Antidepressants are a class of medication used widely across the United States. Initially used to treat major depressive disorder, they are now taken to manage symptoms of an array of health conditions, including eating disorders, bipolar disorder, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention deficit hyperactivitiy disorder (ADHD), neuropathy, and chronic pain. [1]
Whilst antidepressants have soared in popularity since their inception in the 1980s, we’re still discovering what long-term risks they pose.
Medications can be approved and marketed for years before research is completed into how they impact long-term users. However, more and more studies are underway, and we are gaining an increasingly comprehensive understanding of the long-term risks of antidepressants.
What are the long-term risks of antidepressants?
A 2016 study found that 85% of people’s quality of life improved following a course of antidepressants. [3] However, while many patients were appreciative of the benefits of their treatment, many were troubled by the adverse effects suffered [3] including withdrawal symptoms, sexual difficulties, weight gain, emotional numbness, addiction, and suicidal thoughts.
Below we’ll explore some risks of taking antidepressants:
Withdrawal symptoms
In the 2016 study, roughly 74% of people said they suffered from withdrawal symptoms and needed more information and support in weaning themselves off antidepressants. Some said they would never have taken antidepressants had they known about the withdrawal effects. [3]
It is important you consult openly and honestly with your healthcare provider about the nature of your symptoms. This will allow them to prescribe you the best antidepressant for your needs.
Whilst taking antidepressants, stay vigilant for side effects and report them to your doctor as they arise. Together, you can assess the benefits of the antidepressant against the risks.
It can feel reassuring to have someone with medical expertise in your corner looking out for you. Remember, you should never stop taking antidepressants suddenly. [2] This increases your risk for side effects significantly. Always consult your doctor before making any changes.
Sexual difficulties
Sexual dysfunction is commonly associated with prolonged antidepressant use and can have an adverse impact on your relationships, mental health, and recovery. [4]
You may choose to endure the sexual difficulties due to other benefits experienced by the antidepressants.
If this is not an option, consult your doctor about a potential change in dosage or type of medication. Whilst it’s a sensitive topic, being honest about your concerns will lead to a better assessment of your condition, resulting in better treatment.
Nonpharmacological interventions such as sex therapy, cognitive behavior therapy (CBT), and homeopathic remedies can be considered in practice. [4]
Weight gain
Sustained use of antidepressants is associated with weight gain, with the amount of weight gained varying on a case-by-case basis. [5]
Older tricyclic antidepressants and monoamine oxidase inhibitors are more likely to cause weight gain in patients than newer SSRIs, but generally, antidepressants have been shown to contribute to long-term health issues, such as obesity. [5]
If you are experiencing weight gain, talk to your doctor about any adjustments you can make to your diet or exercise regime to combat weight gain.
Tolerance issues
Some people may develop a tolerance to the effects of antidepressants over time, requiring higher doses to achieve the same therapeutic benefits.
The pharmacological term used for a progressive decrease in response to a dose of medication is ‘tachyphylaxis’ and studies suggest it affects 9% to 33% of people who take antidepressants. [6]
Increased doses of antidepressants can lead to addiction/physical dependence in patients, with 45% of people in a 2016 study believing they had some level of addiction. [3]
As an alternative to increasing the dose, a doctor may switch you to a different antidepressant with a different mechanism of action.
Suicidal thoughts
Suicidal thoughts are a long-term risk of taking antidepressants, with a study showing that 36% of patients experienced suicidal thoughts during a course. Suicidal ideation typically presents at the beginning of a course of antidepressant treatment, with young adults being most at risk.
If you have suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and guidance from a trained counselor.
Managing long-term use of antidepressants
Managing long-term use requires a comprehensive, open approach that involves both the patient and their healthcare providers. The following steps are all advisable in the management of long-term antidepressant use:
- Regular communication with healthcare provider: Maintain a constant dialogue with your doctor to monitor your progress and assess any side effects you’ve been experiencing. They can adjust your dosage or switch you to a different medication.
- Never discontinue the use of antidepressants on your own: Take your course of antidepressants exactly as prescribed by your doctor. Stopping your medication prematurely can lead to withdrawal symptoms,which can worsen your condition.
- Talk therapy: Many people choose to combine medication with talking therapy, such as cognitive behavior therapy. Therapy can be effective in conjunction with antidepressants, providing coping strategies to help a patient cope with their condition. [3]
- Lifestyle changes: Implementing an exercise program and stress-management techniques, such as meditation and mindfulness, can be key to maintaining wellness in a patient’s life. [3] Dietary changes, when combined with exercise, can be helpful in counteracting the weight gain caused by some antidepressants.
Remember, before taking any medication, discuss the potential risks and benefits with your healthcare provider.
Ensuring you’re as informed as possible and have a healthy, open dialogue with your doctor and/or therapist are key steps towards a successful treatment.
- Skånland, S. S., & Cieślar-Pobuda, A. (2019). Off-label uses of drugs for depression. European Journal of Pharmacology, 865, 172732. https://doi.org/10.1016/j.ejphar.2019.172732
- NHS. (2021, February 5). Side Effects – Antidepressants. Nhs.uk; nhs. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/side-effects/
- Cartwright, C., Gibson, K., Read, J., Cowan, O., & Dehar, T. (2016). Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Preference and Adherence, 10(1), 1401–1407. https://doi.org/10.2147/PPA.S110632
- Higgins, A. (2010). Antidepressant-associated sexual dysfunction: Impact, effects, and treatment. Drug, Healthcare and Patient Safety, 2, 141. https://doi.org/10.2147/dhps.s7634
- Gafoor, R., Booth, H. P., & Gulliford, M. C. (2018). Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ, 361, k1951. https://doi.org/10.1136/bmj.k1951
- Katz, G. (2011). Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: Results of a retrospective naturalistic chart review study. Psychiatry and Clinical Neurosciences, 65(5), 499–504. https://doi.org/10.1111/j.1440-1819.2011.02231.x
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