Clinical guidelines are vague; here’s what psychiatrists say to consider when deciding whether to continue taking these medications
When Marjorie Isaacson started taking medication for depression in her late 20s, she considered it lifesaving. At the time, she had been dealing with a rocky marriage and struggling to eat. The drug, she found, helped her gain equilibrium.
“I was really grateful just to be able to function,” she said. But recently, Isaacson, 69, has been considering whether she wants to stay on antidepressants for the rest of her life. Specifically, Isaacson wonders about the long-term effects of her medication, a serotonin-norepinephrine reuptake inhibitor that is known to raise blood pressure. And she feels unsettled by the emerging backlash against psychiatric drugs that has condemned their side effects and difficult withdrawal symptoms. “As the years have passed, things have changed from ‘Take it and see how it goes, no need now to be concerned’ to ‘Well, it’s turning out things might be kinda complicated,’” she said. “That is worrisome.” But even though modern-day antidepressants have been around for decades — the Food and Drug Administration approved Prozac for depression treatment in 1987 — there is very little information about long-term use. The FDA approved the drugs based on trials that lasted, at most,, and randomized controlled trials of antidepressants have typically spanned only two years or less. Current clinical guidelines do not specify the optimal amount of time they should be taken for. The lack of data can make it hard for people to know when — or whether — to quit. So we asked psychiatrists: How long should someone stay on antidepressants?Psychiatrists say it is a decision best made alongside your doctor. The answer depends on your symptoms, diagnosis, response to the medication, side effects and other factors — all things to discuss with a medical professional.And providers keep prescribing antidepressants to people at low risk of relapsing into depression “out of inertia,” he added. “That’s the problematic part, and it needs to be addressed.” Antidepressants are known to have adverse effects that often fade as your body adjusts. But some side effects, like weight gain and sexual dysfunction, can linger.For major depression, clinical guidelines suggest taking medication until patients feel “virtually back to themselves,” said Dr. Jonathan E. Alpert, chair of the department of psychiatry at Montefiore Einstein in New York. After that, it’s important to continue treating them for at least four to nine months to “anchor in” their recovery, he added.Patients may then continue taking the medications for at least one or two additional years — what is known as maintenance treatment.that have found higher relapse rates among those who stop taking the medication versus those who do not. And they represent a consensus among experts, distilled into guidance by the American Psychiatric Association and other professional societies like theFirst, how long has the patient been ill for? Has that person had multiple depressive episodes? People who, like Isaacson, have had depression lasting two or more years or at least two depressive episodes are Second, he considers the severity of the illness. Was the patient admitted to the hospital? Did that person have trouble functioning in their daily life or need to try multiple drugs before landing on one that worked? An illness that is severe and tough to treat would suggest the need for long-term use, he said. Finally, he looks at efficacy: Is the medication working? Some people get better but still have residual symptoms. Continuing the medication often makes sense, Alpert said, to prevent “the risk of a flare-up.” Antidepressants are also used to treat a wide variety of other conditions, such as anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and chronic pain. For these issues, long-term treatment is often necessary, experts say.that about 1 in 6 people who discontinue their antidepressant experiences adverse symptoms. These can include dizziness, fatigue and brain zaps. For 1 in 35 patients, symptoms can feel especially severe. In some cases, they are so problematic that trying to quit proves too difficult.suggest that antidepressants are generally safe. But no randomized controlled studies have been funded by drug manufacturers to examine decades-long use.), if there were additional problems connected to their use “it would be pretty hard to miss,” said Dr. Paul Nestadt, medical director of the Center for Suicide Prevention at the Johns Hopkins Bloomberg School of Public Health. The drugs are not without risks, which vary depending on the medication. Certain antidepressants have been associated with increases in blood pressure, heart rate and cholesterol. They can alsopublished in May found that people who took antidepressants for one to five years had a higher risk of suddenly dying from a heart condition than those who did not have a history of taking the drugs. However, it is unclear whether the deaths were driven by the medication orAny downsides have to be balanced against the very real risks of avoiding medication, psychiatrists stress. “I’m still of the opinion that, in people who have real depression, the benefits outweigh the risk,” Nestadt said.Officials believe San Diego is well positioned as cities compete for dwindling state homeless dollars At 82, retired teacher and former marathon runner has discovered his next chapter doesn’t require a busy social calendar At 82, retired teacher and former marathon runner has discovered his next chapter doesn’t require a busy social calendarFast Lane at San Ysidro, Otay Mesa border crossings will soon open to cross-border workers Amtrak’s Pacific Surfliner launches 13th roundtrip between San Diego and Los Angeles, with plans to expand still moreAfter second trial, jury convicts San Diego County deputy who seriously injured restrained inmateEncinitas to explore new limits on late-night business hours
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