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Summary: Yes, your depression medication can be making you anxious. Evidence shows possible side effects of depression medication – called antidepressants – may include anxiety, restlessness, and agitation.

Key Points:

  • Antidepressants are a first-line treatment for major depressive disorder (MDD)
  • Antidepressants may also be prescribed for anxiety disorders
  • In people with major depressive disorder (MDD), antidepressants use may lead to antidepressant-induced jitteriness/anxiety syndrome
  • Symptoms most often appear within 2-6 weeks of initiating antidepressant use

Depression Medication and Anxiety

Treatment for depression typically includes a combination of medication, psychotherapy, lifestyle changes, and various types of complementary support, such as peer groups, expressive therapies, and stress management techniques such as meditation and/or mindfulness.

Medication for depression, called antidepressant medication or simply antidepressants, is associated with a variety of side effects. In some cases, patients with major depressive disorder (MDD) report feelings of restlessness or agitation after beginning a course of treatment with antidepressants. Medical researchers first identified this phenomenon, called antidepressant-induced jitteriness/anxiety syndrome, in the mid-1990s.

The primary symptoms of antidepressant-induced jitteriness/anxiety syndrome include:

  • Anxiety
  • Agitation
  • Panic attacks
  • Insomnia
  • Irritability
  • Hostility
  • Aggressiveness
  • Impulsivity
  • Akathisia (uncontrollable urge to move)
  • Hypomania
  • Mania

Over the two decades after scientists first described the syndrome, neither the symptoms nor the mechanisms associated with this syndrome were well-understood or well-described by medical researchers. However, a study conducted at the University of North Carolina School of Medicine in 2016-2017 “mapped out a serotonin-driven anxiety circuit that may explain this [phenomenon] and lead to treatments to eliminate it.”

That paper followed the most exhaustive research on the topic, published two years earlier. Researchers in Japan designed a study called “A Prospective  Naturalistic Study of Antidepressant-Induced Jitteriness” with the following goal:

“To survey the incidence of antidepressant-induced jitteriness/anxiety syndrome and clarify its predictors in a natural clinical setting.”

The authors of that study reviewed the potential reasons antidepressants may cause anxiety, which indicated the following:

“Antidepressants activate brain monoamines, which are responsible for many forms of active behavior and it is assumed that in the case of jitteriness/anxiety syndrome, antidepressants abnormally stimulate the production of brain monoamines and trigger emotional excitement and exaggeration, although the actual biological mechanism remains unclear.”

That proposal was confirmed by the research we share above, conducted in North Carolina. Now that we know the answer to the question “Can my depression medication be making me nervous?”, which is “Yes,” and have an idea why – neurotransmitter changes in the brain – let’s take a look at the study conducted in Japan and find out more about what they learned.

What’s the Likelihood My Depression Medication May Be Making Me Anxious?

If you have major depressive disorder (MDD) and take antidepressants, evidence from the study indicates you may have a significantly increased risk of developing anxiety, compared to people who take antidepressants for another mental health condition.

Before we share the exact details on your elevated risk, let’s look at the details of the study and review the top-line results.

About the Study: Depression Medication Associated With Anxiety/Anxious Feelings

The research team analyzed records from 301 patients who met the following criteria:

  • Reported no antidepressant use for at least 1 month before treatment
  • Took antidepressants for at least after initiating treatment

Patients who experienced the symptoms we list above – anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania – during the first month after initiating antidepressant met criteria for antidepressant-induced jitteriness/anxiety syndrome.

After a careful review of the data, the research team reported:

  • 0% of patients – 21 people out of 301 – developed jitteriness/anxiety syndrome.

Here are the symptoms those patients reported:

  • Insomnia: 42.9%
    • 9 patients
  • Irritability: 33.3%
    • 7 patients
  • Anxiety/agitation: 23.8%
    • 5 patients
  • Panic attack: 14.3%
    • 3 patients
  • Impulsivity: 9.5%
    • 2 patients
  • Akathisia (uncontrollable urge to move around): 4.8%
    • 1 patient
  • Hypomania: 4.8%
    • 1 patient

The patients who developed jitteriness/anxiety syndrome had diagnoses of the following mental health disorders:

  • Major depressive disorder (MDD): 52.4%
    • 11 patients
  • Panic disorder: 19.0%
    • 4 patients
  • Adjustment disorder: 9.5%
    • 2 patients
  • Somatoform disorder: 4.8%
    • 1 patient
  • Depressive disorder not otherwise specified: 4.8%
    • 1 patient
  • Anxiety disorder not otherwise specified: 4.8%
    • 1 patient

Among those patients, the antidepressant medications they took included:

  • Paroxetine: 38.1%
  • Sertraline: 33.3%
  • Fluvoxamine: 9.5%
  • Escitalopram: 4.8%
  • Milnacipran: 4.8%
  • Clomipramine: 4.8%
  • Trazodone: 4.8%

Those are the primary results of the study: 21 percent of patients developed anxiety/jitteriness, which is slightly less than the 27 percent identified in a study of 230 patients conducted in 2017. Before we circle back to share the likelihood of developing anxiety/jitteriness, we’ll take a moment to answer a question you may have about the results:

Why would someone with anxiety take a medication that can increase anxiety?

That’s a good question with a simple, two-part answer. First, the majority of people who take antidepressants don’t report anxiety as a side effect. Second, some providers prescribe antidepressants for certain anxiety disorders, because evidence shows they may be effective for symptom relief.

Hold that thought while we share the final results from the study.

 How Likely is it That My Depression Medication May Be Making Me Anxious?

To determine what factors increase risk of developing antidepressant-induced jitteriness/anxiety syndrome, the researchers conducted statistical analysis related to determine and odds ratio (OR) for each possible factor. Potential predictors of risk included type of antidepressant, age, sex, use of anxiolytic medication, diagnosis of generalized anxiety disorder (GAD).

Here’s what they found:

  • Diagnosis of major depressive disorder yielded an OR of 10.2 or a 92% increased risk, compared to patients who take antidepressants who don’t have MDD.
  • Diagnosis of mood disorder in first-degree relatives yielded an OR of 4.65, or a 36% increased risk, compared to patients who take antidepressants who don’t have first-degree relatives with a diagnosis of a mood disorder.
  • Type of antidepressant, age, sex and use of anxiolytics did not increase risk of developing antidepressant-induced jitteriness/anxiety syndrome

Now – about that thought we asked you to hold. Here’s why:

Diagnosis of generalized anxiety disorder (GAD) did not increase risk of antidepressant-induced jitteriness/anxiety syndrome among patients who took antidepressant medication.

That finding may seem counterintuitive, until we remember that in some cases, antidepressants are effective in relieving anxiety, and don’t cause additional anxiety or jitteriness. With all this new information in mind, you may wonder how to handle any anxiety caused by your depression medication.

We’ll offer our best tips now.

If My Depression Medication is Making Me Anxious, What Do I Do?

Do Not Stop Taking Antidepressant Medication Without Talking to Your Provider First.

Read that sentence again and then read on.

The first thing to do is talk to your treatment team about the symptoms you experience. If you feel anxious in a way you didn’t before and know your depression medication can be making you anxious, then share those thoughts with your therapist, counselor, or psychiatrist. Your psychiatrist most likely manages your medication, and will need to know about your symptoms, but if you can’t get in touch with them right away, that’s okay.

Talk to whomever you can reach first and let them know what’s going on. It’s important to make a record of your experience – including when the symptoms first appeared – in order to make any necessary changes to your treatment plan.

Your symptoms may be short-term and pass after several weeks. If they persist, however, your provider may recommend trying a lower dose of your current antidepressant, adding a short-term anxiolytic, or switching to a different antidepressant.

We adapted this helpful list of possible ways to manage antidepressant-associated anxiety this article from VeryWellMind.

How to Handle Anxiety and Jitteriness Associated With Antidepressants

  • Manage Emotional Consequences:
    • You may experience distress because of this change in your emotions or emotional state
    • Understand that anxiety from your antidepressant does not mean you’ve developed an anxiety disorder in addition to MDD
    • Talk to your psychiatrist/therapist/counselor about what you experience
    • Wait until the stabilization phase is over, and reassess
  • Improve/Shore Up the Physical Components of Treatment:
    • Ensure you get plenty of exercise and activity
    • Ensure you eat a healthy diet and avoid or reduce:
      • Alcohol
      • Excess sugar
      • Tobacco
      • Caffeine
    • Maintain good sleep hygiene
  • Stay Social and Maintain Connections:
    • Keep contact with your friends and family
    • Participate in community and peer self-help groups
    • Find activity groups in your area
    • Say yes to social invitations (and actually go)

Remember: it’s not unusual for you depression medication to cause some jitteriness. If it happens to you don’t panic. Get in touch with your treatment team, follow our tips above, and you’ll find a way to resolve your symptoms and get the most out of your depression treatment.

Finding Help: Resources

If you or someone you know needs professional treatment and support for anxiety, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.