The use of antidepressants has increased substantially in recent years, yet relatively few studies have asked patients about their experiences with these drugs. A new study, published open-access this week, does just that. After interviewing 180 long-term users of antidepressants, the researchers found that while the majority reported an improvement in depression, many also experienced problems with withdrawal symptoms, and others said they “felt addicted.”
“I was never informed by doctors of long-term side effects or addiction/development of tolerance and went through extremely severe withdrawal symptoms attempting to get off (suicidal level depression),” one participant shared. “Only by persisting through terrible suffering did I wean myself off.”
“While there is no doubt I am better on this medication, the adverse effects have been devastating – when I have tried to withdraw with “head zaps,” agitation, insomnia and mood changes,” another wrote. “This means that I do not have the option of managing the depression any other way because I have a problem coming off this medication.”
The researchers conducted an anonymous online survey of patients in New Zealand who had been taking antidepressants long-term (3-15 years). They asked about how effective the patients felt their antidepressants have been, their levels of depression before, during, and after using antidepressants, their overall quality of life, and their perceived adverse effects. The survey also allowed participants to leave comments about their personal experiences.
While there has been a steady increase in the number of people who take antidepressants long-term, relatively little research exists to support this practice. A recent review of the literature reveals that, to date, there have yet to be any randomized control trials – the gold-standard for evidence-based medicine – that evaluate the long term use of antidepressants in primary care.
The research we do have on long-term antidepressant use, often naturalistic studies, have poor results. A 2008 study of patients using antidepressants over two years found a higher rate of recurring symptoms (63%) among those continuously taking antidepressants compared to those who were not taking medication (26%).
The present study aimed to add to the body of literature on the long-term use of antidepressants by gaining insight into users’ experiences. Nearly nine out of ten participants answered that they had experienced some degree of improvement in their depression symptoms while on their medication, although 30% also said that they continued to experience moderate to severe bouts of depression during treatment.
Nearly three-quarters of all of the participants reported problems with withdrawal symptoms, however, and, like those quoted above, a significant proportion (21%) chose to write about these problems in their comments. In a similar vein, 45% of patients surveyed believed that they had developed some level of addiction to their antidepressants.
“Have now been taking SSRIs for the better part of 15 years. Whenever I have tried to stop, I find I ‘relapse’ or experience withdrawal symptoms,” another participant offered. “I worry that my brain chemistry has been permanently affected, so I now feel I cannot be ‘normal’ without them […] I try to get off them but can’t seem to do it, no matter how slowly I wean myself off.”
The participants also left comments suggesting a need for more training for physicians and prescribers about how to safely taper patients off of these drugs.
“The difficulty of getting off has been a tough road and taken me years of trying and is something that doctors could be more knowledgeable of and supportive with,” one commenter wrote.
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Claire Cartwright, Kerry Gibson, John Read, Ondria Cowan, Tamsin Dehar, 2016. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Preference and Adherence, July 2016. (Full Text)
I”m glad people are doing this kind of research now. Some people do benefit from “antidepressants,” although I think very long term use, particularly of the SRI drugs, is a bit…troubling, given the lack of long term data and the problems that many have reported since the early days of the next generation “antidepressants.”
“Antidepressants” are safer than many other options (neuroleptics, for instance), so think they do have some value, at least for some people, for a time. I think there needs to be more research on how to taper and what to do about problem that come up during dosage reduction (and, for some people, after a time on the pills–“Prozac poop-out,” etc.).
I think it goes without saying that many people are handed an Rx when non-medical solutions could have been used. I know its bad in the US and the UK…I don’t know about other places. I think the only way to “fix” that problem would be to work on taking more and more of our lives back from Mental Health, Inc. and, honestly, the Medical Establishment as a whole. I think that’s probably more do-able in Europe, the UK, etc…more humane, live-able societies. I’m not saying those places are Utopias, but I am saying that the US, right now, is not exactly poised to change its ways dramatically.
I get the impression that a lot of people are on “antidepressants” because society and the economy don’t give most of us time or space to think, feel, etc. With the “New Normal” taking the place of the American Dream (which never was accessible to many people, anyway), Prozac and friends make life/existence more bearable and keep up the myth that pain is sickness, inability to keep up is illness, and (probably above all else) that these are “brain diseases,” or at most…”personal problems,” etc. I think the truth–“The personal is political”–isn’t all that palatable anywhere, but in the US…stating the obvious is blasphemy against the quasi-religious dogma that’s been engrained in all of us from childhood on up.
The people who seem to be helped are probably seeing the placebo response. Study after study points to the fact that the so-called “antidepressants” are little better than placebo in response. And these drugs carry some possibilities for some truly horrible results, like suicidal and homicidal ideation with people often acting on these impulses. And then you have the problems with them interfering with sexual response and the fact that they separate you from your feelings and emotions so that you turn into a zombie. Personally I believe that these things are dangerous and will never touch them, although I was once a great believer in them. It’s how I know what they do to you because I suffered with everything that I listed except wanting to go out and murder people. To me they are the devil’s tic tacs.
I agree about the placebo response. Most people who are depressed feel better within several months or less without ANY intervention, psycho-social or medical. But AD users understandably attribute the changes to the drug they are taking, rather than other actions or decisions or changes in environment or diet or exercise or thinking or beliefs that have contributed. And of course, withdrawal effects reinforce the idea that getting off ADs is a bad idea.
It’s also important to remember that the fact a substance makes one feel better doesn’t mean it’s an effective medical treatment. A shot of Jim Beam three times a day will definitely reduce your anxiety levels, as will smoking a small amount of marijuana in controlled doses. This doesn’t mean marijuana or alcohol are treating a medical condition. It just means you’ve found a substance that makes you feel better temporarily. Just because a drug is prescribed doesn’t make that any less true. Unless the doctor has an actual understanding of what condition they are “treating” and how the drug works, antidepressants or any other psych drugs are simply a way of temporarily altering your emotions. While that may seem appealing to some, this kind of action is no more medical than getting drunk on Saturday night to forget your troubles.
—- Steve
Hey, Steve, don’t knock alcohol. It works. Tip to the manic: if you’re going to overdo it, stay home. I drink. I talk to people. I no longer try to do both at the same time. Ditto drunken blogging. Cheers.
I don’t knock it at all. In fact, if someone wanted a short-acting anti-anxiety agent, I’d definitely recommend alcohol over Benzos any day. Of course, dosage control CAN be a problem…
— Steve
Don’t knock the placebo response. It works even when you tell people they’re receiving placebos. It’s an extraordinarily complex phenomenon.
Hey, I like placebos. It’s too bad that you can’t use them ethically in treating people because, as you mention, they are very powerful.
Placebos must work better when you can determine tangible adverse effects like headaches, nausea and wotnot. I know this because I experimented on myself with inert homemade placebos (flour + glucose and a hand-held pill press) and the results were lamentably zero.
I agree that the power of placebo is amazing but I think it must work better when there is loss of money and/or interpersonal credibilty added in to the equation.
I give an A++ to Mr Stephen Gilbert’s recommendation of alcohol. It is the drug of choice of The Bible for suffering souls. And what finer recommendation could there be?
Not sure about that.
I experimented on my husband (for his own benefit) by withdrawing him from ziprasidone (an “anti-psychotic”) without his knowledge, by gradually reducing to zero the amount of powder in the capsules. (He wouldn’t have agreed to try by himself, as he’d been so filled with fear by the medical profession and his family at what they saw as the inevitable consequences if he stopped the drugs.) He never suspected a thing and there was no recurrence of the psychosis for which he’d been prescribed the stuff.
He was symptom-free for 1 1/2 years and then I decided I’d tell him what I’d done, thinking that it would give him confidence in his ability to live drug-free.
Instead what happened was a slow spiral back into psychosis, albeit accompanied with environmental factors that contributed to this.
Now he’s back on meds and unbeknownst to him, back on a hidden withdrawal. I’ll have to plan this one better and have a good crisis plan ready in case it’s needed.
did you keep giving him capsules filled with something that was harmless? I sometimes think that some people are scared or fearful of recovering. This is quite interesting.
A reply to Stephen Gilbert – sorry, there was no reply button under your comment:
I just left the capsules empty – they’re so tiny, the weight difference isn’t so noticeable.
Yes, I think he is very afraid of becoming “normal” with all the connotations of responsibility in the real world. I guess it depends on when the person “broke down.” For him it was at age 16 so there isn’t really a sense of self to return to. No memories of a time when he felt competent. Really, it was probably the fear of entering the adult world that precipitated that first crisis.
Hollywood cliche numero uno: I did it for you.
stating the obvious is blasphemy against the quasi-religious dogma that’s been engrained in all of us from childhood on up.
Looks like you broke the code.
It’s interesting how many people talk about “doing better” on such drugs, but in the same breath acknowledge that if it weren’t for the pressure to meet “societal” (i.e. corporate) norms they wouldn’t feel the “need” for them.
I got miraculously good results from one SSRI but I was only one it for a month or so. In my view, they’re best used as a chemical crutch to get you feeling good enough to do the things that will keep you well. Once you’re feeling better, I think it’s best to get by without them if at all possible. If I ever suffer from severe depression again, I’ll certainly have no hesitation about taking the SSRI again for a while.
I think you used them in the best way they should be used – short term, help get over a hump and get active again, then OFF. The idea of taking the long-term is increasingly being shown to have an increasing downside over time.
— Steve
Thanks for your support. I’ve been shamed elsewhere for supporting the judicious use of the vast array of drugs we have available. Too much moralizing going on in some quarters, methings (not at all a reference to you as I love your contributions.)
That was “methinks,” obviously.
Truly, it is authoritarianism that is the real enemy. I hate someone else telling me what is supposed to work and getting upset if I don’t agree. Everyone’s got their own path to follow.
And thanks for your kind words!
— Steve
I absolutely agree the medical community needs to be better informed about the ADRs and withdrawal effects of the antidepressants (I had the common symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar,” “depression caused by self,” and “schizophrenia” – so much for the reliability of the DSM diagnoses). And the doctors do need to be trained in how to properly wean people off the drugs.
I’ll also mention the problem with this very common type of misdiagnosis is that adding an antipsychotic to an antidepressant can result in ‘psychosis,’ via anticholinergic toxidrome.
https://en.m.wikipedia.org/wiki/Toxidrome
Every doctor should know this, but unless the patient points it out to the doctor, no doctor will admit to the iatrogenesis.
Yeah, and God forbid a lowly psych patient ever tries to educate a shrink. Been there.
Just wondering if any research has been done on whether particular individuals find “anti-depressants” more useful than others. For example, dependent, slightly naive and gullible types who would not readily question authority and easily slip into the passive-recipient patient role or people whose self-esteem and moods are more externally regulated (and one can reasonably assume that such issues stem from some form of abuse). If so, then doctors have under the guise of “help” taken advantage of really vulnerable people and ensured that their “mood problems” are perpetuated and thus also a steady income stream
I applaude MIA and its efforts to better educate and inform
Not sure how such a thing could be approached but it’s a fascinating prospect. Maybe a sociologist could look at gender, income strata, race, etc.?
Sometimes I think…the problem isn’t all the drugs shrinks use per se; its Mental Health, Inc.
Some people do find that low dose neuroleptics help them, at least for a season. Antidepressants can take the edge off some forms of distress, at least for a while. My problem is that psychiatrists, counselors, etc. trap people with their labels.
I’m not saying the drugs are perfect, but…think about it… if someone diagnosed as, say, “Schizophrenic” could take a low dose neuroleptic until he had things sorted out in his life well enough to start tapering, was given psychosocial support, etc., and then given medical assistance should any major problems with tapering the drug(s) pop up…if people were allowed to taper off and exit the sick role…would we have so many problems with the drugs? I used the example of neuroleptics, but the same would definitely go for “antidepressants” and other mood and anxiety drugs.
Guns don’t kill people; people kill people. I don’t agree with that (not an NRA fan), but couldn’t that line of thinking extend to the drugs psychiatrists prescribe?
I agree so much – LABELS are the big problem! Drugs have always been around and people have always used drugs to alter their mental/emotional state, sometimes for the better, sometimes for the worse. The problem is not the drugs themselves, but the pretense that they are being “prescribed” for “treatment” of some “condition” that is essentially invented by those holding the strings of power in society. Without the labels, the concept of “medical treatment” dies a swift and well-deserved death, and the drugs can be viewed as what they are: mind-altering drugs that have effects on the body and brain, which effects are up to the user alone to determine whether they’re worth the cost or not.
—- Steve
Nice one Mr Steve McCrea and a very liberal approach to boot.
However, it lacks honesty.
What I mean by that is a drug such as seroquel or abilify or chlorpromazine has no natural history. It is not comparable to the effect of say cannabis or opium or ethyl alcoholon the human brain and body (including at a genetic level).
When we talk about many of the modern psychiatric drugs it would be better to compare them to other toxic remedies from the past, such as arsenic and cyanide.
What I mean by that is a drug such as seroquel or abilify or chlorpromazine has no natural history. It is not comparable to the effect of say cannabis or opium or ethyl alcoholon the human brain and body (including at a genetic level).
Confirming that even a broken clock is right twice a day.
Can’t argue with you there. It’s almost laughable when doctors critique natural remedies and herbs because there is a “lack of controlled studies” supporting their use, when such things have a 10 thousand year or longer evidence base, compared to a couple of biased 6-week studies run by pharmaceutical companies or their minions. I prefer the 10,000 year data track. Arsenic may even be safer, because at least everyone knows and admits it’s poisonous!
—- Steve
Just to add there is clearly some evolutionary factor going on with regards cannabis, opium and (at a stretch) alcohol.
The brain has an identified cannabinergic system. It has an identified opiate system. Alcohol works on multiple systems and is not so benign, hence its damaging effects.
Drugs such as SSRIs and neurleptics don’t mimic pre-existing neurochemicals. They disrupt them.
Big big difference.