Persistent or worsening symptoms, fluctuations in your mood and emotions, and continued sleep disturbances are possible signs your antidepressant dose may be too low.
Antidepressants are a class of medications primarily used to treat depressive disorders, though they can also be part of the management plan for certain other physical and mental health conditions. They work by influencing neurotransmitters in your brain, the chemical messengers that regulate mood, emotions, and behaviors.
Your doctor selects an antidepressant for you based on your symptoms, their severity, and factors like your lifestyle and overall health. Not every antidepressant will work the same for each person, and it can take some trial and error to find the one that works best for your individual needs.
If you’ve been prescribed an antidepressant, keeping track of your symptoms and how you’re feeling overall and noting any new changes in your daily experience can help you recognize as soon as possible if your antidepressant dose may be too low.
Most antidepressants have standardized dosing recommendations developed through rigorous clinical trials and efficacy studies.
These general usage guidelines are a starting point when developing a medication management regimen, and many people are started at the low end of the dosing recommendation to try and find the lowest, most effective dose possible.
Antidepressants can cause negative side effects, and finding the lowest dose where your symptoms are controlled reduces the likelihood of medication complications.
Sometimes, the starting dose of an antidepressant is too low, however, and it’s also possible for antidepressants to become less effective over time through a phenomenon referred to as “tachyphylaxis.”
Signs your antidepressant dose may be too low include:
Persistent or worsening symptoms
It takes time for antidepressants to start working.
Your doctor will tell you when you should see improvement. If symptoms aren’t improving as expected or worsening on a new antidepressant, your current dose may not be high enough, or the medication may not be right for you.
If you’ve been on an antidepressant and notice your symptoms are starting to worsen again, you may be experiencing tachyphylaxis, and your current dose or medication may not be as effective anymore.
Mood and emotional changes
Antidepressants are designed to stabilize mood and reduce major shifts in emotions that can cause distress and impairment.
Continuing to experience extreme mood and emotional shifts after you’ve been on an antidepressant for its recommended duration could indicate your dose isn’t high enough to correct underlying neurotransmitter imbalances.
Mood and emotional changes can also be a side effect of certain antidepressants. Selective serotonin reuptake inhibitors (SSRIs), for example,
It doesn’t necessarily mean the dose is too low, but it may mean the antidepressant isn’t the right one for you or your body needs more time to adjust.
Sleep disturbances
Mid-nocturnal insomnia (i.e., difficulty staying asleep in the middle of the night) is one of the most common residual symptoms of depression. If your other symptoms have improved but you’re still experiencing sleep challenges, your antidepressant dose may be too low, or your antidepressant choice might need to be reconsidered.
Like emotional symptoms, some sleep disturbances can be side effects of an antidepressant, not an indication of ineffective dosing. Certain antidepressants can be stimulating, while others may be too sedating in the long term.
Heavy reliance on additional coping strategies
Antidepressants don’t “cure” depression, but they should manage your symptoms well enough to get you back to regular daily function.
If you’ve noticed partial improvement on an antidepressant but are still relying heavily on other coping strategies (like caffeine, alcohol, or napping) to get through your day, your antidepressant dose may still be too low.
Finding the right antidepressant and the most effective dose for your symptoms can take time, and each antidepressant comes with a list of indications for use and possible side effects.
Some people notice symptom improvement in just a few weeks, while others may not experience the full benefits of an antidepressant for several months. During this process, it’s OK to call and speak with your doctor at any time about symptoms, questions, or concerns.
Don’t make any adjustments to your medication without consulting your doctor. Raising your antidepressant dose could increase your chances of serious side effects, and decreasing your dose too much or too soon
Call your doctor any time your symptoms worsen, increase in frequency, or if new symptoms develop. Your doctor can offer practical solutions for common side effects of antidepressants, like:
- dry mouth
- dizziness
- restlessness
- headaches
- sexual dysfunction
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Tips to help you make the most of your appointment and discussion with your doctor include:
- Bring a written list of symptoms and their changes (positive or negative).
- Mention if your symptoms are worse at certain times of the day or after specific triggers.
- Bring a sleep log that includes the duration and quality of your sleep, as well as any sleep disturbances.
- Be honest about how symptoms are affecting your daily life.
- Consider using a ranking system, like a 1 to 10 scale, to provide context for experiences.
- State your treatment priorities (for example, you might be more concerned about sleep quality than sexual dysfunction).
These practices can give your doctor valuable insight that might steer the dose and choice of antidepressants in your management plan.
Persistent or worsening symptoms, partial symptom improvement, unresolved mood shifts, and sleep disturbances can all be signs your antidepressant dose is too low, or a medication change is warranted.
Only your doctor can determine if what you’re experiencing is related to your antidepressant dose, the adjustment of your body to the medication, or an expected side effect of use.