How Long Should You Take Antidepressants?

From the WebMD Archives

If you are considering taking an antidepressant, you may be concerned about how long you’ll need to stay on it. Even if you feel that it will help treat your depression, you may not like taking any medicine if you can help it. You may wonder about side effects or long-term effects of taking a drug that alters brain chemistry.

If you’re already taking a medication for depression, you might be wondering about when to stop. If your mood and outlook on life have gotten brighter, do you really need to continue taking an antidepressant?

In general, doctors recommend that people stay on an antidepressant at least one year to experience the full benefits. Beyond that, when -- and whether -- you should to go off depression medication is a personal choice that requires serious thought. This article will help you understand different types of medications that treat depression, how the use them most effectively, and what to consider when deciding how long to take them.

How Depression Medications Help Mend the Mind

“Often a patient with depression will come in, very reluctant to try medication,” says Anthony Rothschild, MD, professor of psychiatry and director of the Center for Psychopharmacologic Research and Treatment at the University of Massachusetts Medical School in Worcester. “Then once they decide to try it, they thank me for convincing them to take it.”

Antidepressants work by targeting certain chemicals in the brain called neurotransmitters. These chemicals affect mood and emotion. But exactly how antidepressants lessen depression is unclear.

Experts have traditionally thought that they restore a chemical imbalance caused by being depressed. But some researchers now believe that depression and stress may actually destroy the connections between nerve cells -- and even the cells themselves. They believe that antidepressants work by restoring these nerve pathways.

Types of Antidepressants and Their Side Effects

There are five types of antidepressant medications available. Most target neurotransmitters such as serotonin, norepinephrine, and dopamine.

All of these medicines can cause side effects. About half of the people who take them experience side effects, especially during the first few weeks of treatment.

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Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medication. They tend to be well tolerated and effective.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of antidepressants and are similar to SSRIs. They are also commonly prescribed to treat depression.

Possible side effects for both SSRIs and SNRIs include:

Norepinephrine and dopamine reuptake inhibitors (bupropion) have no sexual side effects, unlike many other antidepressants. Possible side effects of these popular medicines are:

Tricyclics are an older class of depression medications that are prescribed less often because of more serious side effects. For example, people with heart disease, congestive heart failure, and arrhythmia should avoid them. Generally, they are only prescribed for people who not respond to treatment with newer antidepressants. Possible side effects include:

Monamine oxidase inhibitors (MAOIs) are also older antidepressants that are usually only prescribed for people who do not respond to other drugs for depression. They may also benefit people who have unusual symptoms such as excessive sleeping, hypochondria, or high levels of anxiety. People who take MAOIs must restrict their diet in order to avoid serious complications. They should avoid pickled, smoked, or fermented foods as well as certain beverages and medications. Possible side effects include:

Dealing With the Side Effects of Antidepressants

When starting these medicines, it’s important to work closely with your doctor so that she can monitor any side effects and how well the medication is working. If you have side effects from one medication, never stop taking it without first talking with your doctor. Brendel says that options for dealing with side effects include:

  • Reducing the dosage of the medicine
  • Adding an additional medication that helps ease the side effects
  • Switching to another medication

People with severe depression and their families should also be aware of the risk for suicide when starting to take antidepressants. The medication itself does not cause adults to become suicidal. But it does help people regain energy and make decisions more easily even while they are still seriously depressed. This may make it easier for a person who is thinking about suicide to take action. If you are having any suicidal thoughts or feelings, work with your mental health provider to put a plan in place in case you start to have difficulty.

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Getting the Most From Depression Medication

“People notoriously quit treatment too soon,” says Jon Allen, PhD, senior staff psychologist at Menninger Clinic in Houston. “They start to feel better so they stop taking medication, quit therapy, and even end hospitalization early. The best thing you can do it stick with it. Persistence is what makes all the difference.”

To treat your depression most effectively, follow these tips when starting and stopping medication:

  • Give an antidepressant time to work. “Antidepressants can take a few weeks to a couple of months before they take full effect,” says David Brendel, MD, PhD, assistant professor of psychiatry at Harvard Medical School and associate medical director for the Pavilion at McLean Hospital in Belmont, Mass. Don’t expect an antidepressant to make you feel better immediately.
  • Take depression medicine exactly as prescribed. Taking less medication or skipping doses will make an antidepressant less effective. If you experience troublesome side effects, be sure to tell your doctor right away.
  • Don’t go off antidepressants on your own. “Stopping a medication should be done only with a doctor’s supervision,” Brendel tells WebMD. “Some medications can have very unpleasant withdrawal side effects. Once it is time to come off the drug, your doctor will help you slowly and safely taper off by gradually reducing the dose over time.”
  • Don’t give up if one medication isn’t helping your depression. Your doctor will likely be able to prescribe another antidepressant if the one you’re taking doesn’t seem to be working for you. A National Institute of Mental Health study found that people with depression who did not respond to a first medication had a better chance of recovery if they tried a second type or added a new one to their treatment. So it’s worth the effort to find a medication that works for you.
  • Continue taking antidepressant medicine even when you start to feel better. Although it may be tempting to stop medication as your mood lifts, continue taking it for as long as your doctor recommends. Most doctors advise patients to take antidepressants for six months to a year after they no longer feel depressed. Stopping before that time can cause depression to return.

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Antidepressants: Knowing When to Stop -- or Not to Stop

So once you have found an effective depression medication for you, how long should you stick with it? Many factors come into play. The most important is your risk for a relapse.

“Depression is an episodic, recurrent illness,” Rothschild tells WebMD. “How long a person needs to stay on an antidepressant depends on how many episodes of depression the person has had. For example, someone who has had only one episode should stay on medication for six months to a year before tapering off.”

Rothschild says the decision is more complicated for people who’ve had two episodes of depression. “If they have a strong family history of depression, or one of those episodes was so severe that their life was impacted significantly in some way, then I would recommend that they stay on medication indefinitely. If not, they could try tapering off after a year and see how they do. But people who have three or more episodes should stay on antidepressants for the rest of their life, as the chance of a relapse is about 90%.”

Brendel agrees. “In people with severe depression, it’s just not worth the risk to come off medication,” he says.

Only you and your mental health provider can make the decision that is right for you, however. You’ll want to take into account the severity of your depression, your risk for relapse, whether you can live with any side effects, and how well the medication continues to work. “It is a very individualized decision that comes out of a conversation between a patient and doctor,” Brendel says.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 06, 2010

Sources

SOURCES:

Jon Allen, PhD, senior staff psychologist, Menninger Clinic, Houston, Texas; author, Coping with Depression: From Catch-22 to Hope.

David Brendel, MD PhD, assistant professor of psychiatry, Harvard Medical School, Boston; associate medical director, the Pavilion at McLean Hospital, Belmont, Mass.

Anthony Rothschild, MD, Irving and Brudnick Endowed Chair, professor of psychiatry, director, Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School, Worcester.

American Psychiatric Association: “Practice Guidelines.”

Family Doctor: “Antidepressants: Medicine for Depression.”

WedMD Drug Reference From First DataBank: “Bupropion,” “Nardil.”

Psychology Today: “Depression: Beyond Seratonin.”

National Alliance on Mental Illness: “Major Depression Fact Sheet.”

National Institute of Mental Health: “Mental Health Medications,” “Depression,” “Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study.”

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