Little Known About Long-Term Antidepressant Use
J. Michael Bostwick, M.D.
DEAR MAYO CLINIC:
I've been on antidepressants for 10 years. I have tried to taper off of them several times and then go without.
After a couple of months, I fall back into a minor depression that is just bad enough to keep me from enjoying and living my life. What are the long-term effects of taking antidepressants?
Unfortunately, we don't know much about long-term problems that could come from taking antidepressants. In the United States, some antidepressants have been available for more than 50 years. Newer antidepressants -- selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Lexapro, Luvox, and others -- are around 20 years old. In this case, 20 or even 50 years is not that much history, though one would think that glaring problems would have emerged by now. Just the same, there aren't conclusive long-term data on risks. It's simplistic to think that any medication doesn't pose some long-term risk, but it's also dangerous to ignore the very real risks associated with untreated depression, including effects on quality of life and the risk of suicide. A decision about taking antidepressants should always involve a discussion about balancing risks and benefits with your prescribing physician.
We know more about the potential short-term side effects.
As with most medications, the lists of possible side effects for antidepressants are long ones. They include dry mouth, dizziness, headaches, constipation, sexual problems, and many more. For a subset of patients, antidepressant use leads to weight gain. Some antidepressants increase the risk of some heart problems. In children and teenagers, antidepressants have been linked to increased risk of suicide, possibly because of their rare capacity to induce unbearable internal restlessness. We don't know if any of the short-term side effects, when they occur, have longer-term consequences.
Not all side effects are negative.
Some classes of antidepressants are sedating, which can be a benefit if sleep is difficult. Others seem to boost energy, a benefit for those patients whose depression zaps their energy.
Prescribing antidepressants is largely based on empirical evidence and clinical experience, seeing what helps and what doesn't. You try a medication, hopefully feel better, and then continue treatment long enough to help prevent recurrence of the symptoms that caused you to seek treatment in the first place. Sometimes, it's a trial-and-error process to determine the most effective medication. But depression often recurs. After one episode, you are about 50 percent more likely to have a second episode. If that happens, there's a 75 percent chance that you'll have a third episode. And if you have a third, you'll likely have recurrent depressive episodes your entire life.
Deciding how long to take antidepressants should be based on your particular situation. You and your doctor need to consider these questions:
What is the medication doing for you that is positive?
Do the benefits outweigh the potential risks in either the short or long term?
You don't mention whether you've tried psychotherapy.
It's worth trying or revisiting if you've tried psychotherapy in the past. Researchers have learned that especially for mild to moderate depression, psychotherapy alone can be as effective as medication. If that's your situation, perhaps psychotherapy would allow to you stop medication for longer periods or entirely. For severe depression, treatment results are better when medications and psychotherapy are used in tandem.
-- J. Michael Bostwick, M.D., Psychiatry,
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