How long for an increased dose of an antidepressant to work

In this article, we are going to discuss how long it takes for an increased dose of antidepressant to work. We will discuss the phenomenon of antidepressant tolerance and the biological mechanism of tolerance.

How long for an increased dose of antidepressant to work?

An increased dose of antidepressant may take up to several weeks to take effect- 3-4 weeks- similar to the initial dosage. 

Antidepressants like SSRIs work to inhibit the transporter that recycles serotonin by preventing the transport of serotonin back into the neurons from which it was released so as to increase the level of serotonin in the brain. 

Antidepressants take so long to work because they inactivate not just individual serotonin transporters, but also the genes in our DNA that code for the transporter.

The effects of the drug increment on the individual will occur with continuous and dedicated usage with mindful attention to response and side effects. 

As a general rule, the first dose that is prescribed is generally the lowest dose that has been shown to be effective. From there on, the dosage is slowly increased every three to four weeks. 

The dose increment depends on the response of the individual along with any side effects that might manifest. The increment and the duration of the pharmacological treatment highly depends on a collaborative effort between the patient and the physician to assess the needs of the client.

What is tolerance in the use of antidepressants?

Antidepressant tolerance is a phenomenon that occurs when people who had previously responded to prescribed medication no longer respond to treatment.

This tolerance phenomenon occurs to 25% of patients taking the prescribed antidepressant drugs which make them at high risk of relapse. In fact, upto 80 percent of patients experience relapse despite being on drugs for treatment due to this phenomenon. 

What are the biological explanations for tolerance?

Experts have hypothesized that this antidepressant tolerance in individuals with depression occurs due to a mechanism developed by the brain that goes against the effect of the drug. 

Researchers suspect that keeping the levels of serotonin elevated in the brain with the use of antidepressants such as SSRIs for a prolonged period of time might cause a mechanism to be triggered.

This mechanism triggered by the central nervous system might occur due to the fact that the elevated level of serotonin is not “normal” according to the central nervous system of the individual thus as a way to cope with this abnormality, the brain might have developed mechanisms to go against the drug effects thus causing tolerance. 

What is the optimal dose for antidepressants?

According to one of the most exhaustive investigations into understanding the optimal dose of SSRI in individuals with depression- Researchers have found that SSRIs display beneficial effects for doses between low to medium levels. 

The researchers also mentioned that it is these beneficial effects of low to medium dosage of SSRIs that lead to dropouts or people stopping treatment. The researchers also concluded that the lower range of doses are likely to give the best balance between efficacy, tolerability, and acceptability.

Thus, researchers stressed that regularly aiming for a dose while being attentive to intolerable side-effects could be the best strategy for pharmacological treatment for depressed patients. 

How does Increasing the dose of antidepressant affect you?

Increasing the dosage of an antidepressant might not be the best course of action since it has little evidence that increasing dosage will actually be a better strategy for treatment.

In fact, the results might be on the contrary as increased dosage might lead to more side effects which might lead people to discontinue treatment. 

However, if there is a discussion to increase your dose of antidepressant you have to understand that it might lead to side effects and might cause you to be at risk of any predisposing medical conditions. 

Thus, it is necessary that you and your doctor have a sit down conversation going into depth of how an increased dose might affect you.

What are some signs that one should adjust dosage?

Three signs that might be indicative of the fact that you might need to adjust your dosage include:

  • Tolerability of the drug and its side effects. If you find that the side effects are becoming burdensome or are causing you to have intense suicidal thoughts- it could mean that the drug dosage is not compatible with you. 
  • Time: If you have been on the drug for more than six weeks and have not noticed any improvements, it is advisable that you speak to your doctor about dosage changes or switching the drug. 
  • Degree of improvement where you find that you are doing well but there could be room for improvement, speaking to your doctor about the dosage could be a smart decision especially when the degree of improvement is being hindered. 

How long does it take to feel the Full Benefits of antidepressants?

Generally, most people experience relief of depressive symptoms within two to three months of antidepressant use. 

If an individual does not show improvement within four to six weeks of starting an antidepressant,steps are taken to increase the dosage or change the medication or even adding another antidepressant. 

It is also notable that the best prognosis for the treatment of depression is when pharmacological treatment is assisted with psychotherapy and lifestyle changes. Thus, being able to make life changes through talk therapy could be one of the key factors to experience the full benefits of antidepressants. 

What are some factors that influence Antidepressant Response Time?

Some individuals respond more quickly to antidepressants than others with many people do not respond to antidepressants at all. The reason why there is this variation requires an understanding of how antidepressants work.

The most commonly prescribed antidepressants are known as SSRIs, or selective serotonin reuptake inhibitors. SSRIs work by elevating the amount of serotonin in the brain. 

SSRIs work to inhibit the transporter that recycles serotonin by preventing the transport of serotonin back into the neurons from which it was released so as to increase the level of serotonin in the brain. 

SSRIs work better for some people than others because of individual variations in gene expression of the serotonin transporter. Other variables that affect antidepressant response time include those related to drug metabolism: genetic differences in liver enzyme function, liver disease, age, sex, hormones, pregnancy, and nutritional status.

Conclusion

In this article we have discussed how long it takes for an increased dose of antidepressant to work. We will discuss the phenomenon of antidepressant tolerance and the biological mechanisms of antidepressant tolerance. .

References

3 Signs You Should Stop, Adjust, or Switch Antidepressants. Health. 29 february 2016. Retrieved on 18th Nov 2021.https://www.health.com/condition/depression/3-signs-you-should-stop-adjust-or-switch-antidepressants

Blanchfield CA. Increase the dose or give it a few more weeks. Psychiatry (Edgmont). 2007;4(3):15.

Furukawa TA Cipriani A Cowen PJ Leucht S Egger M Salanti G. Optimal dose of selective serotonin reuptake inhibitors, venlafaxine and mirtazapine in major depression: systematic review and dose-response meta-analysis.Lancet Psychiatry. 2019; (published online June 6.)

http://dx.doi.org/10.1016/S2215-0366(19)30217-2

How Long Does it Take for Antidepressants to Work? The Recovery Village. 4th September 2021. Retrieved on 18th November, 2021. https://www.therecoveryvillage.com/mental-health/depression/faq/how-long-for-antidepressants-to-work/

What It’s Like To Increase Your Antidepressants. JR Thorpe. Bustle. May 9, 2015. Retrieved on 18th November 2021. https://www.bustle.com/articles/81954-increasing-your-antidepressant-dosage-get-ready-for-these-5-stages-from-side-effect-neuroses-to-fear\

FAQ for How long for increased dose of antidepressant to work

Why does it take so long for antidepressants to work?

It takes so long for antidepressants to work because of their mechanism of affecting one’s nervous system. The drugs used to combat depression are (SSRIs), which means selective serotonin reuptake inhibitors.  Generally, when you start this drug treatment, it takes several days or even weeks to take effect because they inactivate not just individual serotonin transporters, but also the genes in our DNA that code for the transporter.

Is it possible for antidepressants to work right away?

No, it is nos possible for antidepressants to work right away. Most of them take between 1 to 4 weeks to start working. You have to be patient and combine the treatment with psychotherapy methods. 

Why do antidepressants make you feel worse before better?

Antidepressants make you feel worse before better because the drug’s side effects occur before your depression symptoms can improve. You have to have a lot of patience with the treatment for depression.

Will antidepressants make me happy?

Antidepressants will not make you extremely happy, but they will help relieve the symptoms of depression and associated anxiety. 

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