Long term effects of antidepressants?

February 2, 2010 10:02 AM

I know you're not a doctor: Do antidepressants cause long term changes to the brain (good or bad), even after they're discontinued?

I'm starting to come to terms with being depressed (probably the long-term, milder kind). I'm seeing a therapist (a psychologist), but I have an appointment with a psychiatrist later this month.

I'm concerned though, I read a comment in another AskMefi post that said Effexor can cause permanent negative changes to the brain, and that has me concerned. I know antidepressants can stop working, and I don't want to leave myself in a worse state in the future.

Can anyone point me to any information about the long-term effects of antidepressants (including after discontinuation)? Are there some antidepressants with worse long term effects than others? Do some have no long term effects?

posted by anonymous to health & fitness (8 answers total)

Everyone has different effects from the meds. Some people have none. Some people have really bad reactions to one (or a couple) and great reactions from others. Read the patient information packets. If you are particularly concerned about ones that indicate long-term non-reversable side effects, refuse those.

As for my personal experience, I've taken 4 different SSRIs. I've had some fatigue with one which was resolved when my dose was lowered and dry mouth for 3 weeks with another which resolved itself. YMMV widely.
posted by Sophie1 at 10:38 AM on February 2, 2010

There are people who say that they haven't noticed any long term effects, but there's still not hard evidence (besides anecdotal, I think) as to what actually occurs long term, in a clearly worded paper. The guys at Crazymeds would know if anybody would, and I don't think they have the definite low down yet.

From what those guys do know: "There's one hypothesis that SSRIs cause you to grow more brain cells. However, the study that backs that hypothesis was done on rats. When I have some proof of that in humans I'll buy it. I don't deny that is what's happening, and you have to start your hypothesis with rats, it's just drugs do different things in rats, too. So I'll wait until they run MRIs on humans comparing before and after images before I jump on the "SSRIs grow new neurons" bandwagon. However, it's as good an explanation as any as to why nothing happens for a month or more in some people, but they work in a matter of days in others."
posted by bitterkitten at 10:48 AM on February 2, 2010

The problem with the internet and drug evaluation is you get lots of anecdotal evidence that is hard to put into context and has nothing like a control. And there's always somebody out there willing to tell you that X is the worst thing EVER for whatever X you'd care to name.

For example, there is a product out there that is the direct cause of several deaths, often children, every year and yet it is barely regulated by the food and drug administration. Sounds pretty sinister, right? If I never get around to telling you that the product is peanuts (or shellfish - take your pick) and that millions of people eat them every day, with no ill effect at all, I've kind of programmed you for needless worry.

This is absolutely not to say that there aren't side effects or that they're something to screw around with. Also, as I state in my profile, I am a pawn of big pharma so clearly part of the conspiracy.
posted by Kid Charlemagne at 11:30 AM on February 2, 2010

If I remember correctly (I took neuropharmacology 5 years ago), it's not that SSRIs grow new neurons, it's that they cause existing neurons to grow more serotonergic projections, and increase the density of serotonin receptors in the synaptic cleft.
posted by Jon_Evil at 12:02 PM on February 2, 2010

My experience (and I looked a lot, though of course as a layperson) is that there is no definitive or even particularly (to my eyes again) suggestive science at this point. I'd love to be proven wrong, though it is probably academic to me, I'm pretty confident I won't take drugs for dysthymia again. There are people out there who are pretty rabid about calling out the pharmaceutical industry for under-reporting the side effects and risks of antidepressants and overstating their benefits and applicability (and not without justification) and if there was any kind of really compelling clinical demonstration of long-term, post cessation after-effects you can bet it would be all over internet.

Personal anecdote for what little it was worth: I was on paroxetine (most commonly, Paxil) for a few years midway through somewhat over 5 years of professional counseling by a non-MD PhD therapist (the Paxil was prescribed and managed by an MD Psychiatrist). I took it specifically to see if I could "get further, faster" than I had with therapy alone, though I did find therapy effective and expected it (accurately as it turned out) to continue to benefit me. I'd been in therapy maybe 2.5 years at that point, with a diagnosis of dysthymia.

The benefits were pretty ambiguous. The most objective-seeming positive impact it had was it appeared to make me less susceptible to repetitive thought-cycles, and allow me to more easily interrupt and end those cycles when I noticed them occurring. I felt there was essentially no elevation of my mood. I've said in past answers here that I feel like being on the drug helped me advance my therapy. As time passes I am less convinced of this though I don't discount the possibility. It could be I don't remember anymore, or that I lost some of the benefit I accrued with time. It could also be that I am more objective now. I had common and not severe side effects. The combination of the lackluster benefits and relatively small but consistently negative side effects led me to withdraw from the medication with the approval of my psychiatrist (though I went much, much faster than recommended - essentially cold turkey - which was unpleasant and probably foolish). I had withdrawal effects that have been widely reported for paroxetine which were mostly gone within a couple weeks and fully resolved in less than two months.

I now feel the evidence for the efficacy of pharmaceuticals for dysthymia is not very compelling but I don't have any regrets about experimenting with this treatment in a properly supervised therapeutic context.
posted by nanojath at 12:22 PM on February 2, 2010

Most modern antidepressants (the ones that are most often prescribed nowadays) haven't been around long enough for meaningful long term testing. Fluoxetine (zoloft) was only released in 1988 and it was basically the "first" in what has become the modern antidepressant class of drugs (SSRI).

Thus, anecdata and short term studies are pretty much all that is available. One interesting thing to read about is the "placebo effect", as there have been a lot of study recently that indicates the power of placebo has been growing over time. This is compelling evidence for someone who is already skeptical.
posted by shownomercy at 12:44 PM on February 2, 2010 [1 favorite]

Fluoxetine is Prozac, not Zoloft.
posted by ishotjr at 12:55 PM on February 2, 2010

I can't find any empirical data on this either, but given what I know about the brain's plasticity and the way that SSRIs work, I'm fairly certain that they induce changes that will last long after use is discontinued. Whether or not those effects are entirely reversible still seems to be an open question, and the answer likely depends on a number of factors including age, length of use, comorbidity, diet, exercise, and a veritable host of other factors.
posted by solipsophistocracy at 1:44 PM on February 2, 2010