What I wish I had known before starting antidepressants

Before we start, a note: this is just my personal experience with my antidepressants. Everyone’s brain and body are different, and these stories do not reflect the experiences of every individual. I’m not a doctor… just someone who’s been on a long mental health journey, and came out the other side glad I tried.

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As a teenager, I thought that meds would be an instant fix for my depression. Like Tylenol for a headache: pop the pill, wait thirty minutes, and you’re happy again.

My primary care doctor tried to temper my expectations.

“Meds won’t get rid of the cloud,” she said as she handed me the phone number of a psychiatrist, “but they can shift it over. Make it easier for you to live your life.”

I gave her a flippant thumbs up. In my head, I was just thinking, Give me the drugs.

It’s been eighteen months since I started my first prescription, and looking back, I realize I was grossly misinformed about the process. In my naivety, I had assumed that antidepressants functioned like “happy pills,” minimally different from one-another except for their effectiveness on the individual. I expected my psychiatrist to write me a prescription, check back in a few weeks, maybe change the drugs around, and we’d be on our merry way. And, desperate for a remedy, I expected any solution to be an improvement over my present condition.

Wow, was I wrong.

At their highest, antidepressants changed my life, giving me a kind of energy and motivation that I hadn’t felt in years—a kind of energy that previously hadn’t been possible for me even on my best days. I spent my weekends practicing photography in the park instead of lying in bed. I remembered class discussions without needing to rely on my frantically-scribbled notes. I moved on from conversations without obsessing over every detail. This is the kind of happiness that most people dream about when they start meds. It’s also the reason I continue taking antidepressants, even on my lower times.

But in reality, the majority of the months I’ve spent on antidepressants haven’t been like that. It took me seven months of trial and error with four SSRIs and SNRIs—Prozac, Lexapro, Cymbalta, and Mirtazapine—before I felt an improvement. Even those benefits were short-lived, with a relapse occurring six months later.

I don’t share this to scare people away from medication, but it's important to be informed. Many people don't realize that it takes six to eight weeks for meds to “kick in,” and only about 33% of people achieve remission with the first antidepressant they take. Another 24% of people don’t experience results until they switch or add a new medication. And a smaller minority, like me, will try three or more before finding the right fit. Individuals starting antidepressants need to know that they likely won’t be a “one-hit wonder.” This is a process that takes patience, grit, and hope. When I'm depressed, I find the latter to be a fragile thing, and my naive expectations almost shattered it completely. "Hope for the best, but prepare to be patient" is my personal mantra with these things. It keeps me positive, but also grounded.

So, by all means, if you’re struggling, speak to a doctor to get the treatment you need. And maybe take note of these five things I wish I’d known before starting antidepressants:

1. Try not to start antidepressants during a time of major transition in your life.

I started my first medication, fluoxetine (Prozac), three days before moving to Virginia for a summer internship. Under normal circumstances, this would have been an exciting, albeit nerve-wracking, change. I had always wanted to live outside the Midwest, to challenge myself by going somewhere where I didn’t know a soul; and there I was, ten hours from home, not a familiar face in sight.

Those first few days should have been spent celebrating Memorial Day weekend. Getting to know my roommates, touring the area, decorating my dorm. But all that I could think about was the pounding headache in my skull. The terrifying fear that the side effects of my meds would last forever, that I’d be a terrible intern bogged down by migraines and fatigue.

If you’re anxious about starting medication, don’t use my anecdote as justification to delay. There’s hardly ever an “ideal time” to begin. But if it’s possible, try to time your first week on meds so that it doesn’t intersect with a major life event—a wedding, an exam, a trip out of the country. And if you don’t have the luxury of avoiding the intersection, make sure you have a support system in place to help you through the transition period. Ask your manager for a day off, invite your friends over for the weekend to check in. These strategies will help you get through the initial few days of brain chemistry f*ckery.

2. Trust your doctor, and trust yourself: no side effect is too small to share.

It turned out that my headaches did last, at least for the duration of the six weeks I spent on Prozac. My biggest regret is not telling my psychiatrist about my side effects sooner. Instead, acetaminophen and water became my best friends.

I think that I was mostly scared that, if I told my psychiatrist what was going on, she would want me to switch medication. Then I would have spent all those weeks in pain "for nothing." So I told myself that the pain wasn't really that bad, that I should tough it out, that I could wait another week or two to see if the benefits of the meds kicked in. I can't emphasize it enough: that was a mistake.

What I wish someone had told me starting out, is that you and your psychiatrist are a team. If you want to push through the side effects for an extra few weeks to see if they get better, that’s your prerogative, but you need to have that conversation with them. The worst thing you can do is make that decision without consulting a professional.

Concealing information isn’t just about safety and trust; it also inhibits your healing. One of the roles of a psychiatrist is to help patients track their responsiveness to treatment—side effects included. Not sharing those side effects makes their job harder. It also makes it impossible for the patient to know which responses are normal, and which are abnormal. As it turned out, the severity of my headaches, which lasted daily for up to hours at a time and bordered on migraine level, were abnormal. My secrecy had prolonged a pain that shouldn't have existed, for no good reason other than pride and a misinformed gut instinct. I ended up switching to a new medication entirely, which brings me to my next point:

3. Ready your support systems, and don’t go through withdrawal alone.

Prozac tends to not have major withdrawal risks for low doses, so my doctor had me stop my 20mg cold turkey—that is, without tapering to gradually smaller amounts. I won’t sugarcoat: what ensued were some of the worst days of my life.

A silver lining of my withdrawal was that I was back home for the July 4th weekend when I stopped Prozac, so I didn't have to go through it by myself. Unfortunately, I spent most of that time crying to my parents, my head buried in a couch. The depression was so bad, I missed my return flight to Virginia because I couldn’t motivate myself to move. We had to call my psychiatrist to start my next medication—Lexapro—a few days sooner, ending my “washout period” earlier than intended. (A washout period is the time you wait to clear the old medication from your system before starting a new one.)

My doctors were surprised by my response to Prozac, so I'd wager that my withdrawal was an extreme case; i.e., not the norm. I also don't think an individual should let a fear of withdrawal stop them from getting potentially life-changing treatment. That said, I'll offer some advice: When changing doses or classes of medication, never go through it alone. Create a safety plan with your doctor, and if possible, surround yourself with loved ones and trusted adults who can help you see the light at the end of the tunnel.

4. Hope, hope, hope. Nothing will change if you don’t believe it can.

I can't overstate the importance of hope.

Between August and December 2024, I modified medication around five times. I switched from Prozac, to Lexapro, to Cymbalta, to Cymbalta with Remeron, to more Cymbalta without Remeron. The whole process was fatiguing, a trial-and-error that brought headaches, and nausea, and brain fog. For a long while, I was ready to give up.

But one day, something clicked into place. September 1, 2024 marked the start of a week filled with incredible days—the longest stretch of stability I had experienced in over a year. It wasn’t permanent, but it was something; some evidence against my long-held belief that I was broken beyond repair. Throughout treatment, I held onto the memories of that week, until eventually, in January—after four and a half months of gradually increasing my Cymbalta dose—the happiness came back. My spring semester of college brought me some of the greatest memories of my life.

When I relapsed again this fall, it wasn’t as catastrophic as I feared. The darkness came back, yes, but I recognized it this time, and I didn’t spiral into the same shame that used to accompany every dip in my mood. Instead, I called my psychiatrist, and we adjusted my dose.

5. Progress isn’t linear, and relapse doesn’t erase your healing.

The past few weeks have been hard, I won't lie. The transition from 80mg to 100mg of Cymbalta has hit me like a truck. I've rescheduled all my exams (via panicked emails to professors) and missed meetings I was meant to lead. My friends have even been dropping off sandwiches on my porch, bless their hearts.

That’s the last thing I wish I’d known before starting antidepressants: It’s so tempting to treat recovery like a staircase, one steady climb upward until you’re finally “better.” But in reality, it’s more like the tide. Sometimes it pulls you back, sometimes it carries you forward, and sometimes it’s all you can do to hold onto the image of the shoreline as you drift out to sea. Even today, I have to remind myself that one bad month doesn’t mean the medication has stopped working forever, or that I’ve lost all the ground I’ve gained. It just means I’m a human being with a stubborn brain that sometimes needs recalibration.

If I could go back and talk to that desperate, impatient version of myself—the one who wanted a magic pill to make it all go away—I’d tell her to take a deep breath. I'd say, antidepressants can change your life, but not by erasing the hard parts. The psychiatric journey in and of itself will be a test of your character. But eventually, it will give you the light you seek to keep going. The energy to get out of bed, the quiet to the constant noise in your head.

The cloud might always be above me, shifting and reforming with each passing minute. I've made peace with that. Because if there's one thing my antidepressants have taught me, more than anything else?

When the cloud moves, I can move with it.

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