Time until Antidepressant Effectiveness and Side Effects | Explaining SSRIs and SNRIs by Generic Name
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Antidepressants are not medications that take effect immediately after you start taking them. In fact, there is a time lag where side effects often appear before the desired effects, leading many people to stop taking them within the first few days, feeling that "it didn't work and just made me feel sick."
This page will organize information about the types of antidepressants, the timeline for their effects to appear, common side effects at the beginning of treatment, the truth behind why people say "it's better not to take them," and how to discontinue them. Medications are referred to by their generic names.
Main Types of Antidepressants
| Category | Representative Generic Name (Brand Name) | Characteristics |
|---|---|---|
| SSRI (Selective Serotonin Reuptake Inhibitor) | Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro), Fluvoxamine (Luvox) | Relatively few side effects, widely used for depression and anxiety disorders |
| SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) | Duloxetine (Cymbalta), Venlafaxine (Effexor) | May be used when accompanied by low motivation or physical pain |
| NaSSA | Mirtazapine (Remeron, Reflex) | Said to have relatively quick effects on sleep and appetite |
There is no ranking of which is superior; the choice depends on factors such as whether there is insomnia, decreased appetite, severe anxiety, or co-administered medications.
Timeline for Effects to Appear
The effects of antidepressants appear gradually. It's important to note that the feeling of "brightening mood" does not come first.
| Period | Common Occurrences |
|---|---|
| Start of dosage ~ 1 week | Common period for side effects such as nausea, diarrhea, drowsiness, and headache. Effects are still difficult to feel. |
| 1 ~ 2 weeks | Side effects start to lessen. Improvement often appears first in sleep and appetite. |
| 2 ~ 4 weeks | Period when changes in mood and motivation begin to be noticed. First benchmark for effect evaluation. |
| 6 ~ 8 weeks | Period to evaluate effects after continuing at a sufficient dose. If insufficient, consider increasing the dose or changing medication. |
Therefore, you cannot judge that it's not working after taking it for only a few days. Conversely, if side effects are too strong to continue, do not tolerate them and consult early to consider changing medication.
Common Side Effects at the Start of Treatment
- Gastrointestinal symptoms: Nausea, loss of appetite, diarrhea. Most common with SSRIs, and usually lessen within 1-2 weeks.
- Drowsiness, headache, dizziness: Can sometimes be managed by adjusting the timing of medication.
- Impact on sexual function: Decreased libido or delayed ejaculation. These symptoms can be difficult to discuss, but may improve with a change in medication.
- Weight changes: Some medications, such as mirtazapine, can increase appetite and lead to weight gain.
- Activation syndrome: Anxiety, irritability, and restlessness may intensify shortly after starting medication or increasing the dose. This requires particular caution in younger individuals, and if these symptoms appear, please consult your doctor immediately.
Additionally, combining multiple medications with serotonergic effects can lead to serotonin syndrome, accompanied by fever, sweating, tremors, and confusion. Please inform your doctor about all medications you are taking, including over-the-counter drugs and supplements.
Why do people say "it's better not to take SSRIs"?
The widespread use of this phrase is due to a mix of facts and misunderstandings.
| What is said | The reality |
|---|---|
| You feel unwell when you start taking them | Most improve within 1-2 weeks, but if it's severe, medication can be changed. |
| You won't be able to stop taking them | This is different from the dependence associated with anti-anxiety medications. However, abrupt discontinuation can cause discontinuation syndrome, so gradual tapering is necessary. |
| Caution is needed for those under 24 years old | There have been reports of an increased possibility of suicide-related thoughts and behaviors in young people, and particularly careful monitoring is conducted during the initial phase. |
| Not suitable for people with bipolar disorder | Using antidepressants based solely on depressive symptoms can trigger manic episodes. It is important to confirm past mood swings. |
| Personality changes | There is no such effect. However, emotional fluctuations may feel flattened, and in such cases, adjustments can be made. |
In conclusion, it is more accurate to understand that it is not a "medication you shouldn't take," but rather a "medication that requires diagnosis and ongoing monitoring."
Medications That May Be Used Concurrently
If antidepressants alone do not provide sufficient effect, or if specific symptoms are severe, the following medications may be used concurrently:
- Sulpiride: Originally used as a gastrointestinal medication, small doses may be used for appetite loss or low mood. Long-term use can cause menstrual irregularities, galactorrhea, and hand tremors, so care is needed to avoid continuing it indiscriminately.
- Aripiprazole: A small amount may be added when the effect of antidepressants is insufficient. Watch out for restlessness (akathisia) and changes in weight.
- As-needed anti-anxiety medications: May be used concurrently only during the period until antidepressants take effect, but long-term regular use should be avoided.
How Long to Continue Taking Medication
If discontinued immediately after symptoms improve, the likelihood of relapse increases. Generally, from the perspective of preventing relapse, it is recommended to continue the same dose for several months or more, often about six months, even after symptoms have stabilized. If relapses are recurrent, it may be continued for an even longer period.
Self-discontinuation with the belief that "I'm feeling better, so I don't need it anymore" is the most common trigger for relapse.
Discontinuation Syndrome When Stopping Medication
Abruptly stopping antidepressants can cause symptoms such as dizziness, electric-shock-like sensations in the head, nausea, anxiety, irritability, and insomnia within a few days. This is called discontinuation syndrome and is a different phenomenon from dependence. It is said to be particularly common with medications that have a short half-life.
When discontinuing, gradually reduce the dose over several weeks to several months under the guidance of a doctor. Similar symptoms can occur if you repeatedly miss doses, so please be careful to continue taking your medication as prescribed.
Handling in Online Consultations
Antidepressants such as SSRIs, SNRIs, and NaSSAs, which have been introduced so far, are not subject to strict prescribing restrictions as psychotropic drugs like benzodiazepine anti-anxiety medications and sleeping pills. Therefore, they can be prescribed even during an initial online consultation. Even those who "don't have time to go to a hospital" or "want to consult from home first" can start antidepressant treatment online.
However, it often takes about 2 to 4 weeks to feel the effects, and they do not have the immediate efficacy of anti-anxiety medications. The appropriate approach differs depending on whether you want immediate symptom relief or aim for fundamental improvement. Please discuss the treatment plan best suited to your condition with your doctor through an online consultation and examination.
SSRI (Zoloft) can be prescribed via online consultation
View ZoloftFrequently Asked Questions
Yes. SSRIs are not subject to strict prescribing restrictions as psychotropic drugs, so they can be prescribed from your first online consultation. After an interview and examination, same-day shipping is also available.
It usually takes about 2 to 4 weeks to feel the effects of SSRIs. It is common to observe for about 6 to 8 weeks to determine efficacy, so it is important to continue without giving up immediately. It is a treatment where you start, monitor progress, and adjust with your doctor.
Initial side effects like nausea often subside within a few weeks, but if they are severe and distressing, do not stop on your own. Please consult a doctor online. We may consider changing the medication (e.g., switching from sertraline to another SSRI).
The most suitable medication varies depending on your symptoms and constitution. During the consultation, after hearing about your medical history and preferences, your doctor will suggest options, including Zoloft (sertraline).
It depends on your symptoms and progress. We often recommend continuing medication for a certain period even after improvement, and the timing of discontinuation will be decided in consultation with your doctor. You can start taking it first and then decide on the course of action while observing your progress.
Yes. Both initial and follow-up consultations can be completed online. Prescribed medications are delivered to your home, so you can continue treatment without the burden of hospital visits.
