Although you should take all medications as prescribed by your provider, you can talk to them if you feel your antidepressant isn’t working for you. If needed, they can help you switch to a new medication safely. Here are five signs that could mean you need a switch.
1. Your Mood Isn’t Getting Better
Your provider may consider switching your antidepressant if your mood hasn’t improved, even after giving it weeks to work. They may also suggest adding a second antidepressant alongside the first, says Ballamudi.
“Someone should speak with their doctor if depressive symptoms are not improving after several weeks,” says Dr. Faynboym. He also recommends reaching out to your doctor if symptoms like sadness, low motivation, hopelessness, anxiety, insomnia, or difficulty functioning continue to interfere with your daily life.
2. You Have Too Many Side Effects
3. You Still Feel Fatigued
“Persistent fatigue can sometimes be caused or worsened by certain antidepressants, particularly those with more sedating effects,” says Faynboym. For his patients, he considers dose changes or other medications if fatigue stays strong.
4. You’re Not Sleeping Well
One large research review that included 166 studies in its insomnia analysis found that the following drugs are more likely to cause sleep disturbances than others:
- vilazodone (Viibryd)
- desvenlafaxine (Pristiq)
- venlafaxine (Effexor XR)
- sertraline (Zoloft)
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxetine (Paxil, Paxil CR, Pexeva)
- escitalopram (Lexapro)
If your sleep doesn’t get better, even after giving your body time to adjust to your antidepressant, let your provider know.
5. You Notice New Depression Symptoms
Tell your provider about any new stressors, changes in your life, or new medications, supplements, or drugs you’re taking, which can potentially change the medication levels and effectiveness and contribute to worsening depressive symptoms, says Ballamudi.
How Switching Antidepressants Works
Some common antidepressant switching techniques include:
- Cross-taper: Slowly lowering your first antidepressant dose while increasing the dose of your new medication at the same time (usually over two to four weeks).
- Direct switch: Stopping your first antidepressant and taking the new drug the next day.
- Taper, stop, and switch: Lowering your antidepressant dose until you can stop taking it, then starting the next drug the following day.
- Taper, washout, and switch: Lowering your dose, taking no antidepressant for a “washout” period, then starting the new drug.
- Stop, washout, and switch: Stopping your antidepressant (without tapering), waiting for a period, then starting the new medication.
Your psychiatrist will recommend one of these strategies depending on the medications involved, says Faynboym.
Don’t stop taking your antidepressant on your own — talk to your provider first. If you stop some antidepressants suddenly, you may experience antidepressant discontinuation syndrome (aka antidepressant withdrawal), which can have symptoms like worsened depression, anxiety, dizziness, electric shock sensations, and trouble sleeping.
“Finding the right antidepressant is often a personalized process,” says Faynboym, who says his patients sometimes get discouraged when they need to switch. “But with careful monitoring, open communication, and a willingness to adjust the treatment plan, many people ultimately find an approach that significantly improves their mood and functioning.”
The Takeaway
- Antidepressants can take weeks to improve your symptoms, but if you don’t feel better after an adjustment period, you can ask your provider about a treatment change.
- Your provider may recommend switching your antidepressant if you have severe side effects, you’re not sleeping well, or you notice depression symptoms returning.
- Always talk to your provider before you stop taking an antidepressant — they can help you decide on a treatment plan so you can switch safely.
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