Side Effect or Just a Bad Week? How to Track Antidepressant Side Effects

Do any of these sound familiar?

• It's 3pm, you're yawning at your laptop, and you can't say whether it's the new medication, the depression, or the third meeting in a row that could have been an email.
• Someone tells a funny story, everyone laughs, and you register that it was funny the way you'd register the weather.
• It's 1am, and you type the name of your medication and the word "weight" into a search bar. Then "normal?". Then you close the tab.

This piece is about noticing and reporting. It names no drug and no dose, and nothing in it is a reason to change, stop or skip anything without talking to the person who prescribed it.

Why it's so hard to tell what's doing what:

Depression already changes your sleep, your appetite, your energy, your interest in sex and how much you can feel. The NHS side effects list names problems with sleep, weight gain, problems with sex and mood changes, including feeling "emotionally numb." The two lists overlap so much you could swap the labels and barely notice.

They also run on different clocks. Side effects can turn up in the first few days, while improvement usually takes weeks (whether the medication is helping at all is a separate question). The NHS says many side effects ease after a couple of weeks and some can continue while you're still taking it. That's why the first weeks are the most confusing ones.

And life doesn't pause while you figure it out. A bad night could be the medication, a deadline, or the neighbor who picked 7am on a Saturday to try out his new drill.

Fun fact: you can tell how far away a storm is without seeing it. Count the seconds between the flash and the thunder, divide by five, and according to the National Weather Service you've got the distance in miles. The timing does the sorting. If you can't sort yours by feel alone, you're not bad at noticing your own life. It's hard for everyone, doctors included.

From the inside they feel the same. On paper, they usually have different dates.

What it can look like day to day:

Nausea or a headache are usually easy enough to mention. These four are the ones people sit on:

• Sleep. You're up at 2am with your eyes open, or you wake up feeling like you're climbing out from under a heavy blanket.
• Weight and appetite. Your jeans fit differently, and you can't tell if it's the medication or the fact that you're eating normally again.
• Sex. Less interest, or it's harder to reach orgasm, and it's the last subject you want to bring up in an appointment.
• Feeling flat. Less sadness, but less of everything else, too. You don't cry at the film that always gets you, and good news arrives like information. Researchers call this emotional blunting. If all you've got for it is "I'm fine," it helps to put a name to it.

The ones that are hardest to say are usually the ones that matter most to how your day goes.

What research turned up:

In 2004, Hu and colleagues phoned 401 people who had started an SSRI for depression, 75 to 105 days after they began. The results, in the Journal of Clinical Psychiatry: 86% reported at least one side effect, and 55% at least one they found bothersome. The most common bothersome ones were sexual problems and drowsiness, 17% each. Most started in the first two weeks, and many were still there at the interview, sexual problems in 83% of the people who had them. The team also surveyed 137 prescribing physicians, who underestimated both how often these side effects happen and how much they bother people. Nobody can see your 3pm crash from across a desk, which is the case for walking in with notes.

In 2009, Price, Cole and Goodwin interviewed people taking SSRIs for a qualitative study in the British Journal of Psychiatry. They described emotional changes they strongly put down to the medication, and most said they could tell those apart from the symptoms of their depression. The changes affected daily life, and even decisions about whether to keep taking the medication. So if something feels like the medication to you, that hunch counts as information.

In 2017, Goodwin and colleagues ran an online survey, published in the Journal of Affective Disorders. Of 669 people on a single antidepressant, 46% reported emotional blunting. The people who were more depressed also tended to feel flatter, so the authors concluded it can't be described simply as a side effect: it's also a symptom of depression. The study was industry-funded and run by a market research firm, with depression self-reported. Feeling flat is still common and worth raising, and where it comes from is for you and your prescriber to work out.

The honest caveat: these are surveys and group averages, and none of them can tell you whether your Tuesday insomnia is the medication. That's less bleak than it sounds. Sorting it out is your prescriber's job, and your part is doable from today: write down when it started, how strong it is and what it changes.

Going by Hu's numbers, if you don't say it, nobody's going to guess it.

How to track antidepressant side effects, so your prescriber can use it:

Keep one short, dated note per change, and leave the decisions to your prescriber.

1. Write down your "before." One or two lines on sleep, appetite, sex and how much you could feel before you started. If you've already started, write what you remember and mark it as memory. Without a starting point, "worse" doesn't mean much.
2. Give each side effect four fields. When it started: the date, and how many days after starting or after the last change your prescriber made. How strong it is, from 1 to 10, on the same scale every time. What it changes in your day, in plain terms: "nap at 3pm," "skipped the gym," "avoiding intimacy." And which way it's going: fading, steady or growing. The effect on your day is the field your prescriber can do the most with.
3. Keep it separate and small. Keep side effects on their own short list, away from your general mood score. Nobody needs a spreadsheet with 14 columns and conditional formatting. Aim for a log that survives week three.
4. Use plain words for the awkward ones. "Things are a bit off" gives nobody anything to work with. "Harder to reach orgasm since around day 10" or "I feel less of everything, good things too" does.
5. Bring three ready sentences. For anything: "Since [date] I've noticed [the change]. It's about a 6 out of 10, and it means [what it changes in my day]. Is that expected, and what are the options?" For sex: "There's been a change in my sex life since I started, and I'd like to talk about it." For flatness: "I feel less low, but I also feel less of everything. I can't tell if that's the medication or me." What happens next is your prescriber's call, so don't change, stop or skip anything on your own. Flatness and what it does to your relationships make good therapy material too, so bring it to your next session.

Focus Areas check-ins
Add what you're watching as a Focus Area and rate it from 1 to 10 in under a minute, so "it's gotten worse" comes with numbers and dates. Try it free in MindSync →

A date, a number and one real example will get you further than "I just feel off."

When it shouldn't wait for your next appointment:

Rare, but don't save these for next time:

• New or stronger thoughts of harming yourself, especially in the first weeks or after a dose change: tell your prescriber now. In the US, call or text 988, or 911 in an emergency.
• Possible serotonin syndrome (agitation, a racing heart, a high temperature, poor coordination): get medical help right away.
• Signs of an allergic reaction, like a swollen face or trouble breathing: call 911.

Even then, don't stop the medication on your own. Call.

Where MindSync fits:

This is what MindSync's Focus Areas check-ins are for. Add the thing you're watching as a Focus Area (sleep, energy, "feeling flat") and log the 3pm crash on day nine, the joke that landed like a weather report, the night you were awake at 2am. Give it time, and Focus Areas on Main chart your last 14 ratings and describe the trend in plain words. Then open the app at your appointment and read the dates out. MindSync is a journal for between sessions that sits next to your treatment, and it won't tell you what the medication is doing.

The dates, kept for you

• Between-session voice notes - When something odd happens mid-afternoon, say it out loud: the note is transcribed and keeps its date.
• Therapy timeline - Every note, card and summary on one timeline, so you can scroll back to the day it started.
• Before therapy card - Flatness belongs in therapy too, and the Before therapy card gathers what came up since your last session into up to three questions.

Keep a dated record of what you notice, and have it on your phone when you see your prescriber.

Which change have you noticed but haven't said out loud to anyone yet?

Frequently asked questions

How do I know if it's a side effect or my depression?

Often you can't tell from a single day, because depression and antidepressant side effects can feel exactly the same. The clearest clue is timing: a change that shows up in the first days after starting, or after a change your prescriber made, is worth reporting with its date. Sorting out which is which is your prescriber's job, and your part is the dated note.

How long do antidepressant side effects last?

It varies. The NHS says many side effects ease after a couple of weeks, and some can continue while you're still taking the medicine. If one stays, gets stronger or gets in the way of your day, tell your prescriber instead of waiting it out, and bring the date it started.

Is feeling numb a side effect of antidepressants?

It can be. Feeling emotionally numb, often called emotional blunting, is on the NHS list of common side effects, and in a 2017 survey by Goodwin and colleagues, 46% of people on a single antidepressant reported it. The same survey linked it with how depressed people were, so it can be part of the depression too. Either way, it's worth raising, and "I feel less low, but I also feel less of everything" is a good first sentence.

How do I tell my doctor about sexual side effects?

Say it plainly and early, with a date and what changed. One sentence is enough to open it: "There's been a change in my sex life since I started, and I'd like to talk about it." It's one of the most common side effects people report, so your prescriber won't be hearing it for the first time.

When should I call my doctor about antidepressant side effects?

Right away for new or stronger thoughts of harming yourself, a sharp drop in mood, agitation, or anything that feels severe. In the US you can also call or text 988, and in an emergency, call 911. For everything else, bring your dated notes to your next appointment, or ask for one sooner if a side effect is getting in the way of your day, and don't stop or change the medication on your own in the meantime.