Why Do Antidepressants Take So Long To Work?
157,983
Published 2021-04-07
There's a couple reasons for this. The first is due to the way the drug works. Medications have to reach a steady state in your body before you can get a reliable effect. It takes approximately 5 half-lives to reach steady state. If you have a medication that has a half-life of 24 hours, it takes five days to reach steady state.
A second reason has to do with the delayed effect the increase in serotonin has on your thoughts. You have the increased serotonin, then a delay, then you have the downstream neuroadaptive effects which is reducing and increasing various receptors, then you have a change in mood that causes a change in emotional bias.
A cognitive model of depression is that negative thinking both causes and perpetuates depression. When you're depressed, you have more negative view of the world. Depression affects what you pay attention to. You're more likely to notice negative facial expressions, spot negative cues in your environment and draw negative conclusions about things. This is referred to as a negative bias or negative valence.
Thoughts, feelings and behaviors are all connected. There's still a model for endogenous depression where you develop depression soley based on brain changes. But we be still believe even that depression affects your thinking. It's debatable as to which came first, depression illness or thought depressed thoughts. But the mind and the body are one. And the best approach to depression is to address them both equally. The mind approach would be through therapy or self-help measures to address your mindset and the body approach would be diet, exercise, sleep hygiene and medication if appropriate.
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References
Wilson SJ, Bell C, Coupland NJ, Nutt DJ. Sleep changes during long-term treatment of depression with fluvoxamine – a home-based study. Psychopharmacology 2000; 149: 360–5.
Harmer CJ, O'Sullivan U, Favaron E, Massey-Chase R, Ayres R, Reinecke A, Goodwin GM, Cowen PJ. Effect of acute antidepressant administration on negative affective bias in depressed patients. Am J Psychiatry. 2009 Oct;166(10):1178-84. doi: 10.1176/appi.ajp.2009.09020149. Epub 2009 Sep 15. PMID: 19755572.
Want to know more about mental health and self-improvement? On this channel I discuss topics such as bipolar disorder, major depression, anxiety disorders, attention deficit disorder (ADHD), relationships and personal development/self-improvement. I upload weekly. If you don't want to miss a video, click here to subscribe. goo.gl/DFfT33
Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.
All Comments (21)
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Who loves Dr Marks content? I think it’s seven shades of brilliance and gratefully bank her advice.
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Lexapro feels exactly like you’re describing for me. The first week I could gradually feel myself getting back to normal. The second week I noticed it fixed my appetite! Not like a stimulant or appetite suppression but “normal” no over eating no emotional eating wanting breakfast curbed my night time soda and chocolate cravings I actually feel full “serving size” of different foods were almost spot on. 3rd week was a little lull but it was likely because I was walking the dog less that week for one reason or another. Praying it stays working it’s been almost a year now.
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Hi Dr. Tracey, thanks for making this video talking about antidepressants. I'm sure so many will benefit from what you're sharing. It's also great to see another mental health professional helping people on YouTube!
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Sometimes I just wanna show your videos to people in my life who don’t understand. I told someone that mental illnesses can be caused by chemical imbalances such as low serotonin and he said “that term is just blown way out of proportion, what does ‘chemical imbalance’ even mean?” It’s so frustrating when I know the information is out there but I don’t know it right on the spot when someone says something like this to me. I love how you explain these things in a way that’s easy to understand! Maybe if I show videos like this to people I know they will understand too
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THE BEST mental health channel on YouTube. Always thoughtful, organized, scholarly, and applicable. You should be a professor somewhere!
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Out of I think hundreds of videos that I have now watched, this has been the most helpful. Thank you so much for being so clear and not dumbing things down to vague terms!
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I LOVE the half life information with the visual aid. I also love that you do not overly water down your content.
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Hello Dr. Marks. Thank you for your content. I will be starting Psychiatric Mental Health Nurse Practitioner Program this August. I've been using your videos and other study materials to help build a decent foundation for the last three years. I love how simple you keep the material. Thank you so much for taking time out of your busy schedule to create these amazing videos.
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I just upped my antidepressants yesterday and had a similar conversation with my psychiatrist. This video is really appreciated with how timely and informative it is!
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Thank you so much for all your high quality content. It is exactly what I needed to hear!
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Love the way you describe the thought patterns. Especially perfectionism - it'll be what does me in. Explosive anger at best, apathy at worst - all the while kills any growth mindset toward life. Things are black and white, on or off, 1 or 0.
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Hi, Doctor Tracey. I'm from Brazil and having found you through your videos has been a blessing (although I'm not religious, that is the word to use here). You've helped me a lot understand so many aspects of my current state, clarifying lots of issues, informing and making my visitis to the doctor much more productive and objective. Thanks for being such a kind person and being around helping people you don't even know.
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Wow, what a great video! All of the information in it was especially relevant to my circumstances. Thank you Dr. Marks. 👍
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Wow what a brilliantly explained video, so interesting and makes perfect sense even though it does seem very complicated. Thank you for another insightful and helpful post xxxx
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Appreciate that you explain the science behind things, most channels just list the symptoms of disorders. You're great, thank you!
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I have always talked to myself when bad thoughts came into my head. It was not until later in life I understood where these bad or negative thoughts come from. I have been on prozac for 10 years. It helps me to not feel so negative about myself. I have also have had some therepy. When something negative comes into your mind make yourself to throw it out of your mind. I also pray about it and think of positive Bible versus and leave my problems in Godś hands. But to answer my prayers I also need medication and therepy. Never feel something is bad about yourself, it just is and you find help for it. I am 64 years old.
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I increased my Lexapro in mid-February and it now makes sense as to why I’m just starting to feel better. Thank you for your videos!
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These videos are great. I like how you don't dumb them down (there are plenty of Youtube videos like that) but you explain them as if talking to an intelligent person.
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I love this and am really glad you made this video. I've met many people who go through this for the first time not understanding how this works and often fall back into detrimental self-medicating (most common here are alcohol, cannabis, and opioids) that ultimately nulls the effectiveness of the treatment in general; due to our underfunded system, lacking of consistent care, affordable therapy, and education. Also sorry this comment is going to be so long. I've had this weird question I was wondering if you had an answer to regarding bipolar: All I get online are people saying "ask a biologist" and biologists saying "ask a psychiatrist". In general, when people lack sufficient sleep, they obviously end up fatigued, have heavy brainfog, mentally check out, etc, depending on how much sleep lost. But for people with bipolar, lack of sleep--even if just a few hours difference in one night--easily get thrown into mania or hypomania. I've been curious for the longest time why that happens and/or the biology behind that. I know bipolar affects circadian rhythm but other than that only have random assumptions like perhaps their body is attempting to compensate for it or something.
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After taking and stopping anti depressants, for over twenty years, due to side effects, I have been approved to start the TMS (Transcranial Magnetic Stimulation) treatments. I will also see a therapist as well. I hope this will, at last, be the final road on my long journey from hell to happiness. Your channel has been a light in the dark, to get me through to this point. The information you provide and that beautiful calm soothing voice, always makes me feel hope. Thank you.
