Can Antidepressants Make You Feel Worse?

Depressed young boy with head in his knees
Rob & Julia Campbell/Stocksy United

While antidepressants are quite effective at relieving depression, it is possible that some patients—in particular, young people—may temporarily feel worse when they first begin taking an antidepressant or when they make changes in their dosage.

Black Box Warning

In October 2004, the U.S. Federal Drug Administration (FDA) issued what is known as a "black-box" warning stating that certain antidepressants, when used in young people 24 years old and under, could increase their risk for suicidal thoughts and behaviors.

The FDA noted that there was no association found between antidepressant use and suicidal thoughts and behaviors in adults over the age of 24.

Antidepressants actually appeared to reduce the suicide risk in adults aged 65 and older.

This black box warning, which is the most serious type of warning that can be issued regarding a prescription medication, was ordered following a thorough review of all available clinical trials, including unpublished ones, regarding the use of antidepressants in children and adolescents.

The study included a total of 24 short-term trials of nine different antidepressants used in over 4,400 child and adolescent patients. In addition, there were 295 short-term trials of 11 different antidepressants involving 77,000 adult patients.

While the risk of suicidality varied between drugs, the pattern of seeing increased suicidality in young people remained true for almost all drugs studied.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

It should be noted that no suicides actually occurred among the young people studied. Although there were some suicides among the adults studied, the numbers were too few for any conclusions to be drawn about whether the antidepressants used were a causal factor.

It is also important to remember that depression itself is also a known risk factor for suicide and cannot be ruled out in these cases.

The black box warning further suggests:

  • In addition, families and other caregivers should be instructed to contact the patient's physician or another appropriate medical professional in the event that any problems occur.
  • Patients of all ages should be monitored closely when they begin treatment with an antidepressant.
  • They should be watched for any signs of worsening depression, increased suicidality, or changes in behavior.

Impact of the Warning

The FDA's decision was not without controversy. There were unintended consequences of the FDA decision and the research itself was criticized due to methodological issues. Research has shown that there was a decrease in both depression diagnoses and antidepressant prescription rates in the wake of the FDA's decision to include the black box warning. 

Another concerning trend was a resulting increase in psychotropic-drug poisonings. This may indicate an increase in suicide attempts, although whether these poisonings were accidental or intentional is not clear.

Some evidence suggests that the FDA warning combined with alarmist media reports that may have exaggerated the connection between antidepressant use and suicide played a role in the decreased use of effective medications. 

What to Watch For

In particular, the FDA recommends that a healthcare provider be contacted if you—or a person who you are caring for—experience any of the following:

  • Aggression, anger or violence
  • Any other unusual changes in mood or behavior
  • Extreme increases in activity or talking (signs of mania)
  • Feelings of agitation or restlessness
  • Impulsiveness
  • New or worsening anxiety
  • New or worsening depression
  • New or worsening irritability
  • Panic attacks
  • Problems with sleeping
  • Suicide attempts
  • Thoughts of suicide or death

While a black box warning might cause some to feel concerned, they should be aware that the benefits to be obtained from treating depression with an antidepressant greatly outweigh the risks in the majority of cases. Untreated depression is quite serious and is much more likely to lead to suicide than is an antidepressant.

The warning is simply provided so that people can be aware of this potential effect and take appropriate measures to get help if they do begin to feel worse.

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Article Sources
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  1. Insel T. Antidepressants: A complicated picture. National Institute of Mental Health. Published December 6, 2011.

  2. U.S. Food and Drug Administration. Suicidality in children and adolescents being treated with antidepressant medications. Updated February 5, 2018.

  3. U.S. Food and Drug Administration. Revisions to product labeling.

  4. U.S. Food and Drug Administration. Revisions to product labeling.

  5. Friedman RA. Antidepressants' black-box warning--10 years later. N Engl J Med. 2014;371(18):1666-8. doi:10.1056/NEJMp1408480

  6. Fornaro M, Anastasia A, Valchera A, et al. The FDA "black box" warning on antidepressant suicide risk in young adults: more harm than benefits?Front Psychiatry. 2019;10:294. doi:10.3389/fpsyt.2019.00294

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