Signs Your Antidepressant Dose Is Too Low or Too High

Antidepressants are the third most commonly prescribed prescription medication in the United States; from 2005 to 2008, 11% of Americans aged 12 years and older were taking an antidepressant, according to the Centers for Disease Control and Prevention (CDC).

Indeed, more than 40 million Americans take antidepressants, and for many of them, the drugs allow them to live full, productive lives, which they may not otherwise be able to do. That said, it can be tricky for medical professionals to determine what dose is ideal for each individual, and they often don’t get it exactly right when they first prescribe it.

If you’re taking an antidepressant medication, it’s important that you be on the lookout for signs that your dose is either too low or too high so that you can work with your primary care provider to get it right. These medications may cause mood swings, particularly in those with bipolar disorders or a family history of the mental illness.

What Are Antidepressants, and How Do They Work?

As the name implies, antidepressants are primarily used to treat clinical depression, but they do have some other uses. In addition to treating depression, according to the United Kingdom National Health Service (NHS), antidepressants are also used to treat:

• Obsessive compulsive disorder (OCD)
• Anxiety
• Panic disorder
• Severe phobias
• Post-traumatic stress disorder (PTSD)
• Certain eating disorders

It’s important to understand that clinical depression is very different from situational depression. Feeling sad occasionally happens to everyone, but clinical depression is a serious mental health condition that affects mood, behavior, sleep and thought patterns, general mental health and can even lead to suicidal ideation (SI).

There are four main types of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

SSRIs

Serotonin is a chemical that the body produces naturally and uses to send signals throughout the body. Serotonin plays a key role in several bodily functions, including blood clotting, mood, sleep, sexual desire and wound healing.

After serotonin sends a message, it’s reabsorbed by the body’s nerve cells, a process known as reuptake. SSRIs work by blocking this process, which allows the body more serotonin with which to send signals. Common brand-name SSRIs that continue to be used today include Paxil, Zoloft (Sertraline), Citalopram, Prozac, and Lexapro.

Although depression isn’t caused by low serotonin levels per se, the increase in serotonin levels that SSRIs provide can improve symptoms of depression and make other types of treatment, such as cognitive behavioral therapy (CBT), more effective.

SSRIs are generally healthcare providers’ first choice when treating depression with medication because they tend to have fewer side effects than other antidepressants. Nonetheless, SSRIs do have side effects, the most common of which are:

• Feeling anxious or shaky
• Dizziness
• Blurred vision
• Diminished sex drive
• Erectile dysfunction

If your healthcare provider prescribes an SSRI, you’ll most likely need to check in with them every few weeks to assess the medication’s effectiveness and monitor side effects.

SNRIs

SNRIs are similar to SSRIs in that they block the reuptake of messenger chemicals in the brain. SNRIs include Cymbalta (duloxetine), Fetzima (levomilnacipran), Savella (milnacipran), Pristiq (desvenlafaxine), and Effexor XR (venlafaxine). Generally speaking, SNRIs are more effective than SSRIs for most people, but the side effects can be slightly more severe. The most common side effects of SNRIs are:

• Nausea and vomiting
• Excessive sweating
• Changes in sexual function or desire
• Loss of appetite
• Headache
• Fatigue
• Insomnia

In rare cases, SNRIs can also cause elevated blood pressure or worsen liver problems. Just like with SSRIs, you should see your healthcare provider regularly when taking an SNRI and keep them informed about any side effects that are severe or persist for more than a few weeks.

TCAs

Like SNRIs, TCAs also treat depression by blocking the reuptake of serotonin and norepinephrine. Unlike SNRIs, however, the side effects of TCAs are more severe, with blurred vision, weight gain, constipation and difficulty urinating being the most common.

Additionally, TCAs have a lower threshold for toxicity, which means they can more easily lead to overdose; for these reasons, TCAs are seldom prescribed as a first choice in the treatment of depression.

MAOIs

MAOIs were the first type of antidepressants available and have been largely replaced by SSRIs, which have fewer and milder side effects. Nonetheless, healthcare providers still sometimes prescribe MAOIs when SSRIs aren’t proving effective.

MAOIs work by preventing monoamine oxidase, an enzyme responsible for removing serotonin, norepinephrine and dopamine from the brain, from doing its job, which increases the availability of these chemicals and alleviates depression symptoms.

In addition to most of the mild side effects of SSRIs and SNRIs, MAOIs can cause involuntary muscle jerks (tardive dyskinesia), tingling sensations in the skin (paresthesia) and dangerously high blood pressure when mixed with certain foods, beverages or medications.

Factors Affecting Optimal Antidepressant Dosage

There are several factors that affect dosage when it comes to antidepressants. According to the National Center for Biotechnology Information, the proper antidepressant dose depends on:

• Age
• Weight
• Severity of symptoms
• Genetic factors
• Lifestyle

It’s also important to note that, in a study consisting of 23 separate interviews, the effectiveness of antidepressant medication was aided by self motivation and belief in the medications and significantly hindered by stigma and the fear of adverse effects, which often lead to diminished adherence to treatment and eventual discontinuation.

In a nutshell, adherence, attitude and belief in treatment play a large role in determining how effective treatment will be.

Signs Your Antidepressant Dose Is Too Low

There are a few telltale signs that your antidepressant dose is too low:

Ongoing Symptoms and Incomplete Alleviation

If your antidepressant dose isn’t high enough, you’ll probably experience ongoing symptoms of depression. Additionally, you might feel like, even though your medication is helping somewhat, the alleviation of your symptoms is incomplete.

It’s important to remember that it takes time for antidepressants to build up effective levels in your body. In fact, in can take up to eight weeks, and even longer in some cases, to experience the full benefit of your antidepressant medication.

Your Side Effects Diminish or Go Away, but Your Symptoms Persist

If you’ve been taking your antidepressant long enough for the side effects to peak and then decline, but you’re still feeling depressed, there’s a good chance your dose is too low. If that’s the case, talk to your healthcare provider about increasing your dose or switching to a different medication. Sometimes, it takes longer than 1 or 2 weeks for your medication to have its full effect. So, if you feel immediately different after starting an antidepressant, it could simply be a placebo effect.

Your Symptoms Go Away but Return

Researcher’s aren’t sure exactly why, but it’s not uncommon for people to experience a marked improvement only to see the return of their symptoms after time. Some have suggested that this is the result of the body building a tolerance to the medication, and increasing the dosage may help.

Signs Your Antidepressant Dose Is Too High

The consequences can be severe when your antidepressant dose is too high. Fortunately, these will be pretty obvious when you know what they are. Here are the most common signs that your dose might be excessive:

• Excessive side effects
• Feeling like you can’t get any pleasure out of things you usually enjoy
• Increased anxiety or irritability
• Significant weight changes
• Mania that’s noticeable to others

What To Do If You Suspect Your Dose Is Incorrect

If you think there’s something wrong with your dose, the most important thing is to be patient; it can take some time for your healthcare provider to zero in on the dose that’s right for you, so it’s imperative that you don’t give up.

Other Reasons Your Antidepressant Isn’t As Effective as It Should Be

The National Institutes of Health estimates that about 15.4% of people with major depressive disorder self medicate with alcohol, and about 7.8% self medicate with drugs, which may or may not include alcohol. Self medicating can seriously inhibit the effectiveness of antidepressants and can even cause dangerous interactions.

Although drugs and alcohol may provide temporary relief from depression or anxiety symptoms, they’re not a sustainable solution; in fact, they are likely to make your symptoms worse over time, and they can cause serious damage to your work life and personal relationships.

Of course, kicking a habit is always easier said than done. Nevertheless, quitting excessive drinking or drug use is entirely possible; people do it every day. If your struggling with substance abuse, you’re not alone, and when you’re ready to live free of addiction, Illinois Recovery Center can help. Call or email Illinois Recovery Center today.

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