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How Long Do Antidepressants Take to Work? Improve the Wait by Setting Accurate Expectations
Daniel Hageman
Antidepressants are often a vital part of the strategy for treating depression. They can be helpful and even life-changing, but the antidepressant process can also be frustratingly slow. Knowing the potential side effects of antidepressants is essential to remaining informed about your condition, but so is understanding how these medications could help you. How will antidepressants make you feel? How long do antidepressants take to work? Why does it take so long for antidepressants to work?
Knowing how antidepressants work and how long they take can help you gauge your expectations if depression is reducing your motivation or causing you to doubt the effectiveness of your treatment. While the wait for symptom relief might feel lengthy, knowing the details of the antidepressant treatment process can help you assess its benefits and drawbacks, which may make the process smoother and more tolerable.
How Will Antidepressants Make Me Feel?
Antidepressants are meant to help you get back to your non-depressed baseline. For some people, it can be hard to remember what this feels like or to imagine feeling anything other than depression, but many people do find relief from their symptoms through antidepressants. However, antidepressants are not "happy pills," as they are sometimes called, and they won't make a person immune to emotional discomfort.
Because the benefits can take time to appear, it isn't always immediately obvious what is changing. It is common for people with depression to notice improvements in retrospect or for loved ones to see a shift first. You might, for instance, be surprised to realize that you have gone three days without showing signs of emotional exhaustion, or you may find yourself genuinely laughing at a coworker's joke. It might feel natural to resume an activity that you once enjoyed, such as reading for pleasure. When antidepressants are working as intended, improvements often do feel natural.
How Long Do Antidepressants Take to Work?
Antidepressants don't result in immediate relief of symptoms. Some individuals experience initial improvement in 1-2 weeks, while others notice smaller, more gradual changes accumulating over the ensuing weeks of treatment. It typically takes 4-6 weeks or more to see the full effect of medication at any particular dose. Dose adjustment is often needed, and different doses are needed by different people.
With that said, medications usually have a “starting dose” which is smaller and an average or “typical” dose, which is higher. Some people improve with a smaller dose, and some need higher doses. Some people see benefits with smaller doses, but if these don't produce the desired effect, it can take time to increase to an adequate amount of the medication. Because incrementally raising the dose requires additional time, the full benefits of antidepressants may take longer than 4-6 weeks to become apparent if the dose needs to be increased.
Why Does It Take So Long for Antidepressants to Work?
Several factors can contribute to how long antidepressants take to work, but the exact ways that antidepressants relieve depression are not yet fully understood.
The most commonly used antidepressants increase serotonin signaling in the brain. Serotonin is a messenger hormone (or neurotransmitter) that is thought to contribute to positive emotions by supporting communication between the brain and other parts of the nervous system. The increase in signaling happens relatively quickly when a person starts using antidepressants, but depressive symptoms typically aren't alleviated at the same pace. Other downstream changes occur as a result of the increased serotonin signaling, and these modifications take time to manifest and influence depression symptoms. Which process is the primary source of antidepressant response has yet to be determined, so treating depression with antidepressants isn't as simple as just increasing brain serotonin.
Another factor that may contribute to the time needed for a clinical response is the medicine's therapeutic dose, described above. Because the starting dose of the medication often isn't the therapeutic dose, antidepressant medications are started at smaller amounts to allow the body time to adjust and avoid side effects. The pace of dosage adjustment may be influenced by how a person tolerates the medicine. If there are side effects, a slower adjustment (or titration) rate may be necessary, which would result in additional time before a therapeutic dose is reached.
At the beginning of treatment, you and your provider will decide whether to stay at the initial antidepressant strength long enough to assess for clinical response, or to titrate up to the average therapeutic dose steadily. Because it can take a long time for antidepressants to produce an effect, some individuals with depression opt to raise the medicine past the initial dose before waiting for a response. If a person will ultimately require a higher dose, the decision to increase sooner may cut down the time it takes to see benefits. This decision is a matter of personal preference and should come after discussing and weighing the pros and cons of both approaches with your provider.
Knowing What to Expect Can Reduce Frustration
Despite producing effects at slow rates, antidepressants remain a fundamental part of the treatment strategy for depression. Confusion about what to expect when you start taking an antidepressant can add frustration to an already difficult situation, but by taking time to learn more about how antidepressants work, you can properly evaluate their benefits and advocate for treatment changes if necessary. If you've tried several treatment strategies and are still experiencing depression, know that you are not alone and that there is hope for relief. Taking time to consider the questions posed above will help you feel more confident about your path forward, but don't hesitate to schedule a no-cost consultation for TMS to have more of your questions answered.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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