What to Expect When Going on an Antidepressant, According to a Psychiatrist

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It took me years to accept the idea of going on an antidepressant. While I think it was somewhat inevitable given my family history, fear of the unknown coupled with the very real societal stigma kept me comfortably cloaked in denial—I was determined to work through my issues on my own. 

But after a particularly bad bout of depression in January of last year, I finally accepted the fact that nothing else would provide the relief I needed. I seldom had the motivation to work a standard nine to five, let alone workout, cook healthy meals, and journal about my feelings. I’ve tried my best not to look at this as a personal failure, but a simple reality—I have a chemical imbalance, and honestly, it is what it is. 

February of 2020 marked the beginning of my first Lexapro prescription—roughly 35 days before the world would shut down. Though I didn’t realize it at the time, I got help right before I’d need it most. My medication would come to serve as a much-needed line of defense against the many pandemic-related anxiety spirals and depression naps. 

I’m certainly not alone in this struggle—Pew Research found an estimated one-third of Americans have experienced clinical signs of anxiety, depression, or both since lockdown began. What’s more, Fierce Healthcare reports prescriptions for anti-anxiety, anti-insomnia, and antidepressant medications jumped 21% in a single month after the pandemic hit in March. 

If you’re considering going on an antidepressant, keep reading for psychiatrist Dr. Danesh Alam’s advice. As the medical director of Behavioral Health Services at Northwestern Medicine Central DuPage Hospital, Dr. Alam believes there are ways to set yourself up for success when going on a psychiatric medication. Find his unfiltered thoughts on the topic below. 

Set Realistic Expectations 

First and foremost, setting realistic expectations for your antidepressant will start treatment off on the right foot. “Medication will not fix everything,” says Dr. Alam. “Psychological disorders are incredibly complex—the interplay between biology, the environment, and social factors manifests differently for everyone.” In other words, you’re still going to have to put considerable effort into your mental health while taking medication. “A healthy diet, exercise, meditation, and socialization are still vitally important,” he notes. “Schedule time for these things, even via Zoom, and stick to them.”

As far as the actual feeling goes, antidepressants have a very subtle effect—you won’t wake up one day and feel like a different person. “And don’t expect any sort of drug high,” he adds. “Fortunately, there’s very low abuse potential for antidepressants.” 

Antidepressants Go Hand-in-Hand With Therapy 

Medication may improve day-to-day anxiety, but therapy will help you uncover root causes and manage your symptoms in the long-term. “An experienced mental health professional will create a sort of game plan for your treatment and recovery,” says Dr. Alam. “This includes identifying target symptoms, setting goals for improvement, teaching coping strategies, possibly prescribing medication, and monitoring potential side effects.” 

While our lack of comprehensive healthcare certainly limits access to accredited therapists, psychologists and psychiatrists, Dr. Alam does advise against working with a primary care physician or nurse practitioner. “GPs don’t provide the important therapy component of mental health treatment,” he explains. “This can lead to a lot of treatment failures. Many patients who go this route are already on their second or third medication trial by the time they come to a psychiatrist, and they’re typically dissatisfied with the results.” 

You May Experience Side Effects 

It’s important to note that side effects vary depending on the medication and the person. But Alam lists gastrointestinal discomfort, headaches, dry mouth, low libido, and increased appetite as some of the most common side effects of antidepressants. 

“Since depression itself affects a person’s appetite and sex drive, it’s hard to determine which symptoms are caused by the medicine and which are caused by the condition,” he clarifies. While antidepressants have come a long way from a side effect perspective, “weight gain alone is a challenging issue for many patients,” adds Dr. Alam. “This can be attributed to our society’s unattainable beauty standards.” Of course, your therapist will help you monitor all side effects and determine the right course of action for you. 

Remember: Progress Takes Time

“As a society, we look for instant gratification—we want a quick fix for everything,” says Dr. Alam. “But antidepressants take six to eight weeks to fully kick in, coupled with months to years of treatment to reap the full benefits.”

What’s more, progress is considerably less quantifiable when treating a mental health condition. “If someone has a physical disorder, there’s objective data proving it,” he notes. “But there’s no simple test for anxiety and depression.” Setting realistic expectations with your doctor, attending regular therapy sessions, and practicing self-care outside of the doctor’s office can help streamline your recovery. 

You May Not Be on Medication Forever

An antidepressant prescription doesn’t necessarily resign you to a lifetime of daily medication. While treatment is different for every person and condition, there are a few general guidelines that mental health professionals keep in mind. 

“For mild to moderate depression requiring medication, we usually start with six months to a year of antidepressants plus therapy,” notes Dr. Alam. “If a patient has three or more severe depressive episodes, then it may be better to stay on medication long-term.” If you ultimately decide to go off medication, your provider will closely supervise the transition and monitor you for any symptoms. 

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