It was with disappointment and concern that I read "The murky perils of quitting antidepressants" (April 21, reprinted from the New York Times).
Although I am sure this represents a well-intentioned effort to increase awareness of antidepressant side effects, the piece is at best misleading and at worst will discourage individuals from seeking treatment for life-threatening medical conditions.
In the U.S., 22 million adults struggle with major depression and 40 million struggle with anxiety disorders. So it does not seem particularly surprising that 25 million American patients have been on antidepressants for at least two years. A more relevant statistic may be that well under half of individuals with serious mental health problems ever seek treatment.
Antidepressant withdrawal is real. It is clearly worse with some antidepressants than others, especially venlafaxine, paroxetine and duloxetine. It occurs much less often with other kinds of antidepressants, but a discussion about how and when antidepressants should be stopped certainly should be had every time an antidepressant is started.
About a third of individuals with major depression will go on to develop chronic illness where they are at risk of life-threatening episodes of depression throughout their lives. Similarly, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder are often debilitating and chronic illnesses for which long-term treatment is indicated.
A good rule of thumb is to aim for one year of clinical stability before attempting to taper psychiatric medication. Stopping or continuing medication should be a focus of discussion at each clinical visit. And stopping medications is always best done slowly over several months.
The brain does exhibit withdrawal symptoms if antidepressants are stopped, and some individuals seem to build up a tolerance to these medications over time. But the same can be said of blood pressure medications, proton pump inhibitors for acid reflux disease, hormone treatments or corticosteroids. These medications are not "addictive," because they do not produce euphoria, cravings or behavioral changes where someone's entire life is dominated by efforts to acquire and abuse these drugs.
No medication is without risk. Serious risks of antidepressants include mood changes, withdrawal symptoms, anxiety and — very rarely — suicidal thoughts. The risks of untreated depression include a 20 percent lifetime risk of suicide and a lifetime of misery. Antidepressants are one of the safest medications available for treating any medical condition with a mortality risk this high.
To imply that the medications themselves are more dangerous than the disease is irresponsible and has no basis in medical fact.
Josh Zimmerman is HealthPartners' senior medical director for behavioral health.
