Asked by Rose, Arizona
Is it dangerous to be on an antidepressant for several years?
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
Ten years ago my answer to this question would have been, "Certainly not."
A year ago my answer would have been, "Almost certainly not."
Now, unfortunately, the most honest answer I can give you is, "I'm not sure."
Coming from a guy who has treated thousands of people over the years with antidepressants, I have to admit that my uncertainty both shocks and distresses me.
I should probably get over my sense of shock. One of the glories of science is that it keeps moving forward, and as it does so, it usually sweeps old certainties into the dustbin.
Psychiatry's commitment to the unqualified goodness of antidepressants is one of those old certainties. That I'm distressed is understandable.
The assault on my certainty about antidepressants comes from several fronts. Over the last several years, it has become increasingly clear that even newer antidepressants may pose health risks in certain situations, such as pregnancy or during childhood.
These sobering findings take their place beside the fact that antidepressants induce significant side effects in many people, and that some antidepressants have really troublesome withdrawal syndromes when people try to stop taking them.
Even more concerning is the fact that a number of recent, high-profile studies have suggested that antidepressants are not as effective as we once believed they were when compared with treatment with a placebo (which is a pill that has no active properties).
Just this weekend, I saw a study that further shook my certainty about antidepressants. Researchers pulled together data from hundreds of studies conducted over the last 30 years or so in which people with depression were randomized to treatment with either an antidepressant or a placebo.
Using this huge database the researchers asked a simple question: Who were more likely to relapse when they stopped taking the study pill -- people who received an active antidepressant or a placebo?
The answer was clear. People who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo.
I'm still trying to digest this fact, but it seems to me that the simplest way to understand this finding is that when a placebo works it is a better form of treatment than an active antidepressant.
In Europe in general -- and Germany in particular -- doctors use placebos to very good effect for many disease states, including depression. On the other hand, it is considered unethical in the United States to treat people with a placebo without their being told that they are receiving an inactive substance, so it is not likely that we will be handing out sugar pills for depression anytime soon.
But a clear take-home message from the current state of the science is that we need to work harder -- as patients and clinicians -- to get key elements of placebo into our lives and practices.
These elements include, above all else, a sense of hope, a belief in the therapeutic relationship and the knowledge that we are doing something positive to improve the current condition of our thoughts and emotions.
Here is how I currently make sense of things: Like all other medications, antidepressants have risks and benefits.
We know, for example, that chemotherapy for childhood cancer greatly increases the risk that children who survive will die of cancer as adults because the treatments themselves are carcinogenic. Would this keep you from treating a dying child?
In the same way, there are many times when the risks associated with antidepressants are more than balanced by the potential benefits. This risk/benefit equation must be performed for each individual we treat, and it is an equation you must evaluate in the context of your own life situation.
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