When To Increase Antidepressant Dosage

Finding the best medication for depression or antidepressant for an anxiety disorder can be a process.

Although antidepressants are a common treatment for many mental health disorders, these medications can affect people in different ways.

From side effects to dosage, everyone’s antidepressant journey is different.

So if you’re currently taking them, how do you know when to increase antidepressant dosage?

Dealing with mental health disorders can already be frustrating, so when your antidepressant doesn’t seem to be helping, it can seem like another roadblock in your treatment plan.

We go over when to increase antidepressant dosage and how to know if you should.

Overview of Antidepressants

Antidepressants are a medication used to treat several conditions, such as major depression, generalized anxiety disorder and post-traumatic stress disorder (PTSD). They can also be used for the treatment of panic disorders.

Different antidepressant medications work in moderately different ways, but it is thought that many work to modify or balance certain neurotransmitters — also referred to as brain chemicals.

Research suggests that antidepressants can be helpful for people with chronic, moderate or severe depression and may not have as much of an effect on symptoms of mild depression.

The most common types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs). SSRIs work to increase serotonin levels in your brain by preventing the brain from reabsorbing the neurotransmitter.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants work to increase both norepinephrine and serotonin levels in the brain.

• Tricyclic antidepressants (TCAs). An older class of antidepressants, TCAs work by increasing certain neurotransmitters in the brain, including norepinephrine and serotonin levels.

• Monoamine oxidase inhibitors (MAOIs). Monoamine oxidase inhibitors are another older class of antidepressants. They increase the neurotransmitters serotonin, norepinephrine, dopamine and tyramine by blocking the enzyme monoamine oxidase, which breaks down those neurotransmitters.

• Atypical antidepressants. Some medications are referred to as atypical antidepressants because they don’t fall under the other classes of antidepressants.

You can learn more from our full list of antidepressants about all the types of antidepressants, their side effects and more.

Talk to Your Health Care Provider First

Increasing the dosage of antidepressants should not be done on your own. Talk to your health care provider or a mental health professional first.

Taking a higher antidepressant dosage than your body is used to can increase the risk of serotonin syndrome, overdosing and other possible complications.

Serotonin syndrome is a potentially life-threatening condition that happens when serotonin levels are too high, sometimes as a result of certain medications.

Symptoms of serotonin syndrome can range from mild to severe and include:

• Nausea

• Tremors

• Dilated pupils

• Nervousness

• Agitation

• Involuntary muscle spasms

• Sweating

• Delirium

• Rapid heart rate

• High blood pressure

• Seizures

Anyone who takes medications that affect serotonin levels — such as SSRIs and SNRIs — is at risk for serotonin syndrome, especially if the dosage is increased or if more than one medication that affects serotonin levels is used.

Overdosing on antidepressants is another possible risk of increasing dosage without consulting a health care provider.

A report from 2017 found that antidepressants were among the top five causes of poisoning.

From 1999 to 2020, the number of overdose deaths caused by antidepressants has more than tripled, according to data from the National Institute on Drug Abuse.

Certain antidepressants are more likely to cause overdoses than others, such as tricyclic antidepressants.

Tricyclic antidepressant overdoses were found to have more fatal outcomes than MAOIs, SSRIs and SNRIs in 20 years of data from antidepressant overdose reports.

You may be tempted to increase your antidepressant dosage on your own if your anxiety or depression symptoms are still present.

However, you should always consult with a health care provider or licensed psychiatry provider before increasing your dosage.

When To Increase Antidepressant Dosage

There are ways to know when you should talk to a professional if it’s time to increase antidepressant dosage.

Short-Term Improvement

Antidepressants can start having an effect within one to two weeks.

While the exact mechanisms are unknown, antidepressants are thought to increase levels of serotonin, norepinephrine and/or dopamine.

This change can take time, so if you start feeling improvements right away, it could be a placebo effect — an improvement of symptoms without using an active treatment.

So, when you first start taking an antidepressant, your brain may associate taking medication with feeling better.

However, the placebo effect may wear off and then the antidepressants start working within a few weeks.

Other times, the placebo effect wears off, but the antidepressant doesn’t start working.

This could either mean the antidepressant dosage needs to be increased or that particular medication wasn’t the right one for you.

Signs of Serotonin Syndrome

Serotonin syndrome can also occur if you take more than one medication that affects serotonin levels.

This can include migraine or headache drugs in the triptan family, over-the-counter cold medications, opioid pain medications, certain anti-nausea medications and others.

Certain herbal supplements that affect serotonin levels, such as St. John’s wort, ginseng and nutmeg, could also cause serotonin syndrome.

Be sure to tell your healthcare provider about any other drugs or supplements you take before starting an antidepressant to avoid the risk of serotonin syndrome.

Your Current Dose Isn’t As Effective

You may develop a tolerance to your antidepressant after some time, which is normal.

A healthcare provider may increase your dose or switch you to another antidepressant.

Here’s what to expect when switching antidepressants.

Your Depression Symptoms Get Worse

Sometimes, symptoms of major depression can get worse on antidepressants.

Your doctor may increase your antidepressant dosage or change your medication, so be sure to let them know how your current symptoms are doing as well as any new symptoms that occur.

No Significant Response

The effects of antidepressant medications vary between individuals.

Generally, many people will start to notice improvements in their symptoms after six to eight weeks.

If you’ve been taking a prescribed antidepressant for several months and haven’t noticed any significant changes in your symptoms, you may need an increase in dosage or a change of antidepressant.

Treatment-Resistant Depression

While trying antidepressants is a trial-and-error process, you may be struggling with treatment-resistant depression.

Treatment-resistant depression is when someone who struggles with depression doesn’t show improvement in mood, thoughts or behavior after trying at least two antidepressants.

One option for treatment-resistant depression is to add another medication, such as bupropion, that can make an antidepressant more effective.

Final Words on Increasing Antidepressant Dosage

Antidepressant dosages vary from person to person.

If you’re currently taking an antidepressant and you don’t think your current dosage is working, don’t increase the dosage on your own. Talk with your health care provider first and let them know about any new or persisting symptoms or side effects.

You can also consult with a licensed psychiatry provider to see if either a new antidepressant prescription or therapy may be the right fit for you.