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.
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
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
"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.