Don’t feel like your antidepressants are working effectively? Experiencing annoying, persistent side effects? You’re not alone. The truth is, antidepressants don’t always work — at least, not all antidepressants work for everyone.
In fact, it’s not uncommon for people to try multiple antidepressants before finding one that works best for them.
If you’re prescribed antidepressant medication and don’t feel like it’s working as effectively as expected, or if you have unpleasant or persistent side effects, consider talking to your healthcare provider about switching to a new type of medication.
There’s often a degree of trial and error involved in finding the right antidepressant. For lots of folks, switching medications several times is a critical step in identifying the specific antidepressant that best suits their symptoms and needs.
Below, we’ll list common reasons for switching antidepressants, as well as the medications you may be prescribed by your healthcare provider. We’ll also go over key information you should be aware of, from side effects to methods of switching.
Reasons to Consider Switching Antidepressants
Needing to switch your antidepressant medication can occur for many reasons, including what it’s treating. You might be on one of these medications for depression, anxiety or various other mood, mental health or compulsive disorders.
Regardless of what it’s treating, there are several reasons why you may want to switch antidepressants, from side effects to a lack of effectiveness. Some of the most common reasons to change antidepressants include:
-
Side effects. Many antidepressants can cause side effects, including nausea, digestive issues, headaches and difficulty sleeping.
Though many side effects are common across antidepressants, the likelihood and severity of certain side effects can vary from one medication to another. If you experience side effects from one antidepressant, your healthcare provider may recommend switching to another. -
Lack of effectiveness. While antidepressants are largely effective at treating major depressive disorder (MDD), not all people experience improvements after they start taking an antidepressant. It’s a good idea to go into treatment prepared to try a few different medications. That way, you’ll be less likely to give up if the first one isn’t quite right for you.
-
Sexual side effects. Some antidepressants, including commonly prescribed ones from the class known as SSRIs (selective serotonin reuptake inhibitors), can cause sexual side effects such as erectile dysfunction, decreased sex drive and difficulty reaching orgasm (anorgasmia). For some, switching to another type of antidepressant can reduce the severity of these sexual side effects.
-
Weight gain. Some side effects, such as weight gain, occur more frequently with certain types of antidepressant medication. Switching to a new type of antidepressant may help reverse any weight gain you’ve experienced during treatment.
Research shows that approximately one-third of people with depression have treatment-resistant depression (TRD). With TRD, depression doesn’t always improve through standard treatments, like antidepressants or psychotherapy.
If you have treatment-resistant depression, or your depression doesn’t respond to the antidepressant you’re currently taking, you may need to try several antidepressants before finding one that works.
In some cases, such as when your current medication isn’t effectively treating your depression, your healthcare provider may suggest changing to a different medication within the same class of antidepressants, such as from one SSRI to another.
How to Switch Antidepressants
If you think switching to a new antidepressant could be a good idea, talk to your healthcare provider. When switching antidepressants, your healthcare provider may recommend switching directly, cross-tapering or tapering down your dosage before you start using your new medication.
Depending on the type of antidepressant you’re currently using and the medication you switch to, you’ll need to follow one of four techniques to switch medications:
-
Direct switch. If it’s safe to switch from one antidepressant to another immediately, you may be able to stop taking your current antidepressant and immediately start using the new one the very next day. Switching directly is usually only a safe option for switching between certain SSRIs and SNRIs with short half-lives, as these medications are less likely to cause drug interactions or unwanted side effects. You’ll also be able to make a direct switch if you’re currently taking the lowest dose of your medication.
-
Cross-tapering. To cross-taper, you’ll need to gradually reduce the dosage of your old antidepressant while gradually increasing the dosage of your new medication at the same time. This technique may be used if your medication puts you at risk for withdrawal symptoms, which may occur when some antidepressants are stopped without a gradual taper.
-
Taper and moderate switch. One of the safer techniques simply reduces your current dosage to a complete stop, then waits for it to clear your body before starting the new antidepressant. You may need to use this technique if you’re using an antidepressant that can interact with the other medication.
-
Taper and conservative switch with a medication-free washout period. Since some tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) can cause harmful interactions if used within 14 days of starting treatment with other antidepressants, you may need to include what’s called a washout period. For medications with a shorter half-life, you might only have to wait two to four days before you begin using the new antidepressant at a low dose.
There’s no one-size-fits-all process for switching from one antidepressant to another. To avoid drug interactions, your healthcare provider will tell you which process to use and how to switch from one antidepressant to another safely based on your medications and overall health.
The strategy your healthcare provider chooses depends on the following factors:
-
Which drugs you currently and how high the dose is
-
The severity of your symptoms
-
Your concerns over symptoms
If you’ve been using your current antidepressant for several months and haven’t experienced improvements or have unpleasant side effects, your healthcare provider may recommend one of the following types of antidepressants:
-
Selective serotonin reuptake inhibitors (SSRIs). SSRIs are modern antidepressants often used as a first-line treatment for major depressive disorder. Common SSRIs include Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram). Effectiveness and side effect rates can vary between SSRIs. As such, your healthcare provider may suggest switching to a different SSRI, even if you currently use this type of antidepressant. See our guide to switching from Lexapro to Zoloft to learn more.
-
Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are another class of modern antidepressants. Common SNRIs include Cymbalta (duloxetine), Effexor XR (venlafaxine) and Pristiq (desvenlafaxine).
-
Tricyclic antidepressants (TCAs). Tricyclic antidepressants are older antidepressants that, due to their side effect profiles, typically aren’t prescribed as first-line depression treatments today. Despite their side effects, some tricyclic antidepressants may be effective for improving depression symptoms when other, newer medications aren’t effective.
-
Atypical antidepressants. Atypical antidepressants like Wellbutrin (bupropion) target neurotransmitters other than serotonin and are prescribed when SSRIs and other antidepressants aren’t fully effective.
-
Monoamine oxidase inhibitors (MAOIs). MAOIs are an older class of antidepressants, primarily used in the 20th century. Because of their side effects and interaction risk, most MAOIs have been replaced by newer antidepressants over the years. In some cases, MAOIs may be prescribed to treat depression when newer medications aren’t effective.
Side Effects of Switching Antidepressants
It’s important to closely follow the instructions provided by your healthcare provider, as switching medications incorrectly or too quickly may increase your risk of experiencing drug interactions and adverse effects.
Common side effects of antidepressant switching or discontinuation include:
-
Returning symptoms of depression
-
Suicidal thoughts
-
Serotonin syndrome
-
Irritability
-
Flu-like symptoms
-
Dizziness
-
Electric shock sensations
-
Anxiety
-
Irritability
-
Lethargy
-
Insomnia
-
Vivid dreams
-
Cognitive impairments
-
Delirium and psychosis
Don’t ever adjust your dosage or stop taking your antidepressant without talking to your healthcare provider or prescriber. Changing your dosage or abruptly stopping your medication could cause you to experience antidepressant withdrawal symptoms like those electric shocks — also known as “brain zaps.”
Switching Antidepressants Safely
Before you get overwhelmed by the details, let’s get our priorities straight and our message clear: You can switch your antidepressant treatment safely, but you’ll have to follow a smart, professionally designed switching strategy.
Switching antidepressants isn’t uncommon. In fact, many people prescribed antidepressants try several medications before finding the one that works best for them. But working with your prescriber is the best way to avoid discontinuation symptoms, serotonin syndrome and other issues.
If you’re prescribed an antidepressant and don’t feel like it’s working, it’s essential that you talk to your healthcare provider before making any changes.
That said, there are some key takeaways you should keep in mind before, after and during those conversations. Whether you eventually switch medications or not, remember this:
-
It’s common to switch antidepressants once, twice or possibly even a third time if your healthcare provider recommends that course of action.
-
Changing to a new medication may help you to recover from depression more effectively — or simply avoid unpleasant or persistent side effects that occurred with your previous antidepressant.
-
Based on your symptoms, the medication you’re currently using, and your overall health, your healthcare provider will work with you to find an antidepressant that’s safe to switch to, effective and suitable for your needs.
-
If you just recently started taking antidepressants and haven’t noticed any improvement in your mood or general well-being, don’t panic. It typically takes several weeks for most antidepressants to start working and, sometimes, months before they reach full effectiveness.
-
If your antidepressant isn’t working after several weeks or is causing side effects, you might not need to change to a new medication. Your healthcare provider may suggest a different dosage or frequency of your current medication.
-
Don’t stop your current antidepressant or adjust your dosage without professional guidance. This could cause you to experience antidepressant withdrawal symptoms or a relapse of your depression symptoms.
This article originally appeared on ForHers.com and was syndicated by MediaFeed.org.
More from MediaFeed:
How to Take the Anxiety Out of Asking for Antidepressants – And What You Should Know Before Starting Antidepressants
When you’re depressed, seemingly small tasks or activities like brushing your teeth, cooking your favorite carbonara or grabbing after-work drinks can feel like an enormous hurdle. And mustering the strength — and vulnerability — to ask for help in your darkest moments can feel nearly impossible.
Whether you’ve been marinating in a two-week funk or have been struggling with severe depression for years, you are not alone. Worldwide, nearly 300 million adults suffer from this mental health disorder.
Fortunately, there are coping strategies and treatment plans that can help make living with this disease feel less debilitating. Along with mental health resources like talk therapy, antidepressant medication is one of the most effective treatments healthcare providers recommend.
But how do you get it? What kind of antidepressant is right for you? And how do these prescription drugs work? We’ll unpack these questions and more below.
tommaso79/istockphoto
While not as quick as adding a pair of shoes to your online shopping cart, getting prescribed antidepressants isn’t as difficult as you might think. But to get these meds, you do need to have a prescription from a healthcare provider.
There are a few ways to go about this:
-
Talk to your primary care provider. Based on your symptoms (and any other coexisting medical conditions you might have), a primary care provider (PCP) can direct you to the right kind of medication. In addition to medication, your PCP may also recommend other forms of treatment, like group therapy or psychotherapy.
-
Get a referral from a therapist or psychiatrist. A therapist cannot prescribe depression medication, but a psychiatrist or a psychiatric nurse can. Making an appointment with a therapist is a good starting point because they can provide coping strategies based on your symptoms of depression in addition to connecting you with a psychiatrist.
-
Utilize online telehealth platforms. If you don’t feel like making the trip to the doctor’s office (understandable!), you can also get antidepressants online, along with support through telehealth primary care platforms like Hers.
Lastly, over-the-counter alternatives might offer benefits when taken with prescription antidepressants.
A handful of the most popular ones include:
-
St. John’s wort
-
Omega-3 fatty acids
-
5-HTP (5-hydroxytryptophan)
-
SAMe (S-adenosyl-L-methionine)
While some research speaks to the effectiveness of the above supplements, it’s important to point out that there’s still uncertainty regarding factors like taking the correct doses and how those doses interact with other medications.
Some experts are against using OTC supplements because active ingredients vary by brand and individual batches, delivering unpredictable results.
If you decide to dip your feet into the over-the-counter antidepressant alternative pond, it’s worth saying this: OTC antidepressants aren’t technically antidepressants, and they’re not a replacement for seeking professional help.
When in doubt, always talk to a healthcare provider.
PeopleImages/istockphoto
It’s totally normal to get down in the dumps, especially when you’re going through a rough patch, like a breakup or a job loss. But when those feelings become more intense and prolonged, you might start to wonder if you need antidepressants.
Antidepressants are most commonly prescribed for people who have major depressive disorder (MDD). MDD is described as feeling depressed, moody or sad all, every day, for at least two weeks.
For many, the first step in talking about mental health struggles begins with a primary care provider. While you might associate your PCP as that person who gives you your annual physical or writes a prescription when you get a gnarly sinus infection, they can actually be a great first stop on the train toward treatment.
To make a diagnosis, a healthcare professional may ask you if you’re experiencing symptoms of MDD, such as:
-
Sleep disruption
-
Weight gain or weight loss
-
Trouble making decisions
-
Feelings of worthlessness
-
Suicidal thoughts or frequent thoughts about death
-
Decreased energy, fatigue or feeling “slowed down”
Depression enters some people’s lives in waves depending on life circumstances. For others, the mental health condition might feel like a more permanent fixture — like a bad roommate who just won’t move out.
Your healthcare provider will likely want to know how long you’ve been experiencing these symptoms, their severity and how your symptoms are presented before making an official diagnosis.
nensuria/istockphoto
When people talk about antidepressants, it may seem like they’re referring to one kind of pill that magically works for everyone. While that would definitely make things more convenient, it’s simply not the case.
The reality is, there’s no one-size-fits-all treatment. There are multiple types of antidepressants, and each person responds to them differently.
How long a person takes an antidepressant varies. Some people may need antidepressants for a relatively short period (like while grieving the loss of a loved one), or they might need medication long-term, if the depression is chronic.
These are the most common antidepressants prescribed to patients:
-
Selective serotonin reuptake inhibitors (SSRIs)
-
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
-
Tricyclic antidepressants (TCAs)
-
Bupropion
(Related: How To Get Antidepressants)
stefanamer/istockphoto
The most commonly prescribed SSRIs include:
-
Escitalopram (Lexapro)
-
Fluoxetine (Prozac)
-
Sertraline (Zoloft)
-
Paroxetine (Paxil)
-
Citalopram (Celexa)
SSRIs (short for selective serotonin reuptake inhibitors) boost your serotonin levels. Many healthcare professionals consider them a first line of treatment for major depressive disorder as well as anxiety disorders.
fizkes/istockphoto
The most commonly prescribed SNRIs are:
-
Venlafaxine (Effexor XR)
-
Desvenlafaxine (Pristiq)
-
Duloxetine (Cymbalta)
-
Milnacipran (Savella)
-
Levomilnacipran (Fetzima)
SNRIs (serotonin-norepinephrine reuptake inhibitors) are also responsible for increasing serotonin levels. They double up by targeting another neurotransmitter called norepinephrine.
Norepinephrine is like the PTA mom who has her hands full: She helps regulate your sleep-wake cycle, stimulates your cardiovascular system and is involved in your body’s fight-or-flight response, among other tasks.
Low levels of norepinephrine are linked to symptoms like lethargy and poor concentration. By targeting both serotonin and norepinephrine, SNRI medication can be effective in treating anxiety and depression.
ilona titova/istockphoto
Tricyclic antidepressants (or TCAs) are a type of antidepressant developed in the 20th century. They’re among some of the first prescription medications to be approved by the FDA.
Lots of people still use TCAs, though they’ve largely been replaced with other medications, like SSRIs and SNRIs. However, if you’re experiencing depression and those aforementioned meds aren’t cutting it, your healthcare provider might recommend TCAs as an alternative.
Hazal Ak/istockphoto
Bupropion is another antidepressant used for the treatment of depression as well as seasonal affective disorder (SAD). It’s sold under the brand names:
-
Wellbutrin
-
Wellbutrin SR
-
Wellbutrin XL
-
Aplenzin
-
Forfivo XL (for major depressive disorder)
Bupropion belongs to a group of medications known as aminoketones. It impacts the way your body uses neurotransmitters like dopamine and norepinephrine to help regulate your moods. People with depression may have lower dopamine and norepinephrine levels, and bupropion works by increasing them.
You might be surprised to learn that bupropion is also commonly used as a smoking cessation medication (sold under the brand name Zyban). Research shows it can help reduce tobacco cravings and withdrawal symptoms in ex-smokers. So if you hear someone say they’re taking Wellbutrin to kick their smoking habit, this is what they’re referring to.
Unlike other antidepressants, bupropion is known to cause fewer and less severe adverse symptoms, like drowsiness, weight loss, weight gain and sexual dysfunction.
It’s worth noting that many of these common antidepressants don’t work instantly, and it may take some time for your body to adjust. Our full antidepressants list goes over additional medication options, as well as more in-depth information on how they work.
(Related: Depression Medications: A Complete Guide)
stefanamer/istockphoto
Everyone’s mental health journey looks different. Your personal road to recovery may include antidepressants, and that’s perfectly normal.
But if you start to feel overwhelmed, remember:
-
A healthcare provider can help. In order to get antidepressants, you first need a prescription. A healthcare professional can ask you about your symptoms to determine which antidepressant is right for you.
-
There are many types of antidepressants. There’s no one-size-fits-all option when it comes to medication. What works for someone else may not work for you, and vice versa.
-
You have other support. Support can look like leaning on loved ones, connecting with friends or spending time with a pet. It can also look like mental health services or resources, be it online therapy or anonymous support groups. The important thing is finding a system that works for you.
Seeking help for your depression can be scary, but your mental health is worth fighting for. Get started today.
This article originally appeared on Forhers.com and was syndicated by MediaFeed.org.
Valeriy_G/istockphoto
AntonioGuillem/istockphoto
Featured Image Credit: Liudmila Chernetska/istockphoto.
