Finding the right antidepressant or anti-anxiety medication (or combination of medications) requires ongoing effort—a persistence that can quickly disappear if side effects start to appear.

Everyone’s brain and body react and process medications differently, so for some people, getting on the right medication regimen can be a frustrating process. The most frustrating thing is that we don’t always Know why.

There are some clues that doctors can use to try to predict someone’s personal response to a prescription — the symptoms they’re experiencing, how they’re responding to other medications, and sometimes, certain types of genetic testing — but even with those clues, for many people That said, it’s still a matter of trial and error.

Trying to predict how a drug will work in a specific individual is nearly impossible, so we must make decisions based on what we know about the patient and the drug to try to get the best chance of successful treatment.

The occurrence of side effects does not always mean that the medication needs to be stopped or changed. But if you feel like something isn’t right, these common side effect scenarios can help you figure out what to do next.

You feel better right away (but it doesn’t last)

Most currently available medications work by indirectly increasing levels of neurotransmitters thought to play a role in mood disorders and anxiety, such as serotonin, norepinephrine, or dopamine, but mood disorders and anxiety are not just The ups and downs of these neurotransmitters.

Sometimes changes that occur immediately after starting a medication (or changing the dose of the medication) can have a temporary effect on mood or anxiety. We still don’t know why this happens in some people, but there are some theories.

Depression and anxiety have different patterns, and sometimes a pattern initially responds well to something but then gets worse because we don’t match the right medication to the right pattern.

For example, a person with bipolar depression may experience some initial improvement after taking medication, but the improvement will not be long-lasting and may require more mood stabilizers than antidepressants.

Likewise, concurrent use of substances or medical conditions that may mimic depression (low thyroid disease) can sometimes explain why transient responses diminish over time.

Medication alone is often not enough to achieve optimal recovery for many people. Maintaining physical health (sleep, exercise, nutrition, other illnesses) and avoiding substances are both part of maintaining your mental health.

Then there’s the placebo effect – the belief that a drug will work – because all drugs have meaning in what it means to take them.

The placebo effect itself isn’t bad, but many people in clinical trials of new drugs respond to placebo pills, in part because having hope in something is inherently good for mental health.

You experience side effects that don’t go away

Some people are more sensitive to drug side effects than others. There are often unknown factors at play, but for some people it may be that they metabolize drugs more slowly, so they tend to build up in the system.

If this is a recurring problem for you, some forms of genetic testing can check how your liver processes these medications, which can highlight opportunities for trying or avoiding medications due to differences in metabolism rates.

You may experience mild nausea, fatigue, or headaches for a few days as your body adjusts to the medication (it may take up to 12 weeks to see the full effects). However, if you experience persistent side effects (diarrhea), these may outweigh the benefits of the drug, and your doctor may want to consider another.

For best results, follow up with your doctor within a few weeks or a month and communicate any side effects you have been experiencing. It’s not just finding the right medication for your condition, but also the right dosage and lifestyle supplements that are key.

Your symptoms make a comeback

Depression and anxiety can be tricky—some people relapse even if they take their medication faithfully.

Turns out, this isn’t unusual.Think of it like asthma: An inhaler may control your asthma pretty well, but sometimes, when seasonal allergies hit, or you spend the night at a smoky bar and put it down, you may have a flare-up.

Likewise, if your stressors continue to mount—you got laid off, your chronic illness flared up, you’re leaving a rocky relationship—you may find your symptoms return, or even become more severe. Even though you are still taking the medication you once strictly adhered to.

This is my most common situation. It’s not that antidepressants suddenly failed, it’s that circumstances have changed or changed and now your depression will be worse.

If there are indeed no significant changes in your environment that could override the effectiveness of your medication, this may be a sign that your medication’s effectiveness is diminishing.

Drugs act on receptors in our cells, and our neurons (brain cells) can modulate their level of response to the drug by adding or removing some of these receptors, thus changing the level of effectiveness.

This doesn’t happen to everyone who takes a particular drug, our individual biology does have an impact, but it’s one of the reasons why drugs that once worked no longer work.

Your depression or anxiety get worse

Doctors usually give you the mildest drugs first, which also have good efficacy and side effects, and then add auxiliary drugs and change the dosage or drugs based on the patient’s response.

While it is true that these medications may take some time for patients to feel the benefits, you should not feel worsened soon after starting. This is a sign that your medication may not be right for you, and you should talk to your doctor about trying other medication options.

You barely notice a difference in how you feel

Many people have only a partial response to medication—for example, they may no longer have panic attacks but still experience high levels of anxiety that interfere with daily life.

The reality is that we rarely get complete symptom relief with the first medication, the first dose, and for many people several dose adjustments are not uncommon.

Another possibility is that the medication simply doesn’t work despite taking it for the recommended time. If there is no change after one month, contact your doctor to discuss other treatment options. These may include trying different classes of medications, using combinations of medications, and consulting a psychiatrist for further evaluation.

Your moods have become intense and unpredictable

Mood swings may be another indicator that the medications you’re taking don’t match your specific depression patterns.

Distinguishing clinical differences between bipolar (characterized by depressive and manic episodes) and unipolar (persistently depressed mood without a history of mania) patterns of depression can be difficult. People with bipolar depression sometimes experience sudden changes in their mood or energy after they start taking antidepressants and mood stabilizers.

New mood-focused symptoms, such as intense mood modification, mixed mood states, hypomania or mania following antidepressant medication, may signal a different underlying mood disorder pattern that is considered masked by the severity of depression.

Your sleep quality plummets

Medication side effects may include drowsiness during the day and restless sleep at night.

It’s also not uncommon to start experiencing strange dreams.This can sometimes be a side effect of medication, a precursor to a different pattern of depression, or a natural worsening of mood symptoms after starting treatment.

Usually, these initial side effects disappear within a week or two as your body adjusts to the medication. You can try changing the time of day you take your medication to give yourself more time to relax before bed, or take an over-the-counter medication (such as melatonin) to help you through the adjustment period.

Drastic changes and side effects that are intolerable or cause crises or safety concerns should be addressed immediately by your doctor. They can offer their knowledge and experience to help you develop an effective treatment plan faster and more efficiently.

How to streamline the process of finding a medication that works for you

Because the disease states of depression and anxiety are subjective, the best way to simplify the process of establishing an effective medication regimen comes down to communicating with your doctor as much as possible.

We don’t have a standard blood test that can tell you that someone has depression or anxiety based on the results. As a service provider, we know you have depression or anxiety and how severe it is based on what you say (or don’t say).

Your doctor will then narrow your drug choices by considering patient-specific factors, such as:

• Your complete medical history (other illnesses you may have and potential drug-to-drug interactions)
• Family medical history (including if certain antidepressants or anti-anxiety meds have worked well for any of your relatives)
• Current and past substance use (including OTC meds and substances, like NSAIDs, vitamins, marijuana and alcohol)
• Past medication use (and why they were discontinued)
• Cost

Patient preference also plays a crucial role. It’s recommended to keep your top symptoms in mind: write down what you want the medicine to do for you, and know which of those you want to target first.

Are you most worried about feeling sad? No power? Feeling anxious? Having trouble concentrating? If your clinician knows what your priorities are, it will help them work with you to find the best starting point.

It’s also important not to be hesitant to admit that you use substances like marijuana, as marijuana or nicotine use can affect the way the medication works, hindering the treatment process.

Likewise, do not let your doctor know what your medication is doing after you take it. How these drugs are dosed (increased or decreased, started or stopped) depends largely on what the patient says – how they respond to it, so make sure you’re not just following the regimen, but also keeping track of how you’re feeling .

Medication trackers like MyTherapy make this process super convenient. Track your dosage, mood and symptoms, then print out your data for your next appointment. Keep it real and specific so you can be yourself.