1. Symptoms Aren’t Improving — or Are Getting Worse
Antidepressants aren’t an overnight fix, and it’s important to give them time to work. But you should notice improvements, such as better sleep or a boost in energy, within the first few weeks, and noticeable improvements in mood and daily functioning within four to eight weeks.
If you’ve given medication a few weeks to take effect and your symptoms haven’t improved, it’s worth speaking up, says Laudy Burgos, LCSW, a board member of Postpartum Support International and the associate director of social work in the women’s and children’s division at Mount Sinai Hospital in New York City.
“If you tell me six to eight weeks into treatment that how you’re feeling is the same, that’s not a good sign,” Burgos says.
Not everyone with PPD finds that their symptoms respond fully to their first prescribed medication. A review of clinical trials of antidepressants for PPD found that, for selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressants and first choice for PPD, reported response rates ranging from 43 to 87 percent and remission rates ranging from 37 to 65 percent after six to eight weeks of treatment.
There’s also an important caveat when medication is involved: Medication hasn’t necessarily “failed” unless it’s been taken at an appropriate therapeutic dose for long enough to have its intended effect, says Lulu Zhao, MD, an obstetrician-gynecologist and the codirector of women’s behavioral health at the Cleveland Clinic, where she specializes in mood disorders during key reproductive transitions, such as pregnancy and postpartum. Starting doses are often intentionally lower to limit initial side effects, which are common with antidepressants, and your provider will likely increase your dose shortly afterward, she says.
If you’re not feeling better after several weeks or months, let your doctor know. They can help you determine whether you need to give the medication more time to work, a dosage adjustment, another medication, or a completely different approach.
And if your symptoms suddenly worsen at any point after starting a medication, especially if you feel significantly more anxious or unable to sleep, tell your doctor immediately. Those may be signs it might not be the right medication for you. “If you’re telling me you’re sadder, you’re more anxious, you’re more hopeless, you’re having difficulty functioning, or you can barely function, that’s concerning,” Burgos says.
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