A common treatment for clinical depression is a type of medication called an antidepressant. Antidepressants come in a variety of forms, but all of them work by impacting certain neurochemicals in your brain, such as serotonin and norepinephrine. Antidepressants are most commonly prescribed by a psychiatrist, but may also be prescribed by a family physician or general practitioner to treat depression.
The different classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine (noradrenaline) reuptake inhibitors, atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Different classes of antidepressants take different amounts of time before you will start to feel their anti-depressant effects.
The most commonly prescribed modern antidepressants include SSRIs — such as Prozac, Lexapro, Celexa and Paxil — and SNRIs — such as Pristiq, Cumbalta and Effexor. Although the claim is made that some people may be able to start to feel less depressed within 2 weeks of taking one of these kinds of antidepressants, most people won’t start experiencing the full positive effects of the medication until 6 to 8 weeks after beginning it.
In addition to feeling less depressed from antidepressant medications, people will often experience the side effects of antidepressants first. While these side effects vary from person to person and from medication to medication, the most commonly observed side effects in antidepressants are:
- Decreased sex drive or no sex drive at all
- Dry mouth — your mouth feels very dry and cannot produce the same amount of saliva as usual
- Mild to moderate nausea
- Insomnia — inability to get to sleep, or difficulty staying asleep
- Increased anxiousness or restlessness
- Weight gain
- Constipation or diarrhea
- Increased sweating
- Tremors or dizziness
You shouldn’t be overtly concerned if you experience any of these side effects while taking an antidepressant, but you should still tell your psychiatrist or doctor about them. Some side effects may go away on their own once your body adjusts to the medication. Others may not, and may be addressed through an adjustment of your medication dose or when you take it.
Antidepressants don’t work for everyone. Sometimes the first antidepressant a doctor prescribes may not work for you (as they don’t in 50 percent of people who try an antidepressant). Don’t get frustrated, just accept that either another medication may need to be tried, or the doctor may suggest a higher dose may be required. Talk to your doctor about adjusting your medication if you’re not feeling any positive effects of the medication after 6 to 8 weeks.
Older classes of antidepressants — MAOIs and tricyclic antidepressants — take about the same amount of time to work — anywhere from 2 to 6 weeks for most people, while most people will start to feel a benefit within 3 to 4 weeks. It is not well understood why antidepressant medications appear to take longer to work than other types of psychiatric medications.
How do antidepressants actually work?
A recent article by Deborah Orr regarding her experiences with antidepressants sparked a lot of debate as to their merits and drawbacks. The truth is, they’re not as simple or as understood as many might think
Very common, but that doesn’t mean they’re perfectly understood. Photograph: Joe Raedle/Getty Images
Very common, but that doesn’t mean they’re perfectly understood. Photograph: Joe Raedle/Getty Images
Last modified on Wed 20 Sep 2017 23.05 BST
Antidepressants the go-to treatment for depression, or generalised anxiety. It’s incredible when you think about it, the fact that you can have a debilitating mood disorder, take a few pills, and feel better. It’s unbelievable that medical science has progressed so far that we now fully understand how the human brain produces moods and other emotions, so can manipulate them with designer drugs.
That’s right, it is unbelievable. Because it isn’t the case. The fact that antidepressants are now so common is something of a mixed blessing. On one hand, anything that helps reduce stigma and lets those afflicted know they aren’t alone can only be helpful. Depression is incredibly common, so this awareness can literally save many lives.
On the other hand, familiarity does not automatically mean understanding. Nearly everyone has a smartphone these days, but how many people, if pushed, could construct a touchscreen? Not many, I’d wager. And so it is with depression and antidepressants. For all the coverage and opinion pieces produced about them, the details around how they work remain somewhat murky and elusive.
Actually, in the case of antidepressants, it’s more a question of why they work, rather than how. Most antidepressants, from the earliest Trycyclics and Monamine Oxidase inhibitors, to the ubiquitous modern day selective serotonin reuptake inhibitors (SSRIs), work by increasing the levels of specific neurotransmitters in the brain, usually by preventing them from being broken down and reabsorbed into the neurons, meaning they linger in the synapses longer, causing more activity, so “compensating” for the reduced overall levels. Antidepressants make the remaining neurotransmitters work twice as hard, so overall activity is more “normal”, so to speak.
But knowing that antidepressants do this doesn’t actually explain how they end up alleviating depression. In a way, neurotransmitters are to the brain what the alphabet is to language the basic elements of much richer, more complex contructs. So, boosting neurotransmitter levels throughout the brain doesn’t really tell us anything specific. It’s like having to restore a classic painting and being told it “needs more green” that may be true, but where? How much? What shade? It’s too unspecific to tell us anything useful.
Depression is so poorly understood that most people illustrate it with someone holding their head in their hands, as a trawl through any image archive will reveal. It doesn’t make your brain heavier or anything. Photograph: Nastia11/Getty Images/iStockphoto
The truth is, antidepressants were discovered largely by accident Swiss scientists looking for treatments for schizophrenia in the 1950s realised a certain experimental substance caused euphoria in their subjects. And lo, antidepressants were born. Nothing unusual here, luck and serendipity are behind the discoveries of many drugs. But this led to the monoamine theory of depression, which argues that, because most antidepressants increase levels of neurotransmitters of the monoamine class, depression is caused by depletion of monoamines in the brain.
Except, the monoamine hypothesis is increasingly seen as insufficient. It’s part of what’s going on, sure, but not the whole story. For one, antidepressants boost neurotransmitter activity pretty much immediately, but therapeutic effects usually take weeks to kick in. Why? It’s like filling your car’s empty tank with petrol and it only starting to run again a month later it means no fuel may have been a problem, but it’s clearly not the only problem.
There are other possible explanations. Neuroplasticity, the ability to form new connections between neurons, has been shown to be impaired in depressed patients. The theory is that this prevents the brain from responding “correctly” aversive stimuli and stress. Something bad happens, and the impaired plasticity means the brain is more ‘fixed’ as is, like a cake left out too long, preventing moving on, adapting, or escaping the negative mindset, and thus depression. Antidepressants also gradually increase neuroplasticity, so this may be actually why they work as they do, long after the transmitter levels are raised. It’s not like putting fuel in a car, it’s more like fertilising a plant it takes time for the helpful elements to be absorbed into the system.
There are other possibilities. Inflammation causing undue stress on the brain is one, an overactive anterior cingulate cortex is another. Essentially, it’s complicated, and we can’t confirm anything yet.
Basically, depression isn’t a broken leg, or a cold. We can’t look at it, say “that’s what’s wrong, right there” and set about fixing it. Psychiatric issues are never that straightforward (and that’s without the many overlaps with more physical ailments). Part of the problem is that “depression” is more of an all-purpose term for something that manifests in many in different ways. It’s a mood disorder, but how mood is affected can vary substantially. Some end up with an unshakable black despair, others experience no mood to speak of, just feeling flat, empty and emotionless. Some (mostly men) become constantly angry and restless.
This is part of the reason why it’s proven so difficult to establish an underlying cause. The human brain is the most complex thing, and even a minor flaw or glitch in the workings can manifest in various, unexpected ways. And there’s no reason to assume that every case of depression has exactly the same cause. It’s not surprising, then, that antidepressants don’t work, or even make things worse, for many patients. There are other approaches too, but then these may not work for you either. If the causes and effects of depression vary considerably from person to person, so would the effectiveness of treatments.
Most therapeutic interventions don’t involve leather couches either. Maybe that’s a Hollywood thing? Photograph: Getty Images/Stockbyte
Antidepressants also have many potential side effects, which themselves vary from person to person. And while the therapeutic effects (which many argue are themselves overstated or based on questionable evidence) take weeks to occur, the same doesn’t apply to the unpleasant side effects, as Deborah Orr recently discovered.
Given all this, you may wonder how antidepressants ended up being so common in the first place? Well, it may boil down to the fact that, for all the flaws and problems they may have, they’re better than nothing, especially when the alternative is untreated depression. Some take a more cynical view, arguing that it’s pharmaceutical companies profiting by pushing profitable pills on people who don’t really need them.
Or, in the UK at least, it may be something to do lack of time and resources. In an ideal world, people with depression would have easy access to CBT or other interventions given how every patient is different and what works for them is often a matter of trial and error. But, in an increasingly-underfunded and overworked NHS, this is increasingly difficult, even impossible, to offer. Many of the interpersonal therapies for depression and other disorders involve many hours of contact time with highly trained (ie expensive) professionals. Given the choice between that or giving someone a box of tablets and saying “see you in a month”, the latter would likely be the go-to option much of the time.
Overall, the widespread use of antidepressants is likely down to numerous complex causes, and the effects are unpredictable and confusing. Much like depression itself, which seems appropriate.
This article is adapted from Dean Burnett’s book The Idiot Brain, released in paperback in the US on 11 July.
Why do antidepressants take so long to work?
An episode of major depression can be crippling, impairing the ability to sleep, work, or eat. In severe cases, the mood disorder can lead to suicide. But the drugs available to treat depression, which can affect one in six Americans in their lifetime, can take weeks or even months to start working.
Researchers at the University of Illinois at Chicago have discovered one reason the drugs take so long to work, and their finding could help scientists develop faster-acting drugs in the future. The research was published in the Journal of Biological Chemistry.
Neuroscientist Mark Rasenick of the UIC College of Medicine and colleagues identified a previously unknown mechanism of action for selective serotonin reuptake inhibitors, or SSRIs, the most commonly prescribed type of antidepressant. Long thought to work by preventing the reabsorption of serotonin back into nerve cells, SSRIs also accumulate in patches of the cell membrane called lipid rafts, Rasenick observed, and the buildup was associated with diminished levels of an important signal molecule in the rafts.
"It's been a puzzle for quite a long time why SSRI antidepressants can take up to two months to start reducing symptoms, especially because we know that they bind to their targets within minutes," said Rasenick, distinguished professor of physiology and biophysics and psychiatry at UIC. "We thought that maybe these drugs have an alternate binding site that is important in the action of the drugs to reduce depressive symptoms."
Serotonin is thought to be in short supply in people with depression. SSRIs bind to serotonin transporters -- structures embedded within nerve-cell membranes that allow serotonin to pass in and out of the nerve cells as they communicate with one another. SSRIs block the transporter from ferrying serotonin that has been released into the space between neurons -- the synapse -- back into the neurons, keeping more of the neurotransmitter available in the synapse, amplifying its effects and reducing symptoms of depression.
Rasenick long suspected that the delayed drug response involved certain signaling molecules in nerve-cell membranes called G proteins.
Previous research by him and colleagues showed that in people with depression, G proteins tended to congregate in lipid rafts, areas of the membrane rich in cholesterol. Stranded on the rafts, the G proteins lacked access to a molecule called cyclic AMP, which they need in order to function. The dampened signaling could be why people with depression are "numb" to their environment, Rasenick reasoned.
In the lab, Rasenick bathed rat glial cells, a type of brain cell, with different SSRIs and located the G proteins within the cell membrane. He found that they accumulated in the lipid rafts over time -- and as they did so, G proteins in the rafts decreased.
"The process showed a time-lag consistent with other cellular actions of antidepressants," Rasenick said. "It's likely that this effect on the movement of G proteins out of the lipid rafts towards regions of the cell membrane where they are better able to function is the reason these antidepressants take so long to work."
The finding, he said, suggests how these drugs could be improved.
"Determining the exact binding site could contribute to the design of novel antidepressants that speed the migration of G proteins out of the lipid rafts, so that the antidepressant effects might start to be felt sooner."
Rasenick already knows a little about the lipid raft binding site. When he doused rat neurons with an SSRI called escitalopram and a molecule that was its mirror image, only the right-handed form bound to the lipid raft.
"This very minor change in the molecule prevents it from binding, so that helps narrow down some of the characteristics of the binding site," Rasenick said.
FAQ for How long for increased dose of antidepressant to work
Why does it take so long for antidepressants to work?
It takes so long for antidepressants to work because of their mechanism of affecting one’s nervous system. The drugs used to combat depression are (SSRIs), which means selective serotonin reuptake inhibitors. Generally, when you start this drug treatment, it takes several days or even weeks to take effect and this is often a cause of frustration and despair for some people.
Is it possible for antidepressants to work right away?
No, it is nos possible for antidepressants to work right away. Most of them take between 1 to 4 weeks to start working. You have to be patient and combine the treatment with psychotherapy methods.
Why do antidepressants make you feel worse before better?
Antidepressants make you feel worse before better because the drug’s side effects occur before your depression symptoms can improve. You have to have a lot of patience with the treatment for depression.
Will antidepressants make me happy?
Antidepressants will not make you extremely happy, but they will help relieve the symptoms of depression and associated anxiety. What happens with depression drugs is that they prevent the neuron from picking up again the serotonin found in the synaptic space to increase the amount of serotonin between the neurons themselves.
Certain types of drugs can be prescribed for short-term use in addition to, or instead of, antidepressants. These include:
To get the most out of your medication:
Give your doctor as much information as possible
Remember to tell the doctor if you are taking any other medication, if you have any allergies, and when you wake up and go to bed. This can help them to work with you to develop a medication plan that best suits you.
Store your medication in an appropriate place
Heat and damp can affect most medications – so don’t store them in the bathroom, near a sink or in your car. Instead keep them in a box (safely out of reach of children) in your bedroom or kitchen cupboard.
Don’t share medication with other people
You should not take medication prescribed for other people, even if their symptoms seem similar. The medication prescribed to you by your doctor is individually tailored to help you other medications may not be suitable and can have adverse affects.
Take the prescribed dose
Studies show that people who take the prescribed dose at the times recommended by their doctor are more likely to feel better than those who take too little or too much. So make sure that you follow the directions on the pack to get the best benefit from your medication.
Will I ever stop taking medication?
When medication starts working and you feel better it can be tempting to stop taking it. Like people with diabetes, high blood-pressure and asthma, many people with depression and anxiety-related disorders need to take medication as prescribed on an ongoing basis to ensure they don’t go back to feeling depressed or anxious. However, others
Before stopping or reducing any medication it is important to discuss your reasons with your doctor, who can advise on the best ways to reduce the dose safely. Stopping antidepressant medication suddenly can cause you to feel agitated and uncomfortable, so this needs to be done step-by-step under your doctor’s supervision. Always let the doctor know if you have problems when reducing the dose, as there are ways to help minimise any discomfort you may experience in this withdrawal period.
Are antidepressants safe in pregnancy?
It is important to let your doctor know if you think you may be pregnant or if you are breastfeeding. Babies are sensitive to medication and your doctor can advise you about the safest ones to use.
How do antidepressants work?
If we’re honest, experts aren’t completely sure how some antidepressants work. Most anti-depression medications work by increasing the levels of specific neurotransmitters in the brain. What they usually do is prevent these neurotransmitters from being recaptured from the intersynaptic space.
This means that they remain in the synapses for longer, causing more activity, and, as a result, they “compensate” for reduced levels. This way, antidepressants make the remaining neurotransmitters work more effectively, thus normalizing the overall activity to some degree.
However, this doesn’t really explain how antidepressants end up relieving depression symptoms. Neurotransmitters are like the basic elements to building something much more complex. It’s the same as the individual numbers in larger figures or the letters of our language. That’s why increasing the levels of neurotransmitters throughout the brain doesn’t really tell us too much.
On one hand, anti-depression medications increase the activity of neurotransmitters almost immediately. However, the therapeutic effects usually take weeks for the patient to notice them at a subjective level.
How I’m feeling six months in to taking antidepressants
I never thought I’d be someone who takes antidepressants.
I never imagined myself having alarms on my phone to take pills, chummily chatting with other depressives about side effects, and counting out little foil packs to take on holiday.
A big part of that was my fear around antidepressants – the worry that they’d change who I was, flatten out all my emotions, or wreck my sex drive.
Another part of me thought that taking meds was the ‘lesser’ option, a way of dealing with mental illness that wasn’t as good as proper therapy.
But reaching a low point (suicidal thoughts, spending weekends sobbing in bed, having panic attacks in the work toilets, you know the drill) made me throw all of the worries and medication-based stigma out of the window.
I wasn’t bothered about what it meant to be taking pills anymore. I would do anything to feel better.
The side-effects were still a little scary. So was the lack of information – I knew antidepressants were meant to help, but I didn’t really have any idea how they made you feel.
Which is why, now, six months in, I feel like it’s worth shouting about how I’m doing. You know, just to add another story to the mix besides ‘my friend’s mum took medication and it RUINED HER LIFE’.
My cheeks do not ache from constant beaming. I do not skip to work. I have not replaced fears of boiler explosions and home break-ins with thoughts of ‘add a little confetti to every day!’ and ‘dream it, do it!’ (I found both of those by googling ‘inspirational Instagram’, full disclosure).
Fluoxetine is not a magical happy pill that gets rid of all your struggles and transforms you into a walking cloud of glitter and joy.
For me, it also hasn’t been an evil mix of chemicals that flattened out my mood and generally ruined my state of being.
Maybe it’s awful for some people – but I don’t think that’s reason enough to bash antidepressants entirely. There are so many different types of medication to take your pick from, and if one type isn’t working, you should feel comfortable asking for another type before giving up on meds. There’s bound to be one that can help.
In my experience, fluoxetine (that’s the unbranded name for Prozac, FYI) hasn’t given me a dramatic transformation.
The best way to describe the feeling is a lift – a slight adjustment to my base level of low moods and obsessive thoughts.
The low moods still happen, just not as often. When they do, they’re slightly easier to get out of.
The anxiety still comes, but I’m more able to stop the thoughts before they spiral into obsession.
Basically, antidepressants give me just enough of a boost that I can see my mental illness for what it is. I can see it from a distance, work out what’s true and real and what’s my brain being nasty, and do what I need to do to keep going.
That’s not to say everything’s peachy, to be clear.
I’m six months into taking antidepressants. The week before last I had to leave a party because I’d had four panic attacks in the bathroom. This week I haven’t been sleeping. I’ve had nights when I’ve told myself I was worthless.
The recent terror attacks and pile-ups of terrible news sent me to a bad place, on constant edge and feeling close to panic whenever I heard a siren or saw another breaking news alert.
But I suspect that without antidepressants, that low period would have been much, much worse.
When the lift from antidepressants is subtle, the side-effects have calmed down, and you’re not still experiencing the high of the initial decision to look after your mental health, it’s easy to feel like medication isn’t doing anything.
‘I’m fine,’ you tell yourself. ‘I don’t need to keep taking these.’
It’s only when you stop that you experience crashing lows and realise that, while the effects of medication may not seem dramatic, they give you the kind of stability, and that tiny lift, that can be life-saving.
Antidepressants haven’t flattened me out. I’m still funny (I think), I still get passionate about some things and infuriated by others.
But they have made things smoother. They’ve levelled things out a bit. The dips are there, but they’re not as deep.
Side-effects-wise, they happened, they still happen, but they’re not bad enough for me to justify changing medication or giving it up.
When I started taking meds, I experienced intense shakes every morning, struggling to walk downstairs or wash my face. Those have completely disappeared, thankfully.
The pills still slightly wreck my sleeping pattern and leave me with dodgy dreams, but that’s something I reckon I can fix.
I’ve put on weight, but it’s tricky to know if that’s general ‘I’m depressed and thus keep eating McDonald’s’ weight or ‘these pills are making me chubby’ weight. I’ll need to start eating healthily and working out to see how I feel.
I haven’t experienced any of the other scary side-effects listed on the pamphlet or yelled about in mental health forums.
I haven’t gone blind, my suicidal thoughts haven’t intensified, and my sex drive is still plodding along.
On a serious note: If you do experience any side-effects like these, though, I genuinely, strongly urge you to bring it up with your GP. You don’t have to put up with sh*t just to feel a little better mentally.
But for me, antidepressants have put me on the track to being able to look after myself.
They don’t work alone. They don’t make things perfect, and I still need to learn how to deal with the low points, panic attacks, and obsessive thoughts that come up – that’s what therapy is for.
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But I am so, so glad that I got over my fears, ignored the pill-bashing in the Facebook comments, and started taking antidepressants – because without them, I wouldn’t be able to keep trying. I wouldn’t care enough about myself, or have the emotional energy, to do the things that’ll make me get better – the therapy, the emotional work, getting enough sleep, eating properly.
Antidepressants haven’t fixed everything, but they’ve lifted me up just enough so that I can do all the other things that’ll help.
This article is part of Getting Better, a weekly series about my journey through getting help with my mental health. You can read all previous Getting Better posts here, and check back next Monday for an update on how everything’s going.
Chat with me on Facebook about all things mental health if you fancy, but, obviously, I am not a therapist or expert of any sort – just someone going through not-so-great stuff, mentally. Let’s get better together.
How to go off antidepressants
If you're thinking about stopping antidepressants, you should go step-by-step, and consider the following:
Take your time. You may be tempted to stop taking antidepressants as soon as your symptoms ease, but depression can return if you quit too soon. Clinicians generally recommend staying on the medication for six to nine months before considering going off antidepressants. If you've had three or more recurrences of depression, make that at least two years.
Talk to your clinician about the benefits and risks of antidepressants in your particular situation, and work with her or him in deciding whether (and when) to stop using them. Before discontinuing, you should feel confident that you're functioning well, that your life circumstances are stable, and that you can cope with any negative thoughts that might emerge. Don't try to quit while you're under stress or undergoing a significant change in your life, such as a new job or an illness.
Make a plan. Going off an antidepressant usually involves reducing your dose in increments, allowing two to six weeks between dose reductions. Your clinician can instruct you in tapering your dose and prescribe the appropriate dosage pills for making the change. The schedule will depend on which antidepressant you're taking, how long you've been on it, your current dose, and any symptoms you had during previous medication changes. It's also a good idea to keep a "mood calendar" on which you record your mood (on a scale of one to 10) on a daily basis.
Consider psychotherapy. Fewer than 20% of people on antidepressants undergo psychotherapy, although it's often important in recovering from depression and avoiding recurrence. In a meta-analysis of controlled studies, investigators at Harvard Medical School and other universities found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse.
Stay active. Bolster your internal resources with good nutrition, stress-reduction techniques, regular sleep — and especially physical activity. Exercise has a powerful antidepressant effect. It's been shown that people are far less likely to relapse after recovering from depression if they exercise three times a week or more. Exercise makes serotonin more available for binding to receptor sites on nerve cells, so it can compensate for changes in serotonin levels as you taper off SRIs and other medications that target the serotonin system.
Seek support. Stay in touch with your clinician as you go through the process. Let her or him know about any physical or emotional symptoms that could be related to discontinuation. If the symptoms are mild, you'll probably be reassured that they're just temporary, the result of the medication clearing your system. (A short course of a non-antidepressant medication such as an antihistamine, anti-anxiety medication, or sleeping aid can sometimes ease these symptoms.) If symptoms are severe, you might need to go back to a previous dose and reduce the levels more slowly. If you're taking an SRI with a short half-life, switching to a longer-acting drug like fluoxetine may help.
You may want to involve a relative or close friend in your planning. If people around you realize that you're discontinuing antidepressants and may occasionally be irritable or tearful, they'll be less likely to take it personally. A close friend or family member may also be able to recognize signs of recurring depression that you might not perceive.
Complete the taper. By the time you stop taking the medication, your dose will be tiny. (You may already have been cutting your pills in half or using a liquid formula to achieve progressively smaller doses.) Some psychiatrists prescribe a single 20-milligram tablet of fluoxetine the day after the last dose of a shorter-acting antidepressant in order to ease its final washout from the body, although this approach hasn't been tested in a clinical trial.
Check in with your clinician one month after you've stopped the medication altogether. At this follow-up appointment, she or he will check to make sure discontinuation symptoms have eased and there are no signs of returning depression. Ongoing monthly check-ins may be advised.
Image: AlinaTraut/Getty Images
To learn what you can do to get the sleep you need for optimal health, safety, and well-being, but the Harvard Special Health Report Improving Sleep: A guide to a good night's rest.
Knowing when you’re done
You might think that undergoing psychotherapy means committing to years of weekly treatment. Not so.
How long should psychotherapy take?
How long psychotherapy takes depends on several factors: the type of problem or disorder, the patient’s characteristics and history, the patient’s goals, what’s going on in the patient’s life outside psychotherapy, and how fast the patient is able to make progress.
Some people feel relief after only a single session of psychotherapy. Meeting with a psychologist can give a new perspective, help them see situations differently, and offer relief from pain. Most people find some benefit after a few sessions, especially if they’re working on a single, well-defined problem and didn’t wait too long before seeking help.
If you’ve been suffering from extreme anxiety, for example, you might feel better simply because you’re taking action—a sign of hope that things will change. Your psychologist might also offer a fresh perspective early in your treatment that gives you a new understanding of your problem. And even if your problem doesn’t go away after a few sessions, you may feel confident that you’re already making progress and learning new coping skills that will serve you well in the future.
Other people and situations take longer—maybe a year or two—to benefit from psychotherapy. They may have experienced serious traumas, have multiple problems, or just be unclear about what’s making them unhappy. It’s important to stick with psychotherapy long enough to give it a chance to work.
People with serious mental illness or other significant life changes may need ongoing psychotherapy. Regular sessions can provide the support they need to maintain their day-to-day functioning.
Others continue psychotherapy even after they solve the problems that brought them there initially. That’s because they continue to experience new insights, improved well-being, and better functioning.
How do I know when I’m ready to stop?
Psychotherapy isn’t a lifetime commitment.
In one classic study, half of psychotherapy patients improved after eight sessions. And 75% improved after six months.
You and your psychologist will decide together when you are ready to end psychotherapy. One day, you’ll realize you’re no longer going to bed and waking up worrying about the problem that brought you to psychotherapy. Or you will get positive feedback from others. For a child who was having trouble in school, a teacher might report that the child is no longer disruptive and is making progress both academically and socially. Together you and your psychologist will assess whether you’ve achieved the goals you established at the beginning of the process.
What happens after psychotherapy ends?
You probably visit your physician for periodic check-ups. You can do the same with your psychologist.
You might want to meet with your psychologist again a couple of weeks or a month after psychotherapy ends just to report how you’re doing. If all is well, you can wrap things up at that follow-up session.
And don’t think of psychotherapy as having a beginning, middle and end. You can solve one problem, then face a new situation in your life and feel the skills you learned during your last course of treatment need a little tweaking. Just contact your psychologist again. After all, he or she already knows your story.
Of course, you don’t have to wait for a crisis to see your psychologist again. You might just need a “booster” session to reinforce what you learned last time. Think of it as a mental health tune-up.
The American Psychological Association gratefully acknowledges the assistance of June Ching, PhD Angela Londoño-McConnell, PhD Elaine Ducharme, PhD Terry Gock, PhD Bethe Lonning, PsyD Nancy Molitor, PhD Dianne Polowczyk, PhD and Michael Ritz, PhD, in developing this material.
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