What to Expect When Starting An Antidepressant: The Good, The Bad and The Ugly

by Toni Stanger

Starting an antidepressant for the first time can be really daunting; especially if you’ve read some of the negative experiences associated with them.

However, antidepressants have proved to be extremely beneficial in treating those with mental illness such as depression, anxiety eating disorders and post-traumatic stress disorder. They help to reduce depression, anxiety and panic attacks, which leads to a better quality of life. When working properly, antidepressants increase energy levels, improve sleep and boost levels of concentration. But what about all the bad stuff? I hear you call from the back. Well, here’s what nobody told you: what to expect when you start taking antidepressants for the first time.

Will antidepressants help me manage my mental illness?
Whilst your treatment can only consist of taking antidepressant medication, they are actually most effective when used in combination with psychotherapy. This is because antidepressants reduce the symptoms, but they don’t tackle the root cause of mental illness. Whilst some can seemingly occur for no reason, mental illness is usually triggered over time by negative personal experiences. This means friends and family, romantic relationships, finance, school or work and loads more. Therapy can help you find a way to deal with these problems, including the introduction of healthy coping mechanisms which all work alongside antidepressant treatment.

How do antidepressants actually work?
Antidepressants work by increasing the levels of neurotransmitters in your brain. Neurotransmitters send signals between cells and certain chemicals, such as serotonin and noradrenaline, are associated with regulating and therefore improving mood. They do this by blocking the reabsorption of serotonin into the cells that released it, which means that more serotonin is available for the brain to access. All antidepressants generally work this way, though some differ slightly in method. Contrary to popular belief, there is no scientific evidence to suggest that depression is caused by a chemical imbalance. Antidepressants work by increasing levels of serotonin, but this doesn’t mean that depression is caused by a lack of. However, a new study has shown that inflammation in the brain may cause suicidal thoughts and feelings. This is means that there is further incentive for research into using anti-inflammatory therapies to treat mental illness.  

The two week adjustment period
The two week adjustment period is the first two weeks you begin taking an antidepressant. During these two weeks, you will experience the most side effects from your antidepressant, and they will be unpleasant. There’s no escaping it, unless you’re one of the lucky bastards out there who experience little to no side effects. It’s completely normal for antidepressants to make you feel worse before you start to feel better. The side effects will be at their worst during this time because your body is adjusting to a new medication, but they should hopefully settle down or disappear completely after the two weeks. If they don’t settle down or become too bothersome, then you should see your doctor to decide whether to alter your dose or try a new medication.

What are the most common side effects?
The most common side effects of antidepressants are nausea, insomnia, anxiety, restlessness, dizziness, weight gain, dry mouth, sweating, upset stomach, headaches, agitation, loss of appetite, decreased sex drive and inability to reach orgasm. As previously mentioned, these side effects are at their worst during your two week adjustment period. Whilst most tend to go away, they can linger further into your treatment. It’s a good idea to start antidepressants during a free week, if possible, as these side effects can really impact your day to day life, causing school and work to be difficult. If you find that you’re still struggling with unpleasant side effects after the two weeks, then go back to your doctor. Remember you are under no obligation to stick with an antidepressant that is causing you problems. There are loads of different ones to try until you find one that best suits you. It may take some trial and error, but that’s normal.  There is also no shame in informing your workplace of new medication you are taking, and the two week adjustment period. Your workplace should make reasonable adjustments for you, under the Equality Act (2010), at this time.

Suicide risk – a word of caution
The worst thing antidepressants can do is increase the risk of suicide. The reason this happens is because antidepressants increase energy levels, so if you’re already feeling suicidal they will give you the energy to physically carry out the act. They may also intensify your low mood and trigger suicidal thoughts and feelings. This is why it’s important to keep an eye on people who have just started taking them. It’s also one of the reasons why your doctor asks to see you again in two weeks time and should make you aware that you can definitely contact them before this time if you are feeling worse. You do not have to “put up with” feeling suicidal for two weeks to see if you adjust. Feeling suicidal is the most horrendous feeling in the world and you do not have to suffer through it. Contact your doctor about switching medication. Just because you cannot tolerate the chemical makeup of one antidepressant, doesn’t mean that you won’t be able to tolerate another.

Do antidepressants work for everyone?
Let’s be honest here: no, they don’t. However, antidepressants do work for most people. They are a complicated medication so it might take some time before you find the right one for you, but sometimes people do find that they just aren’t suited to them at all. You also don’t have to try an antidepressant if you really don’t want to. Remember that other forms of treatment, such as making healthy lifestyle changes, are also an option that is proven to be effective. But please keep in mind that whilst this may be beneficial for some people mental illnesses, this also doesn’t work for everyone. Lifestyle changes probably aren’t going to help someone with bipolar disorder, as that’s a complex mental illness. Antidepressants are life-saving for some people, so think of the potential benefits you may gain from trying this medication. Think about how your life may change for the better. Even if you do experience a bad time whilst adjusting, sometimes it’s worth it to see what may be waiting for you on the other side.


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Sarah January 29, 2018 - 9:48 pm

Hi! I have mixed anxiety-depressive disorder and health anxiety also. Have you ever found a medication that works? I keep being unable to handle the side effects but I don’t want to continue like this.

Mental Movement Magazine
#MentalMovement March 2, 2018 - 9:52 pm

Hi Sarah, I totally hear you on this one. What are you using at the moment? Everyone is different and can handle different medications in different ways. Citilopram didn’t work well for me at all, neither did Fluoxetine, but after a while I discovered Sertraline. It has it’s down sides but I don’t live with the disabling anxiety I once did. What side effects are you getting? Have you spoken with your Dr about this? Hope you are well! Emma X

Toni March 3, 2018 - 9:23 pm

Hi Sarah! I’m really sorry that you’re struggling with similar things. As Emma said, everyone is different when it comes to medication. However, I found Duloxetine to be the only one that’s really worked for me. Since then I’ve tried a few more, but I feel the one I’m on now doesn’t really help much with my anxiety. I have found medication in combination with a talking therapy (especially cognitive behavioural therapy) to be the most effective though, and so I’d highly recommend those!

I also wrote about my experiences with health anxiety for Blueprint Zine, and there are a few tips at the bottom which you may find somewhat helpful in the meantime: https://blueprintzine.com/2017/12/11/heres-a-diagnosis-for-you-hypochondria/

I hope things improve for you soon! I wish you all the best. Toni X


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