Long-term use of antidepressants can make it 'notoriously' tough for people to quit the drugs
Patients who have taken antidepressants for many years will likely face difficult and even dangerous withdrawal symptoms due to a physical dependence on these drugs, which are not intended for permanent use.
Antidepressants are not considered to be addictive in the sense that users do not seek them to “get high” but rather to alleviate symptoms of serious medical problems. However, with extended use, they can be “notoriously difficult to quit” because they can produce a “state of physical dependence,” according to researchers from the Department of Clinical Integration at Midwestern University/Chicago College of Osteopathic Medicine.
Discontinuation of antidepressant after long-term treatment can result in the appearance of unpleasant physical, neurologic, and psychiatric symptoms that may take weeks or months to resolve. The researchers explain that patients who stop taking their medication often experience what is known as Antidepressant Discontinuation Syndrome (ADS). This includes flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances often described as electric shocks or "brain zaps", and hyperarousal.
“Discontinuation can cause a group of symptoms that are very unpleasant and can lead patients to continue to seek the medications. The persistent use is not for a high but to alleviate symptoms of disease or to avoid unpleasant Antidepressant Discontinuation Syndrome,” says the study published in The Journal of the American Osteopathic Association (JAOA).
Antidepressants are a diverse group of medications commonly used as frontline agents for the treatment of various forms of depression. However, many of these medications are also used to manage other conditions, such as obsessive-compulsive disorders, generalized anxiety disorders, eating disorders, neuropathic pain syndromes, and chronic pain syndromes.
“Given the widespread use of antidepressants, physicians may be driven by an overestimated consideration of potential benefits, while appraisal of adverse effects are, by comparison, often overlooked,” says the team.
The US Centers for Disease Control and Prevention (CDC) had said in 2017 that a quarter of people taking antidepressants had been using them for a decade or more. The 2017 CDC report said that during 2011–2014, about one in eight Americans aged 12 and over reported taking antidepressants in the previous month. Antidepressant use increased nearly 65% over a 15-year time frame, from 7.7% in 1999–2002 to 12.7% in 2011–2014.
“Antidepressant use increased with age and was twice as common among females as males. Long-term antidepressant use was common. One-fourth of all people who took antidepressants in the past month reported having taken them for 10 years or more,” said the report.
According to the researchers of the current study, the CDC report makes the case that patients and physicians are overly reliant on medication without concern for long-term consequences.The current analysis also says that older, first-generation antidepressants often come with additional risks for more severe symptoms, including aggressiveness, catatonia, cognitive impairment, and psychosis.
Discontinuing any antidepressant also carries a risk for gradual worsening or relapsing of depression and anxiety, as well as suicidal thoughts, says the study.
Based on their findings, the team recommends following a “tapering schedule” for varying classes of antidepressants. They suggest consulting with a physician before and throughout the process to monitor their symptoms and progress.
They recommend that physicians should counsel patients about the possibility of ADSs before initiating therapy with antidepressants. According to experts, physicians should also be able to recognize antidepressant discontinuation symptoms and treat patients to minimize discomfort and psychiatric issues.
"I understand that many people feel safe in that their depression or anxiety is continuously managed by medication. However, these are mind-altering drugs and were never intended as a permanent solution,” says lead author of the study, Dr. Mireille Rizkalla.
“Once the patient's depression or anxiety has been resolved, the physician should guide them toward discontinuation, while providing non-pharmacologic treatments to help them maintain their mental health," says Rizkalla, assistant professor at the Department of Clinical Integration at Midwestern University Chicago College of Osteopathic Medicine.