Quote Originally Posted by Lady Penelope View Post
I now have to decide whether to go up to 50mg or stay on 25mg. Does 25mg ever work for anyone?
25mg is a sub therapeutic dose for most. Taking sub therapeutic doses may increase the risk of the AD failing to work.

ADs have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly. For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.

The problem with taking sub/borderline therapeutic doses is neurogenesis may be interrupted whenever AD plasma levels drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002). Taking a low dose for months may create a similar situation as stopping and restarting it as plasma levels fluctuate. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.

The side effects of 25mg have not been as bad as I feared and I am worried about increasing the dose. I am the sort of person who gets a big effect from medication- I only ever take 1 paracetamol instead of 2 if I have a headache.
The side-effects will likely be not worse than at 25mg.

As per above, ADs have no direct effect on anxiety so experiences with other meds may not be a guide to AD dosing. Most serotonergic ADs need to be taken at doses high enough to saturate at least 80% of the serotonin transporters (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available diagnostic tests to determine the dose needed to achieve this for individuals.

I think I may feel marginally better than I did twelve days ago but not markedly so.
ADs typically take 5-12 weeks to kick-in. It takes about 7 weeks for new cells to bud, grow and reach maturity, although some improvement may begin earlier.