Antidepressants are medications used to treat depression and other mental health conditions like anxiety, OCD, and PTSD. They work by increasing the levels of certain neurotransmitters like serotonin, norepinephrine, and dopamine in the brain. While antidepressants can be very effective in treating these conditions, sometimes the dose prescribed can be too strong or cause unpleasant side effects. So how do you know if the antidepressant you are taking is too strong? Here are some signs to look out for.
Side Effects
Most antidepressants cause some side effects, especially when you first start taking them. Common side effects include nausea, headache, sleep problems, agitation, decreased sex drive, and weight gain or loss. These tend to improve with time as your body adjusts to the medication. However, if the side effects are severe, persistent, or interfering with your daily life, it could be a sign the antidepressant dose is too high. Some specific side effects to watch out for include:
- Extreme fatigue or sleepiness
- Dizziness or lightheadedness
- Blurred vision
- Rapid or irregular heartbeat
- Muscle spasms, shaking, or tremors
- Severe irritability or agitation
- Extreme anxiety or restlessness
These types of side effects suggest the medication levels in your system are too high and may require dosage adjustment.
Worsening Mental Health Symptoms
While antidepressants are meant to improve symptoms of depression and anxiety, sometimes they can make symptoms worse, especially right when first starting. However, if symptoms continue to get worse with continued treatment, it could mean the medication dose needs adjusting.
Some signs that mental health symptoms are worsening on antidepressants include:
- Increasing depression, sadness, crying spells, hopelessness
- More frequent or more intense anxiety or panic attacks
- Emergence of manic symptoms like hyperactivity, impulsiveness, racing thoughts
- New or worsening suicidal thoughts
- Hallucinations or delusional thinking
Notify your doctor right away if you experience any new psychiatric symptoms or any worsening of existing symptoms. This may be a sign you need a lower antidepressant dose or to switch medications completely. Do not abruptly stop medication on your own.
How Antidepressant Dosages Are Determined
Antidepressant dosing is not an exact science. Finding the ideal dose that provides maximum benefit with minimal side effects requires some trial and error. Here are some factors that influence antidepressant dosage:
Age
Older adults are often started on lower antidepressant doses because their bodies process medications more slowly. Higher doses can more easily build up to toxic levels in their system.
Other Medications
If you take other prescription medications, drug interactions may increase or decrease antidepressant levels in your body. Your doctor may prescribe a lower dose to start, then adjust up from there.
Liver and Kidney Function
If you have any impairment in liver or kidney function, it can affect your ability to metabolize antidepressants. Your doctor will monitor this and adjust dosage accordingly.
Genetics
Genetic differences affect liver enzymes that metabolize antidepressants. Gene testing can sometimes identify if you are a poor, intermediate, extensive, or ultra-rapid metabolizer, allowing more personalized dosing.
Symptom Severity
People with more severe depression or anxiety often need higher antidepressant doses to improve symptoms. Milder cases may respond well to lower doses.
Starting at a Low Dose
Since it is impossible to predict exactly how a person will respond to an antidepressant, most doctors start at a low dose and increase gradually until therapeutic effects are achieved. Some general starting doses for common antidepressants:
| Antidepressant | Common Starting Dose |
|---|---|
| Prozac (fluoxetine) | 10-20 mg/day |
| Zoloft (sertraline) | 25-50 mg/day |
| Lexapro (escitalopram) | 10 mg/day |
| Effexor (venlafaxine) | 37.5 mg/day |
| Cymbalta (duloxetine) | 30 mg/day |
| Wellbutrin (bupropion) | 150 mg/day |
This allows the body to adjust to the medication slowly and reduces risk of severe side effects. The dose can then be increased every 1-2 weeks if needed and tolerated. Some people may see benefits at lower doses. Higher doses do not always mean better efficacy.
Maximum Recommended Doses
While dosage must be individualized, every antidepressant has a maximum recommended dose. Exceeding this provides little added benefit and increases side effect risks. Maximum doses per day for some common antidepressants:
| Antidepressant | Maximum Recommended Dose |
|---|---|
| Prozac (fluoxetine) | 80 mg |
| Zoloft (sertraline) | 200 mg |
| Lexapro (escitalopram) | 20 mg |
| Effexor (venlafaxine) | 375 mg |
| Cymbalta (duloxetine) | 120 mg |
| Wellbutrin (bupropion) | 450 mg |
Doses above these provide little added psychiatric benefit for most people. Higher doses could indicate potential over-medication requiring adjustment.
Monitoring Blood Levels
For some antidepressants, blood tests can measure medication levels to see if they are within the therapeutic window. This can help confirm if symptoms are due to having too little or too much medication on board. Checking levels requires timing blood draws carefully, as timing matters. Work with your doctor to interpret blood levels in context with your symptoms.
Trust Yourself
You know yourself best. Pay attention to any new symptoms or side effects you experience when starting an antidepressant or dose increase. Keep track of any changes in your mood and mental state. Don’t dismiss anything as unimportant. Promptly report any concerns or observations to your doctor. Your input guides proper antidepressant dosing.
Conclusion
Finding the optimal antidepressant dose provides the greatest chance of treatment success. Dose too low and symptoms don’t improve. Dose too high and side effects overwhelm any benefits. Start low and go slow when adjusting dose, carefully monitoring symptoms and side effects. Maximum doses are not always best. Blood levels can sometimes guide dosing. But often it comes down to carefully listening to the patient. Speak up about any concerns so your doctor can adjust dosing for maximum efficacy and tolerability. Ongoing open communication ensures antidepressant treatment is helping, not harming.