Why Antidepressants Make You Feel Worse - At First

This problem of antidepressants making you feel worse can happen when we use it for anxiety or depression. With depression, you can feel even more depressed after you take it, but if you keep taking it, that effect wears off. The problem is more pronounced with anxiety. Taking it can make your anxiety spike and feel even worse than before you took the medication.

So why would we even use this medication to treat anxiety? Because the effect is usually transient, meaning it goes away after several days. For some people it may persist and then they have to stop the medicine, but it usually goes away.

Why does it happen?
Researchers from the University of North Carolina identified another pathway in the brain that gets activated with serotonin. Serotonin activates one pathway that helps mood and anxiety, but it also activates another pathway that increases a brain chemical called corticotropin releasing factor also called corticotrophin releasing hormone. This hormone is normally secreted in response to stress or a perceived environmental threat. This activates the body's fight or flight response that is intended to protect you from a threat. But when there is not real threat to respond to, you experience that adrenal response as anxiety.

The researchers found that serotonin can trigger this stress response through the corticotrophin hormone release. This finding has led to new research on a drug that can block this hormone during the initial phase of your treatment until you get fully onboarded with the antidepressant.

To address this problem, we start with a low dose of antidepressant and slowly increase the dose to reach a therapeutic dose (titration). Sometimes we will use When you are fully onboarded with your medication, your doctor would taper you off the benzodiazepine and you would remain only on the antidepressant to treat your anxiety.

References
Catherine A. Marcinkiewcz, Christopher M. Mazzone, Giuseppe D'Agostino, Lindsay R. Halladay, J. Andrew Hardaway, Jeffrey F. DiBerto, Montserrat Navarro, Nathan Burnham, Claudia Cristiano, Cayce E. Dorrier, Gregory J. Tipton, Charu Ramakrishnan, Tamas Kozicz, Karl Deisseroth, Todd E. Thiele, Zoe A. McElligott, Andrew Holmes, Lora K. Heisler, Thomas L. Kash. Serotonin engages an anxiety and fear-promoting circuit in the extended amygdala. Nature, 2016; DOI: 10.1038/nature19318

Li Z, Pfeiffer PN, Hoggatt KJ, et al. Emergent anxiety after antidepressant initiation: a retrospective cohort study of Veterans Affairs Health System patients with depression. Clin Ther. 2011;33(12):1985-1992.e1.

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.

[titachabow]

I just want to be normal and feel normal😭😭😭😭😭😭

[tayzonday]

Prozac (taken for anxiety) just made me gain weight and become emotionally blank. So, I still had anxiety but didn’t care that I had anxiety. Because I didn’t care about anything. I could lay in bed all day and go “gee, this is cool” instead of laying in bed all day going “this sucks, I’m paralyzed and my life is falling apart.”

[gunjac]

Before anti-depressants I tried to take my life three times, struggled with drug abuse and was homeless. I’ll keep the anti-depressants thank you.

[CristinaMartinez-lnrh]

I’ve been on Zoloft for two months almost and it is life changing. First time I had ever considered taking meds for my inconsistent mood, constant crying and over worrying. I thought it was all a normal part of life. I’m so glad I started it. My only side effect as stomach issues but besides that, I’m so calm. The emotional blunting was bothering me but I think it was due to me used to being in such extremes modes of emotional responses; I have to get used to a new way to respond that is balanced. I am hesitant to speak to others about my positive experience but I would like to eventually bc it has literally changed my life and kept me off a destructive path.,

[benhernandez]

Day 3 on Zoloft and I’m feeling my anxiety elevated! But I’m really glad that it is common. Usually the comments section stresses me out but it’s nice to know I’m not alone in these feelings/symptoms. Thank you for your videos!

[dopehousex]

I been on Zoloft 50mg for 7 months and they have made my life a lot better. But the first 4 to 5 months it's a up and down daily ride. Some days I would wake up depressed and others days super happy. Around the 6th month I started feeling normal no more anxiety or panic attacks. I am much happier today and I can live and enjoy life. Just stick to it and it will get better in the long run but the beginning does suck I won't lie.

[lymarie]

I have been on all the antidepressants listed in the last 20 years. The side effects were brutal. I made the decision to go to traditional medicines. But I have seen some of these truly help others. Thank you so much for explaining why these side effects happened. 💕

[malindasmith]

I started on antidepressants when I was 11 because my dad died. I am now 42 and just got off them. I feel better than I have in my entire life.

[mwwhatever]

Well I've been on various antidepressants for over 18 years now, and mostly I felt that they just numbed me and made me complacent to my crappy life

[hopethin]

I just love Dr. Marks. I was always so afraid to take medication, especially antidepressants, until I started watching her videos. It is amazing how she answers questions that are the next on my mind to be asked and that I have wanted to ask for so long but been afraid to.

[GamersXnostalgia]

I have been suffering from anxiety and depression for years, and social anxiety makes it hard for me to get help. But I've finally called and made an appointment for a mental assessment and hopefully I can get back to feeling "normal". I want to be able to work and support myself. I was offered a promotion, but I can't accept it until I'm more stable. I probably might crack under the pressure.

[kingalex]

Okay- this makes so much sense. When I got to the top dose of my new meds for a week I was a total anxious mess and felt absolutely horrid.

[richardbartholomew]

‘make you feel worse’... that’s an understatement. Unless by ‘worse’ you mean manically suicidal.

[kaylasmusic]

I also think many psychiatrists are not focusing enough on which neurotransmitters you are lacking or are too high, .. and just giving wrong medication

[blackviking]

I had no idea corticotropin existed, let alone its relationship to serotonin. Your videos are a treasure trove of interesting information.

[mehdizj]

Dr Marks, the first like was me! FINALLY! I love your YouTube channel.

[helenhucker]

I assumed the drug manufacturers would know why patients can feel worse before feeling better. It seems this is not the case which doesn't inspire confidence.

[BrownGeorge-pwxo]

I could remember several years ago I suffered severe depression and mental disorder. Not until my mom recommended me to psilocybin mushrooms treatment. Psilocybin treatment saved my life honestly. 8 years totally clean. Never thought I would be saying this about mushrooms.

[kristenjohns]

I wish more people knew this. It’s so normal. Mine got so bad but looking it up I power through and I can feel like I felt before my depression and anxiety developed. After a few weeks that calms down. And after a few months, life is just so so much better. I always try to let people starting something like Zoloft know at first because they have no idea. Aside from it being a possible bad medication match, I think this is why so many people say it made their anxiety worse when they quit before two months.

[reallifepsych]

Thank you for this video. As a therapist, medications are outside of my scope, so it’s always helpful to learn when i can.