Mant patients after a period of time on antidepressants develop considerable fatigue and apathy, described by a lack of motivation, energy and a feeling of  just “wanting to sit on the  couch.” 

What does this mean?

For starters it could represent a side effect of could represent a worsening of symptoms. 

What can be done?

1) decrease the dose to see if apathy or fatigue resolves

2) switch to dose in evening 

3) add a stimulant–bupropion, modafanil

4) change to a TCA not associated with apathy

5) add abilify

6) if insomnia develops with the antidepressant, adding trazodone or remeron for a more restful sleep may help