Tempted to Quit Antidepressants?

Antidepressants are designed to boost mood and relieve sadness, but for some patients, their side effects fuel another emotion: frustration. Just ask Maryland resident Jane Niziol. Her doctor prescribed Paxil after a difficult breakup left her feeling depressed and overwhelmed. Niziol recalls the medicine calmed her mood. "Suddenly I didn't care about anything."  

Except that the drug started to affect her waistline. After just a few months on Paxil, Niziol gained nearly 35 pounds. She soon found herself faced with a frustrating choice: Feel better on the medicine or feel fat? "I decided to stop taking it because I got fat," she admits.

Stories like Niziol's are common and unfortunate, experts say. Many patients with major depression quit antidepressant therapy too soon after starting, usually because of unwanted side effects, and often without telling their doctor.

Niziol gave antidepressant therapy a good, long try - she stuck with it for several months. But "at least 30% of patients who are prescribed an antidepressant never refill the medication after the first month," says Gary J. Kennedy, MD, director of the division of geriatric psychiatry at the Montefiore Medical Center in New York.

Quitting too soon makes it more likely depression symptoms will return. According to the National Institute of Mental Health (NIMH), patients with major depression should take an antidepressant for at least six to 12 months so the drug has time to work.

Give It Time

Antidepressants can be a valuable tool in the treatment of major depression, but they aren't a quick fix. They work by restoring the balance of naturally occurring, mood-regulating substances in the brain called neurotransmitters.

But these changes take time to occur. You won't notice an improvement in symptoms soon after you swallow the pill, like you might when you take a painkiller. Most patients see signs of improvement within two to four weeks.

"Patients need to take the medication 'on faith' [that they'll soon feel better]," Boadie W. Dunlop, MD, director of the Mood and Anxiety Recovery Program at Emory University School of Medicine, tells WebMD. "Early changes may not be very noticeable to a patient, although a spouse may note that the patient is less irritable." 

But a lot of patients give up before the drug has had time to enact changes in the brain's chemistry. Side effects are the most common reason for quitting an antidepressant within the first two weeks.

Fatigue, nausea, insomnia, and sedation are common and most notable when the drug is first started. Stomach upset occurs in about 5% to 10% of patients. Doctors say these side effects, while frustrating, usually go away within a few weeks, and they encourage patients to persevere and continue therapy. Patients who are depressed can be vulnerable to feeling pessimistic or hopeless about antidepressant treatment and may give up too early, Dunlop warns.  He says patients need to understand that treating the depression will make them more able to tackle the challenges in their life and thereby improve their overall situation.

"Sometimes, the doctor has not taken the time to explain the rationale for treating the depression and how the medicines are thought to work, so the patient may not fully comprehend the reason for the medications and stop prematurely," Dunlop says.