Antidepressants can take anywhere from 2 -6 weeks to see a therapeutic effect. You may notice a little improvement sooner than that, but the usual is weeks.
There’s a couple reasons for this. The first is due to the way the drug works. Medications have to reach a steady state in your body before you can get a reliable effect. It takes approximately 5 half-lives to reach steady state. If you have a medication that has a half-life of 24 hours, it takes five days to reach steady state.
A second reason has to do with the delayed effect the increase in serotonin has on your thoughts. You have the increased serotonin, then a delay, then you have the downstream neuroadaptive effects which is reducing and increasing various receptors, then you have a change in mood that causes a change in emotional bias.
A cognitive model of depression is that negative thinking both causes and perpetuates depression. When you’re depressed, you have more negative view of the world. Depression affects what you pay attention to. You’re more likely to notice negative facial expressions, spot negative cues in your environment and draw negative conclusions about things. This is referred to as a negative bias or negative valence.
Thoughts, feelings and behaviors are all connected. There’s still a model for endogenous depression where you develop depression soley based on brain changes. But we be still believe even that depression affects your thinking. It’s debatable as to which came first, depression illness or thought depressed thoughts. But the mind and the body are one. And the best approach to depression is to address them both equally. The mind approach would be through therapy or self-help measures to address your mindset and the body approach would be diet, exercise, sleep hygiene and medication if appropriate.
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Wilson SJ, Bell C, Coupland NJ, Nutt DJ. Sleep changes during long-term treatment of depression with fluvoxamine – a home-based study. Psychopharmacology 2000; 149: 360–5.
Harmer CJ, O’Sullivan U, Favaron E, Massey-Chase R, Ayres R, Reinecke A, Goodwin GM, Cowen PJ. Effect of acute antidepressant administration on negative affective bias in depressed patients. Am J Psychiatry. 2009 Oct;166(10):1178-84. doi: 10.1176/appi.ajp.2009.09020149. Epub 2009 Sep 15. PMID: 19755572.
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