Anti-depressants - how long?

Physicians will sometimes tell patients about time periods like "a few months" or "6 months" at first to avoid giving the impression that it will take that long to start feeling better.

However, in reality, 18 months is probably closer to the average - between 1 and 2 years. Research into relapse risk finds a significant benefit of longer versus shorter - patients who remained on an SSRI for 2 years versus only 1 year showed a significantly lower risk of suffering a subsequent major depressive episode.

This is not considered long-term for these medications - if you have read anything about "long-term effects" of these medications, they are more likely talking about 10 years or so...

My doctor was very quick to put me on antidepressants and when i informed him that i wasnt sleeping he went to double the dos, i wanted to come off them, had only been taking them nearly four weeks and he told me i couldnt for atleast three months, so with love and a lot of support from a new partner i just stopped taking them and have felt the best i have in years, in fact dont think have been this happy ever before.

I didnt fancy the idea of being on antidepressants for a long time and only yook them becuase i was really low and couldnt see another way out, luckily i had no side effects coming off the mediaction but had loads when i was on them

I would never pressure a client into taking medications of any kind because I think that should in most cases be a decision the client makes - especially for depressed clients because after all one of the things we are trying to do is counteract the feelings of helplessness that are part of the syndrome. On the other hand, depressed individuals also often feel emotionally "out of control" and medications can be helpful in counteracting this as well as in helping to give them the psychological resources to fully engage in psychotherapy for the depression.

I do believe that for many people medicatons can be helpful. For SSRIs, although they are better tolerated than older antidepressants, there can be side-effects certainly - however, for the majority of patients these are temporary adaptation effects. If they haven't started to diminish significantly within a week or so, my advice is usually to return to your physician and ask for something else - with so many in this family to choose from, there is rarely any need to suffer prolonged side-effects and switching to another medication in the same family is often the solution.

As for "going off" these medications, one needs to be very cautious and to know which medications you are on before deciding to go it cold turkey. One of the worst for sudden discontinuation is Paxil - it has a relatively short half-life and unless you taper off gradually it can have some very unpleasant "withdrawal" effects. At the other end of the extreme is Prozac: with a half-life of about 10 days, this one basically tapers itself off. But for all such medications, it is best to discontinue it gradually over a period of a week or two and to monitor any withdrawal effects carefully.

i know that coming off the medication without advice could have been a stupid move, i was taking cipralex, but fortunately i had no side effects as a result and feel it is the best move i made in taking my life back once and for all, i no longer feel out of control

That's good to hear, Donna - both that you didn't have the withdrawal effects and that, for you at least, not being on medication was an improvement...

My post was meant more for people who might be thinking about stopping "cold turkey" - sometimes tha can be relatievly uneventful, as in your experience, but sometimes it can be disastrous - one of my clients who did that passed out in her car while driving and totaled it (fortunately without serious injuries to her), while another found her mood plummeted and she ended up in hospital on a suicide watch.

I was on Citalopram for about 6 months - it did help to the extent that I was able to sleep and return to work (after a month's absence), but it did not lift my mood to my pre-depression state, and I relapsed whilst still on the drugs. I ended up in hospital after an attempted suicide, and was switched onto Venlafaxine. I am now back at work (again) and feeling loads better, so I would certainly agree that it is worth trying a different antidepressant if the first one doesn't work. Although I hate taking drugs of any kind, I think it is helpful in some cases e.g. if it reduces suicidal impulses. I would also agree that the side effects of withdrawal can be horrendous - I was really unwell for about a week after I came off the Citalopram before the Venlafaxine kicked in, to the extent that I was under 24-hour supervision in hospital.

In case it is of use to anyone, here is some information on Venlafaxine Withdrawal

There is a need to differentiate between different kinds of depression, I feel. When the onset is sudden and unprecedented, a strong need for therapy which addresses core psychological issues is coming forward. While anti-depressants can buy time and make life barable enough to go into a process of inner change, in themselves they by no means represent a solution.

I have suffered one severe bout of depression (and anxiety) as an adult. Today I thank this period of my life as a crisis in which I was growing out of ana old ego structure. The dramatic changes that came with healing were truly liberating, bringing a sense of direction and quality of vitality I would never before have dreamed possible.

I took Seroxat for 6 months but after 4 months took it only every other day. It gave me the feeling that half my brain was numbed, and I was unable to write. I weaned myself off it very gradually but I don't think the anxiety and panic would have been removed without hypnosis, therapy and some deeply gifted spiritual healers.

Hi Claire

I have been working as a pharmacist for 5 years now and thought you might like to hear about the changes in antidepressant treatments times that have arisen in that time - it may explain the various times you have heard of.

It was always commonly accepted that the average treatment length for reactive depression (or a single episode of depression) should be a minimum of 18 months. However, several years ago, it became widely accepted that 6 months therapy was all that was required - this was based on a report from the medicines control agency. This is where the confusion sets in..... because what that report actually said was that therapy should be continued for 6 months AFTER remission had been achieved.

Depending on how someone responds to the therapy, and how quickly the doctor adjusts your dose for the right effect you could be looking anywhere between those 2 figures of 6-18months. In my experience, however, most doctors tend to plump for the 18month option - "just to be on the safe side"

As for coming off antidepressants........ Withdrawal is now recognised as a possibility, though it is by no means the norm. However, it can be extremely upsetting for the patient should it occur. The current recommended withdrawal times are as follows:

Length of time on treatment Reduction Period
under 2 months none needed
2 months plus minimum 4 weeks
4 yrs plus 6 months

sorry! I've dribbled on a bit
Anyway, hope it helps!

Thanks Fergus, that is really helpful. I have only been in remission since February, so that would explain why I now have to be on the drugs for a further 8 months.