When Marjorie Isaacson started taking medication for depression in her late 20s, she considered it to have saved her life.
At the time, she was dealing with an unstable marriage and struggling to feed herself. The medication helped her regain her balance. “I was really grateful to be able to function,” she says.
But recently, at age 69, Isaacson is wondering if he wants to continue taking antidepressants for the rest of his life. She questions the long-term effects of the drug, a serotonin and norepinephrine reuptake inhibitor known to increase blood pressure.
“Over the years, things have changed from ‘Take it and see how it goes, there’s no need to worry now’ to ‘Well, things might be a little complicated,'” he says. “It’s worrying.”
Antidepressants are among the most prescribed and easily accessible medications in the United States, and many people take them for years.
But even though they’ve been around for decades — the FDA approved Prozac to treat depression in 1987 — there’s little information about its long-term use. Drugs were approved based on trials that lasted a few months at most, and randomized controlled trials typically lasted only two years or less.
Current clinical guidelines do not specify the ideal time they should be taken. Due to a lack of data, it can be difficult for people to know when – or if – they should stop.
What factors should you consider?
Psychiatrists say it’s a decision best made with your doctor. The answer depends on the symptoms, diagnosis, response to medications, side effects and other factors.
But those conversations often don’t happen, says Awais Aftab, a psychiatrist in Cleveland. And antidepressants continue to be prescribed to people at low risk of depression relapse.
They are known to have side effects that often go away as the body adapts. But some side effects, like weight gain and sexual dysfunction, may persist.
What do clinicians recommend?
For major depression, clinical guidelines suggest taking medication until patients feel “back to themselves,” says Jonathan E. Alpert, chief of psychiatry at Montefiore Einstein in New York.
There are several factors to consider during long-term use. How long has the patient been ill? Has he had several depressive episodes? People who have suffered from depression for two years or more or who have two or more depressive episodes are much more likely to experience additional episodes, research shows.
Alpert considers the seriousness of the illness. Was the patient hospitalized? Have you had difficulty functioning in daily life or had to try several medications before finding one that works? A serious, difficult-to-treat condition would require long-term use, he says.
Finally, it analyzes effectiveness: does the drug work? Some people improve but still have residual symptoms. It often makes sense to continue treatment, he says, to avoid “the risk of relapse.”
Antidepressants are also used to treat other conditions, such as anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and chronic pain. For these problems, long-term treatment is often necessary, experts say.
Is it harder to stop antidepressants after prolonged use?
More data is needed, but some studies suggest that long-term use may produce strong withdrawal symptoms.
In general, it is estimated that one in six people who stop taking an antidepressant experience adverse symptoms. These may include dizziness, fatigue and brain shock. For one in 35 patients, symptoms appear severe. In some cases, they are so problematic that it becomes very difficult to try to stop.
Gradually reducing the dose can help, doctors say.
Is there any danger in taking medication long term?
It’s hard to say. Observational studies suggest that antidepressants are generally safe.
Because a large number of people take antidepressants (about 11 percent of U.S. adults), if there were problems with their use, “it would be pretty hard to ignore them,” says Paul Nestadt, medical director of the suicide prevention center at the Johns Hopkins Bloomberg School of Public Health.
Medicines are not without risks, which vary depending on the medicine. Some antidepressants have been linked to increases in blood pressure, heart rate, and cholesterol. They can also reduce sodium levels and increase the risk of blood clots.
A Danish study published in May found that people who had been taking antidepressants for one to five years had a higher risk of dying suddenly from heart disease than those who had no history of taking the medication. However, it is not clear whether the deaths were caused by the medications or by the psychiatric illness itself.
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