Starting Medication: Your First 4-8 Weeks
What to expect when starting psychiatric medication: timeline, common early effects, when to call your doctor, and how to track progress.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: July 2025
Key Takeaways
- Weeks 1-2 are an adjustment period; side effects often peak then improve
- Weeks 3-4 some people notice subtle mood, sleep, or energy improvements
- Weeks 5-8 full therapeutic effect usually becomes apparent
- Track mood, sleep, energy, and side effects daily to help your doctor
- Stay in close contact with your prescriber, especially in the first month
Week 1-2: The Adjustment Period
What's happening: Your body is adjusting to the medication. You likely won't feel the full mood benefits yet, but you may notice side effects.
- Common experiences: Nausea, jitteriness, sedation (depends on medication)
- Sleep changes: May sleep more or have disrupted sleep initially
- Energy: Some medications cause temporary fatigue; others activation
- Mood: Usually no significant mood improvement yet
What to do: Give it time. Most early side effects improve by week 2-3. Stay in contact with your doctor.
Week 3-4: Subtle Shifts
What's happening: Medication reaches steady levels in your system. Early responders may notice improvements.
- Sleep: May become more regulated and restful
- Energy: Some people notice more consistent energy
- Mood: Subtle improvements; less intense sadness or hopelessness
- Side effects: Often lessening by now
Week 5-8: Full Effect
What's happening: For most people who will respond, full therapeutic benefits emerge.
- Mood: More consistent emotional stability; reduced depression symptoms
- Functioning: Better able to engage with work, relationships, activities
- Assessment time: Your doctor evaluates if medication is working adequately
If you're not seeing adequate improvement by week 8, your doctor may adjust dose or try a different approach.
Frequently Asked Questions
What should I expect in the first week?
The first week is about adjustment. You may notice some side effects (nausea, jitteriness, sedation depending on the medication) before you notice mood benefits. This is normal. Side effects often lessen after the first 1-2 weeks.
When will I feel better?
Most people notice full mood benefits around 4-8 weeks. Some notice earlier improvements in sleep or energy (weeks 1-3), but mood changes typically take longer. Be patient and give the medication adequate time.
What if I feel worse at first?
Some medications can cause initial activation (restlessness, anxiety) or sedation. This usually improves in 1-2 weeks. If you feel significantly worse, have new suicidal thoughts, or can't tolerate side effects, contact your doctor promptly.
Should I take it in the morning or at night?
Depends on the medication and how it affects you. Activating medications (SSRIs, bupropion) are often taken in the morning. Sedating medications (mirtazapine) are usually taken at bedtime. Your doctor will provide guidance, and you can adjust based on your response.
Can I take it with food?
Most antidepressants can be taken with or without food. Taking with food may reduce nausea for some people. Check your specific medication's instructions or ask your pharmacist.
What if I have side effects?
Contact your doctor. Many side effects are temporary and manageable. Your doctor may suggest waiting them out (if mild), adjusting the dose, changing the timing, or switching medications if side effects are intolerable.
How often should I see my doctor?
Typically every 1-2 weeks initially, then every 4-6 weeks once stable. More frequent visits may be needed if you're having side effects or not responding. Regular monitoring ensures safety and allows dose adjustments.
Can I adjust the dose myself?
No—never adjust psychiatric medication doses on your own. Dose changes should always be guided by your prescriber based on your response, side effects, and clinical monitoring.
What if I don't notice any change by week 6?
Contact your doctor. If there's truly no response after 6-8 weeks at an adequate dose, your doctor may increase the dose, add a second medication, or try a different medication altogether.
When should I call my doctor right away?
Call immediately if you experience: new or worsening suicidal thoughts, severe agitation or panic, unusual mood elevation (mania), severe allergic reaction (rash, swelling, difficulty breathing), or any symptom that feels dangerous or unbearable.
References
- 1. Taylor MJ, et al. (2006). "Early onset of selective serotonin reuptake inhibitor antidepressant action." Archives of General Psychiatry 63(11):1217-1223.
- 2. Papakostas GI, Fava M. (2008). "Predictors, moderators, and mediators of treatment outcome in major depressive disorder." Dialogues in Clinical Neuroscience 10(4):439-451.