The surprising truth about antidepressants: Should we be more cautious?
Thursday, June 6, 2024.
Have you ever wondered why so many people are popping antidepressants like candy? Well, you're not alone.
About one-in-six people take antidepressants, with the rate being 50% higher among women.
But should we be more cautious about prescribing these meds? A new review of their withdrawal effects suggests we should do so.
Antidepressants: Overprescribed and Overstayed
Antidepressants are often prescribed for longer periods than necessary. The issues with coming off these drugs, especially after long-term use, are underacknowledged and poorly understood.
The risks of taking antidepressants for mild to moderate depression might actually outweigh the benefits. Some studies even suggest that antidepressants are no more effective than a placebo (a sugar pill) for treating depression. Despite this, antidepressant use is soaring globally.
Antidepressant Side-Effects: More Than Just a Nuisance
Many studies on antidepressants focus on symptom reduction rather than what truly matters to patients, like quality of life and social functioning. The side-effects of antidepressants, particularly SSRIs, are significant:
1 in 5 report profuse sweating, daytime sleepiness, weight gain, and dry mouth.
1 in 4 experience sexual problems.
1 in 10 suffer from nausea, twitching, constipation, dizziness, muscle spasms, or restlessness.
For those taking antidepressants for more than a year, side effects can include emotional numbness and a mental 'fog.'
The challenge of antidepressant withdrawal
Coming off antidepressants can be a rocky road. People report a range of withdrawal symptoms, including anxiety, depression, appetite changes, agitation, and insomnia. These symptoms can be hard to distinguish from a relapse.
The study’s authors note:
“The recognition that withdrawal effects from antidepressants are more common, more long-lasting and more severe than previously recognised prompted the Royal College of Psychiatrists to issue a position paper, alerting prescribers to this issue, including the recommendation that patients be informed of this risk.”
Gradually reducing the dose over time, known as ‘tapering,’ is recommended as the best way to stop taking antidepressants. However, tapering comes with its own set of challenges. For instance, sexual problems can persist even after tapering. Plus, the standard sizes of antidepressant doses make it difficult to reduce the dosage gradually.
Time to re-evaluate antidepressant prescriptions?
The study’s authors argue:
“There continues to be considerable uncertainty about the benefits of antidepressant use in the short- and long-term, particularly in regard to the lack of a clinically significant difference between antidepressant and placebo treatment.
In light of this uncertain balance of benefits and harms, we should re-visit the widespread—and growing—prescription of antidepressants.
Increasing knowledge about the difficulty that some patients have in stopping antidepressants should lead to more cautious prescribing practice—with antidepressants given to fewer patients, for shorter periods of time.”
The study, published in the Drug and Therapeutics Bulletin (Horowitz & Wilcox, 2021), illuminates the complexities and challenges associated with antidepressant use and withdrawal. It calls for a more cautious approach to prescribing these medications, ensuring they are used appropriately and for the shortest time necessary. This is very sobering research.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Horowitz, M. A., & Wilcox, G. (2021). Antidepressant withdrawal effects and their management. Drug and Therapeutics Bulletin, 59(9), 133-138.
