Starting an antidepressant such as escitalopram (Lexapro), sertraline (Zoloft) or duloxetine (Cymbalta) takes patience. The side effects usually show up before the benefits, which is the opposite of what most people expect. Knowing the timeline makes it much easier to stick with.
The first two weeks
Common early side effects include nausea or an upset stomach, headache, feeling jittery or more anxious, trouble sleeping or feeling drowsy, and sweating. Most of these ease within one to two weeks as your body adjusts. Taking the medicine with food helps nausea, and taking it in the morning or at night, depending on whether it energizes or sedates you, helps sleep.
When it starts to work
Sleep, energy and appetite often improve first, within one to three weeks. Mood and worry usually take four to six weeks, and the full effect can take eight weeks or more. If there is little change by then, your prescriber may adjust the dose or try a different medicine. Not responding to the first one is common and does not mean nothing will work.
Side effects that may last
Sexual side effects such as lower desire or delayed orgasm can continue. Tell your prescriber; there are often ways to manage them, including a dose change or a different medicine.
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Watch for these
In people under 25, antidepressants can occasionally increase suicidal thoughts in the first weeks, so close follow-up matters. Agitation, unusual restlessness or worsening mood should be reported right away. Do not stop the medicine suddenly, even if you feel better.
Tell your prescriber about every medicine and supplement you take, including St. John's wort, tramadol and migraine triptans, because combining serotonin medicines can rarely cause serotonin syndrome. Get urgent care for agitation, fever, heavy sweating, muscle twitching or stiffness, or confusion. These medicines can also raise the risk of bleeding when taken with anti-inflammatory pain relievers such as ibuprofen or with blood thinners. Report racing thoughts, unusual energy or needing much less sleep, which can be a sign of bipolar disorder.
If you have thoughts of suicide, call or text 988, or call 911 if you are in immediate danger.
Get help from Hope Integrative Medicine
If you are starting an antidepressant or the first one is not working, our team can guide the dose and the follow-up. Our mental health team sees patients in person in West Ashley and by telehealth across South Carolina, alongside our primary care providers, and new patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If you are having thoughts of harming yourself, call or text 988 or call 911.
Frequently Asked Questions
Most early side effects of Lexapro, such as nausea, headache, jitteriness and sleep changes, ease within one to two weeks. Sexual side effects can last longer and are worth raising with your prescriber.
Yes, a short-term rise in anxiety or jitteriness in the first week or two is common when starting Zoloft or another SSRI. Tell your prescriber if it is severe or comes with agitation or worsening mood.
Sleep, energy and appetite often improve within one to three weeks. Mood and worry usually take four to six weeks, and the full effect can take eight weeks or more.