"I've Started the Medication – Why Don't I Feel Better Yet?" Understanding Why Psychiatric Medication Can Take Time to Work

Starting psychiatric medication can involve a strange mismatch between expectation and reality. You have finally decided to try treatment, collected the prescription and started taking the tablets. Understandably, you want to know whether they are working.

A few days pass and very little seems different. Sometimes you may even notice side effects before you notice any improvement.

This can be frustrating, particularly if you have already spent weeks or months feeling unwell. If a medication is going to help, why can't it simply start helping straight away?

The answer is that many psychiatric medications do not work like painkillers. Although the medication begins affecting the body relatively quickly, the clinical changes we are looking for can take considerably longer to emerge.

Taking a Tablet and Feeling Better Are Not the Same Process

When you swallow a medication, it is absorbed into your body and begins interacting with its biological targets. However, that does not necessarily mean that the symptoms of a mental health condition will immediately improve.

Antidepressants are a good example. Medications such as SSRIs begin affecting serotonin signalling relatively quickly, but improvement in depression or anxiety typically develops more gradually.

This is one reason I am cautious about the familiar explanation that depression is simply caused by "low serotonin" and antidepressants correct it. The biology is much more complicated than filling up a chemical that has run low.

Changes in neurotransmitter signalling appear to lead to further adaptations within brain systems over time. The eventual clinical benefit is therefore more complicated than the medication's immediate chemical effect.

How Long Should I Give It?

There isn't one answer because it depends on the medication, the condition being treated, the dose and the individual taking it.

With antidepressants, for example, improvement usually develops over weeks rather than days. Some changes may appear earlier than others. Sleep, anxiety, energy or concentration may begin changing before somebody notices a clear improvement in their overall mood.

Other psychiatric medications have different timescales. Some treatments used for agitation, severe anxiety, mania or psychosis may produce noticeable changes relatively quickly, while their fuller therapeutic effect develops over a longer period.

This is why your prescriber should explain what you are realistically looking for and when.

Why Do I Have Side Effects Already?

This is something patients understandably find particularly frustrating.

"If the medication takes weeks to work, why did I feel nauseous on the second day?"

Therapeutic effects and side effects do not necessarily develop at the same speed.

Some side effects can appear soon after treatment begins because the medication is already having biological effects even though the changes responsible for improving the underlying condition take longer.

Fortunately, some early side effects also settle as the body adjusts to treatment.

For example, someone starting an antidepressant may initially experience nausea, headaches, changes in sleep or increased anxiety. These do not occur in everyone, and persistent or troublesome effects should be discussed with the prescriber.

The important point is that experiencing an early side effect does not necessarily mean that the medication will continue to feel that way.

Don't Check Whether It Is Working Every Few Hours

When somebody is desperate to feel better, it is natural to monitor themselves closely.

"Do I feel different today?"

"Am I less anxious than yesterday?"

"Was I happier this afternoon?"

The problem is that mental health symptoms naturally fluctuate.

You may have a better Tuesday and a terrible Wednesday for reasons that have nothing to do with medication.

Assessing treatment hour by hour can therefore create a great deal of uncertainty.

It is usually more helpful to look for patterns over time.

Are you functioning differently compared with a few weeks ago? Are you sleeping better? Are you avoiding fewer things? Are you becoming interested in activities again? Are other people noticing a change?

Sometimes improvement is gradual enough that somebody else notices it before the person taking the medication does.

Improvement May Not Feel Dramatic

People sometimes expect successful medication to produce a very obvious feeling.

One morning they will wake up and suddenly know:

"It's working."

Occasionally improvement does feel striking, but often it is much quieter.

You realise you have started answering messages again.

You went shopping without spending the entire journey worrying.

You laughed at something.

You managed a full day at work.

You became interested in a programme you were watching rather than simply staring at the television.

None of these changes alone seems dramatic. Together, they may indicate that recovery has started.

This is why functioning can sometimes be as useful to monitor as symptoms.

Does No Improvement Mean We Should Increase the Dose?

Not automatically.

If there has been little improvement, the first question is whether the medication has had a reasonable opportunity to work at an appropriate dose.

Increasing too quickly can expose somebody to additional side effects without necessarily giving the existing dose enough time.

On the other hand, remaining indefinitely on a dose that is not providing sufficient benefit is not helpful either.

This is where review appointments matter. The decision should consider how long you have been taking the medication, the dose, any improvement, side effects and what condition is being treated.

Medication changes should have a reason rather than simply happening because a certain number of days have passed.

What If the First Medication Doesn't Work?

This can be disappointing, but it is not unusual.

Psychiatric prescribing is not currently precise enough for us to look at somebody and reliably predict which medication will work best for them.

We make decisions using evidence, clinical guidelines, previous treatment, physical health, side-effect profiles, family history where relevant and the individual's preferences. Even with all that information, people respond differently.

One antidepressant not helping does not mean that antidepressants as a whole will not help. Similarly, experiencing side effects with one medication does not mean that every psychiatric medication will cause the same problem.

Sometimes treatment requires adjustment.

That may involve changing the dose, changing medication or reconsidering the overall treatment approach.

Medication Is Working While Life Is Still Happening

Another difficulty is that treatment does not occur in a laboratory.

Someone may start medication and then have an extremely stressful month. They may lose their job, experience relationship difficulties, become physically unwell or stop sleeping properly.

Medication cannot remove every source of distress from somebody's life.

This can make assessing response more complicated.

The useful question is not always:

"Do I feel completely well?"

It may be:

"Am I coping differently than I would have done before?"

Medication can be helping even when life remains difficult.

When Should I Contact My Prescriber Earlier?

You should not assume that every new symptom simply needs to be endured until your next routine appointment.

If side effects are significant, unexpected or concerning, contact your prescriber or another appropriate healthcare professional for advice.

You should also seek prompt help if your mental health deteriorates significantly, particularly if you develop thoughts of harming yourself or feel unable to keep yourself safe.

Some medications also have specific warning symptoms that require urgent assessment. Your prescriber or pharmacist should explain these where relevant.

Giving medication time to work does not mean ignoring significant problems while you wait.

A Final Thought

When somebody starts psychiatric medication, I think there can be an understandable pressure to decide very quickly whether it has "worked" or "failed".

In reality, the answer is often not available after a few days.

Good prescribing involves allowing enough time to observe what happens while also avoiding the opposite problem of continuing ineffective treatment indefinitely.

We look for patterns.

Are symptoms changing?

Is functioning improving?

Are side effects settling or becoming problematic?

Does the dose need adjusting?

Is this still the right medication?

And importantly, what does the person taking it think?

Sometimes psychiatric medication works dramatically. More often, recovery appears through a collection of small changes that become clearer when you look backwards.

You may not wake up one morning feeling transformed.

You may simply realise that something which felt impossible three weeks ago has become manageable again.

And sometimes that is how we first notice that treatment is beginning to work.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry