Signs your antidepressant dose is too low or high — plus when to talk with your provider about adjusting your prescription

How Long Does It Take for Antidepressants to Work?

Before you consider whether or not to decrease or increase your antidepressants, it’s important to learn how different types of antidepressants work and how long they generally take to go into effect. Depending on your specific situation, your provider may recommend one of a few common types of antidepressant medications. While some medications take effect immediately, it’s common for antidepressant medications of various types to take 4-6 weeks to show full benefits. 

NDRIs (norepinephrine and dopamine reuptake inhibitors) work by increasing the availability of norepinephrine and dopamine in the brain and can help improve mood, energy, and attention. NDRIs are often not recommended for people with high anxiety.

• How long NDRIs take to work: Effects are noticeable after a few days but full benefits typically observed after four weeks.
• Examples: Wellbutrin (Bupropion) 

SSRIs (selective serotonin reuptake inhibitors) increase the availability of serotonin in the brain. They often have fewer side effects than NDRIs like Wellbutrin, but may take longer to show full effects.

• How long SSRIs take to work: SSRIs generally take 4-6 weeks to show full benefits, with dosage increases requiring the same time frame to assess effectiveness.
• Examples: Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram) 

SNRIs (serotonin norepinephrine reuptake inhibitors) help treat fatigue, hypersomnia, and depressive symptoms. 

• How long SNRIs take to work: They typically take 4-6 weeks for significant improvements to be observed, and the same time frame applies to dosage increases.  
• Examples: Effexor (Venlafaxine) and Cymbalta (duloxetine) 

If you have been taking your antidepressants for the appropriate amount of time and are not feeling the effects of the medication or you are not feeling better, it is time to ask your provider about adjusting your antidepressants. 

12 Signs Your Antidepressant Dose Is Too Low

If you have been on your antidepressant for long enough that you should be feeling effects but aren’t, you might be wondering if it’s time to increase your dosage. To determine that, look out for these signs that your antidepressant is too low.  

1. Persistent sadness: If your low mood remains unchanged, even after several weeks on medication, your antidepressant dosage might be too low. 
2. Lack of interest: Struggling to enjoy activities that once brought you joy or pleasure could be a sign that your antidepressant isn’t working the way it should.
3. Continued anxiety: If anxiety symptoms persist or worsen, you may want to increase your antidepressant dosage. 
4. Difficulty focusing: Problems with concentration or memory might suggest your current dose isn’t addressing cognitive symptoms.
5. Ongoing feelings of guilt: If negative thoughts and feelings of worthlessness persist, it may be a sign your medication needs adjustment.
6. Low motivation: Struggling to feel motivated or complete daily tasks could indicate the dose isn’t strong enough to improve your energy levels.
7. Mood swings: Frequent or intense mood fluctuations might mean your dose isn’t providing the stability needed.
8. Social withdrawal: If you continue to avoid social interactions or isolate yourself, it could be a sign your dosage is too low.
9. Sleep problems: Difficulty falling or staying asleep despite treatment might suggest an inadequate dose.
10. Fatigue: If you still feel exhausted or drained despite getting rest, your current dose may not be addressing depressive fatigue. In some cases, fatigue and sleepiness could also be a sign your antidepressant dose is too high. 
11. Therapy isn’t helping: If you notice therapy, used together with your prescription, isn’t helping as much as it should, consider asking for a dosage increase. 
12. Feedback from others: If family or friends have given you feedback that your mood and demeanor appear to be worsening or remaining unchanged, consider if you need to increase your antidepressants. 

If you notice any of the above signs, it’s time to talk with a provider. But if you’ve been taking your prescription for less than four weeks, you may be advised to be patient and wait for the medication to do its work. 

14 Signs Your Antidepressant Dose Is Too High

Prescription medications and their dosages are highly specialized and moderated for each individual. Your provider will make sure that it’s not too high, and your antidepressant dosage shouldn’t be compared to someone else’s. Antidepressants also have a strict safety profile. This means your dosage and the amount of antidepressants you’re prescribed are closely monitored during treatment for safety. But you and your psychiatric provider are a team, so if you want to bring down your dosage, they’ll likely work with you to make it happen.

Signs that your antidepressant dose is too high include: 

1. Emotional blunting: This symptom makes it difficult for individuals to feel emotions fully. You may notice or be informed that you don’t seem to react to anything, and you might think to yourself, “I’m not sad… but I’m also not happy.”
2. Reduced libido and sexual dysfunction: In some cases, individuals may partially or entirely lose their desire for sex. Though it sounds alarming, these symptoms typically wear off as the body adjusts to the medication. Sometimes, if after 4-6 weeks, an individual doesn’t regain their sex drive, the dosage can be lowered to help bring it back. 
3. Increased anxiety: Some antidepressants, like Wellbutrin, may temporarily increase anxiety. As with lowered libido, these symptoms can subside once someone gets adjusted to their prescription. But if the anxiety becomes severe or too disruptive, your psychiatric provider can lower the dosage to help you adjust to the medication more smoothly. 
4. Heightened irritability: If you are experiencing sudden bursts of frustration or irritability, even over minor issues, it could mean your dose is too strong and causing more mood swings. 
5. Restlessness: If you feel jittery or are experiencing an overwhelming need to fidget or constantly move, your antidepressant dose might be too high.
6. Fatigue or sleepiness: If you’re feeling tired or drowsy during the day, your medication may be sedating you too much. It can be normal, however, to feel fatigued in the first week or two of trying a new antidepressant as you are adjusting to the medication. 
7. Difficulty focusing: Struggling to concentrate, make decisions, or complete tasks might mean you are experiencing some amount of cognitive impairment from too high a dose.
8. Gastrointestinal issues. Nausea, diarrhea, or stomach problems can sometimes be a result of taking antidepressants that are too strong for your system to handle. 
9. Intense sweating: Excessive sweating without physical exertion can be a side effect of an overly strong antidepressant dose.
10. Tremors or shaking: Involuntary trembling or shaking in your hands or other body parts could signal that your medication is too powerful.
11. Dilated pupils: Unusually large pupils can be a response to a high dose, especially with certain types of antidepressants.
12. Loss of appetite or weight fluctuations: Sudden and significant changes in your appetite or weight could be a sign that your dose needs adjusting.
13. Unusual risk-taking: Engaging in impulsive or risky behaviors, like reckless driving or excessive spending, may indicate an issue with dosage.
14. Muscle stiffness or twitching: Tight muscles or unexpected twitching could be a physical side effect that your antidepressant dosage isn’t quite right. 

Different dosages work for different people—a higher or lower dose isn’t better or worse. It’s just what works for you; this is why psychiatric providers rely on and value their clients’ feedback.  

What to Do if You Think Your Antidepressant Dose Is Incorrect

If you think your antidepressant dose is too high or too low, there are several things you can do about it. First, it’s important to know that you should not try adjusting your medication yourself. Stopping, reducing, or increasing your dose suddenly can cause withdrawal or worsen your symptoms. Let your healthcare provider guide you through a safe process. Here are some things you can do if you think you need to adjust your antidepressant dose.

• Reach out to your doctor. Whether it’s your psychiatrist, general doctor, or mental health expert, your doctor can help you determine the best plan of action to change your antidepressant dosage. If your doctor advises a dose change, stick to their plan as they help you adjust your medication safely and gradually.
• Track your symptoms and try to communicate them clearly. As your dose is modified, pay close attention to any shifts in your mood, energy levels, or side effects. Consider keeping a journal of any changes or symptoms you notice. The better you track your symptoms, the more clearly you can describe them to a doctor who can help you make further adjustments, if needed.
• Talk to a therapist. While taking antidepressants, consider additionally talking to a therapist. Not only does medication plus therapy increase your chances of improving overall, but a therapist can help you navigate any changes or symptoms and make helpful suggestions and observations on how the medication is going for you, and what you can do about it. 
• Follow-up with your provider: Regular check-ins with your doctor are important to assess how well the new dose is working and to determine if any further changes are needed. If increasing your antidepressants or lowering the dosage isn’t working over time, your doctor may suggest trying a different kind of medication. 
• Get a second opinion, if needed. If you don’t have a great relationship with your provider, or feel like you just can’t talk with them about your dosage, they can help you get a second opinion. Taking feedback is part of their job, and they won’t take your desire to talk to another professional personally. They can get you a referral, which is a normal process that happens all the time. As a client, you have the choice to seek care from a new provider if you need, or want to. 

Experimenting with antidepressants can be difficult, especially as you are likely already in a vulnerable position. Be kind to yourself through the process, knowing that many people go through some degree of dosage changes. During any medication change, try to focus on activities that help reduce stress and boost your overall well-being. Lean on trusted friends, family members, or mental health professionals for additional support.  Try to be patient as you wait for your new dosage to kick in. 

Signs Your Antidepressant Is Working

Medications can take a few weeks to show their effects, but it could take a few months to get your antidepressant dosage just right. Keeping track of symptoms and attending follow-ups with your doctor is important for finding the right balance.

Here are some signs that your antidepressant is working.: 

• The anticipation of anxiety doesn’t arise or doesn’t reach its previous intensity
• You’re getting feedback from coworkers and friends that your mood and behavior are improved
• You have more energy to do the things you love
• Therapy becomes more productive, and you can use the coping skills you’re taught successfully
• You’re able (and motivated) to practice self-care 
• You have improved self-esteem
• Your mood, sleep, and appetite have more or less stabilized 

In short, examine if your previous daily struggles have become less difficult to manage or disappeared. One of the best signs your antidepressant dose is too low is that, after the adjustment period to a new medication, few, if any of these indicators are experienced. 

How Long Should I Stay on Antidepressants?

After finding the right dose, you can work with your psychiatrist or doctor to create a long-term plan for your treatment. Some people may need to stay on antidepressants for several years, while others might only need them for a shorter time, like to get through a crisis or an episode. Since antidepressants help prevent the return of symptoms, it’s so important to keep taking your medications as prescribed, even if you start feeling better—this is a sign that the medication is doing its job. 

Final Thoughts

Whether you think you should decrease or increase your antidepressants, finding the right dose can be a process that requires being in tune with signs that your antidepressants are too low or too high. When adjusting medications be sure to work with your healthcare provider, who can help guide you through the journey. Equally important is combining medication with therapy for the best long-term results. Therapy can help you develop the tools to manage your mental health alongside medication, providing a more comprehensive treatment approach.