How long is too long for antidepressants?
Young people spend too long on antidepressants without examining whether they still need them, a Duke psychiatrist argued in a recent New York Times post.
The psychiatrist, Doris Iarovici, is almost certainly right that more young adults are taking these meds for longer these days than in the past. The problem is that we don’t have a very good idea of how many – or for how long. As a result, it’s hard to know how much concern is justified.
Here’s what the CDC found in a 2011 analysis of antidepressants users ages 12 and over:
|Less than 2 years||2-10 years||More than 10 years|
|Age 12-17||61%||39%||too small to calculate|
|Age 18-24||63%||37%||too small to calculate|
|Age 25-34||65%||35%||too small to calculate|
|All over age 12||39%||47%||14%|
(Note: The data with age breakdowns is unpublished but comes from the author of this CDC data brief).
As you can see, compared to the average antidepressant user, young people ages 12 to 34 are much less likely to have been on medication for more than two years.
As for the young people who had been taking medications for more than 10 years, like I have? There were too few in the sample to calculate with any degree of certainty.
Now, it’s true that even two years is a pretty substantial portion of your life when you’re only 12 or 14 years old. A lot can change in that time.
Dr. Iarovici – and many of her commenters – are concerned about young people continuing with medication treatment without knowing whether that treatment is still necessary. That’s a valid consideration. Well into young adulthood, young people continue to undergo changes in their brains, bodies and life situations. The depression that dogged them in middle school may well have lifted by college.
And, as Iarovici points out in her column, there are few relevant studies to guide how long young people should continue antidepressants. U.S. treatment guidelines for child and adolescent depression recommend that doctors continue prescribing antidepressants for at least 6-12 months after the patient’s symptoms abate but stop short of clearly advising what to do after that. Treatment guidelines for adults are based on relatively short-term studies, conducted on older patients.
So do we need more studies about the long-term effects of antidepressant use in young people? Absolutely. Should we freak out about young people unthinkingly continuing medications when they don’t need them? Probably not.
Because here’s the thing: most young people do try stopping their antidepressants at some point. Studies show that teenagers, in fact, have the lowest rate of adherence to psychiatric medication of any age group. Young people have a powerful desire to be independent, to experiment and, most of all, to figure out “who they are.” In short, they’re naturally curious about what they’d be like – and how they’d fare – without psychotropic intervention.
No one wants to be on medication if it’s not necessary. That much was clear in the dozens of interviews I conducted for my book on young people and psychotropics. Many of them had successfully quit their meds for good. Others tried going off even in the fact of quite severe dysfunction. That’s how powerfully they wanted to avoid relying on a “chemical crutch.”
As for me, I’m now almost 31 and have spent the past 14 years on one antidepressant or another. During college, my pediatrician recommended I try going off my antidepressant. Like a lot of Dr. Iarovici’s patients, I fared poorly. Since then, I’ve had numerous recurrences of anxiety and depression – and that’s with medication and therapy.
Would I like to be medication-free? Sure. Is it worth risking dysfunction, panic and despair? So far, the answer is still ‘no.’
But here’s the thing: this is a decision I – and each person who takes medication – should be allowed to make for himself or herself, with input from our family, friends, doctors and therapists.
It’s not for other people – whether psychiatrists or internet commenters – to make some sweeping jugdement about, based on a gut feeling they have about too many people being on medication for too long.
Bell Barnett, K. (2014). How long is too long for antidepressants?. Psych Central. Retrieved on April 26, 2015, from http://blogs.psychcentral.com/my-meds/2014/04/1852/