Don’t Quit Before the Miracle

Antidepressants and anti-anxiety medications such as SSRIs and SNRIs have helped many people to live happier, healthier, more balanced lives.

By helping to create the right balance of brain chemicals including serotonin and, in the case of SNRIs serotonin and norepinephrine, these medications are often a critical part of the mental health journey of recovery- A journey that may be trying at times but well worth embarking on.

For some, the first medication they try will work well for them, and the starting dosage of the medication won’t need to be changed. For others, it may take some dosage changes and medication changes until the right fit is found.

The first place to start when it comes to finding out if a medication is right for you is to increase or decrease the dosage.

Though there are clinically backed guidelines as to what the starting dose and the therapeutic dose ( the dose at which the medication is found to be most effective, through gradual increases in dosage) are, what works for one person may not be effective for another.

The reason is, when it comes to medication, each person responds differently based on the severity and duration of their symptoms, as well as on how their body metabolizes the medication. For some, lower-than-average doses are required, while for others, higher-than-average dosages are found to be beneficial.

In fact, an article published in The Lancet Journal of Psychiatry points out that several studies have found that the average dosage of medication that is found the be most effective varies.

Some clinical studies have evidence to support that, for example, the SSRI fluoxetine needs to be at 20-40 mg for maximum efficacy. While others found evidence to support that the best dosage of fluoxetine in the treatment of depression and anxiety is 40-50mg.

The guidelines set forth regarding the therapeutic dosage range are not set in stone, but they are evidence-based and should be taken into consideration- Provided there are no serious adverse effects from the medication such as increased thoughts of self-harm or doing harm to others.

One of the issues that can happen regarding finding the most effective medication, is stopping the medication too early.

Some people may notice a lifting of their depression symptoms and a decrease in their anxiety within the first 2 weeks of taking an SSRI or SNRI medication. However, for most, these medications will take an average of 4-6 weeks to take effect.

This means, patience, patience, and more patience.

In fact, sometimes stopping medication or switching a medication too early, can be a bit of a roadblock on the journey to find the medication that works best.

The Swedish periodical, Acta Psychiatrica Scandinavica, recently published the results of a large meta-analysis of SSRI dosages for depression.

Researchers analyzed the data regarding  38,868 individuals less than 65 years of age, that were prescribed an antidepressant for the treatment of depression. The medications used among the participants were the common and typically most tolerable SSRIs citalopram, escitalopram, and sertraline.

What they found was that the majority of the patients treated with these SSRIs for depression never reached the recommended therapeutic dose.

In fact, with the medication citalopram, the recommended therapeutic dose is up to 40mg, however, 7/10 patients on citalopram never received a dosage above 20mg.

As for escitalopram, with a recommended therapeutic dosage of up to 20mg, and sertraline with a recommended therapeutic dose of up to 200 mg, almost  6/10 never reached a higher dose than 10 of escitalopram and 50 mg of sertraline.

This is problematic, as many of these people could have experienced further relief from their depression symptoms, had these medications been increased to these clinically backed therapeutic dosages.

Therefore, it is important to give both SSRI and SNRI medications time to work when first starting them and with each increase in dosage.

Though it typically will not take the full 4-6 weeks for a dosage change to take effect, it usually does take time. And, on average, most people report feeling a change within 2 weeks following the increase.

In our next article, we will look at some of the common start-up and dosage increase side effects. We will also provide some information on what can be expected, as well as how to make these transitions and adjustments smoother.

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