Textbooks of psychiatry traditionally advise that you find a dose of antidepressants which has eradicated your symptoms, and you take this same dose for many months or years.


However, in my experience, the above scenario can rarely apply.  When people are under stress, or have had a virus, their symptoms of depression tend to slowly creep back, and it is necessary to increase the antidepressant dosage slightly to compensate.  Typical early symptoms of depression returning are difficulty thinking clearly, difficulty with memory, reduction in sexual interest,  general fatigue and lack of motivation.


In contrast, when life is not so stressful, or when the antidepressants have eventually eradicated your depression, and particularly the accompanying anxiety, many people find they start to feel very tired and flat.  They are sometimes told the antidepressant must be losing its effect, and that they should change antidepressants or increase the dosage.  For some antidepressants, this has been described as the “therapeutic window” of that medication.  In fact, in my experience, all that is happening in very many cases is that the medication has proved to be too strong for the few remaining symptoms.  The person is now being over-sedated by the powerful antidepressant, and all that is needed is to reduce the dose of the antidepressant.


THE YES SYNDROME (Yawning, Expression problems, Silly mistakes)

Typical symptoms of being over-medicated are feeling tired, yawning a lot, having difficulty thinking of the right word, having difficulty saying the right word, making simple mistakes in spelling or calculations, typing errors, putting things in the wrong place,  or falling asleep as soon as one sits in a comfortable position.


With experience, I advise my patients to slightly adjust the doses of their own antidepressant medication, up or down, depending on whether they are experiencing return of depressive symptoms, or being over-medicated. The effects of dose changes are clear usually within 48-72 hours. In your particular case, your own doctor must advise you.


I wrote the above YES syndrome as a letter to the specialist psychiatry journal, the ANZ Journal of Psychiatry.


Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

2 thoughts on “Need to adjust dosage of antidepressants

  1. Des Spencer says:

    Hi I had a major depression 4years ago and needed 300mg a day of fluvoxamine I found I had to come back to 250 after 18 months then 200 at the start of the year,occasionally increasing to 225 or 250 occasionally. Falling asleep at 9pm became usual. Recently got sore tummy from a blood pressure pill the doc started so I increased slightly and depression symptoms worsened so return to 200 again and it improved.now on 175mg and better still. Probably move on to 150 can’t see Psych till September 3. If not suitable wait it out till then.
    Also take Valdoxan 1 tab. And .25 of Kala as needed

  2. Cam C says:

    Hi David,
    Thank-you for putting so much effort into your websites and sacraficing your personal time to do so, it is greatly appreciated. In case it may further assist those reading this section, I have included some of my own experiences with the YES syndrome. Also, with regard to the above, one thing I would add is that if your treatment regimen is complex and involves use of a stimulant as an adjunct medication, the yawning and tendency to fall asleep easily etc. may not be quite as apparent. However, the other signs most certainly are, and confirming what you have described, from my own experience I have found:
    – when writing a report or in conversation with someone I will repeatedly find myself having to pause whilst I try and remember the word I intended to use, it is as though you have a ‘memory blank’ – you know the word you want but you simply cannot recall it.
    – I have found that when in a meeting for example, I will start speaking to someone (who I know well) and without even realising it I will be addressing them by the wrong name (it will be the name of someone else I know at least!!). My brain seems to be on auto-pilot.
    – I find that when I am in conversation and my attention is momentarily distracted because of something, when I attempt to continue the conversation I will have a complete ‘mental blank’ and simply cannot recall whatever it was I intended to say next “ahh…where was I going with that line of thought..?
    – When in conversation speech can be a bit ‘stunted’ (for want of a better word). In this instance you know the words but it can be difficult to complete your sentences in a fluid manner. This is especially prominant when trying to explain something to someone.

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