Why Antidepressants May Worsen Mood Swings in Depression and Insomnia

Medication for insomnia related to depression?

My mother has been experiencing mental and emotional instability for many years.
She previously denied having any related mental health issues, but recently she finally sought treatment and is now taking medication for depression and insomnia.
However, her mood has become even more unstable, and she often cries (which was not a common symptom for her before).
Could you explain why her emotions have become more volatile after starting the medication? Thank you!

H, 30~39 year old female. Ask Date: 2016/02/16

Dr. Liang Sunyuan reply Psychiatry

Hello, there could be different reasons for this.
One possibility is that medications for depression typically require a period of consistent use before they start to take effect, usually between two to six weeks.
Therefore, if this is during the early stages of treatment, the effects may still be influenced by the depression itself, and the protective effects of the medication may not have manifested yet.
Having family support and care during this time is very important.

Another possibility is that sedatives and anti-anxiety medications have a relaxing effect.
If someone has been suppressing their feelings in the past, they may release those emotions once they relax.
In such cases, the listening and support from family members are crucial.
If she feels empathized with and understood, it is usually easier for her to stabilize her mood.

The most reliable approach is to return for a follow-up appointment and discuss coping strategies and solutions directly with the physician.
Best wishes to you.

Reply Date: 2016/02/16

More Info

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and other classes of antidepressants, are commonly prescribed to manage symptoms of depression and anxiety. However, it is not uncommon for some individuals to experience worsening mood swings or emotional instability after starting these medications. This phenomenon can be perplexing and concerning, especially for family members observing these changes.

There are several reasons why antidepressants may initially exacerbate mood swings or emotional instability:
1. Adjustment Period: When starting an antidepressant, the body undergoes a period of adjustment. This can take several weeks, during which time the brain's neurochemistry is changing. Some individuals may experience heightened anxiety, agitation, or emotional lability during this adjustment phase before the medication begins to take effect fully. This is particularly true for SSRIs, which can initially increase serotonin levels in a way that may lead to increased anxiety or mood swings.

2. Side Effects: Antidepressants can have side effects that may contribute to emotional instability. For example, some individuals may experience increased agitation, restlessness, or insomnia as side effects of the medication. These side effects can lead to a cycle of increased anxiety and mood swings, making it difficult for the individual to stabilize their emotions.

3. Underlying Conditions: If your mother has a long history of emotional instability or other underlying mental health conditions, such as bipolar disorder, the introduction of an antidepressant may not be sufficient to stabilize her mood. In some cases, antidepressants can trigger manic or hypomanic episodes in individuals with bipolar disorder, leading to increased mood swings.

4. Dosage and Medication Interactions: The dosage of the antidepressant may also play a role. If the dose is too high, it may lead to increased side effects, including mood swings. Additionally, if your mother is taking multiple medications, interactions between them could exacerbate emotional instability.

5. Psychological Factors: Starting a new medication can also bring about psychological changes. The awareness of being treated for a mental health condition can lead to increased self-reflection and emotional responses. If your mother is grappling with the reality of her mental health issues, this could manifest as increased emotional volatility.

6. Expectations and Stigma: There can be societal and personal expectations regarding how quickly and effectively antidepressants should work. If your mother expected immediate relief from her symptoms and instead experienced worsening mood swings, this could lead to frustration and emotional distress.

Given these factors, it is crucial to communicate openly with your mother's healthcare provider about her experiences. The provider may need to reassess her treatment plan, which could involve adjusting the dosage, switching to a different medication, or incorporating therapy to help manage her emotional responses more effectively.

In addition to medication, psychotherapy, particularly cognitive-behavioral therapy (CBT), can be beneficial in addressing the underlying issues contributing to mood swings and emotional instability. CBT can help your mother develop coping strategies, challenge negative thought patterns, and improve her emotional regulation.

Lastly, lifestyle factors such as regular exercise, a balanced diet, adequate sleep, and stress management techniques can also play a significant role in stabilizing mood and improving overall mental health. Encouraging your mother to engage in these healthy habits can complement her treatment and support her emotional well-being.

In summary, while antidepressants can be effective in managing depression and anxiety, they may initially worsen mood swings for some individuals due to adjustment periods, side effects, underlying conditions, and psychological factors. Close communication with healthcare providers and a comprehensive treatment approach can help address these challenges and support your mother's mental health journey.

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