Finding the right antidepressant or anti-anxiety medication (or combination of medications) requires a steady stream of diligence — a level of persistence that can quickly dry up if side effects start to make an appearance.
“Everyone’s brain and body responds to and processes medications differently, so getting on the right medication regimen can be a frustrating process for some people,” Melissa Shepard, board-certified psychiatrist and assistant professor at Johns Hopkins School of Medicine, told HuffPost. “The most frustrating part being we don’t always know why.”
There are some clues doctors can use to try to predict how someone will personally respond to a prescription — the symptoms they’re experiencing, how they’ve responded to other medications, and on occasion, certain types of genetic testing — but even with these clues, for many people it’s still a matter of trial and error.
“Trying to predict the effect of one medication on a particular individual is nearly impossible, so we have to make decisions based on what we know about the patient and the medication to try and yield the best chance for a successful treatment,” said Shane Rau, vice president and medical director for the telepsychiatry practice Array Behavioral Care.
Experiencing side effects doesn’t always mean stopping or changing your medication is necessary. But if you feel like something’s off, these common side effect scenarios can help you suss out what to do next.
You feel better right away (but it doesn’t last)
Most currently available medications do their thing by indirectly increasing the levels of neurotransmitters thought to play a role in mood disorders and anxiety, such as serotonin, norepinephrine or dopamine — but mood disorders and anxiety are more than just the ups and downs of these neurotransmitters.
“Sometimes, changes that occur right after the initiation of a med (or change in med dose) can produce effects on mood or anxiety that are transient,” said Erik Vanderlip, board-certified psychiatrist and family physician at the Pacific Premier Group in Portland, Oregon. “We still don’t know why this may be the case for some individuals, but there are a few theories.”
There are different patterns of depression and anxiety, and sometimes one pattern can respond well initially to something but then get worse “because we haven’t matched the right medication to the right pattern,” Vanderlip explained.
Someone struggling with a bipolar pattern to their depression, for instance, may have some initial improvement on their medication that doesn’t last and may need something that’s more a mood stabilizer than an antidepressant.
Similarly, concurrent taking of substances (like alcohol) or medical conditions that can mimic depression (low thyroid disorders) can sometimes explain why a transient response can lessen over time.
“Just taking a medication is often not enough to achieve optimal recovery for many,” Vanderlip said. “Staying on top of your physical health (sleep, exercise, nutrition, other conditions) and avoiding substances are all part of maintaining your mental health.”
Then there’s the placebo effect — the belief that a medication will work — due to the fact that all medications have meaning to the person taking them.
“The placebo effect isn’t bad in and of itself, but many people in clinical trials of new medications respond to placebo pills in part because having hope in something can innately be helpful for mental health,” Vanderlip said.
You experience side effects that don’t go away
Some people are natively more sensitive to medication side effects than others. “There are often unknown factors at play, but for some, it may be because they metabolize the medications more slowly, so they have a tendency to build up in their system,” Vanderlip said.
If this is a repeated problem for you, some forms of genetic testing that examine how your liver processes these medications can highlight opportunities for meds to try or avoid due to differing rates of metabolism, he added.
As your body adjusts to medication (it can take up to 12 weeks to see the full effects), there can be side effects like mild nausea, fatigue or headaches that wear off within a few days. However, if you experience ongoing side effects (think: diarrhea), these may outweigh the benefits of the medication and your doctor may need to consider a different one instead.
“For an optimal outcome, follow up with your doctor in a few weeks or one month and communicate all side effects you’ve been experiencing,” said Vrushali Gersappe, a psychiatrist at digital primary care app K Health. “This is key to not only finding the right medication for your condition, but the right dosage and complementary lifestyle changes.”
Your symptoms make a comeback
Depression and anxiety can be tricky — some people experience recurrences even when they’re faithfully taking their medications. Turns out, this isn’t unusual.
Think of it like asthma: An inhaler may be controlling your asthma well, but sometimes you can have a flare when seasonal allergies are in the air or if you spend a night in a smoky bar and set it off.
In much the same way, if you’re experiencing an uptick in stressors — you’ve been laid off, your chronic illness is flaring up, you’re leaving a rocky relationship — you may find your symptoms make a comeback or get stronger even though you’re still taking a medication that was once toeing the line.
“This is what I find most commonly to be the case,” Vanderlip said. “It’s not that the antidepressant is suddenly failing, it’s that the environment has shifted or changed and now your depression is worse.”
If you genuinely have no significant changes in your environment that could overwrite the efficacy of your medication, it could be a sign your medication is becoming less effective.
“Medications act on receptors in our cells,” Rau said. “Our neurons (brain cells) can regulate the level of their response to a medication by adding or removing some of these receptors, which can change the level of effectiveness.”
This doesn’t happen to everyone taking a particular medication and our individual biology does make a difference, Rau added, but it’s one of the reasons a medication that once cut it no longer does.
Your depression or anxiety get worse
A doctor will usually start you off with the mildest medications first that also have good efficacy and side effect profiles, then add in adjunct medications and change doses or medications based on how a person’s responding to them.
“While it’s true these medications may take some time before a patient feels the benefits, you shouldn’t have a worsening feeling soon after starting,” said Shaili Gandhi, vice president of formulary operations at SingleCare. “This is a sign your medication may not be right for you and you should consult with your doctor about trying alternative medication options.”
You barely notice a difference in how you feel
Many people only have a partial response to their medication — they may stop having panic attacks, for instance, but still experience a high anxiety level that interferes with daily life.
“It’s rare, in fact, that we get a full remission of symptoms with the first med, first dose,” Vanderlip said. “For many, a couple of dosage adjustments isn’t unusual.”
The other possibility is the medication isn’t working at all, despite taking it as prescribed for the recommended amount of time. If there’s no change after one month, follow up with your doctor to discuss other treatment options. These might include “a trial of a different class of medication, using a combination of medications, and consulting with a psychiatrist for further evaluation,” Gersappe said.
Your moods have become intense and unpredictable
Mood swings could be another indictor the medication you’re on doesn’t jibe with your particular pattern of depression.
“Teasing apart the clinical difference between bipolar [characterized by episodes of depression and mania] and unipolar [persistent depressed mood with no history of mania] patterns of depression can be difficult,” Vanderlip said. “People with bipolar depression can sometimes feel like their mood or energy suddenly shift after they start an antidepressant versus a mood stabilizer.”
New mood-centric symptoms, like intense mood adjustments, mixed mood states, hypomania or mania after medication therapy with an antidepressant might signal a different underlying mood disorder pattern that was being cloaked by the severity of your depression.
Your sleep quality plummets
Medication side effects can include grogginess during the day and a more restless sleep at night. It’s also not unusual to start experiencing weird dreams.
“This can sometimes be a side effect of the medication, a harbinger of a different pattern of depression or a native worsening of your mood symptoms after initiation,” Vanderlip said.
Usually, these initial side effects fade within a week or two as your body acclimates to the medication. You might try changing the time of day you take your medication, giving yourself more time to unwind before bed or taking OTC meds, like melatonin, to see yourself through the adjustment period.
“Dramatic changes and side effects that are intolerable or result in crisis or safety concerns should be addressed more immediately by your physician,” Vanderlip said. “They can bring forward their knowledge and experience to help you navigate your way to an effective treatment plan more rapidly and effectively.”
How to streamline the process of finding a medication that works for you
Because the disease states of depression and anxiety are subjective, the best way to streamline the process of establishing an effective medication regimen comes down to communicating with your doctor as much as possible.
“We don’t have a standard blood test that, based on the results, lets you know someone has depression or anxiety,” said Shari N. Allen, associate professor in the department of pharmacy practice at PCOM School of Pharmacy in Georgia. “As a provider, we know you have depression or anxiety — and how severe it is — based on what you say (or don’t say).”
Your doctor will then consider patient-specific factors to narrow down your medication options, such as:
- Your complete medical history (other illnesses you may have and potential drug-to-drug interactions)
- Family medical history (including if certain antidepressants or anti-anxiety meds have worked well for any of your relatives)
- Current and past substance use (including OTC meds and substances, like NSAIDs, vitamins, marijuana and alcohol)
- Past medication use (and why they were discontinued)
- Cost
Patient preferences play a crucial role too. Rau recommends having in mind your top priority symptoms: Write down the things you want the medication to do for you and know which of these things you want to target first.
Are you most worried about feeling sad? Not being motivated? Feeling anxious? Not being able to concentrate? “If your clinician knows what your priorities are, it will help them work with you to find the best place to start,” Rau said.
It’s also important to resist any hesitation you feel about admitting you use substances, a la marijuana, since the use of weed or nicotine can affect the way medications work, and therefore hold up the process.
Ditto to not keeping your physician in the loop as to how the medication is working once you’re on it. “The way these medications are dosed (increased or decreased, started or stopped) is largely dependent on what the patient says — how they’re responding to it,” Allen said, so make sure you’re not just adhering to the protocol, but tracking how you feel too.
Medication trackers, like MyTherapy, make this process super-convenient. Track your dosages, moods and symptoms, then print out the data for your next appointment. Be truthful and specific, so you can get back to being you.