Finding the correct dosage for your antidepressant is essential for symptom relief and treating depression effectively. If your current dose is too low, you may still struggle with lack of motivation, crying spells, and sleepless nights.
This is especially the case if you are attending therapy, such as Cognitive Behavioral Therapy (CBT), or making lifestyle changes to improve your mental health, but still not seeing as much relief as you’d have thought. If you have been on your antidepressant for 6 to 8 weeks and are not seeing any therapeutic effects, consider speaking with your doctor about adjusting your dose.
Or if you have already tried multiple courses of medication, therapies for treatment-resistant depression, such as Ketamine Therapy and Transcranial Magnetic Stimulation (TMS) can provide long-awaited relief. Read on to learn more.
What Does It Mean When Your Antidepressant Dose Is Too Low?
When your antidepressant is considered too low, it means the medication dose is insufficient to produce the necessary therapeutic effects for depression or anxiety. Clinically, your antidepressant might be considered too low and need adjustments if you still show persistent symptoms, despite medication adherence, after 6 to 8 weeks [1].
Too low a dose does not block serotonin or norepinephrine reuptake like it’s supposed to, so likely you won’t experience the full benefits, such as improved mood, reduced anxiety, or better sleep. Your provider monitors symptom progression and side effects closely and may consider increasing the dose if no improvement occurs within the standard window.
5 Common Signs Your Antidepressant Dose Is Too Low
1. No Improvement or Worse Symptoms
It takes time for antidepressants to work, with 40% to 60% of people reporting symptom improvement within 6 to 8 weeks [1]. However, if in this time frame you notice your symptoms have not even slightly improved or have gotten worse (e.g., depressed thoughts turn into suicidal thoughts), speak with your doctor right away, who can adjust the dose or even switch medication.
2. Mood Changes
Antidepressants are supposed to help stabilize your mood and improve emotional regulation. If you continue to have sudden emotional shifts, such as crying spells or angry, aggressive outbursts after continued use of medication, it could mean the dose needs to be upped.
Speak with your doctor, as mood swings or feelings like anxiety can also be a short-term side effect of certain antidepressant SSRIs as your body adjusts to the medication.
3. Overreliance on Negative Coping Skills
Antidepressants aren’t a magic cure for depression, but they should improve symptoms enough to help you function daily (eat regular meals, sleep sufficiently, wake up at consistent times, perform well in school or work).
If you’re still using negative coping skills such as caffeine, excessive napping, or nicotine to manage symptoms such as lack of energy and low motivation, it could signal your current dose isn’t effective.
4. Odd Changes or No Change in Appetite
If your antidepressant dose is too low, you may continue to experience poor appetite or unexplained weight change as the medication may not be sufficiently correcting neurotransmitter imbalances that regulate hunger.
5. Sleep Difficulties
Ongoing insomnia or difficulty staying asleep can indicate an insufficient antidepressant dose. Research shows that mid-nocturnal insomnia is a common residual symptom when dosage or medication choice is inadequate [2].
However, it’s important to rule out other causes that could be causing poor sleep as well, such as lifestyle habits (e.g., using phone before bed) or symptoms of trauma, like nightmares.
What are The Signs My Antidepressant Dose Is Too High?
There’s also the case that your antidepressant dose may be too high, as finding the “sweet spot” can be challenging, and more medication or a higher dose doesn’t always equal better.
Signs that your antidepressant dose may be too high can include nausea, dizziness, headache, blurred vision, excessive sweating, dry mouth, and feeling unusually drowsy or confused.
More serious symptoms might include rapid heart rate, muscle twitching or rigidity, seizures, hallucinations, agitation, low blood pressure, difficulty breathing, and, in extreme cases, loss of consciousness. If you experience any of these symptoms, seek medical attention immediately.
What If Antidepressants Don’t Work?
Estimates suggest that about 30% to 41.5% of patients with Major Depressive Disorder (MDD) experience Treatment-Resistant Depression (TRD). TRD typically requires a failed response (often less than 25% improvement) to at least two antidepressants given at correct doses and for adequate durations [3].
Patients who are not responsive to antidepressants typically have more severe symptoms, higher rates of co-occurring disorders (PTSD or anxiety), and a greater risk for suicide. However, hope exists now more than ever. Evidence-based therapies such as CBT, DBT, and Dance Therapy show significant symptom improvement when combined with medication [4].
Healthcare providers are also exploring innovative techniques clinically supported by neuroscience, such as ketamine therapy and transcranial magnetic stimulation.
Alternative Treatment for Medication-Resistant Depression
For people whose depression does not improve with standard antidepressant medications, regardless of dose adjustments, alternative treatments have become essential in providing relief.
Currently, two of the most promising therapies for TRD are ketamine therapy and transcranial magnetic stimulation. Both of these are proven to provide quick, targeted relief, with few side effects.
Ketamine Therapy for Depression
Ketamine, long used as a surgical anesthetic, has emerged as a fast-acting antidepressant, effective for treatment-resistant depression. It’s administered intravenously or as a nasal spray with the FDA-approved version “Esketamine”.
Ketamine acts on glutamate receptors to increase neuroplasticity and quickly reduce depressive symptoms, often within hours to days. Studies show that ketamine can achieve significant symptom improvement in many who have not responded to conventional treatments. It is also growing in popularity for its ability to treat intense anxiety, OCD, and help emotional blocks from PTSD [5].
TMS Therapy for Depression
Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure FDA-approved for depression that uses magnetic fields to stimulate nerve cells in the brain regions involved in mood regulation, particularly the left dorsolateral prefrontal cortex.
TMS treatments typically last about 30 minutes, are conducted daily over several weeks, and have shown efficacy in reducing symptoms of depression without the side effects commonly associated with medications [6].
Medication Management, Ketamine, and TMS Therapy for Depression in Utah
If you’ve already tried conventional methods of mental health treatment with no relief, ketamine or TMS may be a good option for you. At Maple Mountain Mental Health and Wellness, we offer both of these growing, innovative approaches to target treatment-resistant depression.
We also have a team of licensed psychiatric providers who can make adjustments to medications you are currently taking and help get you on the best course of treatment personalized for your needs.
Contact our admissions team if you believe your antidepressant medication needs adjusting or if you would like to learn more about whether you are a candidate for TMS or ketamine therapy.
Sources
[1] Carvalho, F. et al. (2021). How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Revista Brasileira de Psiquiatria (São Paulo, Brasil: 1999), 43(2), 189–202.
[2] Cubała, W. J. (2023). Residual insomnia in major depressive disorder: a systematic review. Frontiers in psychiatry, 14, 1190415.
[3] Maj, M. et al. (2023). Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World psychiatry: official journal of the World Psychiatric Association (WPA), 22(3), 394–412.
[4] Dunlop, W. (2016). Evidence-Based Applications of Combination Psychotherapy and Pharmacotherapy for Depression. Focus (American Psychiatric Publishing), 14(2), 156–173.
[5] Grinspoon, P. 2024. Ketamine for treatment-resistant depression: When and where is it safe? Harvard Health.
[6] Khan, A. M. (2019). Use of Transcranial Magnetic Stimulation for Depression. Cureus, 11(5), e4736.