Antidepressants are a widely used prescription medication representing the first line of defense against depression for many people. There are several different kinds of depressants that are approved by the Food and Drug Administration (FDA) to be used to treat depression. Plus, antidepressants have been found to be effective in treating many other mental and behavioral health problems like bulimia, fibromyalgia, and neuropathy.
Antidepressants are relatively safe, and some are even approved for children to use. They aren’t likely to cause chemical dependence or addiction, and many people use them for a long time without encountering dangerous symptoms. But is it safe to use antidepressants as a long-term treatment for depression and other issues? What happens if you use them for months, years, or decades?
Some recent research has found that there may be some health risks associated with long-term use. Learn more about antidepressants and the risks they pose with long-term use.
What Are Antidepressants Used For?
Antidepressants can be used to treat a host of mental health issues, including mood disorders and anxiety disorders. They are often first-line medications for treating common mental health issues, especially SSRIs and SNRIs. Here’s a breakdown of some of the common mental health disorders that may be treated with antidepressants:
The primary use for antidepressant medications is to treat depression and mood disorders. You may think of depression as a signal mental health issue, but there are several different types of depression, which are all characterized by periods of very low mood. One of the most recognizable forms of depression is major depression. Major depression is characterized by either low mood or the loss of interest in most activities or both.
On top of at least one of those symptoms, you will also experience several other symptoms with major depression. These symptoms may include low energy, unintended weight fluctuations, sleep problems, agitation or restlessness, feeling worthless, concentration issues, and thoughts of suicide. Many mood disorders share these symptoms, but major depression lasts for at least two weeks at a time and impairs normal functioning. Major depression can manifest in people differently, some people feel anxious depression while others experience deep sadness. Antidepressants can boost your mood during major depressive episodes, treating many of the symptoms of depression.
Persistent Depressive Disorder (PDD)
Persistent depressive disorder (PDD) is another mood disorder that’s characterized by depression symptoms that last for two years or more. Persistent depressive symptoms may be less severe than major depressive episodes, but they can last much longer. Persistent depressive disorder can disrupt your life by causing you to sleep for long hours, sapping you of energy, and causing unhealthy weight changes because of changes in your appetite. Because persistent depressive disorder can last for a long time, it may require long-term treatment solutions, which means examining the long-term effects of certain medications. However, there are several treatment options to consider.
Bipolar disorder is a mood disorder that involves both depressive and manic episodes. There are two types of bipolar disorder. Bipolar I involves at least one manic episode that lasts for a week or more and periods of normal or low mood. Bipolar II does not involve a manic episode but can involve periods of high moods and periods of major depressive episodes. Antidepressants can be used to treat periods of low mood and depressive symptoms. In some cases, antipsychotic medications are also used to treat psychosis that’s caused by extreme depression or mania.
Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD) is a mood disorder characterized by depressive symptoms that happen around the same time each year. SAD is often associated with the winter months, especially in places with cold dark winters. People with SAD often feel depressed most of the day on most days of a given season. Symptoms typically appear in late fall and end in the spring. SAD will cause the same symptoms to return around the same type during the following year. In less common cases, SAD can occur during the spring and summer. Antidepressants may be used to manage symptoms during the seasons you are affected by SAD.
Peripartum depression is depression that surrounds birth and affects mothers that are pregnant or have recently given birth (postpartum depression). Peripartum depression can cause mood swings, irritability, anxiety, concentration issues, fatigue, and a feeling of being overwhelmed. This form of depression is thought to be related to hormonal shifts during and after pregnancy, as well as the significant transitional period of having a baby. Antidepressants and certain contraceptives have been shown to help alleviate symptoms.
Anxiety may seem like the opposite of depression, but it can also be treated with antidepressants. Anxiety is the most common mental health problem in the United States, affecting an estimated 19.1% of people each year. More than 31% of adults in the U.S. experienced an anxiety disorder at some point in their lifetime.
The reward chemicals in your brain that antidepressants work with can lift your mood, which makes them useful in treating depression. However, they can also cause feelings of satisfaction and a general sense of well-being which makes them useful in treating anxiety disorder, including:
- Generalized anxiety disorder
- Post-traumatic stress disorder
- Panic disorder
- Social phobia
- Obsessive-compulsive disorder
What Are Some Medications Used to Treat Depression?
There are several medications that are used to treat depression. Each one works in a way that is unique. These unique medications can cause different effects and may be useful in different circumstances. They also have their own set of side effects that make them more or less viable as a commonly used antidepressant. Here’s a breakdown of some of the prescription options when treating depression.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used prescription medication for treating depression. They are generally safe for most people, and they don’t have a high likelihood of chemical dependence or addiction. They primarily work with serotonin, a chemical in your brain that’s tied to feelings of happiness and reward. SSRIs block the natural removal of serotonin in your system, which elevates your serotonin levels. This can help increase your mood and treat many of the uncomfortable symptoms of depression. Common SSRI medications include escitalopram (Lexapro), sertraline (Zoloft), and fluoxetine (Prozac).
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another common antidepressant drug. Some are also used to treat other conditions like anxiety disorders. Like SSRIs, they work with serotonin and increase the levels of the chemical by blocking its removal. However, SNRIs also block the removal of norepinephrine, which is tied to energy levels and heart rate. SNRIs are similar in their effectiveness to SSRIs. SNRIs are also used to treat some causes of neurological pain. Common examples of SNRIs include duloxetine (Cymbalta) and levomilnacipran (Fetzima).
Tricyclic antidepressants (TCAs) are prescription drugs used in antidepressant medications, but they work differently than SSRIs and SNRIs. TCAs do work with serotonin and norepinephrine, but they work with them at different levels of selectivity. Some work more with norepinephrine than with serotonin. TCAs also block other receptors that SNRIs and SSRIs aren’t associated with, which can contribute to a different set of effects and side effects. Some examples of TCAs include amitriptyline (Elavil) and clomipramine (Anafranil). TCAs are primarily used to treat depression, but some can be used for other issues like migraine prevention, neuropathic pain, and insomnia.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are antidepressants that also work by inhibiting MAO enzymes. These enzymes break down chemicals like serotonin and dopamine, which are feel-good chemicals in the brain. By stopping MAOs from breaking down serotonin, you can increase the levels of the chemical in your brain. There are several MAOIs that are approved by the FDA to treat depression, including Isocarboxazid (Marplan) and Phenelzine (Nardil). Selegiline is another MAOI that’s primarily used to treat Parkinson’s disease but selectively inhibiting a specific MAO that breaks down dopamine.
Atypical antidepressants are drugs that are unique and don’t fit into any of the other antidepressant categories. Each one may work in a slightly different way. Most of them block the reuptake of certain rewarding chemicals, and some block certain receptors. For instance, bupropion is a weak dopamine uptake inhibitor, which allows it to slightly increase the levels of this rewarding chemical. It may be used to treat people that are going through nicotine cravings and withdrawal.
Lithium is one of the oldest drugs for treating mood disorders. It was once used more frequently in treating depression, but it’s more commonly used to treat bipolar disorder today. Lithium doesn’t just help patients that are experiencing low moods. It’s a mood stabilizer, which means that it can also prevent manic episodes that can cause anxiety and hyperactivity. Despite its long history of use, the way lithium works to stabilize mood isn’t fully understood. Although there are some theories. Lithium isn’t used as a first-line treatment for depression because it can have a high toxicity.
Are Antidepressants Safe to Use Long-Term?
If you’re experiencing depression or anxiety, antidepressants may be able to help by interacting with some important chemicals in your brain to lift your mood and alleviate some symptoms. Ideally, short-term use of an antidepressant will correct certain chemical imbalances in your brain, and you will be able to stop using antidepressants after a few weeks. Short-term therapeutic use of prescription medication is often the goal in treating mental health problems. But the brain is complicated, and mental health problems can sometimes last longer than a few weeks, even with treatment. Some mood disorders can last for months or years. In that case, long-term treatment may be necessary to manage symptoms. But is it safe to use antidepressants for months or years?
Antidepressants are sometimes used to treat long-term mental health problems. In fact, around a quarter of patients that use antidepressants, use them for more than a decade. For the most part, antidepressants don’t cause tolerance to develop, and you’re unlikely to become chemically dependent on the drugs, so doctors often keep patients on them as long as they are alleviating mental health problems and aren’t causing significant side effects. However, there is a lack of long-term studies that go beyond just a few years, despite the fact that many patients are using the drug for longer.
Antidepressants and Heart Health
Research has suggested that using the drugs for a few months to a few years is relatively safe. However, there are a few common side effects that may happen with more than a few weeks of use. Long-term use may have some negative effects on your heart health, leading to serious chronic conditions. But there is some research that suggests the long-term use of antidepressants can lead to some more severe consequences. A 2017 study found that people that used antidepressants had a 14% higher risk of heart attacks and strokes and a 33% higher risk of death.
However, the study also found that it was generally safe among patients with heart disease. Antidepressants have some anti-clotting capabilities, but they can also affect important chemicals in the brain. This may make it slightly more dangerous for the general population, but it doesn’t significantly increase the heart-health risks of people that are already at risk.
Changes in Serotonin Levels
Antidepressants also affect serotonin all throughout the body, not just the brain. Affecting serotonin levels in the brain can help relieve some of the symptoms of anxiety and depression, but it also affects serotonin that’s responsible for other things in the rest of the body. Serotonin is involved in growth, digestion, and immune function. Changing serotonin levels for long periods of time may contribute to negative health effects in these important areas.
SSRIs in Older Adults
SSRIs are among the most common substances that are used in treating depression and anxiety. However, using them for long periods may be associated with more health risks as you age. Older people experience more risks of falls, fractures, and injuries. Plus, falls may be more dangerous to people as they age. SSRIs are associated with an increased risk of falls and injuries in older adults. Research has also investigated SSRIs for causing an increase in dementia, but the results are mixed. One reason for mixed results is that it’s difficult to separate the use of antidepressant medications from the underlying mental health problem as a cause for issues like dementia.
What Are the Acute Side Effects of Antidepressants?
Each type of antidepressant may have its own side-effect profile. When you first start taking a prescription antidepressant, it’s important to be aware of the potential side effects and let your doctor know if a side-effect is persistent, severe, or new. There is no single medication that works for every person, and you may need to work with your doctor to adjust your dose or switch medications to meet your needs. Between the many antidepressant drugs and psychotherapies, you have many options when it comes to treating depression.
While each prescription is different, there are some common side effects of antidepressants in general, including:
- Dry mouth
- Digestive issues
- Increased sweating
Drugs that increase serotonin levels may carry some risk of something called serotonin syndrome. Serotonin syndrome is characterized by nervous system overexcitement, which can include high blood pressure, increased heart rate, increased body temperature, agitation, overactive reflexes, and dilated pupils. In severe cases, this can cause fevers, seizures, and muscle breakdown.
SNRIs may cause some side effects related to increased blood pressure and heart rate. Because they increase the level of norepinephrine in your system, they can have an effect on your heart rate, which can be unwanted for people with hypertension and other heart-related symptoms.
Different TCAs can cause unique sets of side effects based on the specific chemicals they work within the brain. The chemical reuptake they block besides just norepinephrine and serotonin are thought to cause some of their unique side effects. TCAs can cause hypotension, dizziness, sedation, blurred vision, dry mouth, and constipation. Some TCAs can lead to heart complications and need to be monitored in vulnerable patients.
MAOIs can be effective in treating depression, but they are often used as a last resort. The reason doctors may be hesitant to use MAOIs is that they can negatively interact with several other medications and even foods. MAOIs block the breakdown of certain chemicals that may be introduced to the body through food and other substances. In particular, aged and fermented foods like beer and cheeses. Taking MAOIs while eating these foods can lead to serious problems like hypertension and strokes.
What Are the Side Effects of Long-Term Antidepressant Use?
Though there are many different kinds of antidepressant medications, they can cause some common side effects with long-term use. Even after taking prescription medication for a long time, you should talk to your doctor if you notice new or worsen symptoms. Here are some common side effects you may encounter:
- Weight gain. Gaining weight can be a distressing symptom of using antidepressants for a long time. Some weight gain may be healthy, especially if depression caused you to lose your appetite or if you had an eating disorder. However, it may cause you to need to adjust lifestyle habits to adapt to increased appetite or weight gain.
- Sexual problems. Many people that take certain antidepressants experience some form of sexual issue. This can include the inability to reach an orgasm or difficulty becoming aroused. You may be able to adjust your dose or change medications if this is an issue you experience.
- Feeling emotionally numb. Antidepressants can take away anxious or depressing feelings but cause you to feel empty. You may not have strong feelings one way or another. Some people are surprised to find that they still feel some negative emotions, but that they are more manageable. This may be a normal experience for someone that’s addressing depression, but emotional numbness, flat affect, or apathy, may mean you need to reassess your treatment plan.
- Feeling fewer positive feelings. You may feel like you are no longer feeling acute anxiety or depression symptoms, but you also don’t feel as many positive feelings. Antidepressants, especially mood stabilizers can take away some of the highs and lows of your emotions. That can mean not feeling as excited or happy as you did before you started taking the medications. For some people, losing positive feelings isn’t worth taking the medication. You may be able to adjust your dose or change medications to alleviate this issue.
- Suicidal thoughts. Some medications can cause what’s called paradoxical reactions, which means that they can worsen a symptom they are designed to treat. Some people experience suicidal thoughts, ideation, or actions on antidepressants. If you start to experience these symptoms, speak to your doctor right away. Adjusting your treatment plan or medication can help you to feel much better.
When Should I Stop Using Antidepressants?
If you’ve been using antidepressants to treat a physical, behavioral, or mental health problem, you may be wondering when you should stop taking the drug to avoid long-term issues. There is no single answer to this question. Antidepressants, like other medications, will affect some people differently than others. Some may use them for years without serious side effects, while others may need to come off of them after a few months. It ultimately depends on your needs, and the symptoms and side effects you experience.
When it comes to taking a prescription drug, you will need to weigh the risks and benefits. For many people, long-term solutions to distressing mental health problems like depression are worth some of the risks of side effects, especially if you monitor your health with the help of a doctor. Other people may need to explore other treatment options to avoid serious problems. But it’s important that you never take a prescription lightly. Talk to your doctor, ask questions, and weigh the risks.