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July 26th, 2011
12:07 PM ET

Is it OK to be on antidepressants for years?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Rose from Arizona
Is it dangerous to be on an antidepressant for several years?

Expert answer:
Dear Rose,

Ten years ago my answer to this question would have been, "Certainly not."

A year ago my answer would have been, "Almost certainly not."

Now, unfortunately, the most honest answer I can give you is, "I'm not sure."

Coming from a guy who has treated thousands of people over the years with antidepressants, I have to admit that my uncertainty both shocks and distresses me.

I should probably get over my sense of shock. One of the glories of science is that it keeps moving forward, and as it does so, it usually sweeps old certainties into the dustbin.

Psychiatry's commitment to the unqualified goodness of antidepressants is one of those old certainties. That I'm distressed is understandable.

The assault on my certainty about antidepressants comes from several fronts. Over the last several years, it has become increasingly clear that even newer antidepressants may pose health risks in certain situations, such as pregnancy or during childhood.

These sobering findings take their place beside the fact that antidepressants induce significant side effects in many people, and that some antidepressants have really troublesome withdrawal syndromes when people try to stop taking them.

Even more concerning is the fact that a number of recent, high-profile studies have suggested that antidepressants are not as effective as we once believed they were when compared with treatment with a placebo (which is a pill that has no active properties).

Just this weekend, I saw a study that further shook my certainty about antidepressants. Researchers pulled together data from hundreds of studies conducted over the last 30 years or so in which people with depression were randomized to treatment with either an antidepressant or a placebo.

Using this huge database the researchers asked a simple question: Who were more likely to relapse when they stopped taking the study pill - people who received an active antidepressant or a placebo?

Are antidepressants glorified placebos?

The answer was clear. People who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo.

I'm still trying to digest this fact, but it seems to me that the simplest way to understand this finding is that when a placebo works it is a better form of treatment than an active antidepressant.

In Europe in general - and Germany in particular - doctors use placebos to very good effect for many disease states, including depression. On the other hand, it is considered unethical in the United States to treat people with a placebo without their being told that they are receiving an inactive substance, so it is not likely that we will be handing out sugar pills for depression anytime soon.

But a clear take-home message from the current state of the science is that we need to work harder - as patients and clinicians - to get key elements of placebo into our lives and practices.

These elements include, above all else, a sense of hope, a belief in the therapeutic relationship and the knowledge that we are doing something positive to improve the current condition of our thoughts and emotions.

Here is how I currently make sense of things: Like all other medications, antidepressants have risks and benefits.

We know, for example, that chemotherapy for childhood cancer greatly increases the risk that children who survive will die of cancer as adults because the treatments themselves are carcinogenic. Would this keep you from treating a dying child?

In the same way, there are many times when the risks associated with antidepressants are more than balanced by the potential benefits. This risk/benefit equation must be performed for each individual we treat, and it is an equation you must evaluate in the context of your own life situation.


soundoff (93 Responses)
  1. B Ann

    Depression can be a symptom of low thyroid levels. But many hypothyroids remain undiagnosed because the screening test for low thyroid, the TSH, is flawed and fails to detect many with low thyroid levels. Here is more: http://tiredthyroid.com/index.html

    July 26, 2011 at 12:57 | Report abuse | Reply
    • DEPRESSIVE

      YES!!! You are so correct on that. It is called SUBCLINICAL HYPOTHYROIDISM!!!
      Even though I still take my Paxil, I also take a small amount of Levothyroxine, and it helps boost the effect of the anti-depressant.

      If you are really depressed, go to a doctor that recognizes "Subclinical Hypothyroidism".
      He/she will give you a more accurate test to determine if you meet those standards.
      And then, sometimes a small amount of thyroid hormone can make all the difference.

      I had major depression for 40 years, and have been experimenting with different kinds of treatment.

      July 26, 2011 at 22:40 | Report abuse |
    • mark brydges

      hey anne ı d lıke to let you know about a treatment ı ve been usıng for the past two years called l theanıne. ıt ıs the actıve ıngredıant ın green tee that cause a calmıng effect on the body, ı was dıagnozed 12 years ago wıth depressıon and was treated wıth antı depresssants for the past twenty years. ın that tıme my lıfe only got worse due to the sıde efffect s and the ınefectual out come of thıs treatment. these drugs are not the answer or evern the correct dıagnozes whıch ı never got untıl seven years ago and for four years ı was treated wıth resperdol thıs ıs the absolute worse drug you can take ı deverloped heart problems uncontrollable shakıng whıch started at any tıme as well as memoryt loss whıch to thıs day ı stıll suffer from .ı turned to alternatıve therapy and came up wıth l theanıne . whıch has ımproved my lıke consıderably not cured but ımproved wıthout the horrıble sıde effects of these other drugs, theır ıs a doctor by the name of dr mıcheal lyon ın vancouver who wıth the unıversıty of b c has been conductıng reasearch o f l theanıne for the treatment of adhd ın chıldren and from what ı ve read and ı can confırm ıs a much safer soultıon to some of these neurologıcal dısorders.check hıs web sıte out and all the other ınformatıon on l theanıne and you can begın to see the sense ın uusıng ıt . ıts not a cure ı stıll have ıssures whıch unfortunatelpy for me wıll be wıthme tıll the end. but for chıldren now beıng dıagnozed wıth adhd or bı polar whıch ı have as well ıt ıs a far better way to go good luck

      April 20, 2012 at 07:41 | Report abuse |
  2. fuyuko

    I've been treated for anxiety, but found the pills caused weight gain and stopped. I think if you can take the meds, and they work for you- do it. Just be aware that medical science is uncertain abuot the long term effects of using these drugs and do so at your own risk.

    July 26, 2011 at 12:59 | Report abuse | Reply
    • B

      I loose weight when I'm on anti-anxiety pills because I'm not eating to sooth my nerves. The majority of folks who take mood-stablizing pills WANT them not NEED them. Folks, it's ok to be blue, to be sad, to be anxious. When you can't function with them, that's when you should take them and do so long term because the chemicals are out of balance.

      I used to work for a pharmacy and I'd fill antidepressant Rxs for every member of the family. Get a clue people. Stop filling your kids with soda and sugars and reduce your To Do list. Make time for relaxation. Not every minute needs to be used up "productively". That's a problem with the US's mentality both at home and at work. Burn yourselves out and take meds to appear that you're happy.

      July 26, 2011 at 17:11 | Report abuse |
    • Brenda

      Brenda not "B"

      July 26, 2011 at 17:12 | Report abuse |
    • Heather

      Brenda (below): You just said that you are taking/ have taken anti-anxiety medications. But then you immediately criticize people for taking anti-depressants, saying they "want, not need" them?? Hypocritical much?

      July 26, 2011 at 19:04 | Report abuse |
    • Jay

      Heather, don't be such a dick.

      July 27, 2011 at 01:11 | Report abuse |
    • Chris

      It's understandable that an entire family might take anti-depressants. Depression often has a genetic component, members of a family will have many of the same environmental factors, those with depression are more likely to recognize the symptoms in others, and parents who overcome the stigma of taking anti-depressants are more likely to agree to their symptomatic children being placed on anti-depressants.

      July 27, 2011 at 13:25 | Report abuse |
  3. KF Gold

    "The answer was clear. People who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo."

    This could be easily explained by the selection bias introduced by "selecting" only those who recovered from each of the two groups. I am professionally concerned, as a statistician who has worked in secondary analysis of trial data, that you conclude that, "but it seems to me that the simplest way to understand this finding is that when a placebo works it is a better form of treatment than an active antidepressant."

    First, anti-depressants are far superior in a positive response than placebos. HUGE effect. So, when you SELECT those who responded to anti-depressants it is a much larger, and I suspect diverse group, than those who responded to placebo.

    Lets say each arm, 1) antidepressant vs 2) placebo has 1000 subjects each. These people have been RANDOMIZED so there is no systematic difference between the two groups. This is a key condition that allows you to draw a causal inference about the superiority of one over the other, the fact that there is no other difference between the two groups that could explain a difference in their response.

    Say 900/1000 assigned to anti-depressant arm respond and only 200/1000 in the placebo arm respond. Clearly, the anti-depressant has superior efficacy.

    Your statement that OF THOSE "who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo."

    You are comparing the 900 positive responders in the anti-depressant arm to the 200 positive responders in the placebo arm.

    Let us assume that of the original 1000 assigned to the anti-depressant approximately 200 would have also responded to the placebo. We can infer this as the groups are identical with the exception of some sampling variability. That leaves us with AT LEAST 700 subjects who would have not responded to the placebo and did respond to the anti-depressant.

    It is very unreasonable to compare the lapse rate of the 200 who recovered on placebo to the 700 who recovered on anti-depressants. At least 500 of the 700 would have been UNRESPONSIVE to placebo in the first place. The difference in lapse rate is almost guaranteed to be explained by the fact that the mechanical regulation of neuro-transmitters that the anti-depressants provide is no longer in effect. Just as if you stop insulin to a diabetic, sugar levels rise.

    If you really want to compare lapse rates between placebo and anti-depressant you would need to compare the 200 responders in the placebo group to the 200 subjects that WOULD HAVE responded to placebo in the anti-depressant group. You could do this in a cross-over trial which would allow you to identify those who are placebo responders and then cross them over to the anti-depressant and see what their lapse rate is.

    I think there is a BIG difference in the psychological composition of placebo responders than the general population. If only the fact that they RESPOND to placebos. So, to compare lapse rates between a group of 100% placebo responders to a group that could at most be 200/900 = 22.2% placebo responders is just poor science. They are not comparable groups.

    July 26, 2011 at 13:06 | Report abuse | Reply
    • KF Gold

      Read," At least 500 of the 700 would have been UNRESPONSIVE to placebo in the first place. "

      as "At least 700 of the 900 would have been UNRESPONSIVE to placebo in the first place."

      July 26, 2011 at 13:36 | Report abuse |
    • Sam

      I agree, well put (outside the typo) these anti medication 'studies' are by a certain cult group who believe in Aliens.

      July 26, 2011 at 14:08 | Report abuse |
    • gary

      you must be employed by the pharmeceutical industry

      July 26, 2011 at 15:36 | Report abuse |
    • wxbuggin

      *high five* for trying to fix "wrong" on the internet! http://xkcd.com/386/

      In all seriousness, though, thank you for your educated response to this article.

      July 26, 2011 at 16:07 | Report abuse |
    • jim

      Finally, someone who understands science and statistics. I too am a scientist, and cringe every day when I read the popular press and the new "studies" which come out and claim ridiculous correlations are causal. They a re total BS, but the uneducation public just sucks it up.
      A couple of ridiculous examples (using the exact principles pseuodoscience "studies" use, but maybe a bit more obvious):
      Its a fact that the rate of lung cancer in the US has gone up exactly proportionally to the number of colour TVs owned by the average household. Its simple- outlaw colour TVs and lung cancer will be no more!
      The larger your big toe is, the higher your income will be- absolute fact. So lets do toe implants on everyone and end poverty!(In actual fact its because children have smaller toes and dont have incomes which drags the whole average down- but hey, that takes the fun away!)
      Most heroin, crack, and amphetimine addicts started out on marijuana- marijuana must be banned as it leads to drug addiction!But wait a minute. They virtually ALL started out on milk before marijuana. I think its the milk that has to go. Doesnt my study "prove that"
      Anyway, I like the old Mark Twain quote about there being lies, damned lies, and statistics. Or Figures dont lie, but liars sure figure.

      July 26, 2011 at 16:43 | Report abuse |
    • Petercha

      Very good point, I was thinking something similar myself.

      July 26, 2011 at 16:43 | Report abuse |
    • Chartreuxe

      An antidepressant literally saved my life. I would have killed myself in my depression without the medication, I don't doubt it. I'm grateful I found a doctor who diagnosed my clinical depression.

      Nothing else had helped. It's possible my thyroid's off, it used to be low. I was on Syntheroid for years.

      July 26, 2011 at 16:46 | Report abuse |
    • Petercha

      Jim, I agree with you on all of them except the marijuana one. Milk is not illegal and is therefore not considered a risk by most people. Marijuana is illegal and there is therefore some level of risk in trying it, but obviously less so than the "harder" drugs. Once a person has tried something illegal, such as marijuana, their level of risk tolerance for other drugs goes down, making them more likely to try them as well. Your comparison between milk and marijuana makes no sense.

      July 26, 2011 at 16:52 | Report abuse |
    • HankM

      You have put up a straw man argument using some very suspect numbers not based on current studies.

      Based on several recent meta analyses, antidepressants showed no clinically significant margin of efficacy over placebo. Your example showing a huge margin of difference between antidepressants and placebo is just not true and creates a misleading argument.

      With each group on an even footing (that is, around 30 t0 35% efficacy), you could fairly compare withdrawal of antidepressants with withdrawal from placebo. And as we could predict, antidepressants have far worse withdrawal effects.

      July 26, 2011 at 17:00 | Report abuse |
    • jim

      Petercha, that is exactly the point. It makes no sense at all and of course you and I know its not true. It just illustrates how hyou can use studies and statistics to support any arguement you choose.

      July 26, 2011 at 17:06 | Report abuse |
    • jim

      To Hankm. the problem with the metanalyses is that they are retropsective and dont control for the indications for which the drugs were prescribed. Studies have shown ADs are very effective for severe depression, for mild, not so much. I maintain that many people on these drugs are not depressed at all, but have other problems (personality disorders, poor coping mechanisms, too much life stress) and of course ADs dont work for them.

      July 26, 2011 at 17:09 | Report abuse |
    • CalgarySandy

      I want to know more about the people in this study. Was their Depression situational, i.e. a death, divorce, a birth, accident....? A response to crisis. Were all or some those who are chronically depressed? Had they tried drugs before and if so what? Is this about Dysthymia (low level and constant depression) or Clinical Depression? What about mixed states of Depression and Anxiety? What about Bipolar Disorder and Borderline Personality Disorder. If these tests do not take into account the different kinds of Depression and disorder it is often a part of and how long the problem has existed they are bunk.

      July 26, 2011 at 17:43 | Report abuse |
    • CalgarySandy

      A person with situational depression caused by crisis level events in their lives are likely, if they look for it, to get help from therapy without the meds. It stands to reason that those people would not relapse or at least not until the next crisis. Those who would be cured because it is not situational are the ones who do relapse when the drug is removed. Without knowing how they handled the difference between situational and chronic states this study is meaningless and could cause people who do need the meds to quit and relapse. Every relapse increases the likelihood that the next relapse will come sooner. Eventually the person is triggering for no discernible reason. The brain itself will set a relapse off one after another. The refusal to acknowledge mental illness exists and the difficulty of treating it is very unkind. 1 in 5 Americans will experience a mental unraveling at some time. Pray it is not you.

      July 26, 2011 at 17:53 | Report abuse |
    • JLS639

      As another poster pointed out, the anitdepressant effect is much smaller than in your example. It can be highly statistically significant, but the effect is small.

      However, what you said: "The difference in lapse rate is almost guaranteed to be explained by the fact that the mechanical regulation of neuro-transmitters that the anti-depressants provide is no longer in effect."

      This is exactly the concern. There is no conflict between what you said and what the authors said. The body adapts and comes to depend on the drug for a normal effect. Rather than aiding in recovery, the antidepressants are forming a novel physiological state that masks depression symptoms, causes side effects and prevents recovery.

      Why do we only prescribe painkillers for only short periods of time and end their treatment when the patient is still in pain? Because the body's nociceptive (pain-sensing) system adapts and ordinary actions such as leaning over or touching something become painful without the painkiller.

      A central concern of mine is that we are creating a chemical dependence on antidepressants similar to a chemical dependence on painkillers. In order to remain normal, the patient must remain on the antidepressant. Painkiller withdrawal can result in chronic pain. There is reason to believe antidepressant withdrawal can result in chronic depression (among other things – serotonin is used for many purposes).

      July 26, 2011 at 22:15 | Report abuse |
  4. Anne

    Is the placebo effect true for anxiety, as well as depression? Given that many people take ssri's for anxiety; it would be helpful to know if this has been studied.

    July 26, 2011 at 13:36 | Report abuse | Reply
  5. BB

    This is ridiculous. If a person is taking AD's and they work who cares about the long term effects. I get so sick of hearing that with medicine. OK, I can stop taking it and feel like crap but maybe live a little bit longer??? I dont know about anyone else, but I would rather live a shorter life and feel good.

    Now if a child is taking them I can see how a DR. may say or think that they shouldnt take them long term, but once you are in to adulthood it should be ok to take them without know-it-alls telling you its bad.

    July 26, 2011 at 14:06 | Report abuse | Reply
    • Rbnlegend101

      If the medication is the only way to relieve severe symptoms, then "who cares about the long term effects" makes sense. But there are other approaches, and doctors prescribe anti-depressants like candy. The long term effects are one of the things the doctor has to take into account when deciding how to treat a problem. For severe depression, sure, go all out and who cares about a decade from now.

      My wife was overprescribed anti-depressants for a very long time. It turns out she had a completely different problem, and the depression was just a symptom of chronic pain. Now, her biggest problem is side effects from anti-depressants that she can't stop taking without crushing withdrawal symptoms. So, who cares about long term effects? The patient does, in ten years.

      July 26, 2011 at 15:24 | Report abuse |
    • CalgarySandy

      Tough out the withdrawal. It is heIIish but worth it if you are on the wrong meds. I added weed back into my life to help get through them but not everyone has that option. Lots of comfort both physical and emotional will help her. Go for walks to burn off the adrenaline. Don't worry about the brain and nerve shocks as they do not kill and will go away. It seems to me that a few days of severe withdrawal is easier than a life on the wrong medications. I have gone through it twice and I have been put on way too much of a med way too fast. That was so bad I went to the emergency and the psych ward over it. Weed did not help that one.

      July 26, 2011 at 18:33 | Report abuse |
  6. John B

    Relevant?

    July 26, 2011 at 14:15 | Report abuse | Reply
  7. Dean

    Dr Raison, with all due respect I must point out that you are passing off rhetoric as a logical conclusion. The central thesis of your letter is based on the following claim:

    "The answer was clear. People who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo."

    You go on to say that you are "still trying to digest this fact..." Well let me just state that the above claim is evidence of precisely the opposite of what your rhetoric might lead some to believe.

    Let me digest it for you correctly:

    The above finding shows that there is a higher correlation between the drug regime and depression status when the drug regime is either taking or not taking an actual anti-depressant versus when the drug-regime is either placebo or no placebo.

    Now I'm not saying correlation implies causation, only that your "conclusion" is baseless and full of rhetoric.

    July 26, 2011 at 14:32 | Report abuse | Reply
  8. Lee

    Doesn't the logical conclusion, if anything, support misdiagnosed depression?

    July 26, 2011 at 14:40 | Report abuse | Reply
    • kake79

      I think it supports over treatment of situational depression. People that have experienced a death, divorce, or other life trauma do not need antidepressants (unless it is a very severe case) and should never be given them because, as I understand, other studies are finding that they will fundamentally alter your brain forever... your brain rewires to work with the antidepressant meaning it cannot function properly without it.

      Having said that, chronic depression or anxiety is another beast. I am diagnosed with dysthymia and generalized anxiety disorder. I began having panic attacks at the age of 5. After 4 years of specialists and therapy, I was still having severe panic attacks every day. At that point, I think it was ok for doctors to turn to drugs. I am now 32 years old and still on drugs (currently Effexor). After 20 years of SSRIs, I'm not sure I'll ever be able to get off of them... Even IF I was no longer psychologically ill, I'm just not sure my brain could function normally without it.

      July 26, 2011 at 21:41 | Report abuse |
  9. Bob S

    OK, here is the deal: Two groups, one cured with real medicine, one cured with placebo, and don't' bother considering those that did not get better. The placebo group is going to be populated with less severely depressed people. We would therefore expect them to relapse less often than those with the severe illness, i.e., those who got better with the real medicine. The problem with placebo treatments is that the results are always subjective. It's like leading the witness in a trial: "Didn't you feel better after taking the fake drug?" Of course the patient says yes. And of course you will get more yes votes in the case of depression vs. say cancer. That does not mean that placebos are just as effective. It just means that the patient has been led to believe that they are better. The more severe the disease the less likely that placebos will have a positive effect.

    July 26, 2011 at 14:42 | Report abuse | Reply
  10. Scott

    This is one of the better articles i have seen from this guy. The reason, however, why those that took AD's relapsed at a higher rate once they got off the pills is because the AD's change your brain. Starting an AD is a big time decision and should be treated as such. If you can handle the usually drastic side effects on your love life i do not think it is terrible to take them for an extended period of time. However, once you start taking them it is hard to quit because they change your brain, sometimes permanently.

    July 26, 2011 at 14:47 | Report abuse | Reply
  11. Sonia

    You didn't mention Serotonin Syndrome? This is a very serious condition that results from long-term usage and having suffered from it myself, I really regret ever going to a doctor over my mild depression. Those pills seriously mess with your body.

    July 26, 2011 at 14:49 | Report abuse | Reply
    • wxbuggin

      As someone who takes an SNRI, I'm curious... when you had serotonin syndrome, was it strictly due to long-term use or had you been taking any other medication, such as migrane medication...anything prescribed or OTC? The Bulk of what I'm finding about Serotonin Syndrome is that it's related to drug interaction. However, I'm a firm believer that science/medicine is ever-evolving and there are lots of unknowns.. I'm not trying to write you off, this is just something I hadn't heard about before and am personally interested to know more about it.

      July 26, 2011 at 16:15 | Report abuse |
    • jim

      True,. bit its rare. But you're right, these are powerful drugs and should not be taken lightly. I think the problem is that many many poeple on ADs are really just having trouble coping, or have poor social skills, or whatever, and expect a pill to make everything right. Just like the ads (that the pharmaceutical giants pay billions for) tell you. And too many overworked GPs just prescribe the drugs as they dont have time to explore whats really going on and get to the root of the problem. Most of these people need cognitive behavioral or other therapy, not drugs.
      But I have no doubt that for true, endogenous major depression, these drugs are a godsend like pennicillin was, and are one of the wonders of modern medicine. I know because i was there.

      July 26, 2011 at 16:51 | Report abuse |
    • CalgarySandy

      When Prozac first came along people who did not have any mental illness took them to give them an "edge." Kind of like coke, speed and Red Bull.

      July 26, 2011 at 18:38 | Report abuse |
    • CalgarySandy

      @jim I suspect that there are many people who do not have a medical plan that provides the kind of therapy that works. That can take a long time if the issues are deep seated. If you cannot afford to take the time off work and spend a very great deal on therapy then you have little choice than the drugs. The pain involved and the emotional and cognitive impairment drive people to do anything they can to be normal.

      July 26, 2011 at 18:41 | Report abuse |
  12. T.Higgins

    Dr. Raison,

    I take Cymbalta on a regular basis. The medication has changed my life. Prior to Cymbalta the doctor tried me on many other antidepressants.

    The best way for you to answer your question would be for your life to be in a severly depressed state and compare it to life with an antipressant that seems to have given you back your life.

    If you were my doctor today, you would not be tomorrow- or any other day.

    July 26, 2011 at 14:55 | Report abuse | Reply
  13. B

    Cortisol and Depression
    Cortisol activates in a brain region called the locus coeruleus, which sends norepinephrine to communicate back to the amygdala, and so responsible for the stress response all over again and resulting in a destructive feedback cycle continuously. Depression often associated with hypercortisolemia as the high levels of cortisol influence the distribution of various types of leukocytes in the blood stream.

    July 26, 2011 at 15:04 | Report abuse | Reply
    • B

      Besides in some people they work, in most they don't. Then again snake oil works in some, not in others.

      July 26, 2011 at 15:06 | Report abuse |
    • CalgarySandy

      My suggestion is to make therapy available for everyone not just those with money. This might help. Stress does cause enormous problems and it is not possible for everyone being hurt by long term stress to get therapy to make them strong enough to handle the stress. For those who are way past the stage where they can get help in 20 sessions drugs are the only way to go. They say that the younger you are diagnosed the better chance healing. But there are few programs for youth at risk that are provided free. So the diagnosis does not lead to the ability to get help for a young 'un. Saying no to the drugs when there is no affordable or even available help is cruel and lacking empathy.

      July 26, 2011 at 18:47 | Report abuse |
  14. Susan

    One problem with antidepressants that the article does not mention is that non-psychiatrist physicians often prescribe them to patients without referring the patients to a psychiatrist or other mental health professional for treatment. Antidepressants are not in and of themselves treatement for depression and they should only be used in conjunction with counseling by a competent mental health professional, such as a psychiatrist or psychologist. This reliance on antidepressants by non-psychiatrist physicians as a panacea for whatever ales a patient emotionally often leads to a viscious spiral downward for patients who never address their emotional issues and require more and more prescription medicine in an effort to feel better.

    July 26, 2011 at 15:10 | Report abuse | Reply
    • B

      I agree, they do not work for Coprolalia, in fact they exacerbate vocal tics. They're also not good for OCD. Obviously someone needs to regulate these types of meds more. Plus they have tons of side effects, like really bad stomach pains, or uncontrollable crying.

      July 26, 2011 at 16:42 | Report abuse |
    • B

      However, even the psychiatrists often don't really understand the role of side effects, they just really want to write a script. The best thing that could be done in this area, is to require new training for psychiatrists centered around neuropsychiatry and endocrinology. Otherwise irregardless of how much you tell a psychiatrist, I don't think that's the right treatment, as per the DSM or European Union psych methods. However, it's up to the patient to discontinue medication, as they should be aware of side effects and cognizant of a need to discuss these with their medical physicians, unless, they're really nuts, in which case, oh well, it was a misdiagnosis on the shrinks fault.

      July 26, 2011 at 16:47 | Report abuse |
    • thinker

      Thank you for that comment, Susan – I was wondering how many I would have to read before someone brought this up. IMHO,the dramatic increase in use of anti-depressants is due to a number factors: 1) insurance companies refusing to pay for people to attend multiple therapy sessions (pills are cheaper); 2) aggressive marketing by pharmaceutical companies, prompting patients to demand the pills from their doctor, leading to 3) since our health-care system is for-profit and patients are viewed as customers, no doctor wants to risk losing a patient by saying no. As a result, I wonder how many people never, ever, address the issues causing their depression or learn that it's okay to feel blue once in a while.

      July 26, 2011 at 18:41 | Report abuse |
    • CalgarySandy

      Very true but most insurance plans only allow a short term of therapy and for those with no plan there is no help. I am fed up to the eyebrows by arm chair specialists coming up with things that would be helpful, depending on the disorder, but are not available. Actually, psychiatrists do this too and if you do not have the financial ability to follow their advice they call you hard to get along with.

      July 26, 2011 at 18:51 | Report abuse |
    • CalgarySandy

      My family doctor of the last 10 years keeps up on new research and alternative methods of help much better than the arrogant, know it all already, psychiatrists. She got me appointments with psychiatrists and now is helping me put together the mess they put me in. I have had psychiatrists who also consider themselves to be therapists. They only have to study one form of therapy in med school. So if you do not respond to that you are not trying hard enough. Cognitive Behavior Therapy is great for some people. It either annoys or depresses me but not clinically as I don't care if a pshrink abandons me. Dialectical Behavior Therapy is wonderful but, again, it is not paid for.

      July 26, 2011 at 18:57 | Report abuse |
    • Heather

      Absolutely. If I went to my gynecologist with a broken finger, I assume she would refer me to an orthopedist. However, family physicians, gynecologists, pediatricians, and others regularly dispense prescriptions for antidepressants, and (in my experience) very rarely refer to psychiatrists.

      July 26, 2011 at 19:08 | Report abuse |
    • Susan

      I disagree, based on my own limited experience. I had a bad event in my life, I couldn't keep myself together very well, so for my kids, I went on a mild AD prescribed by my physician. Was just enough to get me over the hump and after 8 months I tapered off easily and everything was better. I did do one session with a therapist, but was not effective and nothing I wanted to pursue, I had to get through myself. I appreciated having a script available when I needed it without having to lay all my problems out to a stranger, which I really did not need, nor have the time for, and oh yes – did not feel like fighting insurance for.

      July 27, 2011 at 01:04 | Report abuse |
  15. Content

    They are serious drugs, but if you have severe depression, and they help, it may be worth it.

    The long-term side-effects have probably barely been studied, but just be aware it can permanently alter things, like your metabolism, your digestive system (causing chronic constipation, for example), and so on. I believe they should be reserved for cases of serious depression, only.

    If you battle depression, look for other causes, too, such a sleep disorder (not necessary apnea but could also be a circadian rhythm disorder), thyroid problems (might not show up on the TSH test), food allergy (including gluten sensitivity or intolerance or other common allergens: dairy, yeast, etc.), lack of vitamin D or Omega 3...

    July 26, 2011 at 16:07 | Report abuse | Reply
  16. Samsdeb

    The good doctor can come to any conclusion he wants; however, it needs to be considered that there are people, such as myself, that would not have a funtional life without the use of ADs. Before I began taking ADs, there would be many times when I could not fuction or react normally to situations that might not bother a lot of people. That is because they do NOT have/suffer from major depression. Certainly, I do not feel ADs should be handed out to just anyone and everyone that experiences some periods of prolonged sadness. But for those of us who simply cannot be "reasoned" out of those depths, I am glad that we have ADs available. As to long term effects, I know I would not have been here long term if not for my diagnosis, and AD treatment.

    July 26, 2011 at 16:07 | Report abuse | Reply
  17. David

    Or Doctor,
    What about studies that show that SSRI's may promote new neuron growth? As time goes on, long term use of these medication seems to be safer and safer, and in the case of prozac, make actually spur your brain to produce new neurons and activity. Unless the medication causes a side effect that you don't like, I don't see any reason why anyone should be afraid or concerned about being on them.

    July 26, 2011 at 16:10 | Report abuse | Reply
    • B

      What study is that, and who paid for it. Show me the proof. Maybe a cholinesterase. They base these studies on stress, cortisol, etc. Not SSRI's, they just use the same model. These are antiquated beliefs, not proven, or taken seriously by the neuroscientist communities.

      July 26, 2011 at 17:01 | Report abuse |
  18. Erica

    I don't understand what the author of this article is trying to get across. He went from being against long term use to now not being sure but seems to be making a case that long term use is still bad? It would be nice if CNN got a second opinion by another doctor for this topic. I am a long term anti-depression user, on a low dose of prozac. I have a family tendency towards severe depression. At the moment I've been taking prozac consistently since December 2009. The lows are more manageable and I have less losses in productivity due to depression. Because of the family history, I just assumed I would be on it indefinitely. Too bad this article wasn't more helpful!

    July 26, 2011 at 16:10 | Report abuse | Reply
    • Chartreuxe

      Prozac is inexpensive so it's prescribed frequently but it doesn't always work long-term. It didn't for me, anyway.

      July 26, 2011 at 16:50 | Report abuse |
    • Nicole

      I totally agree with your post! I wish Prozac worked for me (yucky side effects), I use Effexor and am so happy it is generic now. But I am on the same 75mg strength that I was when I started out. I will be on it forever and am totally ok with that as living without it is NO FUN!

      July 26, 2011 at 23:51 | Report abuse |
  19. Drug Free

    I just let my prescriptions run out. Been taking them for years. No question they helped with me depression, but they robbed me of so much more. Been two weeks and I have been going to the gym religiously trying to get the endorphans to help out. Those drugs made me so flat I just couldn't take it anymore. I want to feel something again. My mom died four months ago and I didn't feel a thing. I didn't feel any highs or lows, nothing. The cure was worse than the disease. Save your breath about me needing to find the right one, I've tried most of them already. I know this decision could be a death scentence, but at least I will feel it.

    July 26, 2011 at 16:54 | Report abuse | Reply
  20. POD

    The real question is why do so many Americans feel the need to do drugs just so they can function in the 'New America'?

    July 26, 2011 at 17:04 | Report abuse | Reply
  21. Richard

    New studies are just coming out that antidepressants are connected to birth defects including autism. It is risky to put any women of childbearing age on these meds; but if this were followed how much profit would the pharmaceutical corporation lose. Is it just a coincidence that since the so-called psychiatric medication revolution in the 80's that the statistics for the following disorders have dramatically gone up: 1) mental illness 2) obesity 3) Diabetes 4) Alzheimer's disease 5) autism. These drugs do far more harm than good. I work in the field every day as a therapist and I have witnessed this dangerous new medical model take over community mental health. We need a movement to stop this dangerous trend.

    July 26, 2011 at 17:38 | Report abuse | Reply
  22. Emma

    The article talks about anti-depressant overuse and raises the quesitons about the AD efficacy. However, the question was about the safety of long-term AD use, and the article failed to answer it. What does the data say about the long-term risks of AD use?

    July 26, 2011 at 18:30 | Report abuse | Reply
  23. Beatrice

    Reading the Bible, learning about Holocaust and historic war atrocities, watching how American soldiers battled, being in a danger of war constantly blows away depression, really.

    July 26, 2011 at 19:02 | Report abuse | Reply
  24. Beatrice

    America, retrieve the purpose of your existence. You were not born so that 5% of human population can fatten itself and indulge in pleasures. You were born to liberate every oppressed human on earth. Your unending Christian mission.

    July 26, 2011 at 19:05 | Report abuse | Reply
  25. Beatrice

    Why should any American be depressed when no one there is starving and no one can overtake the nation by invading?

    July 26, 2011 at 19:08 | Report abuse | Reply
    • DEPRESSIVE

      Why should any American be have Schizophrenic Disorder, when no one there is starving and no one can overtake the nation by invading?

      July 26, 2011 at 23:02 | Report abuse |
  26. wendy5

    i was on low dose paxil no problems but i stopped taking them; i have no clue why i was given them i had panic attacks i was not depressed just give me somthing to take that feeling away if and when it struck; they are awful i dont know if im going to have a stroke or heartattack and lasts for 8 hours sometimes a week;and when it happens i think i am going to die and get myself probly in a worse tizzy and probly make it worse; so what i do now is go look up panic attacks and the words calm me down; your not going to die and i start breathing better and calm down it gives me the symptoms 1 by 1 and then in 10 minutes i feel better and go do something so thank you websites; i think i have had them since i was a kid an never told anyone and lived with it caffine is really bad for me even a cup of green tea; so if you have this try that maybe it will help you to; just remember you not going to die; your great; breath and go out for a run stress yourself in otherways to get some air and oxygen and get a favorite upbeat song ; peace and love to all

    July 26, 2011 at 19:08 | Report abuse | Reply
  27. KF Gold

    HankM – for seriously clinically depressed patients the effect of anti-depressant over placebo is substantial. The numbers I presented were to demonstrate the issue of comparing NON-EQUIVALENT groups and were not statistics about effectiveness per se. The take home is the LAST sentence- it is inappropriate to evaluate lapse rates by comparing responders to placebo against responders to anti-depressants in the context of substantial differences in response efficacy.

    I am not saying that anti-depressants are for everyone. Personally, I think they are a miracle for those with serious on-going depression.

    My main issue was the methodological problem with the validity of author drawing the conclusion that placebos are superior to anti-depressants with respect to lapse rates.

    July 26, 2011 at 19:24 | Report abuse | Reply
  28. giggity.giggity

    these are all crazy pills!

    July 26, 2011 at 19:30 | Report abuse | Reply
  29. wondering eye

    I have been on Effexor for 15 years in a very high dose. Now I am weaning myself off the drug and so far I can tell no difference. When I completely stop, I will then have the answer to my question about long term use and the ability to get off the drug. It looks promising.

    July 26, 2011 at 20:20 | Report abuse | Reply
  30. Nick

    Have fun messing up your body with the anti-depressants. Marijuana is safe, and it is the only anti-depressant I need.

    July 26, 2011 at 21:35 | Report abuse | Reply
  31. erich2112x

    Anti depressants have been proven to have no affect in the treatment of depression, yet they're still being prescribed.

    July 26, 2011 at 22:43 | Report abuse | Reply
    • Sheogre

      Come spend a day in my world if I ever skip a dose or two, and you will learn that there is a use for them. Ask my husband what life was like a few years ago, when I tried to stay off my medication...after 6 months when the panic attacks and helplessness were threatening our life, I went back on them, and have never regretted it. I am living proof that the medications work, when you work with a knowledgable dr and follow the treatment plan. I am sure most everyone commenting, who has been in my shoes, can tell you that it is a true illness that often requires medical attention.

      July 27, 2011 at 00:54 | Report abuse |
    • Elle

      It not true that they have been proven useless. Unfortunately people with different agendas do all the studies and because there is big $ involved, we can't get a straight answer.

      July 27, 2011 at 02:53 | Report abuse |
  32. DEPRESSIVE

    My general experience with anti-depressants is that they tend to poop out after awhile, but there are things you can do such as adjusting the levels, adding augmenters, and getting your thyroid treated, by visiting a doctor that will treat subclinical hypothyroidism.
    Also, the truth is, that taking anti-depressants long term can result in some nervous system problems. I get uncontrolled body movements from the trunk upwards when I relax, but mostly at night.
    But I take Requip for it (originally developed for Parkinson's Disease), and the problem is handled.

    July 26, 2011 at 22:55 | Report abuse | Reply
  33. blpbmp

    From personal experience I can attest to the dangers of ADs when perscribed by other than those specifically trained for their use. Mine is quite the horror story. I woke one day to discover I had lost hearing in my right ear. I went to the ENT who perscribed prednisone. My hearing returns, off the prednisone my hearing left. ENT perscribed higher and higher doses of prednisone. Like a lemming I went along, since I wanted my hearing back. Finally the ENT came to the conclusion I had Meniere's and prednisone should be discontined. Hello "prednisone psychosis" and hello anxiety attacks like this world has never seen. I can only describe the next year of my life and HELL. I was incapable of making decisions and well meaning doctors tried a series of ADs trying to return me to function when in reality they really messed me up. Finally my moment of clarity came when I nearly killed myself and asked one of the docs "how can you tell if someone has a chemical imbalance or just has an issue they need to deal with." He looked embarrassed and mumbled something. It became clear the medical community can't so the default is pharmaceutical roulette. I eventually ended up at the Mayo clinic getting electroshock to try to return myself to sanity. I refused any further medical treatments and medication. I spent about six months getting the stuff out of my system (I can't describe the feeling other than to say I felt like my head might explode) with frequent anxiety attacks. I was a junky!!! Now several years later I am on no meds., my hearing has stablized (I don't think it was Meniere's) and I am functioning as if this horror never happened. The biggest change in my life is that I now run from psychiatrists and wouldn't take a medication long term on a bet (not even short term unless I'm pretty damn sure it's necessary). I also ask many questions and am basically a big pain in the butt to all my doctors. If you have a doctor suggest an AD to you, remember my story. Protect yourself and make sure YOU believe it's necessary. You don't want to go down that road if it isn't.

    July 26, 2011 at 23:03 | Report abuse | Reply
  34. Nicki

    Diagnosed with Complex PTSD, I have no intention of ever going without my antidepressant again! I no longer have "episodes" or "flashbacks", I do not lie awake at night with severe anxiety and I do not feel the need to "hide in a corner". Yes I did gain weight and that stinks. But being able to cope with life every day is totally worth the extra pounds. AD Medication prescriptions may need to be tweaked, some may need to try a few different brands before they find the right fit. A little xanax helps take off the edge those first few weeks. If you feel you need something to help you cope, please do not let someone talk you out of it, because it is well worth the results!

    July 26, 2011 at 23:59 | Report abuse | Reply
    • Nicki

      No Placebo could ever give me what my Effexor gives me!

      July 27, 2011 at 00:03 | Report abuse |
  35. KC

    If people relapsed more often when they came off the antidepressant it's because they still need to take it. Duh.

    July 27, 2011 at 00:06 | Report abuse | Reply
    • Elle

      I agree with this. Having tried several ssris that had no effect, it took a high dose of effexor to cure me. However, the side effects, especially the withdrawal syndrome that was long denied by the pharma companies-is excruciating. Even following a tapering program more gradual than recommended, I relapse and get very very sick. The plan for me therefore, is to stay on them. But I would like informed disclosure of what the long term damage might be.

      July 27, 2011 at 02:51 | Report abuse |
    • Chris

      Exactly! Those whose depression was relieved by placebos had probably become more grounded or able to deal with their problems through just knowing someone cared, situational changes, better quality of sleep/nutrition, etc. Those factors didn't change when the pill was discontinued. Those whose depression was relieved by anti-depressants were benefiting from the changes in neurotransmitters, and that chemistry changed drastically once treatment was discontinued.

      July 27, 2011 at 13:33 | Report abuse |
  36. Elle

    I wish he addressed the question at hand, which is the long term risks. I tried many SSRIS and settled on an SNRI before getting relief. i am certain that the relief is not from placebo effect. However, withdrawal syndrome, even when tapered down, can be excruciating. I cannot get off of the medication and I would like to know what long term hazards i am looking at. Sanjay?

    July 27, 2011 at 02:48 | Report abuse | Reply
  37. Reluctant convert

    I have been in therapy for five years dealing with severe childhood abuse that I packed away and ignored for over 30 years. I convinced myself that the abuse made me stronger, and I had a family and became a successful, contributing member of society. Suddenly, my defense mechanisms all began to fail and the depression got to the point of suicide. Looking back now, of course, I see that I had been depressed for much longer than the five years, but I chose to 'suck it up'.

    I was very much against AD's and refused to take them. I made progress with therapy, but it would wax and wane. I finally relented and began to take an anti-depressant prescribed by my GP (mistake). At first I improved, but then the depression became so severe that I almost took my life. I repeated this process two more times with different meds until I finally went to a psychiatrist who advised me that AD's are not for everyone. He said that while they caution against people under 18 taking them because of the suicidal risk there is not enough emphasis on the fact that this particular side effect affects many adults as well. I am lucky to be alive because I had a suicide plan, wrote my letters, picked my location, and was committed to ending my life. The only thing that stopped me was that I couldn't figure out why I wanted to do it. Suicide didn't make sense as an answer for me yet I was compelled to take that route. That's when I stopped taking the AD's and saw a dramatic improvement.

    I now take a mild anti-epilepsy medication that is also used to treat depression,and it has helped quite a bit. My depression, while still present, is much less severe. I am able to function better and work more effectively on my therapy. My progress in that area has definitely accelerated and my overall quality of life has improved. My goal, under the guidance of my shrink (who is not my therapist – he just monitors my meds regularly), is to be off the meds in about 18 months and to be done with continual, long-term therapy. As much as I hate to admit it, I couldn't have done it without the PROPER meds.

    AD's are not for everyone and there are other options. If you are considering taking them please do so under the supervision of a professional who understands how they all work. I love my GP, but he's just not an expert in the field. He could not really monitor me in the way that I needed to be watched. Also, consider other alternatives to AD's. They can be great for some people, but not for others.

    July 27, 2011 at 06:24 | Report abuse | Reply
  38. Conky2012

    Do some research on depression, and the effects it's medications have on the brain. If you take anti-depressants, you either don't know how bad they are for you, or welcome dying. I took em, stopped taking them, and managed my depression without medication. Very easy to do. Depression doesn't require medicine, fact.

    July 27, 2011 at 12:10 | Report abuse | Reply
    • D'oh!

      @Conky2012

      Nice one-size-sits-all answer. Are you a real doctor, or do you just play one on TV?

      July 27, 2011 at 13:50 | Report abuse |
  39. Byrd

    Absolutely not. Paxil darn near killed me a few years back – had three what are called near-death or death experiences – when it was bundled into my chemo. Do yourself a favor and smoke a joint. It will help you a lot more than any pharmaceutical – which is why they oppose legalization so vehemently. Natural remedies are always better because they contain all of nature's buffers, which modern medicine removes just so they can patent the resulting poison.

    July 27, 2011 at 13:14 | Report abuse | Reply
  40. Kristin

    I took antidepressants for years, and I tried dozens of combinations along with therapy. They would always work initially but then the efficacy would wear off. Tired of the run around and not wanting to take a pill for the rest of my life, I stopped taking them and looked into alternative therapies. Within months of starting acupuncture, I had progressed from barely functioning to living the best life I have in ages.

    July 27, 2011 at 15:25 | Report abuse | Reply
  41. Iatrogenia

    Dr. Raison –

    The advantage ascribed to placebo in these meta-analyses is only partly due to the so-called "placebo effect." Rather, the rate of so-called "relapse" off antidepressants is inflated by the inclusion of withdrawal syndrome in the statistics for "relapse."

    Not one of those studies reviewed, or any study of antidepressant efficacy ever, includes a protocol to distinguish withdrawal syndrome from relapse. Patients who had been on antidepressants were taken off them and incidences of withdrawal were misdiagnosed as relapse, supposedly arguing for antidepressant efficacy. (If you don't take your antidepressant, you get sick again.)

    The inflated statistics for post-medication relapse look bad when compared to recovery on placebo. The true interpretation is not that placebos are more powerful than antidepressants, it is that antidepressants are MORE DESTRUCTIVE than placebo.

    If the stats for withdrawal were taken out of the column for relapse (showing antidepressant advantage) and counted properly as adverse events, antidepressants would lose their original statistical advantage, still fall short of placebo, and be revealed for what they are: Drugs that may make you feel good for a while but, in the long term, cause brain changes and withdrawal problems that are destructive.

    July 27, 2011 at 22:46 | Report abuse | Reply
    • Rhiannon

      Absolutely.

      "People who recovered from their depression with the help of active antidepressants were significantly more likely to relapse when the medication was stopped than were people who recovered while taking a placebo."

      Drugs that mess with neurotransmitters cause our brains to react by changing their chemistry and their cell networks and structure. Now you don't have your normal healthy brain any more. So you quit taking the drug and your newly remodeled brain can't function normally any more.

      People who took placebos still have their normal healthy brains intact, so they don't have "relapses."

      It's not relapse, it's the revealing of the underlying damage the medication has caused.

      Doesn't seem so hard to digest to me. Not nearly as hard as, for example, actually surviving AD withdrawal, and digesting the new reality that your brain may never be fully normal and healthy again.

      (Then again, I don't have to deal with pangs of conscience from having prescribed to thousands of people–with the best of intentions but, perhaps, not the best of actual scientific homework-doing–drugs that, as it turns out, may have done them much more harm than good over the course of their lives. )

      July 30, 2011 at 02:34 | Report abuse |
  42. mark brydges

    ı was dıagnozed wıth bıpolar dısorder as well as adhd seven year ago .ı was prescıbed many dıfferent types of antı depressent drugs as well as antı pychcotıc drugs as well. my lıfe never ımproved and only got worse for the past twenty years and serıous sıde effects whıch resulted ın numerous trıps to the hospıtal for treatments. fınally after takeıng rıtalın for sıx months whıch dıd ımprove my condıtıon ı was taken off them because of a blood pressure problem. for sıx months ı took nothıng and thıngs got even worse. then through some research ı dıd ı found out about a treatment called l theanıne whıch a doctor mıchaeal lyon at the unıversıty of brıtısh columbıa was conductıng on teenagers ın vancouver bc . ı emmedıately went out and bought thıs non prescrıptıon treatment and for the past one and a half years that ı have been takıng ıt my lıfe has ımproved a lot. ı no longer have nıght mares ı m more relaxed my thınkıng ıs much better ı don t seem to be lookıng allo over the place for thıngs ı can t remember where ı put them . ı m more organızed and much happıer. theır are stıll some problems but much more manageable then ever before. ı wısh ı had found out about thıs treatment forty years ago . ı thınk a lot about what my lıke would have been lıke ıf ı had had thıs treatment ınstead of all the thıngs ı ve taken wıth no progress ın my lıfe. ıts not a cure you have to take ıt contınuously or you wıll fall back but theır are no sıde effects wıth thıs treatment and my over all health ıs better than ıt has ever been. check out dr lyon and hıs research and then make your own conclusıon s after tryıng ıt for four or fıve months. good luck everyone

    July 31, 2011 at 08:42 | Report abuse | Reply
  43. brooklynjg

    I was so sure Dr. Ronson would reply with the "party line," i.e. "of course it's okay to stay on meds indefinetly." How refreshing and even courageous that he stated the truth of the real risks and growing uncertainty regarding these medications. Hats off to Dr. R!

    August 4, 2011 at 19:30 | Report abuse | Reply
  44. TexasChick9

    " ... there are many times when the risks associated with antidepressants are more than balanced by the potential benefits. This risk/benefit equation must be performed for each individual we treat, and it is an equation you must evaluate in the context of your own life situation."

    I can't believe Dr. Raison ended the article with that, rather than starting with it. I would say, for any disease, for any medication, answering the question, "Is it ok to take this medication long-term?" should be a process that starts with, "Is it keeping you alive?" In other words, if the patient is prone to suicidal ideation when not taking antidepressants, it's a no-brainer: long-term antidepressant therapy, until they invent something radically new and way better. It is, of course, acceptable to try a different medication, dosage, or dosing schedule if the patient doesn't seem to be responding as well as hoped or is experiencing onerous side effects, and it's acceptable to have the patient thoroughly checked for medical conditions that could be causing the depression, and it is also acceptable to insist that the patient see a well-chosen therapist for cognitive behavioral therapy and coping techniques etc., but that risk/reward analysis should be the first consideration, just as it would be with insulin for a diabetic or clotting factor for a hemophiliac. I am a long-term user of antidepressants (tricyclics, MAOIs, SSRIs, SNRIs) who would have been dead many years without them, and I agree that they have their down side, and I agree that people shouldn't take them long-term if they don't have to, that after a certain amount of time the family doctor should send the patient to a mental-health professional for more specialized care so the root problem can be addressed and the patient can stop taking the meds. But there will always be a few people whose neurotransmitters just don't work right, no matter what, and who start sliding along the suicidal spectrum when they don't take antidepressants, and a few people who don't become suicidal but whose quality of life is below zero. Those people need long-term, possibly life-long, antidepressant therapy, and they will happily accept the side effects and other risks, because those side effects and risks are nowhere near as unpleasant as life without the meds.

    August 12, 2011 at 06:43 | Report abuse | Reply
  45. Osvaldoz Poliani

    You must take part in a contest for one of the best blogs on the web. I'll recommend this site!

    July 28, 2012 at 01:09 | Report abuse | Reply

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