Why Does Lexapro Make You Feel Worse Before You Feel Better?

Understanding the Science Behind SSRI Medications

When it comes to taking medications like Lexapro, many patients report feeling worse before they feel better. This phenomenon, which is increasingly understood in the clinical community, is particularly common with selective serotonin reuptake inhibitors (SSRIs) like Lexapro. SSRIs do not produce an immediate therapeutic effect. Instead, it typically takes several weeks for patients to notice an improvement in symptoms. This delay is due to the time it takes for the brain to adapt to increased serotonin levels. During this period, the brain undergoes neuroplastic changes, including receptor sensitivity adjustments and neuronal connectivity enhancements. The initial increase in serotonin can cause temporary imbalances before these adaptations occur.

The sudden surge of serotonin can disrupt the delicate balance between neurotransmitter systems such as serotonin, dopamine, and norepinephrine. This disruption can exacerbate symptoms in the short term, leading to increased anxiety, agitation, and other distressing feelings. Many patients experience side effects during this initial period, which can contribute significantly to feeling worse. Common side effects include nausea, headaches, dizziness, insomnia, and sexual dysfunction. These side effects are often most pronounced during the first few weeks of treatment and can add to the discomfort and distress of the patient.

The Importance of Patience and Persistence

Most often, your symptoms get worse initially when you start taking antidepressants, indicating that the medicine is beginning to work. This worsening of symptoms is a sign that the medication is having an effect on your system. Doctors prescribe these medications during the initial stage to help patients adjust to the medication. It is crucial to be patient and stay positive during this period. The medical community advises that the full therapeutic effect of SSRIs can take up to 3 weeks to manifest. Therefore, it is important not to give up on the medication too soon.

For example, some individuals might be prescribed a benzodiazepine (benzo) during the initial stage of treatment to help manage the anxiety and agitation associated with starting an SSRI. However, the focus should ultimately be on the SSRIs helping to restore neurological balance. The worsening of your depression during the adjustment period is a sign that the medicine is working on your system. All that is needed is patience and positive thinking.

A Personal Experience with Lexapro

Many people, like myself, have experienced the challenging journey of adjusting to Lexapro. I was on Lexapro for 12 years and then drastically discontinued it, which turned out to be a bad decision. My primary care physician did not prescribe a replacement, and I am now almost 3 months back on it. The road to feeling like myself again has been long and arduous, and while I still don't like the side effects, I understand their importance in the full therapeutic process. Patience and perseverance are key when dealing with these medications. Best of luck to all those who may be going through a similar experience.

Conclusion

Understanding the science behind SSRIs and the adjustment period is crucial for both healthcare providers and patients. While the initial few weeks can be difficult, the long-term benefits of these medications often outweigh the short-term discomfort. It is important to communicate openly with your healthcare provider about any concerns you have, to ensure that you are receiving the best possible care.