January 14, 2026
Signs antidepressant dose is too low, when medication isn’t working, and how integrative psychiatry in NYC can help.
Finding the right antidepressant dose is rarely a one-step process. In fact, one of the most common reasons people feel “stuck” in treatment is that their antidepressant dose is too low to create meaningful symptom relief.
Clinicians often start with conservative dosing to minimize side effects, especially for individuals with anxiety, trauma histories, postpartum changes, or medication sensitivity. While this approach is clinically sound, it can leave patients unknowingly underdosed for weeks or even months.
This issue has been increasingly discussed in recent media coverage about rising antidepressant use in the U.S., particularly post-pandemic, where many patients report being “on medication but still depressed.” In many of these cases, the problem isn’t the medication itself—it’s that the dose hasn’t reached a therapeutic range.
One of the clearest signs an antidepressant dose is too low is some initial improvement followed by a plateau. You may notice:
This “almost but not quite” response is common in people being treated for depression or anxiety disorders and often indicates that the brain has not yet reached adequate neurotransmitter modulation.
If hallmark symptoms of depression remain largely unchanged after 6–8 weeks, dosing should be reassessed. These include:
Many individuals seeking care for depression assume the medication has “failed,” when in reality the dose has simply not been optimized.
In anxiety treatment, underdosing is particularly common. Signs include:
This is frequently seen in people receiving care for generalized anxiety, OCD, or trauma-related conditions, where higher doses are often needed for full symptom control.
For individuals with overlapping diagnoses—such as ADHD, OCD, or PTSD—low antidepressant dosing may improve mood but leave executive dysfunction, intrusive thoughts, or hypervigilance unchanged.
Patients being treated for ADHD frequently report emotional regulation benefits from antidepressants, but only once dosing is sufficient to support frontal-limbic balance. The same applies to OCD, where subtherapeutic doses rarely reduce intrusive thoughts or compulsions.
Contrary to popular belief, emotional blunting does not always mean the dose is too high. In some cases, low doses can flatten affect without improving mood, especially early in treatment.
This pattern is increasingly discussed in recent psychiatry commentary and is often misinterpreted as a medication mismatch rather than a dosing issue.
If daily functioning remains impaired—difficulty working, parenting, or maintaining relationships—it may indicate that symptom reduction is insufficient. This is particularly relevant for:
Hormonal changes, sleep deprivation, and identity shifts mean postpartum depression and anxiety often require careful—but adequate—dosing. Many individuals in postpartum therapy remain underdosed due to fear of side effects, despite ongoing symptoms.
Evidence consistently shows that OCD and some anxiety disorders require higher antidepressant doses than depression alone. Subtherapeutic dosing is one of the most common reasons treatment stalls in OCD care.
In bipolar-spectrum conditions, clinicians may be cautious with antidepressants, sometimes leading to doses too low to help depressive symptoms while still posing risks. This is why integrated psychiatric oversight is essential in bipolar treatment.
Low dosing can be particularly problematic when depression co-occurs with:
In these cases, medication should be part of a broader, integrative treatment plan that may include CBT, DBT, ACT, EMDR, or trauma-informed therapy.
Even with excellent psychotherapy—such as CBT, DBT, or ACT—an antidepressant dose that is too low can limit overall progress. Medication creates the neurobiological stability that allows therapy to work more effectively.
This is especially true in trauma-focused care, including EMDR, where emotional regulation capacity is essential for processing.
You should consider discussing dosage if:
Dose adjustments are not failures—they are a normal part of precision psychiatric care.
At Integrative Psych NYC, antidepressant dosing is approached holistically, considering:
This approach helps prevent prolonged underdosing while minimizing unnecessary side effects.
Integrative Psych NYC is a multidisciplinary mental health practice offering evidence-based, personalized psychiatric and therapeutic care for adults, adolescents, and couples. Our team of psychiatrists and therapists specializes in depression, anxiety, OCD, bipolar disorder, trauma, ADHD, addiction, autism spectrum conditions, and LGBTQ+ affirming care.
Whether you’re exploring medication adjustments, therapy integration, or virtual therapy options, our clinicians work collaboratively to help you feel better—not just medicated.
Learn more about our expert team of psychiatrists and therapists in NYC and how integrative care can support lasting mental health.
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