Antidepressant Not Working? 12 Signs to Watch For

Signs Your Antidepressant Dosage May Be Too High

Antidepressants can provide much-needed relief from depression symptoms when used properly. However, some people experience signs their antidepressant dosage is too strong. Recognizing when your medication dose is too high and adjusting it can help minimize side effects.

Common Signs Your Antidepressant Dosage Is Too High

Watch for these potential indicators your antidepressant dose may be exceeding what your body can tolerate well:

1. Nausea

Nausea is a common side effect of antidepressants, especially when first starting. But persistent and severe nausea may suggest your dosage is too high. This side effect often improves with dose reductions.

2. Dizziness

Some people feel lightheaded, dizzy or unsteady on their feet when their antidepressant dose is too high. Dizziness may indicate blood pressure changes or imbalances in brain chemicals caused by excessive medication.

3. Fatigue

While antidepressants aim to boost energy and motivation at optimal doses, very high doses can cause fatigue. Excessive drowsiness and sleepiness throughout the day may indicate an overly strong medication dosage.

4. Headache

Headaches are another common complaint with overly high antidepressant doses. Tension headaches around the forehead are most typical. If headaches persist, ask your doctor about adjusting your dosage.

5. Tremors

Tremors or uncontrollable shaking of the hands, arms, legs or head can develop from antidepressant doses that are too high. Tremors normally improve rapidly with dose reductions.

6. Agitation

Some people feel more restless, tense and keyed up if their antidepressant dose is too strong. Paradoxically, lowering the dose often helps minimize this agitation and nervousness.

7. Anxiety

Heightened anxiety is another possible sign your antidepressant dosage is too high. Anxiety may worsen initially when starting an antidepressant before improving. But persistent anxiety could indicate the need for a lower dose.

8. Irritability

Increased irritability, anger outbursts and feeling short-tempered can occur with excessive antidepressant dosing. Like anxiety, lowering the dose often helps lessen this iatrogenic irritability.

9. Insomnia

While antidepressants aim to improve sleep, high doses can have the opposite effect. Difficulty falling asleep, frequent waking and insomnia are common symptoms that often resolve with dose reductions.

10. Nightmares

Vivid, strange or frightening nightmares and dreams are another possible sign of an overly strong antidepressant dose. High doses disrupt REM sleep, which may contribute to nightmares.

11. Restlessness

Physical restlessness, an inability to sit still and akathisia (inner restlessness) can occur with excessively high antidepressant doses. Lowering your dose helps calm this discomfort and need to keep moving.

12. Sexual Problems

Antidepressants frequently cause sexual side effects like low libido, erectile dysfunction and difficulty orgasming. Overly high doses tend to worsen these problems. Dose adjustments may restore sexual function.

13. Sweating

Excessive sweating or night sweats, especially at night, are common with high antidepressant doses. This hyperhidrosis usually resolves when the dosage is reduced.

14. Diarrhea

Loose stools, urgency and diarrhea frequently result from antidepressant doses that are too strong. Lowering your dose generally relieves this troublesome side effect.

15. Confusion

High doses of some antidepressants like tricyclics may cause confusion, disorientation and scattered thinking. Dose reductions typically minimize this cognitive dysfunction.

16. Blurred Vision

Vision changes like blurred vision and difficulty focusing can indicate an excessive medication dose. Antidepressants impact neurotransmitters involved in visual processing pathways.

Other Factors Contributing to Side Effects

While an overly high dose is the most common cause of antidepressant side effects, other factors may also play a role, including:

• Underlying health conditions
• Age
• Genetic differences in metabolism
• Interactions with other medications
• Liver or kidney impairment

Discuss any side effects thoroughly with your doctor to determine whether dose adjustments, added treatments or switch to an alternative medication may help.

Antidepressant Dosage Considerations by Drug Class

Dosage requirements can vary depending on the type or class of antidepressant. Here is some general guidance:

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram) have a wide therapeutic window. This means an overly high dose causes more side effects but is less likely to be toxic.

SNRIs

Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta (duloxetine) and Effexor (venlafaxine) may cause more side effects at lower dosages. Most people require doses at the lower end of the approved range.

Tricyclics

Tricyclic antidepressants like Elavil (amitryptiline) and Pamelor (nortryptyline) have greater risks from high doses, including serious heart problems. Older adults require lower doses monitored closely by ECG.

MAOIs

Monoamine oxidase inhibitors (MAOIs) like Marplan (isocarboxazid) and Nardil (phenelzine) can cause severe reactions if combined with foods high in tyramine. Strict diet limitations are needed to prevent dangerous interactions.

Atypical Antidepressants

Bupropion (Wellbutrin), mirtazapine (Remeron) and other atypical antidepressants have varying therapeutic windows. Remeron may cause more weight gain at higher doses. Wellbutrin is less likely to produce side effects with dose increases.

Safer Strategies for Finding Your Optimal Antidepressant Dose

Work closely with your doctor to find the minimal dose needed to manage your depression with acceptable side effects. Safer strategies include:

• Starting low and increasing slowly
• Monitoring symptoms and side effects
• Splitting tablets to taper doses
• Switching to a long-acting version
• Getting frequent lab tests
• Avoiding abrupt dose changes
• Using lowest effective dose

Finding your optimal antidepressant dose takes patience through careful trial and error. But the payoff is maximizing benefits and minimizing adverse reactions.

What to Do If You Think Your Dose Is Too High

If you experience signs your antidepressant dose is too strong, take these steps:

1. Dont stop your medication abruptly without medical guidance. This could cause withdrawal symptoms.
2. Contact your doctors office promptly to discuss your symptoms and get recommendations.
3. Take any lab tests your doctor orders to check medication blood levels and health parameters.
4. Follow your doctors instructions for safely lowering your antidepressant dosage.
5. Closely monitor your mental health and physical symptoms as your dose decreases.
6. Report any new or worsening issues to your doctor right away.
7. Schedule a follow-up soon to reassess your adjusted dose.
8. Do not increase, decrease or stop medication without your doctor's oversight.

With close monitoring and collaboration with your doctor, you can find an antidepressant dosage that optimizes benefits and minimizes adverse reactions.

When to Consider Switching Antidepressant Medications

If lowering your antidepressant dosage fails to adequately relieve troublesome side effects, switching medications may be advised. Consider a different antidepressant if:

• Symptoms dont improve after 6-8 weeks at the maximal tolerated dose.
• You cannot tolerate the starting dose without side effects.
• Side effects significantly worsen your quality of life.
• A dose that controls your depression causes excessive side effects.
• New side effects develop after taking the medication long-term.

Work with your doctor to safely transition to an alternative antidepressant. Switching medications requires slow taper of the current drug and gradual increase of the new one.

Lifestyle Changes That May Improve Tolerance

Certain lifestyle adjustments may help you better tolerate your antidepressant dose with fewer side effects:

• Avoid alcohol and recreational drugs
• Improve sleep hygiene
• Manage stress with relaxation techniques
• Optimize nutrition and hydration
• Increase physical activity
• Take probiotics to improve gut health

A supportive lifestyle enhances overall wellness and helps your body process medications more smoothly. Consult your healthcare providers before making significant diet, exercise or supplement changes.

When to Consider Psychotherapy Instead of Medication

For mild to moderate depression, psychotherapy alone may suffice instead of antidepressant medications or other treatments.

Studies demonstrate certain types of talk therapy like cognitive behavioral therapy (CBT) are effective for many people with depression. Psychotherapy may benefit those who:

• Have mild symptoms.
• Wish to avoid medication side effects.
• Have relationship issues contributing to depression.
• Struggle with rumination and negative thought patterns.
• Want help making behavioral and lifestyle changes.
• Need support developing coping strategies.

Consult with a psychologist or psychiatrist to determine if psychotherapy without medication may be appropriate for your depression.

The Takeaway

Finding the ideal antidepressant dose involves balancing maximum symptom relief with minimal side effects. Watch for signs your medication may be too strong like nausea, insomnia or tremors. Collaborate closely with your prescribing doctor to adjust your dosage for optimal tolerability and efficacy.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.