidepressants cause violence? The study is the best designed one weve seen to tackle this question, which dates back to the early 1990s when case reports were described on fluoxetine. The idea goes against the grain of practice, where SSRIs are used to treat anger and aggression due to conditions like personality disorders and intermittent explosive disorder. But it reminded us of another issue one that we see a lot more often in clinical practice can antidepressants make depression worse?
This is the kind of problem that even if its rare youre likely to encounter in psychiatric practice because the majority 80% of antidepressants are prescribed in primary care. The ones that get better are not likely to come to our doors, but the ones who dont respond or get worse will.
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