Medications and Watchful Waiting

When it comes to treating the symptoms of depression and anxiety, medications such as SSRIs or SNRIs have proven to be quite beneficial. However, in order to reap the full benefits of these medications, sometimes adjustments need to be made.

According to a meta-analysis study that was published in the Journal of Clinical Pharmacological Therapy, called “Augmentation strategies for treatment-resistant depression,” it is estimated that 40 to 60 percent of SSRI users experience relief from their baseline depression and anxiety symptoms. At the same time, it is also estimated that at least one-third of all persons treated with these medications, will develop recurrent symptoms of depression and anxiety.

Fortunately, when a medication shows some level of efficacy and is well tolerated, there are several actions that your doctor can take, to help improve the effectiveness of the medicine.

Each of these methods is backed by clinical evidence proving that they can result in the improvement of symptoms.

Therefore, over the next few weeks, we’re going to take a look at some of the most common medication adjustments and augmentations that can improve the efficacy of an SSRI or SNRI.


We will look at:

1) Raising the dosage of the SSRI to see if that shows any improvement.

2) Switching to another SSRI to see if it lifts the depression more while continuing to decrease anxiety.

3) Switching to another class of antidepressants. For example, trying an SSRI first, then switching to an SNRI.

4) Adding another medication to the SSRI, such as a mood stabilizer, an antipsychotic, etc.

We will begin our series on the different strategies that could be implemented to improve the efficacy of an antidepressant, by looking at the very first step which is- watchful waiting. This begins with the understanding that these medications take time to work, and it’s important to give them an adequate amount of time to take effect.

Though initial improvement of symptoms can occur in one to two weeks after starting the medication, it is not uncommon for the full effect of SSRIs or SNRIs to take at least 4 – 6 weeks.

4 – 6 Weeks!?

Sometimes, yes. That’s not to say there won’t be major improvements day by day.  However, whether it takes one week or 6 weeks, there is no way around the fact that there will be an adjustment period for your body and your brain.

During this time, it may feel as though some of your psychological symptoms are getting worse- especially when it comes to treating anxiety. This can be a result of the adjustment taking place in your brain regarding your neurotransmitters. And, it can also be due to the increased anxiety that can come with trying a new medication or medication in general for the first time.

Rest assured that this is completely normal, and you are not alone.

That being said, if you are experiencing initial side effects that are too difficult to handle, it’s important to be in contact with your doctor about this. Your doctor can work with you to help relieve these start-up symptoms by reducing the dosage or temporarily adding on a fast-acting anti-anxiety medication to help get you through the early days of adjusting to the medicine.

In our next article, we will look take a look at the typical starting doses for SSRI and SNRI medications, and potential dose adjustments that may improve their efficacy and decrease side effects.

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