Although antidepressants start to work immediately within the brain, patients may not notice the effects until some time later.
One of the biggest controversies in the mental health field concerns how long it takes for people with depression to respond to antidepressants. Studies confirm that the type of antidepressant and the individual can have major impacts on the timing of response to these medications.
It is generally accepted that all antidepressants have a delayed onset of action (the length of time needed for a medication to become effective) — with no major effects seen until after at least three weeks of treatment. Some studies show that in certain individuals, a full response to antidepressants could even take weeks to months. Full response from these medications is defined as at least a 50 percent reduction in symptoms.
There is growing evidence, however, that antidepressants at effective doses produce partial improvements in some patients within one to two weeks of treatment. Partial response from these medications is defined as at least a 25 percent reduction in symptoms.
Signs of Improvement
The effects of antidepressants are gradual and the benefits are subtle. You may tend to feel less teary with fewer thoughts of self-harm. You may also notice decreased nervousness and an increase in your ability to control worries. As time passes, your energy level should go up, and your sense of enjoyment should improve. These drugs may also help relieve physical manifestations of depression, like neck pain or backaches.
This delay before antidepressants start working has many negative consequences, including:
- Prolonged length of the impairments associated with depression
- Increased risk of suicide
- Increased likelihood of stopping treatment prematurely
- Increased medical costs associated with depression
Response to treatment varies among individuals, as does the required duration of treatment. On average, 55 to 70 percent of the people who take antidepressants can expect at least a 50 percent improvement in their symptoms. Yet only 30 percent of patients achieve remission (complete elimination of symptoms) from depression with medications. Remember, the goal of antidepressant therapy is complete remission of symptoms and a return to normal daily functioning.
When to Talk to Your Doctor
Talk to your doctor about coping with symptoms as you wait for your medications to take effect. If you don't notice any improvements by three to four weeks, you should contact your doctor. According to the American Psychiatric Association, if you have no response after four to eight weeks of treatment with an antidepressant, your doctor may need to increase the dose or change your medication.
How Long to Take Antidepressants
Current guidelines recommend between four to nine months of treatment with an antidepressant after depressive symptoms go away.
Studies have shown that achieving remission and continuing antidepressant therapy long after the initial symptoms subside can protect against relapse (an early return or worsening of symptoms) or recurrence (later episodes occurring after remission) of the depressive episode. Discontinuing antidepressant treatment too soon may increase the risk of relapse or recurrence.
The treatment of recurrent episodes of depression is even more complicated. After the initial episode of depression, the risk of another is 50 percent. After three episodes, the risk of another episode jumps to 90 percent. Therefore, the more depression recurs in a patient, the longer the duration of antidepressant treatment:
- The first episode of depression should be treated for at least four to nine months
- The second episode of depression is usually treated for two years
- The third episode of depression is often treated for at least five years
Some experts believe that, in certain instances, antidepressant treatment should possibly continue for life.
Always take your antidepressants exactly as prescribed. Do not change the dose or stop taking them without consulting your doctor first. In addition to increasing the risk of relapse, stopping antidepressants prematurely may precipitate unpleasant withdrawal symptoms.