You might consider switching antidepressants if you're still experiencing symptoms of depression. Some signs that your current medication may not be working include unpleasant side effects, worsening symptoms, or trouble sleeping. This can sometimes happen if your body builds a tolerance to the medication.

The most effective antidepressant is one that lifts your mood, reduces your depression symptoms, and helps you achieve remission. If you're not seeing any improvement, it could be a sign that your dosage is too low.

On the other hand, taking too high or too strong a dose could lead to an overdose.

Finding the right treatment can take some trial and error. Solutions may include adjusting the current dose, adding a second medication, or switching to a different antidepressant altogether. Below are some common signs your antidepressant may not be working properly and when it’s time to contact a healthcare provider.

1. You Develop a Tolerance

People often take antidepressants for six to twelve months or longer. If the medication no longer works as effectively as it once did, you might have developed a tolerance. This is known as antidepressant tachyphylaxis, which refers to a reduced response to a medication over time.

Studies show that individuals taking selective serotonin reuptake inhibitors (SSRIs) may be more likely to develop tolerance. SSRIs are a common class of antidepressants that help increase levels of serotonin, a hormone involved in regulating mood.

2. You Develop Serotonin Syndrome

Serotonin syndrome is a rare but serious reaction to antidepressants. It may occur when an antidepressant interacts with other medications or in cases of overdose.

Common symptoms include:

  • Agitation

  • Confusion

  • Rapid heartbeat

  • Flushed skin

  • Heightened anxiety

  • Nausea and vomiting

  • Restlessness

  • Excessive sweating

These symptoms usually appear within 24 hours and tend to go away after the antidepressant is stopped. A healthcare provider may decide to lower the dose or switch to a different medication.

3. You Do Not Get Enough Sleep

Antidepressants can affect sleep quality. Common side effects include insomnia (difficulty falling or staying asleep) and excessive sleepiness. Oversleeping or not sleeping enough can negatively impact your mental health and potentially worsen symptoms of depression.

To manage these side effects, a healthcare provider might suggest:

  • Avoiding caffeine later in the day

  • Not napping after mid-afternoon

  • Exercising regularly

  • Maintaining a consistent sleep schedule

  • Practicing a relaxing bedtime routine, such as reading or taking a warm bath

4. You Have Side Effects

Antidepressants can cause unpleasant side effects that may interfere with your daily life. Common ones include:

  • Blurry vision

  • Dizziness

  • Drowsiness

  • Dry mouth

  • Headache

  • Increased anxiety

  • Insomnia

  • Decreased or absent sex drive

  • Nausea

  • Weight gain

If these side effects affect your quality of life, it's important to speak with a healthcare provider. They can help you weigh the risks and benefits and explore other medication options if needed.

5. You Skip Doses

Missing doses or taking your medication inconsistently can reduce the effectiveness of antidepressants. To get the full benefit, it’s essential to take them as prescribed by your healthcare provider.

6. Your Symptoms Are Not Improving

It’s common to notice improvements in sleep and appetite before you feel better emotionally. Most people begin to see changes in their mood within four to eight weeks. If there’s little or no improvement after several weeks, a provider might suggest switching medications.

Everyone responds differently to antidepressants, so it can take time to find the right one for you.

7. Your Symptoms Get Worse

If your symptoms worsen after starting an antidepressant, this may be a sign that the medication isn’t working properly. Let your healthcare provider know if you experience:

  • Physical aches or pains

  • Appetite changes

  • Digestive issues

  • Feelings of sadness, anxiety, irritability, or hopelessness

  • Loss of interest in hobbies or daily activities

  • Changes in sleep patterns

  • Thoughts of self-harm

  • Persistent fatigue

When To Contact a Healthcare Provider

You should always consult a healthcare provider before stopping or switching antidepressants. Stopping suddenly can lead to withdrawal-like symptoms such as agitation, “brain zaps,” insomnia, and nausea. These effects highlight the importance of tapering off medication under professional guidance.

Questions To Ask Your Provider

Here are some questions to ask a healthcare provider if you want to stop or switch antidepressants:

  • How long does it take for an antidepressant to work? How long will I need to take it?
  • What other things can I do to alleviate symptoms?
  • What other treatments for depression are available?
  • What side effects can I expect? Is there anything I can do to manage them?
  • When and how often do I take antidepressants?

Changing Your Depression Medications

Mental health professionals often talk about “response” and “remission.” A response means partial improvement, while remission means that symptoms have mostly or completely gone away. Achieving remission is the goal for most people.

If your current medication isn’t helping, your provider may consider different strategies, such as:

  • Continuing the current dose but adding another antidepressant (combination therapy)

  • Adding a different type of medication to boost effectiveness (augmentation therapy)

  • Increasing the dosage

  • Recommending psychotherapy

  • Switching to another antidepressant entirely

Switching medications usually involves tapering off the current drug and slowly introducing a new one.

Types of Antidepressants

There are several types of antidepressants your provider might consider:

  • Atypical antidepressants: These work differently than other classes and help the brain use mood-related chemicals. Examples include mirtazapine (Remeron) and bupropion (Wellbutrin).

  • Atypical antipsychotics: Occasionally used based on diagnosis and side effect tolerance. Examples include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).

  • Monoamine oxidase inhibitors (MAOIs): These are used when other drugs haven’t worked and can have more serious side effects. Examples include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

  • Selective serotonin reuptake inhibitors (SSRIs): These increase serotonin levels. Common examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft).

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These raise both serotonin and norepinephrine levels. Examples include duloxetine (Cymbalta), venlafaxine (Effexor XR), and desvenlafaxine (Khedezla).

  • Tricyclic antidepressants (TCAs): These work similarly to SSRIs but tend to cause more side effects. Examples include clomipramine (Anafranil), trimipramine (Surmontil), and imipramine (Tofranil).

A Quick Review

Your antidepressant may stop working effectively if you develop side effects, experience worsening symptoms, or have trouble sleeping. The problem could be related to an inappropriate dose—too low, too high, or too strong. A healthcare provider can help by adjusting the dose, adding a second medication, or switching to a different one. Always seek medical advice before changing or stopping your medication.