Starting New Antidepressant Can Make Depression Worse Before It Gets Better
I’m an impatient patient.
When I was first diagnosed with depression seven or so years ago, my doctor prescribed me an antidepressant medication, warning me that it might take 2 to 4 weeks before it made any difference.
Boy was that an understatement. I vividly remember getting worse before getting better, even dealing with physical pain caused by my depression.
The first depression drug he prescribed proved ineffective, even after a month, so we tried another. The same cycle repeated itself. I didn’t start feeling better until my third antidepressant prescription—a few months after being diagnosed.
I know that is not very encouraging to those who have recently been diagnosed with depression. Hearing that it may get worse before it gets better is frustrating. But it’s true.
Be Patient with Depression Meds
It takes patience to get the payoff from antidepressants. Two to four weeks is generally the minimum to see any improvement, and it may take up to six months to get the full benefit of a new depression drug. At least, that’s what my psychiatrist tells me.
Changing antidepressant medications can be just as frustrating as taking an antidepressant for the first time. The last couple of weeks have been extremely difficult for me. I began to slide back into a deep bout of depression, and my doctor wanted to be aggressive in trying to stop it. It got so bad that my stomach ached and I could barely get out of bed for a day or two, so we had no choice but to try something different.
And we did. We changed my antidepressant. While I’m generally a compliant patient, I didn’t follow the doctor’s orders exactly on how to switch antidepressants safely and make the transition. Big mistake.
Instead of slowly weaning off my old drug, which I was supposed to do over a three-day period, I suddenly stopped the antidepressant cold turkey and started taking the new drug. This led to what's called antidepressant discontinuation symptoms. Several days of pure hell followed. I had suicidal thoughts. My anxiety increased exponentially, and I was feeling utterly hopeless and severely depressed.
I didn’t intentionally ignore the doctor’s orders. He told me to get off the old drug by cutting my dosage in half for three days before dropping it entirely. When I got home that night, I was frustrated to discover that the pill I had been taking was the type that can’t be cut in half. So I just quit taking it instead of asking for the smaller dosage.
Let’s just say I won’t ever do that again.
So if you are suffering from depression and have just been put on an antidepressant, my advice is to be patient. If you have been on an antidepressant and a decision is made to discontinue it, follow the doctor’s orders. I learned that lesson the hard way.
APA Reference
Smith, J.
(2012, February 17). Starting New Antidepressant Can Make Depression Worse Before It Gets Better, HealthyPlace. Retrieved
on 2024, November 2 from https://www.healthyplace.com/blogs/copingwithdepression/2012/02/new-meds-can-make-depression-worse-before-it-gets-better
Author: Jack Smith
There is a lot to be said for genetic testing and psychiatric medications. About 10% of the general population has an issue metabolizing prodrugs. If a prodrug does not work, switching to a different one that is metabolized by a different enzyme may well prove very beneficial.
Example:
Prozac (Fluoxetine) is metabolized by Human Cytochrome P450-2D6 where Celexa (Citalopram) is metabolized by Human Cytochrome P450-2C19 and Amitriptyline fluoxetine by 2C9.
So, why do I mention genetic testing? If your insurance will pay for it, tests can be run to see which, if any, variants are present in your liver and guide your doctor to the most effectatious drug available. If your insurance will not cover it, as you try new medications be certain to log them and check the liver enzyme they are metabolized with.
Some may read your post and believe your underlying condition worsened when you went cold turkey. I do not know of anyone with a true immediate onset of symptoms, we tend to slide into them until they become overwhelming. The problem is as humans we tend to forget just how bad our symptoms were and when we stop taking meds the symptoms manifest much more quickly than the original onset did. Gradually weaning off your meds allows you to adjust to your symptoms again and gets the old medication out of your system so you do not get something like serotonin syndrom when your new medicine is added back in.
Sorry for the split post, but there were two topics I felt needed to be addresses. I hope you the best.
Each unusual clinical psychiatric experience should take carefully and seriously. Your case report isn't an exception. Generally,there is psychopharmacologic protocol of antidepressant medication that should be as guideline in the treatment of depression of any form. But psychiatric medication seeks an authentic approaching in order to avoid unexpected and serious side effect of antidepressant therapy. However, among these two counterpart of my recommendation, the main intention is the benefit of depressive patient. Once more, every experience is welcomed!
My doctor switched me from Luvox 300 mg that I had been on for 6 years to Prozac last week and I am so severely depressed. I drove around crying for 2 hours straight the other day. I called the office to leave a message and I have yet to receive a phone call. The staff (who are terrific) said she is only there on Thursdays. I mean I can't wait weeks before this stuff is supposed to "kick in". I have a 3 year old and all I can think of is him remembering his mom was always sad. Is this how all docs make these transitions? I feel it is risky for the patient.I question whether these doctors have any idea the depths of depression tears a patients soul.
Hi Sharon. Thanks for taking the time to comment. I'm SO sorry that you are having such a hard time... both with the meds switch and with reaching your doctor. THAT is NOT good. Did these rotten symptoms start earlier last week and she still didn't respond to you even on her day in the office on Thursday? Is going to the emerg an option for you? My doctor switched me from Celexa to Cipralex overnight but I was told they were so similar that I wouldn't feel any side affects. Thankfully, I didn't.
As for your son, take my word for it that a) he's too young right now to really remember anything and b) he's going to remember all the good stuff about you being a terrific mom!
Keep me posted. I hope you feel better soon.
Hi, Ive just started on Seroxat again for the 2nd timein a number of years. Atm i am feeling anxious and my mood is erratic. Im on 20mg a day . I can honestly say that although i am feeling this way atm, from experience the last time, after about 4wks this was a wonder drug for me. I woke up in the mornings happy and feeling like a new person. Even my wife saw a big difference in me. I suffer from social phobia, but the meds really turned this around . Only bad thing about the meds is that i suffer from an itch , so im thinking that i might be allergic to them.
I was on effexor ( which worked great for my depression.) for 3 weeks by my md then visited a psychiatrist who said he wanted to put me on an antidepressant without sexual side effects so he switched me to cymbalta which I was on for 3 weeks as well. It worked to eliminate depression but my urgency to pee was so
uncomfortable, he then switched me to Pristiq which is like effexor but without sexual side effects. My question is I've ben on it for a little over one week I forgot to take it a couple of days ago but took it the next day! Is it normal that I experienced depressing thoughts and hopelessness two days after? I haven't felt this way since I first started taking an antidepressant 7 1/2 weeks ago! I'm frustrated and hate feeling this way! Any help would be greatly appreciated!:) Thank you!:)
I was on sertraline but got echoing in my ears and trouble with my speech so doctor swapped me onto amitriptyline which are no better. I stopped them 2 days ago but I've been itching really bad for aday n a half. Itching everywhere and can't stop. The other day I got severe pain in centre of my chest, my speech is still bothering me, I can be having a conversation and suddenly get tongue tied and can't get the word out proper. I put the chest pain down to indigestion cos I took two gaviscon and it took pain away. I take citirizine cos if I don't my skin gets itchy and I get burn like marks on my skin, the problem is that no amount of citirize is taking the itching away this time. I literally have been awake all night scratching !please could u advise me what to do !
I was on a medication for about 2 weeks but it was for mood swings,it helped some but not enough, I went back to the Doctor and he prescribed me an Anti-Depressant he told me just to stop the other pills and start the Anti-Depressant the day I got it, and i've been on it for 2-3 days and today I just feel so....horrible and kinda blank....is this normal :/
I have also been switched and experiencing the same things... I have been on new med for 2 weeks now though so feeling a slight bit better off and on. It will get better.
I'm so glad you're starting to feel better. And, yes, I agree with you. It will get better!
--Michelle Sedas, coauthor of "Coping With Depression" blog
Iv had depressiom amd severe anxiety for 18 years and om several different antidepressants for 6 years I was on 20mg of citalspram 1 a day but the past 4 weeks iv been om 60mg of cymbalta 1 a day plus 40mg of propranonal when needed plus 1 5mg of diazipan at the minute I still feel as if my heads empty amd I get anxious a bit just womderin wen will my new antidepresant start working ty
I'very had depression most of my life but the past 7 years have been awful with the best 6 months being he'll. I was on Pristiq and it wasn't working so now I'm weaning off it and onto.Lamotrigine and feeling really depressed and hopeless.
I have never felt as hopeless as while switching from pristiq to Lamotrigine.
I have been on Zoloft for 10years my body is now rejecting the drug my MD says, because I am having major side effects, she is weaning from Zoloft its been 5 days I'm suppose to wean to 25 mg 1x a day for 10days then every other day 25mg for 2 weeks suppose to start Cymbalta week 2 of weaning I have had the worst withdraws I'm ever imagined should I been weaning like this or should I have started the pill already while weaning!!