Dear Doctor: Just how addictive are antidepressants? My doctor thinks I should take one, but I know a lot of people who have had trouble stopping them. Do the drugs even work?
Dear Reader: Your questions land us in the midst of an important and ongoing discussion that has been taking place for some time now. Depression is a serious and sometimes life-threatening disorder that affects people of all ages, races and nationalities. According to the World Health Organization, it was the third-leading cause of disability throughout the world in 2004 and tops the list of disabilities in the developed world. A variety of medications to treat depression have been developed over the decades but have been accompanied by persistent questions about efficacy and long-term viability.
A specific group of symptoms, when experienced over time, mark a diagnosis of depression. These include low mood, low energy, feelings of worthlessness and an inability to experience pleasure, which is known as anhedonia. Additional symptoms can include altered sleep patterns, diminished appetite, an inability to concentrate and thoughts of self-harm. Diagnosis of depression, which can range from mild to moderate to severe, depends on accurate self-reporting of symptoms and of their duration.
When it comes to medications, things get complicated. That's because the causes of depression are poorly understood. Research suggests the condition may arise from certain chemical imbalances in the brain, chronic stress and anxiety, response to life events, temperament and a genetic predisposition. Antidepressants tackle the various chemical pathways that are believed to play a role in the disorder. However, depression medications don't work for everyone. As many as two-thirds of patients don't respond to the first drug they try. But by working with their doctors to fine-tune their treatment regimens -- there are a number of classes of antidepressants, each with its own therapeutic pathway -- many patients living with depression do find relief.
When it comes to stopping pharmaceutical treatment, there's sobering news. Although antidepressants were originally developed for short-term use, six to nine months in most cases, the nature of depression and the scarcity of alternative treatment options meant patients have stayed on the drugs for years at a time.
According to a recent report in The New York Times, which analyzed federal data, more than 15 million people in the U.S. have been taking antidepressants for more than five years. When you look at the two-year mark for antidepressant use, that number jumps to 25 million. It's this long-term use that has been most often associated with adverse effects among patients who stop the drugs. Symptoms of withdrawal may include headache, fatigue, nausea, insomnia, unwanted feelings and unusual physical sensations. Tapering rather than quitting an antidepressant is important, and it should always be done in partnership with the prescribing physician.
While all of this may sound dire, it's important to note that antidepressants, when used properly and as part of a comprehensive treatment program, can be helpful. If you do decide to move forward with a prescription, talk all of this over with your doctor. Make a plan regarding duration, and never make any changes to your drug regimen without medical supervision.
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