Your First Weeks on an Antidepressant: What Is Normal and What to Report
Based on Hope Integrative Medicine, Starting Lexapro, Zoloft or Cymbalta
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Why side effects come before benefits on an SSRI or SNRI, how long the early anxiety and sleep problems last, and when to expect improvement.
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In this guide
Usually Normal Early On
- Nausea or upset stomach
- Headache or sweating
- Feeling jittery for a week or two
Tell Your Prescriber About
- Every medicine and supplement
- Sexual side effects that linger
- Racing thoughts or less need for sleep
Get Help Right Away For
- Agitation, fever or heavy sweating
- Muscle twitching or confusion
- In crisis? Call or text 988
What the guideline says
- With antidepressants such as escitalopram (Lexapro), sertraline (Zoloft) or duloxetine (Cymbalta), side effects usually show up before the benefits.
- Common early side effects include nausea, headache, feeling jittery or more anxious, sleep changes and sweating, and most ease within one to two weeks.
- 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.
- Not responding to the first medicine is common and does not mean nothing will work.
- Sexual side effects can continue, and there are often ways to manage them, so tell your prescriber.
- Do not stop the medicine suddenly, even if you feel better; talk with your prescriber first.
Source: Hope Integrative Medicine, Starting Lexapro, Zoloft or Cymbalta
This guide is general health information and does not replace advice from your own provider.
Frequently Asked Questions
Every medicine and supplement you take, including St. John's wort, tramadol and migraine triptans, because combining serotonin medicines can rarely cause serotonin syndrome. Anti-inflammatory pain relievers such as ibuprofen and blood thinners can also raise the risk of bleeding.
Get urgent care for agitation, fever, heavy sweating, muscle twitching or stiffness, or confusion, which can be signs of serotonin syndrome.
In people under 25, antidepressants can occasionally increase suicidal thoughts in the first weeks, so close follow-up matters. Report agitation, unusual restlessness or worsening mood right away. If you have thoughts of suicide, call or text 988.