I have been on antidepressants since 1978 (yes, that's 25 years!) and
I have wondered about the adverse effects this long term use has on my
brain, my physical well being etc.  I cannot find studies or research
that has been done in this area.  Would you be able to either find
research on this subject or give me leads to find it myself.  Thank
you very much!

---

Request for Question Clarification by pinkfreud-ga on 30 Jun 2003 19:41 PDT

Kay,

This is a subject of great interest to me. I'd like to ask a few
questions, if I may.

I presume that when you began taking antidepressants in 1978, you were
taking either tricyclics or MAO inhibitors. Do you happen to remember
the names of the antidepressant drugs you've taken over the years,
approximately how long you took them, and in what dosage?

In recent years, have you switched to the newer types of
antidepressants, such as Prozac, Wellbutrin, or Effexor?

How old are you now?

Other than depression, do you have any other health problems, and are
you taking any other kinds of medication on a regular basis (including
non-prescription drugs, "supplements", and "herbals")?

The more details you can provide, the better.

Thanks!

There is no hard evidence that long-term use of antidepressants is
harmful. Unfortunately, the lack of evidence may be due to the lack of
studies on this subject. I've gathered some information for you below,
and have extracted brief excerpts from each article, so that you can
get an overview of the material. For more depth, I recommend reading
these articles in their entirety.

======================================================================

"America, in short, is becoming very comfortable with seeking
medication. So comfortable that our poll found almost half of
Americans using antidepressants are staying on them longer than a
year, which is a gamble.

'We don't know the exact magnitude or types of adverse long-term
affects that could occur if you take these drugs for long periods of
time,' says Dr. Cynthia Mulrow of Health and Human Services...

'There is no research conducted in this country on any large scale by
people who are skeptical about the drug because they can't get any
funding,' says Peter Breggin, the author of Your Drug May Be Your
Problem.

'We really need some data to look at multiyear effects to have a
better way of assessing long term problems,' says Allan Tassman, the
president of the American Psychiatric Association. Our poll found 72
percent of patients using the drugs believed those long-term studies
have been conducted. They are wrong. So in unprecedented numbers,
Americans are growing reliant on a medication that seems to help, but
whose long-term consequences are not really known."

ABC News
http://abcnews.go.com/onair/CloserLook/wnt000410_CL_antidepressants_feature.html

======================================================================

"The possibility that antidepressant drugs, while effectively treating
depression, may worsen its course has received inadequate attention...
A number of reported clinical findings point to the following
possibilities: very unfavorable long-term outcome of major depression
treated by pharmacologic means, paradoxical (depression-inducing)
effects of antidepressant drugs in some patients with mood and anxiety
disturbances, antidepressant-induced switching and cycle acceleration
in bipolar disorder, occurrence of tolerance to the effects of
antidepressants during long-term treatment, onset of resistance upon
rechallenge with the same antidepressant drug in a few patients, and
withdrawal syndromes following discontinuation of mood-elevating
drugs. These phenomena in susceptible individuals may be explained on
the basis of the oppositional model of tolerance... The possibility
that antidepressant drugs may worsen the course of depression needs to
be tested, even though its scientific exploration is likely to
encounter considerable methodological and ideological difficulties.
The clinical implications of this hypothesis in depression are
considerable. Antidepressant drugs are crucial in the treatment of
major depressive episodes. However, appraisal of paradoxical effects
that may occur in susceptible patients during long-term treatment may
lead to more effective use of the drugs."

HedWeb Good Drug Guide
http://www.biopsychiatry.com/antidepworse.htm

======================================================================

"In a recent issue of the Journal of Clinical Psychiatry, Dr Giovanni
Fava of the University of Bologna in Italy, calls for more research to
be done on the effects of the long-term use of antidepressants
following his comprehensive literature review of their negative
effects.

'Patients are encouraged more and more to take antidepressant drugs
for longer periods of time,' said Fava, who is also attached to the
State University of New York at Buffalo. 'However, there is very
little research on what actually happens with long-term treatment.'

In his review, Fava found a range of long-term effects, including loss
of effectiveness and withdrawal symptoms. He also found evidence that
the longer the period of treatment, the more likely the patient is to
relapse into depression when they stop taking the drugs...

The idea that some antidepressants lose their effectiveness or can
lead to 'discontinuation symptoms' in some people is not news to the
psychiatric community. However, most practitioners argue benefits
outweigh risks, pointing to evidence of several long term studies that
show that people on antidepressants fare significantly better than
those on placebo."

Australian Broadcasting Corporation Health News
http://www.abc.net.au/science/news/health/HealthRepublish_867510.htm

======================================================================

"Antidepressant drugs have been found to be effective in alleviating
many of the symptoms of chronic diseases. They are used to ease pain,
improve sleep disorders, and increase energy-three of the major
symptoms of most chronic illnesses, including CFIDS. Research even
documents that some antidepressants can actually improve immune system
response...

Antidepressants are in fact among the safest on the market (unless, as
with any drug, they are taken in overdose quantities). When taken as
directed, antidepressants do not cause physiologic toxicity, (i.e.,
they have no significant adverse impact on the liver, heart, or
kidney) and are not addictive. While there may be side effects, these
are mostly annoying, not life threatening. Alt studies suggest that
there are no negative cumulative effects with long term use of
antidepressants."

Immune Support
http://www.immunesupport.com/news/best3004.htm

======================================================================

"When looking at long-term risks from taking SSRI's, several problems
stand out. One is the persistent sexual dysfunction that a significant
percentage of users experience.

Another problem concerns the increased risk of liver toxicity when
SSRI's are combined with many other drugs. About five to ten percent
of the general population are genetically predisposed to being poor
metabolizers. These are the people who are most at risk of liver
problems that occur when SSRI's are taken along with other
medications.

A third problem is the deteriorating health of those who take SSRI's.

Long term side effects are very rarely studied. Even long term
effectiveness of depression medications are rarely studied."

Join-the-Fun
http://join-the-fun.com/antidepressant-side-effects.html 

======================================================================

"There is some data that long term use of antidepressants may actually
increase the risk of breast cancer, but the results are not clear
('Antidepressant Use and Breast Cancer Risk', American Journal of
Epidemiology, 151:952, 2000)."

Carol Franc Buck Breast Care Center
http://www.ucsfbreastcarecenter.org/forum/2000/juneminutes.html

======================================================================

"The type of antidepressant drug that you use may have important,
long-term health implications, according to a study published today in
The American Journal of Medicine.

In research conducted at the Albert Einstein College of Medicine in
New York, investigators found a strong association between the use of
tricyclic antidepressants - an older class of drugs that includes
amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil)
and desipramine (Norpramine) - and an increased risk of myocardial
infarction.

However, the researchers found no increased risk associated with the
use of selective serotonin reuptake inhibitors (SSRIs), a newer class
of antidepressants that includes fluoxetine (Prozac), sertraline
(Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox)... The
researchers found that the risk of myocardial infarction was about two
times greater in users of tricyclic agents, when compared with
patients who did not use antidepressants. This risk persisted after
adjusting for age, sex, baseline heart disease, diabetes,
hypertension, hyperlipidemia, and anxiety. By contrast, there was no
increase in the risk of myocardial infarction among patients who used
SSRI's."

Doctor's Guide
http://www.pslgroup.com/dg/1576f2.htm

======================================================================

"Some drugs commonly prescribed to treat depression and obesity may
cause changes in brain cells that are similar to the effects of the
'recreational' drug Ecstasy...
 
The drugs studied are known as selective serotonin reuptake inhibitors
(SSRIs). Serotonin is a chemical messenger produced in the brain that
is believed to regulate an array of functions, including appetite and
mood.

In experiments with rats, scientists discovered that large doses of
these antidepressants, as well as the obesity drug Redux, caused
certain brain cells to swell or take on a corkscrew shape. Redux is no
longer on the market, pulled in 1997 due to evidence of heart-valve
damage in some patients.

While further research is needed, these findings cast doubt on the
assumption that such drugs do no damage to brain cells."

Dr Joseph Mercola
http://www.mercola.com/2000/mar/12/antidepressants_change_brain_cells.htm

======================================================================

"What are the long-term effects of antidepressants on a woman's body?
The answer is that no one knows what the long-term effects of
antidepressants are since there are few scientific studies to go on...
Most "long-term" studies are done for about a year and the vast
majority of studies on antidepressant medication are done for much
shorter time spans, weeks to a few months. One recent study published
by N Buchman (et. al.) in Clinical Neuropharmacology (2002), volume
25, pp. 55-57, entitled Side effects of long-term treatment with
fluoxetine (generic name for Prozac), found that the side effects of
restlessness, tension, agitation and sleep disturbances resolved after
discontinuing of medication after treatment for 6 to 10 years. Chronic
changes in the serotonin neurons called 'super sensitivity' may have
caused the side effects."

Alternative Mental Health
http://www.alternativementalhealth.com/articles/antidepressants.htm

======================================================================

"The long-term implications of taking antidepressants are an ongoing
issue of research. Since the course of many patients with depression
is that the likelihood of recurrence increases and the period of
wellness between episodes shortens, many researchers argue for early,
vigorous and lengthy treatment to prevent the disorder's apparent
escalation over time. Whether this strategy does blunt the typical
accelerating course remains an important question for study, but, to
date, there has been no evidence of long-term cumulative adverse
effects for maintaining on antidepressants."

ScienceNet
http://www.sciencenet.org.uk/database/Biology/0105/b00935d.html

======================================================================

Like you, I have been a long-term user of antidepressant drugs. I've
been prescribed dozens of different antidepressants over a 30-year
period, and only recently stopped bathing my brain in them. I'd like
to recommend an interesting book, "Prozac Backlash: Overcoming the
Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe,
Effective Alternatives," by Dr. Joseph Glenmullen. Unlike many recent
books that are critical of the overprescribing of antidepressants,
this book is well balanced, not alarmist in tone, and discusses
options other than drugs for depressed individuals.

Amazon.com
http://www.amazon.com/exec/obidos/tg/detail/-/0743200624

Google search strategy:

Google Web Search: "antidepressants" + "long-term" 
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=antidepressants+%22long-term

I hope this is helpful. Please keep in mind that Google Answers is not
a source of authoritative medical advice; the material above is for
informational purposes, and is not a substitute for the services of a
qualified medical professional. If you are considering any changes
regarding your medication, I urge you to discuss this with your
physician. The effects of suddenly discontinuing antidepressants can
be quite drastic.

If anything I've said is unclear, or if a link does not function,
please request clarification; I'll gladly offer further assistance
before you rate my answer.

Best wishes,
pinkfreud

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Request for Answer Clarification by kay7777-ga on 01 Jul 2003 00:02 PDT

I have been interested in this question for a long time.  

I really can't remember all the antidepressants I've taken, but the
ones I took for at least a year or more were:  tofranil, lithium,
desyrel, anafranil, zoloft, effexor (about a year), remeron (about a
year), and I am presently on 60 mg of prozac (since December 2001).  I
cannot remember the dosages of the others.  I take fosamax, premarin,
provera, extra strength tums, "senior" vitamins.

I had an eating disorder for years (anorexia and bulimia); I have
osteoporosis.  I have always been more healthy than most.  I have
balance problems and have fallen several times.  I fall forward and
land flat.  Somehow I don't have the ability to catch my fall.  Once I
thought it was inner ear problems.  Last February I had two very bad
falls, my right leg from my knee down to my toes was a beautiful
bright purple.  I still have the bump on my right knee that never went
away.  I decided to go to a doctor.  They couldn't find anything wrong
with me (don't you love that diagnosis?)  I am presently going to a
gym and doing exercises that focus on my balance and flexibility. 
Lastly, I'm not sure whether I'm just getting old, but my memory has
so many "holes" in it.  I wonder whether I'm getting alzheimers, just
normally forgetful for a 61 year old, or affected by my long-term use
of antidepressants.

---

Clarification of Answer by pinkfreud-ga on 01 Jul 2003 09:29 PDT

It's interesting that you mention memory loss in possible connection
with antidepressants. I used to have a terrific, near-eidetic memory,
and now, at the age of 55, I have a mind like a steel sieve. I chalk
it up to a decade of tricyclic antidepressants:

"Even though the tricyclic antidepressants or TCAs were effective in
treating depression, they had significant side effects on blood
pressure and pulse rate, caused constipation and urinary retention,
interfered with other medications, and had the potential to cause
memory loss."

Greater Long Island Psychiatric Society
http://www.longislandpsych.org/Articles/Archive/Depress/Depress.html

As I see it, the issue with antidepressants is an intensely personal
one involving the evaluation of one's total quality of life: are you
better off with the drugs (and their concomitant side-effects), or
would you be better off in dealing with your neurotransmitter quirks
in other ways? I can't make that decision for you, obviously. If, as
it appears, you are ill at ease with your medication, I do suggest
that you investigate other options. The book that I mentioned, "Prozac
Backlash," has helped many people to re-evaluate their situations
regarding antidepressants.

Again, I'd like to emphasize that you should consult your physician
before making any decision regarding a change in medication. Abrupt
cessation of antidepressant use can be quite unpleasant (I stopped
taking Zoloft "cold turkey" once, and I was really knocked for a
loop.)

~pinkfreud

I was very pleased with my researcher, pinkfreud.  (S)He gave me very
many articles to read, book resources that will help me find more
answers to my questions, and answered so quickly.  This is the first
time in many, many years that I have received help in finding answers
to my questions.  Thank you, pinkfreud!

Thank you very much for the kind words, the five-star rating, and the
generous tip! I am glad to have been able to help.

~pinkfreud