Prescription drugs used to treat mental health conditions are called psychotropic drugs; about 16 percent of American adults have taken them, according to a 2020 report from the Centers for Disease Control and Prevention.
The two mental health conditions most commonly treated with medication are depression and anxiety, says Dr. Alex Dimitriu, founder of Menlo Park Psychiatry and Sleep Medicine. Some people receive prescriptions for mental health medications through a psychiatrist, but primary care providers can also prescribe antidepressants, which are one of the five main categories of psychotropic drugs.
Antidepressants are a first-line treatment for both depression and anxiety. “Antidepressants don’t make problems disappear,” says Dimitriu, “But they can make things hurt a little less so people can do the work in therapy.”
The efficacy of antidepressants is mixed. In one 2020 report, 40 to 60 percent of people said they benefited from taking them. On the flip side, that means antidepressants didn’t work for about half of respondents, a finding that’s consistent with one 2012 review.
Even when antidepressants are effective, they can take a while to kick in. While the precise timeline depends on the medication, it can take up to eight weeks for an antidepressant to work. But what does “working” even mean? Carmen Kosicek, a psychiatric nurse practitioner and founder of Alay Health Team, says the answer varies, and that it’s important for patients and providers to establish a shared definition of success.
Here’s a guide to help you understand when an antidepressant is (or isn’t) doing its job and how to discuss your progress with your provider.
Why medications work for some people and not others
Chemistry. There are several types of antidepressants, and they target a few different neurotransmitters, says Dr. Holly MacKenna, an integrative psychiatrist and founder of Dara Wellness in New Orleans. Three of the most common types are:
- Selective serotonin reuptake inhibitors: SSRIs such as Lexapro, Prozac and Zoloft increase the available supply of the mood-regulating hormone serotonin. This class of drugs can take up to six weeks to start working. In 2022, researchers from the University College London came out with a study suggesting serotonin may play less of a role in depression than previously thought. But many psychiatrists—and meta analyses of past studies—support the use of SSRIs and show that they work better than a placebo.
- Serotonin and norepinephrine reuptake inhibitors: SNRIs stop cells from reabsorbing serotonin and norepinephrine, a neurotransmitter that affects energy levels. Drugs in this class include Cymbalta, Effexor XR and Fetzima. If you don’t notice improvement after about eight weeks of taking an SNRI, reach out to your doctor.
- Atypical antidepressants: These medications don’t neatly fit into one category because they don’t all act on the same brain chemicals. Bupropion (aka Wellbutrin), for example, prevents the body from reabsorbing feel-good chemical dopamine. Similar to SSRIs and SNRIs, it can take several weeks for atypical antidepressants to start working.
If a patient isn’t responding to one medication, it may be because they need one that affects a different neurotransmitter.
Biology. Though medications can alter brain chemistry to improve mood, innate biological differences appear to influence the efficacy of some psychotropic medications. “People’s [bodies] metabolize medications differently,” says MacKenna. Also, one 2019 study found that SSRIs were less likely to alleviate depression in people with abnormally shaped serotonergic neurons (which produce serotonin).
Interference. Alcohol and other medications can affect your brain and mood in a way that counteracts the medication’s effects. Some of these interactions can also be dangerous to your physical health. Speak with your provider about any other medications you are taking and your drinking habits.
Signs medication is working
Someone in your life notices that you seem different. “Often, when one is in a state of depression or anxiety, that [sadness or anxiousness] becomes the go-to feeling,” MacKenna says.
But medications can change the brain over time. Though it may take several weeks for you to notice significant changes, a loved one may pick up on more understated differences sooner.
“Once our brain starts to adjust to the medication, our behaviors and facial expressions will begin to subtly change,” says MacKenna. “Those who see us every day will pick up on these changes before we realize we are beginning to feel better.”
You start sleeping better. Studies suggest the relationship between healthy sleep and mental wellbeing is bidirectional. That means getting enough high-quality sleep leads to lower levels of depression and anxiety, and not feeling anxious or depressed leads to more restful nights.
“I don’t usually hear people saying, ‘I’m running through fields of daisies,’” Kosicek says. “They usually say, ‘I’m sleeping better.’”
That said, different antidepressants can have different effects on sleep: Some may improve sleep while others may cause insomnia or hinder REM sleep. Your doctor might suggest taking your medication in the morning to reduce the impact on your sleep.
Your work performance improves. Mood disorders can affect your ability to perform well at work. The World Health Organization estimates that depression and anxiety cost the global economy $1 trillion each year in lost productivity. But some research links antidepressants to enhanced work productivity.
“For many people with depression and anxiety, there is a lot of wasted brain energy thinking about things that are not productive,” says Dimitriu. “Medications make it easier for people to let go of the past and direct that energy into the future.”
You notice a change in your energy. Mood disorders can have a negative impact on your energy, both how much you have and how it feels. Medications may help.
Dimitriu says patients with depression will often come in and note they have more motivation and energy to do the things they love, such as watching a baseball game. Meanwhile, patients with anxiety often report having a bit less negative energy: “People will say, ‘Wow, there’s actually peace and stillness. That’s a wonderful feeling.’”
Signs medication isn’t working
You feel apathetic. When you bang your knee, you might numb the pain with ice. But medication for mental health doesn’t serve the same purpose.
“You need to feel things to be able to deal with life,” Kosicek says. “Feeling numb is not what we are looking for.”
You feel worse (or no different) after four to eight weeks.. While you might experience some initial side effects like fatigue, stomach upset or dizziness, you should start feeling better about four to eight weeks after starting meds. Dimitriu advises that patients give it that amount of time, as early side effects are common.
“There can be a wobble,” Dimitriu says. “Things can get a little bit worse before they get better.”
But if you aren’t noticing a difference after the first several weeks, it could be a sign that the medication isn’t working. Call your provider if you’re unsure; they might suggest trying a different type of medication.
What to ask and tell your provider about medication
Ask questions. Experts recommend asking your provider some questions before you start taking medication and as you go along. For starters, you should understand their reason for prescribing it.
“Ask, ‘Why do you think this is the medication for me?’” Kosicek suggests. “The prescriber should say, ‘You said this is the problem, and that is what this medication is for.’”
It’s also beneficial to ask about side effects before starting and as you experience them.
“Transparency can prevent you from going down a Google rabbit hole,” MacKenna says, adding that your provider can help you understand what is and isn’t normal.
Label feelings differently. We often think of our feelings as “good” or “bad,” Dimitriu says. He suggests delving deeper.
“Break it down into overall mood states,” he says. “Overall, how happy or sad do you feel? Overall, how anxious do you feel? I also like to look at motivation and sleep.”
As you continue treatment, this granular level of thinking can help you and your provider examine progress.
Collect and discuss data. Dimitriu says that his patients sometimes have difficulty recalling how they felt before taking the medication. But if you confuse your pre-medication feelings with your current ones, it’s challenging to evaluate efficacy. Journaling can help.
“I encourage my patients to take careful notes on how they felt before an intervention and how they feel after 15, 30 and 60 days,” Dimitriu says.
Before sessions, MacKenna suggests using your journal to make a list. At an appointment, tell your provider how many days or weeks you’ve experienced issues or improvements.
“Data is hard to argue against,” she says. “It gives you information so you and your doctor can have a more targeted conversation rather than talking in generalities.”
Medication isn’t magic
Even medication that works isn’t a cure-all. Dimitriu suggests a holistic treatment approach that includes strategies like talk therapy, exercise and meditation.
“Don’t just sit back and wait for the medicine to work,” he says. “It’s usually more than just the medicine that makes people better.”
Even if other, non-pharmacological treatments didn’t have a measurable impact on your mental health prior to medication, they may be more effective in conjunction with it. Your provider can help you put together a well-rounded treatment plan.