Why Do Antidepressants Take So Long To Work?

Antidepressants can take anywhere from 2 -6 weeks to see a therapeutic effect. You may notice a little improvement sooner than that, but the usual is weeks.

There's a couple reasons for this. The first is due to the way the drug works. Medications have to reach a steady state in your body before you can get a reliable effect. It takes approximately 5 half-lives to reach steady state. If you have a medication that has a half-life of 24 hours, it takes five days to reach steady state.

A second reason has to do with the delayed effect the increase in serotonin has on your thoughts. You have the increased serotonin, then a delay, then you have the downstream neuroadaptive effects which is reducing and increasing various receptors, then you have a change in mood that causes a change in emotional bias.

A cognitive model of depression is that negative thinking both causes and perpetuates depression. When you're depressed, you have more negative view of the world. Depression affects what you pay attention to. You're more likely to notice negative facial expressions, spot negative cues in your environment and draw negative conclusions about things. This is referred to as a negative bias or negative valence.

Thoughts, feelings and behaviors are all connected. There's still a model for endogenous depression where you develop depression soley based on brain changes. But we be still believe even that depression affects your thinking. It's debatable as to which came first, depression illness or thought depressed thoughts. But the mind and the body are one. And the best approach to depression is to address them both equally. The mind approach would be through therapy or self-help measures to address your mindset and the body approach would be diet, exercise, sleep hygiene and medication if appropriate.

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References
Wilson SJ, Bell C, Coupland NJ, Nutt DJ. Sleep changes during long-term treatment of depression with fluvoxamine – a home-based study. Psychopharmacology 2000; 149: 360–5.

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

[nicoletambasco]

Lexapro feels exactly like you’re describing for me. The first week I could gradually feel myself getting back to normal. The second week I noticed it fixed my appetite! Not like a stimulant or appetite suppression but “normal” no over eating no emotional eating wanting breakfast curbed my night time soda and chocolate cravings I actually feel full “serving size” of different foods were almost spot on. 3rd week was a little lull but it was likely because I was walking the dog less that week for one reason or another. Praying it stays working it’s been almost a year now.

[paulmillich]

Who loves Dr Marks content? I think it’s seven shades of brilliance and gratefully bank her advice.

[CaptCozy]

I just upped my antidepressants yesterday and had a similar conversation with my psychiatrist. This video is really appreciated with how timely and informative it is!

[chadbaker]

THE BEST mental health channel on YouTube. Always thoughtful, organized, scholarly, and applicable. You should be a professor somewhere!

[adapoole]

I have always talked to myself when bad thoughts came into my head. It was not until later in life I understood where these bad or negative thoughts come from. I have been on prozac for 10 years. It helps me to not feel so negative about myself. I have also have had some therepy. When something negative comes into your mind make yourself to throw it out of your mind. I also pray about it and think of positive Bible versus and leave my problems in Godś hands. But to answer my prayers I also need medication and therepy. Never feel something is bad about yourself, it just is and you find help for it. I am 64 years old.

[brunoliamat]

Hi, Doctor Tracey. I'm from Brazil and having found you through your videos has been a blessing (although I'm not religious, that is the word to use here). You've helped me a lot understand so many aspects of my current state, clarifying lots of issues, informing and making my visitis to the doctor much more productive and objective. Thanks for being such a kind person and being around helping people you don't even know.

[strangedivine]

I increased my Lexapro in mid-February and it now makes sense as to why I’m just starting to feel better. Thank you for your videos!

[rubygloom]

Sometimes I just wanna show your videos to people in my life who don’t understand. I told someone that mental illnesses can be caused by chemical imbalances such as low serotonin and he said “that term is just blown way out of proportion, what does ‘chemical imbalance’ even mean?”
It’s so frustrating when I know the information is out there but I don’t know it right on the spot when someone says something like this to me.
I love how you explain these things in a way that’s easy to understand! Maybe if I show videos like this to people I know they will understand too

[justins]

Love the way you describe the thought patterns. Especially perfectionism - it'll be what does me in. Explosive anger at best, apathy at worst - all the while kills any growth mindset toward life. Things are black and white, on or off, 1 or 0.

[mrzirker]

Hello Dr. Marks. Thank you for your content. I will be starting Psychiatric Mental Health Nurse Practitioner Program this August. I've been using your videos and other study materials to help build a decent foundation for the last three years. I love how simple you keep the material. Thank you so much for taking time out of your busy schedule to create these amazing videos.

[Charmed]

After taking and stopping anti depressants, for over twenty years, due to side effects, I have been approved to start the TMS (Transcranial Magnetic Stimulation) treatments. I will also see a therapist as well. I hope this will, at last, be the final road on my long journey from hell to happiness. Your channel has been a light in the dark, to get me through to this point. The information you provide and that beautiful calm soothing voice, always makes me feel hope. Thank you.

[itamarbenitez]

Out of I think hundreds of videos that I have now watched, this has been the most helpful. Thank you so much for being so clear and not dumbing things down to vague terms!

[corayilmaz]

Psilocybin containing mushrooms saved my life. The drastically reduced my benzodiazepine withdrawal allowing me to quite illicit pill addiction after three years of heavy daily use before it would had became medically dangerous to quit. It has also helped me survive depression.

[alessandrojaker]

I think we're framing this question the wrong way. I think the right question to ask is: why does depression take so long to recover from? I had 2 depressive episodes that were very severe, where I had stopped eating, couldn't walk, couldn't stand up, couldn't understand people talking to me, etc. In both cases it took me about 3 months to make a full recovery, even with SSRI medication. However, I wouldn't say the medication was slow, just that recovery from depression is a healing process and healing takes time. Actually I could feel the SSRI start to work almost immediately, within a few hours I was getting better sleep, within a few days I was eating better, so it was doing something, it's just that if you have dug yourself into a very deep hole it just takes time to come out of it.

[polarpalmwv]

I LOVE the half life information with the visual aid. I also love that you do not overly water down your content.

[kelliew.]

This was very helpful. Depression definitely does change your entire world view, making you more aware of "negative" expressions. I didn't know antidepressants could help with this.

[JordanJSparks]

Could you make a video all about you? Who you are, what's your story, how you became a Psychiatrist, etc?

[mariellelaaa]

I'm on Sertraline and Alprazolam for about a month now. This video helped me understand how my medications work. Thanks for this!

[JohnCordray]

Hi Dr. Tracey, thanks for making this video talking about antidepressants. I'm sure so many will benefit from what you're sharing. It's also great to see another mental health professional helping people on YouTube!

[geminiteevee]

Not just take a long time but I also have REALLY bad stomach pains as my body get to the therapeutic dose. Its really miserable and especially when you're in thr throws of a depression episode, pure hell. I'll be glad when new classes of these meds become readily available. Because a lot of us are really suffering