Staying On Antidepressants For Life
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Staying On Antidepressants For Life
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Long Term Anti-Depressant Use Doesn’t Always Mean Better Quality of Life, Research Finds
Verywell Mind's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Ⓒ 2022 Dotdash Media, Inc. — All rights reserved
Verywell Mind is part of the Dotdash Meredith publishing family.
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.
Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.
Do you worry about the effects of long-term use of antidepressants ? These drugs are among the most commonly prescribed in the United States, and they're often prescribed for long-term use. 1 But is it safe to use antidepressants for years on end?
While this class of medications is named after a single condition, the drugs are used to treat a wide variety of illnesses other than major depressive disorder, including: 2
Many of these conditions are chronic or can return if you go off the medication. That means a lot of people take them for years, and that leads to concerns about the long-term side effects.
In spite of how popular these drugs are, we're just learning what those long-term effects may be. Extended studies are rarely done before a drug gains approval for use, so medications can be around for a long time before we start to get a clear picture of what can happen after years of continuous use.
Fortunately, the body of literature on the long-term use of antidepressants is growing, and we're gaining a better understanding of their impact on us.
Before delving into the research, let's look at how antidepressants work. Antidepressants come in several forms. The major ones are:
In your brain, information—including emotion—moves from one neuron (brain cell) to another via chemical messengers called neurotransmitters . 3 Think of neurotransmitters as mailbox keys. Each one unlocks certain receptors (chemical "locks") on neurons in order to allow the message to keep traveling.
With many of these conditions or diseases, something is wrong with the brain's neurotransmitters (usually serotonin , norepinephrine , dopamine , or others). 4 Sometimes, there's just not enough of one or more of the neurotransmitters. In other cases, the brain doesn't use neurotransmitters efficiently, or the problem could lie with the receptors. There's either no key for the lock, the key isn't used properly, or the lock is broken.
Regardless of the cause of the problem, the result is the same: neurotransmitter dysregulation. 3 The mail isn't getting to the right mailbox, so messages aren't being delivered.
Antidepressants change how neurotransmitters function, making more available so that when a message comes along, it can be properly delivered. This is achieved by slowing down a process called reuptake , which is essentially a clean-up or recycling process. 5
Once the messages are flowing more as they should, your brain works better and the symptoms related to the slow-down diminish or go away.
However, the brain is a complex environment. Each neurotransmitter has a lot of different jobs. Increasing the available neurotransmitters might have the desired effect of alleviating depression, lowering neuropathic pain, or improving one's thought process, but it can also have unwanted effects.
The potential side effects of antidepressants are many, and they can range from mildly annoying to debilitating and even life-threatening. Beyond that, there's the issue of antidepressants becoming less effective over time.
As we've learned more about the long-term side effects, some of the top concerns that have emerged have to do with weight gain and diabetes. However, many other side effects can continue long term and can have a negative impact on your quality of life.
In 2016, the medical journal Patient Preference and Adherence published a paper looking at what people taking antidepressants long-term had to say about the side effects that they've seen. 6
Overall, they did say they were less depressed and had a better quality of life because of the drugs, but about 30% still said they had moderate or severe depression.
The main side effects they complained about included:
Many of the participants wanted more information about the long-term risks of their medication. About 74% of people also mentioned withdrawal symptoms and said they needed more information and support about going off of antidepressants.
Some people noted that they'd had to try multiple antidepressants before finding one that worked well for them and was tolerable. However, more than two-thirds of the people questioned said the medication helped them cope with life.
About one-fifth of the participants said antidepressants helped them to function well. However, some said that if they'd known about the side effects and possibility of withdrawal, they would never have started taking the medication at all.
You should never stop taking antidepressants suddenly. Talk to your doctor about the proper way to wean off of them.
Before taking an antidepressant, make sure you're familiar with the possible side effects as well as the proper method of going off of them. Know that you may need to try several drugs before finding the best one for you.
While you're on the medication, stay vigilant for side effects, and weigh how significant they are versus how much the drug helps you.
You should involve your doctor in any decisions you make regarding antidepressant use. That said, you're the only one who can decide whether the benefits of taking a medication outweigh the drawbacks.
A 2015 study published in The Journal of Clinical Psychiatry suggests the long-term risk of weight gain from antidepressants that alter serotonin receptors could be significantly higher in women than in men, possibly due to differences in how serotonin is used. 7
A 2015 Australian study noted that people on antidepressants tended to gain more than 3% of their body weight each year. Over time, that can really add up.
Weight gain can have negative effects on your self-esteem as well as your health. Talk to your doctor about how you may be able to improve your diet and/or increase exercise to help keep those extra pounds from piling up.
Several studies have noted what appears to be a link between antidepressant use and problems with blood sugar regulation, including type 2 diabetes. 8
A systematic review published in a 2013 edition of the journal Diabetes Care examined this relationship to get a better feel for what's going on. They looked at 22 studies, including a couple with more than 4,000 participants. Here's a look at some of the findings that prompted the review:
The aim of the review was to determine whether antidepressants raise the risk of diabetes in people who didn't have it when they started on the medications. They concluded that some antidepressants affect blood sugar regulation and that the drugs could be a risk factor for diabetes. However, the larger and more recent studies they looked at suggested that the risk was small.
They do say, though, that higher doses appear to be linked to greater risk. Also, in some cases, people who have developed type 2 diabetes while on antidepressants have seen the disease disappear when they went off of the medication. Researchers also note that people who were diagnosed with diabetes were more likely to be prescribed antidepressants, but the relationship there isn't clear.
If you have diabetes, your doctor may want to adjust your diabetes medications while you're on antidepressants to make sure your blood sugar levels are staying in a healthy range.
You might also want to focus more on weight loss and exercise since both of those things play a role in diabetes, and your antidepressant may be causing some weight gain.
If you're concerned about your diabetes risk or have type 2 diabetes, you may want to talk to your doctor about finding an antidepressant that is less linked to blood sugar problems. You may also want to test your blood sugars more frequently.
If your antidepressant is no longer working as well as it did when you first started taking it, you could have developed a tolerance for the drug. Some people refer to this as antidepressant "poop-out," although the medical term is tachyphylaxis. It has not been determined how many people taking antidepressants experience this phenomenon, but studies show rates ranging from 9% to 57%. 9
While no one knows for sure why this decrease in effectiveness occurs, one theory suggests that receptors in the brain become less sensitive to the medication. Other culprits include:
If you think you’ve built a tolerance to your antidepressant, talk to your doctor who may suggest the following:
Roughly 10% to 30% of people don't respond to antidepressant treatments at all, which may be caused by treatment-resistant depression (TRD) . 10 Although there is not a standard definition, TRD is often defined as failing to respond to two or more treatment attempts despite adequate dose, duration, and adherence. TRD can lead to poor social functioning, medical comorbidity, and increased mortality.
While the cause of TRD is still unknown, genetics, 11 metabolic disorders, 12 and misdiagnosis often play a role.
If your doctor has determined that you have TRD, they may try one or more of the following treatment approaches:
As all drugs do, antidepressants have lists of potential pros and cons. Treatment is a balancing act, with you and your doctor(s) weighing the good against the bad and deciding what the next move should be.
Starting a new drug is a big decision, and so is continuing treatment long-term or opting to discontinue. Make sure you're well informed at every step and getting professional advice. In the end, it's all about making you feel better.
Everything feels more challenging when you're dealing with depression. Get our free guide when you sign up for our newsletter.
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Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: From monoamines to glutamate . Exp Clin Psychopharmacol . 2015;23(1):1–21. doi:10.1037/a0038550
Skånland SS, Cieślar-Pobuda A. Off-label uses of drugs for depression . European Journal of Pharmacology . 2019;865:172732. doi:10.1016/j.ejphar.2019.172732
Sheffler Z, Reddy V, Pillarisetty L. Physiology, Neurotransmitters . Treasure Island, FL. StatPearls Publishing; 2020.
Harmer CJ, Duman RS, Cowen PJ. How do antidepressants work? New perspectives for refining future treatment approaches . The Lancet Psychiatry . 2017;4(5):409-418. doi:10.1016/S2215-0366(17)30015-9
Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: Patient perspectives of benefits and adverse effects . Patient Prefer Adherence . 2016;10:1401–1407. doi:10.2147/PPA.S110632
Noordam R, Aarts N, Tiemeier H, Hofman A, Stricker BH, Visser LE. Sex-specific association between antidepressant use and body weight in a population-based study in older adults . J Clin Psychiatry. 2015;76(6):e745-51. doi:10.4088/JCP.13m08896
Paige E, Korda R, Kemp-casey A, Rodgers B, Dobbins T, Banks E. A record linkage study of antidepressant medication use and weight change in Australian adults . Aust N Z J Psychiatry . 2015;49(11):1029-39. doi:10.1177/0004867415607365
Fabbri C, Corponi F, Souery D, et al. The genetics of treatment-resistant depression: a critical review and future perspectives . International Journal of Neuropsychopharmacology . 2019;22(2):93-104. doi:10.1093/ijnp/pyy024
Li J-M, Zhang Y, Su W-J, et al. Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis . Psychiatry Research . 2018;268:243-250. doi:10.1016/j.psychres.2018.07.020
Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli RM. Ect in treatment-resistant depression . AJP . 2012;169(12):1238-1244. doi:10.1176/appi.ajp.2012.12050648
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This coming autumn will mark my seventh year of taking antidepressants.
It began when I was 19 and due to start university after an unplanned gap year in which I’d spent all day, every day worrying myself sick that I was a terrible person who was capable of terrible things.
I had spent almost that entire year locked in a cycle of terror and sadness. I didn’t want my next few years at university to be as dark.
So, while my new flatmates were sleeping off hangovers and ordering pizza, I booked an appointment at the campus medical centre.
I was lucky, the doctor I saw – and continued to see throughout my time at university – understood exactly what I was trying to tell her, and was kind and helpful. She held my hands, gave me tissues and listened to me through my tears.
When she mentioned the fact that antidepressants might be worth a try, I wasn’t so sure. Although I was put on a waiting list for therapy, I was told that it would probably take weeks, or even months, to get an appointment. My doctor and I agreed I’d try the medication and that we’d see each other once a month.
The antidepressant I was given, Sertraline, did help. In fact, it helped so much that the previous few, painful months I’d lived through started to feel a little like a fever dream.
I still take Sertraline now, and I actually in a considerably higher dose than I did back then. While initially I was wary of taking medication, now I feel no shame in the fact that I am on antidepressants.
Recently, I found myself hurtling back down the rabbit hole to where I’d been all those years ago. I saw my doctor and explained that I wasn’t coping, and that things felt unbearably hard.
She suggested increasing the dosage of my antidepressants, I told her I’d hoped that, by this point in my life, I wouldn’t need them. I was worried about the fact that I’d never felt well enough to come off them.
‘What if that was always the case? What if my anxiety and depression never leave me?,’ I thought.
But my doctor likened it to dealing with any other illness: ‘If you were diabetic, you’d take insulin. If you had an infection, you’d take antibiotics. This isn’t any different,’ she said.
It seems somewhat obvious, but thinking about it that way has really helped me to feel okay and comfortable with continuing to take them.
After all, there is no guilt or shame attached to taking most other kinds of medication.
Ultimately, I never want to go back to how things were before I went on antidepressants.
Feeling OK, staying well and being able to cope is a far better than suffering and being in pain.
I’ve had a lot of (unsolicited) advice from people, including friends, telling me I should try to overhaul my diet by cutting out dairy, sugar and meat instead of continuing to take antidepressants.
I’ve also been told to ‘just get outside’ or to try a new hobby so as not to become reliant on taking medication. For me, suggestions like this just reassert the fact that there is still a stigma attached to talking openly about taking antidepressants.
I understand that some of these ideas might help others, but I find it unhelpful and unnecessary to be told how I ought to treat and manage my anxiety and depression.
I like to think of taking antidepressants as a sign of strength, not weakness. It reminds me that even as a terrified teenager, I was brave enough to open up and seek help.
If I have to take them for the rest of my life to feel OK and well, then that’s what I’ll do.
If you, or anyone you know, is struggling, Samaritans are here to help.
They’re available 24 hours a day and offer a safe place to talk, about anything that is getting to you. Call 116 123.
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Staying On Antidepressants For Life
Hello, I recently weaned myself off Paxil after being on it for about six years, but two months later my panic attacks/depression returned. I am now thinking I may have to take Paxil for the rest of my life, just like I have to take thyroid and BP meds for life. When I read about antidepressants it seems that they
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