“My good friend started taking an antidepressant but says she now feels worse. Is this normal?”


Many people say that they feel worse when they start taking an antidepressant. Here are some possible reasons… As the brain and body adapt to higher neurotransmitter levels, side effects such as headache and upset stomach may occur. Worse, some people feel more depressed or anxious than they did before. This may be due to restlessness and agitation provoked by a discharge of serotonin in response to the medication—and may also be behind the increased risk for suicide, which, although quite small, is most likely in the first days of treatment. Other possible reasons: It may be that many people start medication because their depression is worsening, and the drug hasn’t started working yet. Or the drug increases mental energy before it improves mood, so people experience negative feelings more strongly. Most adverse effects go away within a week, but if your friend’s are severe, she should see her doctor, who may change her dose or suggest a different drug. Also, for about 20% of people responding well to an antidepressant, the drug loses its effectiveness after several months or longer. It could be that too much of the drug in the system makes them feel flat and lethargic, and they’ll do better on a lower dose. Or the body has learned to metabolize the drug more efficiently, so they need a higher dose or a different drug. Situational factors, such as job stress, could be triggering more distress than the drug can alleviate, and psychotherapy or lifestyle changes may help. A good professional can advise your friend on why her medication is making her feel worse and what to try to make things better.