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Signs Your Antidepressant Dose May Be Too Low

Antidepressant dose is too low
Written by:

Wafaa Amjad Dar

Pharm-D

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Medical Disclaimer
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs. Read more

Depression is one of the prevalent mental health disorders that significantly impacts a portion of the global population. Fortunately, there are various treatment options available to help manage depression symptoms and mitigate its effects on daily life. One of the most commonly used treatments for depression is antidepressant medication. In fact, a survey indicates that 13.2% of adults [1*] are prescribed antidepressants to manage depression. 

However, choosing the right antidepressant and the right dosage can be a trial-and-error process. It means it may take some time to pinpoint your optimal dosage that will bring the desired effects without causing severe side effects. 

In this blog post, we will explore different types of antidepressants and their selection factors, how to recognize potentially low dosages, and effective strategies to tackle this problem.

Common Antidepressant Medications

Depression, or major depressive disorder (MDD), is characterized by persistent sadness, a lack of interest in previously favorite activities, and hopelessness. Antidepressants are medications used to treat depression. Usually, they are accompanied by psychotherapy and lifestyle changes to increase the chances for long-term improvement.

Several classes of antidepressant medications are available, each with its own mechanism of action, advantages, and side effects. The most common classes of antidepressants include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs). These medications block the reuptake of serotonin, a mood-regulating neurotransmitter. This leads to increased serotonin levels in the brain. As a result, SSRIs [2*] assist in alleviating depressive mood and other symptoms. Within this classification are fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).
  • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). Serotonin and norepinephrine are neurotransmitters collectively involved in mood regulation and stress response. SNRIs [3*] increase the levels of both, thus relieving depression and anxiety symptoms. Categorized under this class are venlafaxine (Effexor) and duloxetine (Cymbalta).

     

  • Monoamine Oxidase Inhibitors (MAOIs). MAOIs [4*] inhibit the enzyme monoamine oxidase which has a part in breaking down chemical messengers among which are serotonin, norepinephrine, and dopamine. As a consequence, the level of these neurotransmitters increases in the brain playing a role in regulating mood and emotions. Among these are phenelzine (Nardil) and isocarboxazid (Marplan).

     

  • Tricyclic Antidepressants (TCAs). They are among the earliest class of antidepressants. They selectively affect various neurotransmitters, including serotonin and norepinephrine. They are mostly used for treatment-resistant depression. Nortriptyline (Pamelor) and imipramine (Tofranil) are classified as TCAs [5*] .
  • Atypical Antidepressants. This includes antidepressants with mechanisms different from other categories, leading to their inclusion in this category. Some examples include bupropion [6*] (Wellbutrin) and mirtazapine (Remeron).
Reach out to MEDvidi for help and support. Our medical providers are here to help you find the path to managing depression.

Antidepressant Dosage

Your healthcare professional will select an antidepressant based on various factors, including your symptoms and medical history, your response to any previous treatments, and the medication’s potential side effects and interactions. Once an antidepressant has been prescribed, one of the most important considerations is determining the appropriate dosage. 

Antidepressant doses vary depending on the specific antidepressant and the severity of symptoms. The right dosage may vary among individuals, and finding the optimal one can sometimes be a process of trial and error. Initially, clinicians often prescribe a low dose, and then it eventually can be increased if needed. The goal is to alleviate depressive symptoms while minimizing side effects.

Factors Affecting Optimal Antidepressant Dosage

There are many factors that can influence the optimal dosage of antidepressants and require adjustment. Below are a few of them.

Pharmacokinetics

Every medicine starts showing its effectiveness depending on its absorption, metabolism, and distribution within the body. In specific situations, these properties can be influenced by an individual’s unique characteristics. As a result, the optimal dose may differ from the most commonly prescribed amount, either requiring an increase or a decrease to achieve the desired therapeutic outcome.

Symptoms Severity

The optimal dosage required to relieve symptoms of depression can vary depending on their severity, which spans from mild to severe depression. In cases of severe depression, higher doses may be required to effectively alleviate the symptoms.

Response to Previous Treatments

A patient’s response to previously used antidepressants and their specific dosages play a pivotal role in determining a current dose for optimal response. This helps a healthcare provider to evaluate and make a tailored medication plan, taking the patient’s past experiences into account. 

Age

The optimal antidepressant dosage varies across age groups due to physiological factors. In children and adolescents, antidepressants are initiated at lower doses to ensure safe use but can be adjusted if needed as treatment progresses. For adults, the dose choice depends on the specific symptoms and one’s medical history. Finally, older adults are more sensitive to potential side effects of antidepressants, including the risk of falls, due to which they are often prescribed lower doses and are monitored more closely.

Coexisting Conditions

The presence of concurrent medical conditions may influence both the choice of antidepressant and its appropriate individual dosage. Examples of such conditions include heart disease, diabetes, liver problems, as well as psychiatric conditions like anxiety, bipolar disorder, or obsessive-compulsive disorder.

Potential for Side Effects

Side effects of antidepressants can vary with the dosage. The optimal dose is one that provides therapeutic effects while minimizing side effects. Adjusting the dosage may be necessary to strike a balance between symptom relief and side effect tolerance.

How Long Does It Take for Antidepressants to Start Working?

In our fast-paced world, we often seek quick solutions and immediate results. However, it’s essential to be patient while starting antidepressant treatment. 

Antidepressants typically take up to a few weeks to reach their full therapeutic effect. An average timeframe of around 13 [7*] to 20 [8*] days. However, the exact timing of seeing improvement in mood and depressive symptoms when taking antidepressants depends mainly on the class of antidepressants, dosage, and severity of symptoms. For example, SSRIs typically take 7 days [9*] to reach full effectiveness while TCAs may take up to 2 weeks.

Note that these time frames may vary from patient to patient. It’s important to be consistent with the medication, even if you do not see immediate improvement. In some people, it may take 2-4 weeks to see initial improvement and up to 12 weeks to achieve stable positive results. Abruptly discontinuing an antidepressant can lead to withdrawal symptoms and may not provide a clear picture of its effectiveness.

Consult with a healthcare professional at MEDvidi to choose the most suitable antidepressant.

Signs Your Dose Is Too Low

Taking the right dose of the prescribed medication is important to ensure effective management of depression. When the dose is too low, antidepressants may not alleviate symptoms adequately, and depressive feelings can persist. To help identify if your antidepressant dosage may be too low, watch out for the following common signs that may suggest the need for adjustment:

  • You may feel an improvement in your mood immediately upon starting the antidepressant, but it doesn’t last long, and you find yourself returning to your previous depressed state. 
  • You may have forgotten to take your antidepressant on a few occasions, and skipping doses can hinder the medication’s effectiveness, potentially leading to the recurrence of depressive symptoms.
  • Sleep issues are some of the prominent symptoms of depression. Antidepressants are supposed to help with this also, but ongoing sleep problems may indicate that your antidepressant dose is too low. 
  • While it can take several weeks for antidepressants to show their full effect, if your mood still hasn’t improved after several months, your antidepressant dose may be inadequate.
  • If you feel energetic but still persistently down, and there is no improvement in your mood overall, discuss changing the dosage or the chosen medication. 
  • If you’re experiencing severe side effects that are interfering with your daily life, it’s important to consult with your healthcare provider to adjust the dose or medication. 
  • If your dose is no longer as effective as it used to be, it may show the possibility of developing tolerance. This may necessitate an adjustment to higher doses for therapeutic relief.
  • One of the most prominent signs that your antidepressant dose is too low is when your depression symptoms worsen. Your mood, depressive thoughts, or behaviors may deteriorate further, making it important to consult a healthcare professional.

Why Do Antidepressants Stop Working Over Time?

Although antidepressants are used to manage depressive symptoms, they may sometimes stop working over time. For example, because of tolerance. When you take an antidepressant continuously for an extended period, there is a possibility that it may stop producing the desired effects at that dosage due to the potential desensitization of your brain receptors to the medication.

According to a study, approximately 25% of people taking SSRIs [10*] have reported reduced effectiveness over a prolonged time. Additionally, the introduction of new medications to your regimen can influence antidepressant efficacy. Always inform your clinician about existing medications when adding new ones.

When to Discuss Increasing the Dosage

The decision of when to increase the dose of your antidepressant is best made by your healthcare provider after a careful evaluation. There are specific indications that might signal the need for an increased dosage, such as:

  • Persistent significant depressive symptoms even after allowing the medication sufficient time to work (usually several weeks).
  • Insufficient improvement that still is not yet at a level where you can function well.
  • Signs of developing tolerance at your current dose.
  • Unmanageable side effects.

What to Expect When Increasing Antidepressant Dosage

When it becomes necessary to increase your antidepressant dosage, there are several steps to follow:

  • Consultation with a healthcare professional: Always consult with a healthcare professional before making any changes to your medication regimen. They may increase the dosage after assessing your current symptoms, medical history, and response to the medication.
  • Gradual changes in doses: Your clinician can make dosage adjustments in a gradual and controlled manner to minimize side effects and make the change smooth.
  • Symptom monitoring: Your clinician will continue to monitor your symptoms and dynamics after increasing the dosage. It may take several weeks to assess the full impact.
  • Monitoring for side effects: Be cautious about any new or worsened side effects that may arise with the increased dosage and inform your clinician promptly. 
  • Improved effectiveness: With an appropriate dosage adjustment, you should start to notice a significant improvement in your depressive symptoms within a few weeks. 
  • Duration of adjustment: The duration of the dosage adjustment can vary but is typically a couple of weeks. Your healthcare provider will tell you the appropriate timing for a follow-up visit. 
  • Follow-up appointments: Your healthcare provider may schedule follow-up appointments with you to assess your response to the new dosage and make further adjustments if necessary.
  • Psychological support: In addition to medication adjustments, continued psychological support, such as talk therapy or counseling, can be an invaluable part of a treatment plan for managing depression.

Final Thoughts

Antidepressants are among the most commonly used treatment options for depression. Getting the right dosage is just as crucial as finding the right antidepressant. If the dose is too low, it may not yield the desired therapeutic effect, and if it’s too high it could risk serotonin syndrome or other severe side effects. Therefore, it is important to work closely with your clinician to ensure you receive the right dose.

If you suspect that your antidepressant dose is too low or that your medication may no longer be as effective as it once was, don’t hesitate to seek professional help. Get in touch with our medical professionals at MEDvidi to start your journey toward mental health improvement.

Sources

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10 sources
  1. Antidepressant Use Among Adults: United States, 2015-2018
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  2. Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review
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  3. SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants
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  4. The Role of Monoamine Oxidase Inhibitors in Current Psychiatric Practice
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  5. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated
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  6. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant
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  7. Time course of improvement under antidepressant treatment: a survival-analytical approach
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  8. Onset and early behavioral effects of pharmacologically different antidepressants and placebo in depression
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  9. Antidepressant drug treatment modifies the neural processing of nonconscious threat cues
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  10. Identification and Treatment of Antidepressant Tachyphylaxis
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Written by:

Wafaa Amjad Dar

Pharm-D
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