People with depression should take fewer drugs, and for shorter periods

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In a new review study, researchers suggest doctors should prescribe fewer antidepressants and for shorter periods of time.

This is because of the ongoing uncertainties about the drugs’ effectiveness and the potential severity and durability of the withdrawal symptoms associated with them.

They also found the use of antidepressants is also linked to a range of side effects, while the clinical trial data mostly don’t assess the outcomes that matter most to patients.

While there might be a role for antidepressants among patients with severe depression, the cons may outweigh the pros in those with mild to moderate depression or in those whose symptoms don’t yet qualify as depression.

The prescribing of antidepressants, primarily the newer generation classes—selective serotonin reuptake inhibitors(SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)—has risen steadily.

Much of the evidence for the effectiveness of antidepressants in adults comes from placebo-controlled trials lasting just 6–12 weeks. And the results don’t meet the threshold for a clinically important difference.

The findings in teenagers and children are even less convincing. Yet the number of 12 to 17 year-olds prescribed antidepressants more than doubled between 2005 and 2017.

What’s more, most of the studies don’t include outcomes that matter most to patients, such as social functioning or quality of life, focusing instead only on symptom measures.

Side effects are also common.

Around 1 in 5 patients on SSRIs report daytime sleepiness, dry mouth, profuse sweating, or weight gain; at least 1 in 4 report sexual difficulties; and about 1 in 10 report restlessness, muscle spasms or twitching, nausea, constipation, diarrhea or dizziness.

The prevalence of side effects may be even higher among those taking antidepressants for more than 3 years, and can include emotional numbness and mental ‘fogginess’.

Patients trying to come off their treatment often experience withdrawal symptoms: these can include anxiety, insomnia, depression, agitation and appetite changes, and can interfere with social functioning and professional life, particularly if treatment is stopped abruptly.

The team suggests gradual dose tapering may best help patients to stop. Patients attempting to stop antidepressant use, particularly long-term users, may very well need additional help.

If you care about depression, please read studies about what you need to know about mental fatigue, and findings that taking some depression drug too much can temporarily shut down the brain.

For more information about mental health, please see recent studies about mental problem that may triple stroke risk, and results showing that this therapy can effectively treat pain, depression and anxiety.

The study is published in the Drug and Therapeutics Bulletin.

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