Signs Your Antidepressant Dose Is Too Low or Too High

Starting any medication can bring on mixed feelings. Relief that you finally have a solution and can start feeling better. Nervousness or frustration that symptoms may not go away as quickly as you might like.

It’s okay. These feelings are expected. And before beginning any treatment plan, it’s important to discuss expectations with your doctor. Treatment is highly personalized and starting a new medication will always be a process. It can take time to find the perfect dose for you. It’s important to attend all of your follow-up visits and reach out to your doctor with any concerns.

As you work with your doctor to find the dose of medication that’s right for you, here are some signs that your antidepressant dose may be either too high or too low and require an adjustment from your doctor.

What are antidepressants and how do they work?  

Despite the name, antidepressants aren’t just used to treat depression—they're also used to treat anxiety disorders, OCD, and PTSD.  Rather than describing the condition that they treat, the term ‘antidepressants’ describes a type or group of medications that work by balancing levels of certain neurotransmitters, or chemical messengers in your brain.

There are different types of antidepressant medications, which work in slightly different ways on slightly different neurotransmitters. The most common antidepressants are SSRIs and SNRIs.‍

The type of antidepressant and the dose you take will depend on factors like your symptoms, your reaction to the medication, and your family and health history. It’s important to work with your doctor to find the right medication and dose for your needs.

Examples of common antidepressants:  

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)
• Savella (milnacipran)
• Celexa (citalopram)

Why did my doctor give me a low dose of antidepressants?

It’s likely that your doctor will start you on the lowest possible effective antidepressant dosage and slowly increase your dose until your symptoms resolve as desired. Waiting to feel better can be frustrating but remember, more and faster isn’t always better—especially when it comes to medications. Starting slow and on a low dose will help minimize any side effects.

How can you tell if your antidepressant dose is too low?  

At your follow-up visits, your doctor will ask you questions about your current symptoms to determine if your medication dose is too low. The goal of medication is to see a reduction in symptoms—how dramatic a reduction will vary from person to person, but you and your doctor will set expectations before you start treatment. If your symptoms are not improving as expected, your doctor may suggest a different medication or dose of medication.

Patience is key when it comes to settling on the right prescription medication. (We know, we know...we sound like a broken record.) But some antidepressants can take 4 to 6 weeks to take full effect so it’s likely your doctor will suggest waiting 6 weeks before making an adjustment. Hang in there. The process of finding the right medication safely is worth it.

When your doctor is evaluating the effectiveness of your medication dose, you can expect to be asked questions like:  

• Have you noticed an improvement in your mood, mood swings, sleep, appetite, concentration, energy, or general interest in pleasurable activities?  
• Do you feel sadder when you take your medication?
• Are you experiencing any new symptoms?  
• Are you experiencing any new side effects?
• Are you experiencing anything that is concerning to you?

Be sure to track your symptoms and attend all follow-up appointments with your doctor. Never make adjustments to your medication on your own. This can lead to dangerous side effects such as serotonin syndrome (dangerously high serotonin levels) or withdrawal if you stop taking your medication suddenly.

I started feeling better but now I feel worse. Why?

It’s important to keep in mind that when you first start taking a medication, you may feel better quickly, and then your symptoms may start to come back. There are a few different reasons for this. That initial drop in symptoms might be caused by the placebo effect—and no that doesn’t mean depression is ‘all in your head.’  The placebo effect is a well-documented phenomenon and is powerful enough to cause people to see a reduction in depressive symptoms in response to taking a ‘sugar pill.’ (On the flip side, the nocebo or anti-placebo effect is when negative expectations about treatment contribute to the treatment not working.)

There is also something called “breakthrough depression”: A term used to describe depressive symptoms that come back after going away even while you are consistently taking your medication. Scientists aren’t sure why breakthrough depression happens, but they suspect it could be due to changes in lifestyle, like new stress, or that your body may become less sensitive to the medication over time.

Bottom line: if you notice a change in your symptoms (positive or negative), let your doctor know. They may recommend adjusting your dose or starting a different medication.

How can you tell if your antidepressant dose is too high?

Doctors will take steps to keep your antidepressant dose as low as possible while still being effective, but there is always the possibility that your antidepressant dose may be too high. If your antidepressant dose is too high you may experience an increase in medication side effects like trouble sleeping, drowsiness, or worsening depression. Monitor your symptoms and report any changes to your doctor. They will work with you to recommend a more appropriate dose or medication.

I’m worried my dose of medication is too high

If you’re experiencing anything concerning that you think may be due to your medication dose, contact your doctor or medical provider right away.

All medications have their own minimum and maximum recommended doses. For example, the starting dose of Lexapro is around 10 mg and the starting dose of Zoloft is 50 mg. If your doctor switches your antidepressant medication from Lexapro to Zoloft, 50 mg may seem like a much higher dose (you were only taking 10 mg of Zoloft!).  Keep in mind the doses are specific to each medication. If you have questions or are concerned about your prescribed dose, reach out to your doctor or pharmacist.

Navigating the middle ground: Identifying the right dose

Antidepressants aren’t just prescribed to treat depression. They can be effective for treating other mental health conditions such as anxiety disorders or OCD. Regardless of what mental health condition is being treated, the goal of antidepressants is to relieve your symptoms so that your mental health condition no longer makes it hard to go about your day.

Most antidepressants take a few weeks to demonstrate effectiveness, but it may take several months to find the right dose and medication for you. Tracking your symptoms and attending all follow-up visits will give you the best chance of finding the dose that works for you.

Your doctor may also suggest combining medication treatment with therapy like cognitive behavioral therapy (CBT). Medication and therapy are the gold standard treatment for mental health conditions.

Once I've found the right dose, how long will I need to take antidepressants?

Once you have settled on the right dose of medication, you and your doctor will discuss a long-term treatment plan. Some people take antidepressants for many years while others may take them for less than a year. Antidepressants can help symptoms of a mental health condition from coming back so it’s important to continue taking your medication as directed, even if you start feeling better (congrats, that means the medication is working!).

Should I adjust or switch antidepressants?

You should never make adjustments to your medication on your own. This can make your treatment less effective and can also be dangerous. Stay in touch with your doctor or healthcare provider and attend all follow-ups to discuss possible dose adjustments. Treatment should feel like a collaborative process and you should always feel informed of the risks and benefits of starting any medication.

The bottom line

• Healing from a mental health condition is a process and finding the right dose of medication can take time. It’s important to be patient and know that having ups and downs in your healing journey is expected.  
• Never adjust your medication on your own. Instead, track your symptoms and attend all your follow-up appointments. This will help you and your doctor decide when and how to make changes to your medication or other parts of your treatment plan.
• If your symptoms are getting worse or not improving as you would expect, make an appointment with your doctor. They may suggest changing your medication or dose.    

Depression treatment at Talkiatry  

Psychiatrists are experts in diagnosing and treating complex mental health conditions through medication management. If you are struggling to find a treatment plan that works for you, take our assessment to see if Talkiatry is a good fit. Our psychiatrists will work with you on a personalized treatment plan that may include medication or medication combined with therapy.

Learn more about how Talkiatry treats depression: Depression Treatment Online  

About Talkiatry

‍Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 60 insurance partners, and first visits available in days. We treat patients with anxiety, depression (major depressive disorder), bipolar disorder, ADHD, and more. Get started with a short online assessment.

‍The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Sources

Institute for Quality and Efficiency in Health Care | Depression: How effective are antidepressants?

JAMA Psychiatry | Association Between Placebo-Activated Neural Systems and Antidepressant ResponsesNeurochemistry of Placebo Effects in Major Depression

John Hopkins Medicine | Why Aren't My Antidepressants Working?