When To Increase Antidepressant Dosage

Although antidepressants are a common treatment for many mental health disorders, they can affect people in different ways, and the optimal antidepressant type and dosage varies from person to person. Because of this, it's not at all uncommon that an adjustment in dosage is needed, based on signs your antidepressant dose is too low, or too high.

While we can’t tell you what antidepressant dose is best for you, we can tell you what not to do — and that’s changing your dosage without medical advice. Keep reading to learn how your provider will determine your starting dose, the signs your antidepressant dose is too strong (or not strong enough), and the next steps to take.

When prescribing an antidepressant, your provider considers several factors to determine the right antidepressant and the right dose of it. 

Initially, they evaluate the severity and duration of your symptoms of depression and any previous treatments you've undergone. Your medical history, including any existing health conditions and other medications you’re taking, is also critical to avoid potential drug interactions. 

Additionally, factors such as age, weight, and overall health can influence the dosage recommended. Doctors often start with a low dose to minimize side effects and then gradually adjust it based on your response to the medication. 

Close monitoring during the initial weeks allows the doctor to make necessary dosage adjustments, ensuring the dosage is effective and well-tolerated. They’ll also schedule follow-up appointments to make sure things stay on track. This personalized approach aims to find the optimal balance between therapeutic benefits and side effects.

This also means that changing the dosage of antidepressants you’re prescribed shouldn’t be done without consulting your provider or mental health professional first. But how are you supposed to know if your antidepressant dose is too high or too low?

Side effects are common when an antidepressant is first started, but most side effects tend to get better after about a week. It’s possible that your antidepressant dosage may need to be reduced if after a couple of weeks you’re still experiencing side effects  such as: 

• Increased anxiety, or feeling unusually agitated and restless

• Difficulty falling or staying asleep

• Excessive daytime sleepiness that interferes with daily activities

• Nausea or vomiting

• Headaches that are new or worsening

• Dizziness or lightheadedness

• Blurry vision or trouble focusing

• Excessive sweating

• Involuntary shaking or trembling

• Irregular or fast heartbeat

• Sudden, extreme mood changes

• Feeling confused or disoriented

Potential Risks of an Antidepressant Dose That’s Too High

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

Serotonin syndrome is a potentially life-threatening condition that happens when serotonin levels are too high, sometimes as a result of certain medications. Anyone who takes medications that affect serotonin levels — such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — is at risk of developing serotonin syndrome, especially if the dosage is very high or if more than one medication that affects serotonin levels is used.

Other medications that affect serotonin levels include headache drugs in the triptan family, over-the-counter cold medications, opioid pain medications, and certain anti-nausea medications. Even taking herbal supplements, like St. John’s wort, ginseng, or nutmeg, alongside your antidepressant can increase your risk. 

Overdosing on antidepressants is another possible risk of increasing antidepressant dosage without consulting a healthcare provider. A report from 2017 found that antidepressants were among the top five causes of poisoning. And from 1999 to 2020, the number of overdose deaths caused by antidepressants 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. These were found to have more fatal outcomes than monoamine oxidase inhibitors (MAOIs), SSRIs, and SNRIs in 20 years of data from antidepressant overdose reports.

It’s also possible that your antidepressant dose may need to be taken up to a higher dose if your body isn’t responding to it after four weeks or so, and your symptoms aren’t getting better — or are getting worse than before you started. 

Some common signs your antidepressant dose is too low include: 

• Persistent feelings of sadness, hopelessness, or emptiness

• Little to no improvement in mood or overall mental health

• Ongoing fatigue and low energy levels

• Persistent or worsening anxiety

• Trouble sleeping or frequent waking

• Continued lack of interest or motivation in daily activities

• Ongoing issues with concentration or memory

• Changes in appetite or weight that haven’t normalized

• Continued social isolation

• Persistent feelings of worthlessness or excessive guilt

• Ongoing irritability or frustration over small issues

Antidepressants typically take several weeks to start working. 

But with consistent use (as directed), most people will begin to notice improvements in symptoms within two to four weeks of taking their new medication. The full effects of antidepressants may not be evident until six to eight weeks, or even longer in some cases. 

This delayed onset is because, although antidepressants increase the amount of available serotonin right away, the antidepressant effect comes from your brain's adaptation to these effects, and that takes time. 

It’s important to have realistic expectations for how quickly you’ll begin feeling better when you start taking antidepressants, and practice patience while continuing your medication as prescribed. If you experience any changes in progress or have any concerns about medication effectiveness, make sure to talk to your provider. 

You may be tempted to increase your antidepressant dosage on your own if your anxiety or depression symptoms are still present. However, changing the dose on your own can cause a range of negative effects.

These effects can include new or worsening symptoms, and potentially dangerous withdrawal symptoms. Further, unsupervised changes can disrupt the balance of neurotransmitters in your brain, leading to increased anxiety, mood swings, or even a relapse of depression. 

All of this to say, it is really important to speak with your healthcare provider before changing your antidepressant dose. Improper adjustments can lead to serious health risks. 

If you’re experiencing any potential signs your antidepressant dose is too low or too high, get in touch with your provider immediately. They may adjust your dose or suggest trying one of the different types of antidepressants instead. (Here’s a look at what to expect when switching antidepressants.)

As finding your ideal type and dose of antidepressants can be a trial-and-error process, know that treatment-resistant depression is also possible. This is when someone who struggles with depression doesn’t show improvement in mood, thoughts, or behavior after trying at least two antidepressants. 

Again, this is why staying in communication with your prescribing healthcare professional is so important when it comes to depression medications.

Everyone has unique needs when it comes to mental wellness, and that goes for the right type and dosage of antidepressant medications. If you think you’re seeing signs your antidepressant dose is too low or too high, here’s what to keep in mind:

• Be patient and realistic. Antidepressants can take several weeks to work and even longer for their full effect to kick in. We know the transitional period can be tough, but hang in there while your body and mind adjust.

• Monitor your symptoms. Your body will tell you if something is  — or isn’t — working for you. Pay attention to whether existing symptoms stay the same, get worse, or improve after starting your treatment plan. 

• Communicate with your healthcare provider. Don’t be afraid to ask questions or speak up about how you’re feeling, especially if you’re concerned about how things have (or haven’t) changed after starting to take antidepressants. Your provider is there to help you navigate treatment and find the right dosage for your needs.

And of course, medication is just one piece of the puzzle when it comes to addressing mental health. Psychotherapy, especially when used in conjunction with prescription medication, can also make a big difference, and there are other treatment options you can explore as well. 

Whether you’re interested in pursuing online mental health treatment or exploring the different medications available to treat depression and other mental health conditions, we can help. Start today by taking our free online assessment to connect with a licensed provider.