When you are prescribed an antidepressant, it can take a bit of trial and error to determine the optimal dosage level. Your ability to identify signs your antidepressant dose is too low or too high can be an essential part of this process.ย
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How Do Antidepressants Work?
Most modern antidepressants work by increasing levels of certain chemical messengers in a personโs central nervous system.ย
Today, most doctors initially prescribe SSRIs, SNRIs, or atypical antidepressants to treat people with depression. They may turn to older types (tricyclics or MAOIs) only if the newer meds donโt provide adequate relief.
SSRIs
SSRI stands for selective serotonin reuptake inhibitor. Frequently prescribed antidepressants in this category include:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
These medications boost levels of serotonin, a chemical messenger that is involved with functions such as mood, appetite, learning, memory, and the sleep/wake cycle.
SNRIs
Serotonin-norepinephrine reuptake inhibitors (SNRIs) function similarly to SSRIs, but in addition to increasing serotonin levels they also prevent the reabsorption of a neurotransmitter called norepinephrine.ย
Commonly prescribed SNRIs include:
- Duloxetine (Cymbalta, Irenka)
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq, Khedezla)
Atypical
The category of atypical antidepressants includes several meds that donโt fit into any other categories, such as:
- Bupropion (Wellbutrin)
- Trazodone (Desyrel)
- Mirtazapine (Remeron)
- Vortioxetine (Trintellix, Brintellix)
These drugs alter various neurotransmitter and hormone levels, which can have the effect of easing depression and elevating mood for some patients.
Tricyclics
Tricyclics are an older type of antidepressant whose use began to drop off after the first SSRI (fluoxetine) was released in the late 1980s. Drugs in this category include.
- Clomipramine (Anafranil)
- Amitriptyline (Elavil, Endep)
- Imipramine (Tofranil)
- Trimipramine (Surmontil)
MAOIs
Monoamine oxidase inhibitors (MAOIs) were developed in the 1950s, around the same time that tricyclics were introduced. Their use has been curtailed considerably since the development of SSRIs, due to their effectiveness as well as their ability to cause severe side effects.ย ย
If patients donโt respond well to other antidepressants, doctors may sometimes still prescribe MAOIs such as:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Signs Your Antidepressant Dose Is Too Low or Too High
One of the reasons why there are so many types of antidepressants is that no single medication works for everyone, and that appropriate dosage levels can vary from one person to the next.
As noted at the outset of todayโs post, it can take a while to find the right antidepressant and the most effective dosage level. When you understand the signs your antidepressant dose is too low or too high, youโll be able to help you doctor find the ideal level for you.
Warning Signs That Your Dose Is Too Low
Depending on which antidepressant youโre taking, possible signs that your dose may need to be increased can include:
- Persistent symptoms: One of the clearest signs that your antidepressant dose is too low is that your mood hasnโt improved. Antidepressants donโt offer immediate relief, with some taking six to eight weeks before you notice any benefits. But if you donโt notice any significant improvements after having the drug in your system for an appropriate length of time, it may be time to either adjust your dosage level or switch to a different medication.
- Mood swings: Antidepressants donโt prevent you from ever feeling sad or having a bad mood. But when theyโre working as designed, they should stop you from having dramatic swings in attitude and energy. If you experience severe, unpredictable fluctuations, that could be a sign that your dosage is too low.
- Disrupted sleep: Some people with depression struggle with insomnia (difficulty falling asleep and staying asleep), while others experience hypersomnia (sleeping too much). If you continue to have sleep problems after taking an antidepressant for a while, that can be a sign that youโre not getting enough of the medication into your system.
Warning Signs That Your Dose Is Too High
Doctors usually start with a low dosage when starting someone on an antidepressant. But sometimes their initial recommendation is too high โ or they may make too large of an adjustment in response to signs that a patientโs antidepressant dose is too low.
If your antidepressant dose is too high, you might notice signs such as:
- Emotional numbness: When youโre on an antidepressant, you should still be able to feel your feelings. If you find that you canโt experience happiness or sadness, or that you simply feel detached from whatโs going on in your immediate environment or the world in general, that may be a warning sign that your dose is too high.
- Exhaustion: An excessively high antidepressant dose can cause you to feel drowsy or exhausted, even when youโre sleeping as much (or more than) you should. Persistent fatigue can contribute to other problematic effects, such as not being able to enjoy important activities or having difficulty concentrating and focusing.ย
- Restlessness and impulsivity: While some people struggle with decreased energy as a result of a high antidepressant dose, others have the opposite experience. If you canโt sit still, are uncharacteristically restless, or have difficulty constraining your impulses, these can also be symptoms of having excess antidepressants in your system.
What to Do if Your Antidepressant Dose is Too Low or Too High
It is clearly important to be able to identify signs your antidepressant dose is too low or too high. But just recognizing the warning signs isnโt enough. You then have to take appropriate action.ย
If you think you may need a dosage adjustment or a different medication altogether, you should address your concerns with your doctor. Be as specific as you can about the type and intensity of your symptoms, and explain how these symptoms have affected your life.
If youโre nervous about having this conversation, or you fear that youโll forget to mention something important during your appointment, write down everything you want to say ahead of time. You donโt have to prepare a script, but jotting down a few reminders about the topics you want to be sure to talk about can make a world of difference.
What you should NOT do is adjust your dosage on your own, without speaking with your doctor.ย
If you have developed particularly distressing side effects, it may be tempting to simply stop taking your antidepressant until youโre able to discuss the matter with your physician. This is never a good idea. Discontinuing or changing your medication regimen may cause even more severe effects than what youโre currently experiencing.
If you feel like you canโt wait until your next scheduled appointment, call your doctorโs office and tell them you need to get in ASAP.
Learn More About Depression Treatment in Georgia
Serenity Grove offers personalized residential and outpatient programming for adults who have been living with depression. We also serve patients who have developed co-occurring addictions to alcohol or other drugs.
In addition to helping you find the right antidepressant at the right dosage level, our team can also provide you customized therapies and support services to address mental health concerns that arenโt alleviated by medication alone. Working together, we can help you find your path toward a much healthier and more satisfying future.
To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Admissions page or call us today.
