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Overview
An antidepressant medication aims to balance specific chemicals in the brain, known as neurotransmitters, to improve mood.
Not all antidepressants are created equal, though. Some may offer relief faster than others and may be suitable for depression that does not improve with traditional medications or other approaches.
Do all antidepressants work immediately?
No, antidepressants do not typically work instantly. These medications gradually modify brain chemistry and neurotransmitter levels. This process takes weeks to produce noticeable effects on how you feel and act.
While individual responses to antidepressants may vary, most people may notice some symptom relief within 2 weeks.
More significant effects may take longer. However, some new antidepressants may offer relief in a few days or weeks.
Consider asking your healthcare professional about newer antidepressants if you are concerned about how fast your medication is working.
Switching to a new drug or stopping your medication without your doctor’s supervision is not recommended. It may worsen your symptoms and cause additional side effects.
List of most common fast-acting antidepressants
Fast-acting antidepressants may provide relatively quicker symptom relief compared with traditional antidepressants.
A healthcare professional may choose to prescribe a fast-acting antidepressant if you experience severe symptoms or other medications have not been effective.
They will advise on the best way to gradually switch to a new drug to avoid possible withdrawal symptoms.
Withdrawal from an antidepressant occurs due to physical changes caused in the body after stopping or reducing the medication. It’s not exactly clear what causes this. However, decreasing the dosage over time or replacing the antidepressant with a different one can reduce the risk of withdrawal symptoms.
Fast-acting antidepressants that may provide relief within 2 weeks or sooner may include:
Esketamine
Esketamine (Spravato) is an NMDA receptor antagonist. The Food and Drug Administration (FDA) has approved esketamine as a fast-acting medication for depression. It is available as a nasal spray, and a doctor will administer this at their office or clinic. This is because the drug requires close and frequent medical supervision on administration.
Esketamine is often used with oral antidepressants to manage depression that has not responded to any other medications. It may also effectively treat major depressive disorder (MDD) that involves severe symptoms, such as thoughts of suicide.
Esketamine is a Schedule III controlled substance, which means it has a moderate likelihood of physical and psychological dependence. Treating depression with esketamine requires close and regular medical supervision.
Common side effects include:
- dizziness
- nausea
- headache
Severe side effects include:
- disassociation (a feeling of detachment from yourself and your surroundings)
- suicidal thoughts and behavior
- high blood pressure
- sedation
- bladder problems
Ketamine
Although approved by the FDA as an anesthetic, ketamine has shown promise as a fast-acting medication for severe depression and other mental health conditions. However, it is not FDA approved for depression, which means the FDA has not validated how safe and effective the drug is for this use.
The use of ketamine for depression requires close medical supervision and may be a short-term alternative for severe cases.
Ketamine (Ketalar) is available in two forms: as an intravenous (IV) infusion (an injection given into a vein over time) and a nasal spray.
Common side effects include:
- dizziness
- nausea
- sedation
- problems with coordination
Although rare, it may also cause mental confusion, disassociation, hallucinations, and bladder problems.
Dextromethorphan/bupropion
Dextromethorphan/bupropion (Auvelity) is a newer FDA-approved fast-acting antidepressant medication.
Auvelity is a combination of a cough suppressant (dextromethorphan) and a traditional antidepressant (bupropion). The combined medication is useful for treating MDD and may offer symptom relief in as soon as 1 week.
Common side effects include:
- dizziness
- dry mouth
- diarrhea
- sleepiness
- sexual dysfunction
Rare side effects include:
- seizures
- anxiety
- fatigue
- joint pain
- high blood pressure
- serotonin syndrome
- glaucoma
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Get free cardOral antidepressants for treatment-resistant depression
When depression does not respond to initial treatment, a healthcare professional may try different approaches.
These may include switching you to another fast-acting antidepressant or combining two or more antidepressant medications. In some cases, they may also combine oral antidepressants with antipsychotics or lithium.
Some oral antidepressants that may be used as add-on therapies to fast-acting antidepressants include:
MAOIs (monoamine oxidase inhibitors)
MAOIs work by inhibiting the enzyme monoamine oxidase, which increases the levels of some brain chemicals.
Examples include phenelzine (Nardil) and tranylcypromine (Parnate).
Common side effects include:
- dry mouth
- dizziness
- nausea
Tricyclic antidepressants
Tricyclic antidepressants block the reabsorption of neurotransmitters such as serotonin and norepinephrine, which increases their levels in the brain.
Examples include amitriptyline and nortriptyline (Pamelor).
Common side effects include:
- dry mouth
- constipation
- drowsiness
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs work by blocking the reabsorption of serotonin and norepinephrine, which are mood-modulating neurotransmitters, thereby increasing their levels in the brain.
Examples include venlafaxine (Effexor XR) and duloxetine (Cymbalta).
Common side effects include:
- nausea
- insomnia
- drowsiness
Atypical antidepressants
Atypical antidepressants include medications that work through various mechanisms to ease depression symptoms.
Examples include bupropion (Wellbutrin SR, Wellbutrin XL) and mirtazapine (Remeron).
Common side effects include:
- sedation
- weight gain
- sexual dysfunction
Fast-acting antidepressants for other conditions
Antidepressants may help treat other types of depression and mental health conditions, such as anxiety. For example, the FDA has approved zuranolone (Zurzuvae) for the treatment of postpartum depression.
Your doctor or pharmacist can tell you more about the use of fast-acting depressants for other conditions.
Summary
Fast-acting antidepressants, such as esketamine and dextromethorphan/bupropion, may be effective in the treatment of severe depression and treatment-resistant depression. They may provide relief within a week.
In some cases, healthcare professionals may choose to use these or other fast-acting antidepressants in combination with traditional oral medications for depression, such as venlafaxine and phenelzine.
If you are concerned about your symptoms or believe your current antidepressant is not working, consider discussing alternative medications with your doctor. Discontinuing the use of your current medication without medical supervision is not recommended.
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