If an antidepressant makes you feel worse, tell your prescriber before you stop it

You were handed an antidepressant, or you are about to be, and the first weeks are not what you hoped. There can be side effects before any relief. Or you feel a little better and wonder whether you can stop. Both are points where a person is tempted to decide alone.

If an antidepressant is hard to take, or you want to stop it, talk to the person who prescribed it before you change anything, and do not stop suddenly.

That is the NHS’s advice in its own words: “Do not stop taking an antidepressant suddenly or without talking to your doctor first.” This page is for adults in the US or the UK who take an antidepressant or have been offered one. It cannot tell you whether to take one. If you are not on one and are thinking of starting from something you read online, a doctor decides that, and the last section says who this page is not for.

What the first weeks can be like

The NHS says antidepressants “usually take 1 to 2 weeks to start having an effect and can take up to 8 weeks to work fully”. The US National Institute of Mental Health (NIMH) says they usually take 4 to 8 weeks, and that problems with sleep, appetite, energy and concentration often improve before mood lifts. The NHS and the NIMH give different timings, so ask your prescriber what to expect with yours.

On side effects, the NHS says many ease after a couple of weeks as your body gets used to the medicine, though some may carry on. Among the common ones it lists are mood changes such as feeling more angry or emotionally numb, feeling agitated, shaky or anxious, difficulty sleeping, headaches, feeling sick, dizziness or drowsiness, loss of appetite and sexual problems. It says “Some side effects are rare but serious and you may need urgent medical help”, and to check the leaflet that comes with your medicine. In England, it says you will be seen by a doctor every 1 to 2 weeks when you first start, and that if you are 18 or over and prescribed one of the most commonly used antidepressants for the first time, you can use the NHS New Medicine Service to get additional advice and support from a pharmacist. NIMH says that people who are sensitive to side effects sometimes benefit from starting with a low dose, raising it very slowly, and changing when or how they take it, for example at bedtime or with food. Whether any of that fits you is for your prescriber to say.

The NHS’s advice for a hard time is short: “If you’re finding side effects hard to manage or do not feel your medicine is helping you, talk to your doctor. They can discuss treatment options with you.” One person describes that a doctor halved their starting dose and the nausea and tiredness eased. One person describes a racing heart, shaking and tingling on the first dose and stopping the medicine at once. This page cannot say whether that reaction needs urgent care. If a reaction feels severe or frightens you, get urgent medical help, and in an emergency call 911 in the US or 999 in the UK.

Some people say the first antidepressant may not be the one that suits, and that finding the right one can take more than one try. NIMH says the same: it may take several tries to find the medicine that works best with the fewest side effects. The NHS says the main types generally work as well as each other for depression, but differ in who can take them and in side effects, and that some people find one type works better for them. One person says a medicine that helped one person caused severe anxiety in another.

Two things are easy to miss. One person says emotional numbness crept in slowly and was noticed by people close to them before they noticed it. The NHS lists emotional numbness among the common side effects, so it can be worth asking someone you trust whether they have seen a change, and telling your prescriber. And one person warns that energy can come back before mood does, and that this can be a risky gap for someone with thoughts of suicide. NIMH says people of all ages taking antidepressants “should be watched closely, especially during the first few weeks of treatment”. That is why the box at the top comes first.

If you want to stop

The NHS says you will usually carry on taking antidepressants for at least 6 months after your symptoms improve, and to talk to your doctor if you want to stop. It says they will help you agree a plan to reduce your dose gradually, usually over several weeks or months. NIMH says people should not stop a prescribed medication even if they feel better, without the help of a health care provider, and that a provider can lower the dose slowly and safely.

The NHS says coming off can cause withdrawal symptoms, including headaches, aching joints and muscles, feeling sick, sweating, a racing or fluttering heart, dizziness or unsteadiness, sleep problems and strange dreams, feeling low, suicidal, emotionally numb or like things are not real, restlessness, irritability, anxiety or tearfulness, confusion, and unusual feelings in the body such as an electric shock in the head, sometimes called “brain zaps”. It says most people get some symptoms, that some of them “may feel like your condition is coming back”, and that they often stop within a few weeks. It also says some people have a harder time: it can be severe for some, start weeks or months later, and last months or longer, and this may be more likely the longer you have taken antidepressants or the higher your dose. Its advice: speak to your doctor, who may suggest reducing the dose more slowly or going back to a higher dose before trying again.

So a low mood while you are coming off a medicine may be withdrawal and not your depression returning, because the NHS says some withdrawal symptoms feel like the condition is coming back. Only a prescriber can help sort out which. If you feel suicidal at any point, the box at the top applies, whether or not you have changed a dose. One person describes withdrawal from some antidepressants as severe, and says it needed very small steps down. One person says their prescriber was not sure of a slow reduction schedule and they had to find out more themselves. If that happens to you, the NHS page links to Mind’s information on coming off psychiatric medication, and the NHS says to speak to your doctor if withdrawal is hard.

Medicine or not: how people weigh it

Some people say medicine is what let them climb out of a bad stretch; one person says refusing anxiety medicine they needed for years did more harm than taking it would have. Some people say it flattened them or that withdrawal was too hard, and they urge trying therapy, sleep, food and activity first; one person says that if the cause is the situation, changing the situation matters more than long-term medicine. One person prefers to wait for a clearer scientific picture of how antidepressants work. People disagree, and this page does not settle it.

The NHS says treatment for depression can involve lifestyle changes, talking therapies and medicine, and that your recommended treatment depends on how severe your depression is. For moderate to severe depression it says a combination of talking therapy and antidepressants is often recommended. This page does not pick for you. It is only about what to do if you are on a medicine or about to start one.

Other things to tell your prescriber

NIMH says to tell a prescriber about all other medicines, vitamins and supplements you take, about any allergies, and about any problems with medicines in the past. The NHS says taking antidepressants with alcohol, some other medicines (including anti-inflammatory painkillers such as ibuprofen, and other antidepressants), some foods and drinks, St John’s wort, and drugs such as cannabis or ketamine can cause problems, and that alcohol can make symptoms worse or make you sleepy or dizzy. NIMH says combining antidepressants with some other medicines or supplements, such as triptans (often used for migraine) or St John’s wort, can cause a rare but life-threatening illness called serotonin syndrome, with agitation, muscle twitches, hallucinations, a high temperature and unusual blood pressure changes. If you notice those after a change, get urgent medical help, and call 911 or 999 if they are severe.

Who this page is not for

If you are in crisis now, call or text 988 (US) or call 116 123 (UK), or 911 or 999 if you are in danger. If you are not on an antidepressant and are weighing whether to start one, this page cannot help you decide: a doctor does. The NHS says antidepressants are usually not recommended to treat depression in under-18s, that some can be taken in pregnancy, with a doctor helping you understand the benefits and risks, and that some can be taken while breastfeeding if your doctor or health visitor says your baby is healthy and your doctor thinks the benefits to you outweigh any possible risks to your baby, so for those readers the doctor comes first. Other medicines, such as sleeping pills, anxiety medicines, mood stabilisers and antipsychotics, have their own rules; NIMH says not to stop any prescribed medicine without a provider’s help, and one person says one class of anxiety medicine can be very hard to come off, so ask whoever prescribed it. Unproven or illegal routes, such as hallucinogenic mushrooms, are not covered here.

Who to call

In the US, 988 is the Suicide & Crisis Lifeline: you can call or text it for suicidal thoughts or a crisis. The SAMHSA National Helpline (1-800-662-4357) helps with mental health and substance use and can connect you to local services. For a pharmacist or prescriber’s question about your own medicine, phone the pharmacy that fills it.

In the UK, Samaritans (116 123) take calls any time. In England, the NHS says to call 111 and select the mental health option, or to ask for an urgent GP appointment, and to call 999 or go to A&E if your life is at risk or you do not feel you can keep yourself safe. In Wales, NHS 111 Wales and the C.A.L.L. helpline (0800 132 737) are open any time. In Scotland, NHS 24 (111) can help. In Northern Ireland, Lifeline (0808 808 8000) is open any time, and your GP or the GP out-of-hours service can speak about a medicine. Mind’s Infoline (0300 123 3393, England and Wales, weekdays 9am to 6pm) gives information about treatment, and is not a crisis service.

If you are in danger now, call 911 in the US or 999 in the UK.