On average, it takes about ten days for antidepressants to start to work for major depression. The first 1-2 weeks is an adjustment period. At this time side effects will usually occur. The dose may need to be reduced for 3-4 days to allow adaptation to occur. Most side effects are short term and will go away, so patience is needed during this time.
Depression may not respond fully from medication for 6-8 weeks. Occasionally augmentation (adding another medication) may be needed for good response.
It is usually better to treat side effects than to change antidepressants if depression/stress symptoms are responding well. This is especially true for long term side effects.

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SIDE EFFECT TREATMENT
• Insomnia - Sonata, Ambien, Trazodone, Remeron
• Drowsiness - Stimulants, Wellbutrin, Provigil,
Phentermine
• Increased Appetite - Phentermine, Wellbutrin, Topamax
• Mood swings - Mood stabilizers
• Nausea - Remeron, Periactin, Zofran, Reglan
• Tremor - Inderal
• Sweating - Clonidine, Tenex, Cardura
• Anxiety/Nervousness - Xanax, Klonopin, Ativan, Buspar, Keppra, Neurontin
• Libido - Wellbutrin, Stimulants, Ginkgo, Testosterone (if low), DHEA
• Sexual Arousal - Viagra, Trazodone
• Orgasm - Wellbutrin, Yocon

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(This article originally appeared on this site 11-16-04 under the category Depression.)

The most common sexual side effect from SSRI’s is delayed orgasm. (more on SSRI’s ) For a lot of men this is not a problem - in fact can be helpful. This effect of SSRI’s is almost immediate - quickest for Effexor, then Lexapro, Celexa, Paxil, Prozac, and Zoloft. Delayed orgasm can be a problem for women - especially if it gets into hours/days (kidding on days). But absent orgasm is a problem for both.
A previous study showed that short acting Wellbutrin taken 1-2 hours before sex would correct orgasm problems in 40-45%. If Wellbutrin were taken regularly, another 20% or so would respond. If it works on a PRN (as needed) basis, why use it daily? Well, if you’re having sex very frequently, daily medication makes sense. If once a week, PRN makes more sense. Other things that have been used for anorgasmia include stimulants, Yocan (OTC or prescription), and Amantadine. Viagra, Cialis, and Levitra have also been helpful for some (probably by increasing degree of stimulation).
For treating problems with arousal in men, Viagra, Cialis, and Levitra have been effective for most - here PRN is the rule. Sometimes trazodone helps PRN for erectile dysfunction through its alpha blocking effect - since norepinephrine decreases arousal (a frequent problem with decongestants and sometimes stimulants).
Treating loss of libido requires daily treatment. Sometimes Wellbutrin or a stimulant can be helpful.