What are the implications of long-term antidepressant use?

October 25, 2007 1:44 PM

Can anyone share or point me towards anecdotal or scientific information regarding the implications of long-term antidepressant use?

I know this can be a sensitive subject in the green, but since crazymeds went down, I'm not sure where to look. I'll try to keep this short as possible, but it seems that such personal questions require personal information...

My basic question is: Is there any evidence to show that long-term use of antidepressants can cause any sort of future mental impairment?

The backstory is as follows: I'm 26 years old, and have been on antidepressants since I was 16 for Anxiety/Depersonalisation and OCD. It took a while to find something that worked, but a low dose of Effexor XR at 75mg/day seemed to do the trick after a few months of trying things out.

On medication, I am highly functional, perhaps even superfunctional. I started a new life on the other side of the world, am in a healthy relationship, and am highly regarded and awarded in my field, in which I successfully operate my own business and and a number of self-initiated projects on top of that.

I have tried to go off the Effexor about 4 times total. Each time was closely monitored and weaned myself over a number of months. Each time I reached the point where I was totally off the meds, I would be stable for a week, and then I would just lose it, and be basically crippled with uncontrollable anxiety. (That said though, those four times were probably not the best times to pick in terms of other things that were happening in my life, i.e, new job, new house, etc)

I have been in therapy this whole time, and working on alot of other areas of my life such as my overall health (which is basically garbage at the moment) as well as taking up a meditation practice in efforts to reduce my overall stress in addition to making alot of smaller changes across the board.

I have reached the point where I have accepted that I will probably have to be on medication for many years to come while I sort these other things out in therapy, because being able to leave the house is something that I greatly value. While the anxiety can still break through the veneer of medication some days, its manageable at least.

Anyone who has tried to come off meds, especially Effexor, knows the awful withdrawal symptoms as discussed on previous posts. The sheer power of the drug, combined with the overall ignorance of how these drugs 'actually' work and my overall distrust of big pharma, makes me a bit uncomfortable, and ironically, can increase my anxiety levels.

Has anyone here been on meds 10+ years and successfully come off? Are there any studies or other resources I could use to possibly gain some more perspective on the reality of long term use of mind-altering substances? Any input would be most dearly appreciated.

posted by anonymous to health (10 comments total)

Your concerns are valid. I have been on SSRIs for over 10 years. My memory (at 48) is horrible. I have tried and tried to get off Zoloft. But, as you know, after long-term use, it's extremely difficult. The drug industry doesn't call it "withdrawal" and for years even denied there was a problem. When it could no longer be swept under the rug - they came up with a much nicer sounding name, "Discontinuation Syndrome."

I highly recommend you read Dr. Joseph Glenmullen's latest book about how to get off the SSRIs safely with his slow-taper program. His personal website is here.

(It's about more than Prozac - it's ALL SSRIs)
His book at Amazon is here.

Good luck to you!
posted by Gerard Sorme at 2:23 PM on October 25, 2007

Sorry to double-dip, but I meant to also mention Dr. Peter Breggin. His website is FULL of excellent information on this topic.
posted by Gerard Sorme at 2:26 PM on October 25, 2007

I would think that if you have been on it for ten years and don't notice any mental impairment by now, it's probably not going to creep up on you. I have been on Paxil for about ten years, after trying numerous other drugs. It has been a life-saver for me. I had terrible panic attacks, and the depersonalization you mention. I tried to "wean" myself off a few years ago--I didn't get the anxiety back, but got weepy and had an "edge" to me, anger and such. Every year I go back for a year's supply of refills, and my doctor has no problem with it. He says if it works, don't fuck with it. This probably doesn't answer your question, but that's my experience. Crazymeds went down? Jeez, that's too bad.
posted by wafaa at 2:30 PM on October 25, 2007

I started Prozac in my late 20's and am now still on it in my early 40s, so I couldn't really say if the fact that my memory is somewhat less agile is a factor of the meds or just a natural result of getting older.
posted by matildaben at 2:50 PM on October 25, 2007

i'm also interested in the answer to this question. i thought that since ssris have only been available for ~30 years that maybe there might not be any data on lifetime use....

sorry to not be more helpful.
posted by misanthropicsarah at 2:53 PM on October 25, 2007

Here's the thing; if your life sucks without SSRIs and it's good with SSRIs, does it really matter that it's going to be hard to get off the pills? Does it even matter if there might be some (relatively) minor negative side effects associated with long term use?

Taking insulin isn't good for you; as time passes you develop greater and greater insulin insensitivity. But I guarantee you taking insuling is a heck of a lot better than not taking insulin if you can' t control your blood sugar any other way.

I raise this because you need to be vary wary on this subject. For example, you might want to skip Peter Breggin whom Gerard brings up. Breggin is very, very controversial. For example, he doesn't believe ADHD exists and the whole thing is a fraud to push unneeded medication. He believes most of modern psychiatry is a sham.

Glenmullen is also trying to sell you a book.
posted by Justinian at 4:10 PM on October 25, 2007

Depression itself damages your brain. This study seems to indicate that using antidepressants can prevent the sort of damage that depression causes.
posted by stefanie at 5:23 PM on October 25, 2007

Isn't every author "trying to sell you a book?" Justinian, you slammed my comments and are doing a great disservice to the OP by trying to assassinate the character of the men mentioned in my posts. Controversial doesn't mean "wrong." And Joseph Glenmullen damned near saved my life at one point when all the other doctors told me I had "nothing to worry about."

I agree that the OP needs to be very wary on this subject - as the accepted truth concerning many of these drugs are proving to be wrong. They have their place, but the OP has every right to hear the other side of the story as far as "discontinuation syndrome," and long-term effects are concerned.

The problem with just taking the pills and not worrying about it is that you eventually reach "tolerance." The drug stops working and you either take more - or you must get off. The difficult attempts to get off is a concern of the OP (and the long-term effects of these drugs). It's not like big pharma has a great record when it comes to telling the truth. These two authors, that you maligned, have much to offer.
posted by Gerard Sorme at 5:34 PM on October 25, 2007

Assassinate the character? I said to be careful. If Glenmullen can't survive me saying to be wary of controversial advice, he's got bigger problems.
posted by Justinian at 7:33 PM on October 25, 2007

You can ask people in the Effexor forum at depressionforums.org
posted by cass at 1:35 PM on October 26, 2007