Samuel L. Pauker, M.D., and Miriam Arond

If you have been depressed and finally decide to have your doctor prescribe an antidepressant for you, it’s natural that you want it to take effect quickly. But it can take many psychiatric medications up to three months to become fully effective and, unfortunately, many doctors don’t prepare their patients with a timetable for what to expect when. Without that guidance, many individuals stop taking their medication prematurely, assuming that it just doesn’t work for them, thus sabotaging their chances for treatment success.

The good news, however, is that there are often small signs to be alert to that show that antidepressants are beginning to work. If you look out for them and recognize them, it will reinforce your commitment to stick with the treatment plan, which will eventually lead to a positive treatment outcome.

Early Signs of Success

Depression has three basic components—the mood component (sadness, anxiety, gloom, apathy); the cognitive component (indecision, lack of focus and concentration, ruminative and negative thinking); and the somatic component (problems with sleeping, eating, waking, energy, motivation).

One useful way of thinking about your condition and its response to treatment is to think about what changes you notice in each of these areas. While it may take several months to target and relieve each of your symptoms, most people experience subtle changes in the early stages of treatment that are like signs of sunlight on the horizon.

Look for any of the following changes in your or others’ behavior and attitudes. They are excellent clues that bode well for your successful recovery from depression.

• You have improved concentration and focus. Being distracted is one of the most disturbing and troublesome symptoms of depression. It can interfere with work, relationships, and the enjoyment of previously pleasurable activities. An early sign that antidepressants are beginning to take effect is an increased ability to focus more on reading, conversations, and work.
• You are starting to engage in activities that you previously avoided. Most people who are severely depressed avoid being with others. They find it requires too much effort to be sociable when they are feeling gloomy and isolated. Within a few weeks of taking antidepressants, however, if you are self-aware, you may notice that you are saying “yes” to social opportunities or going to fitness classes or other recreational or cultural opportunities you previously avoided. While you may not yet be fully active, you are beginning to “dip your toes in the water.” Even if you don’t feel fully back to yourself, you don’t feel hopeless because you recognize glimmers of recovery.
• People relate better to you. Colleagues and friends who formerly seemed distant and disengaged are suddenly more proactive about talking and being with you. It’s as if a magnetic pull is drawing them to you in a way that didn’t happen when you were in the depths of depression. Others may sense positive signs of your recovery even before you do.
• Psychotherapy has begun to flourish. Psychotherapy typically stalls when one is in the midst of depression. People who are depressed lack energy and can feel emotionally numb or insufficiently motivated to engage in the work of psychotherapy. Once psychiatric medication begins to lift the dark cloud of depression, individuals can utilize psychotherapy and achieve self-awareness and self-regulation that previously may not have been possible.
• You have regained some faith. Feeling hopeless and helpless are signs of depression. They lack faith in themselves and, often their religious beliefs, as well. Signs of a turnaround may include the development of a trusting relationship with a doctor, increased self-esteem, or a spiritual awakening.

The acknowledgment that “I am better” usually is one of the last stages of recovery for depression. Others often see improvements before you do. They notice you are getting more things, and seem less dejected, and are more pleasant But that final global self-report—that lightbulb moment when you experience a sense of relief and feel “Aha, I am better”—may not occur until after three months of therapeutic medication dosages have kicked in.