A new review of the data brings up some concerns about how the drugs are currently prescribed.
The review says that antidepressants may be doing patients more harm than good when taken over long periods of depression.
In many instances, antidepressants save lives and work well, so we shouldn't stop using them.
The authors of the new review suggest that doctors should not prescribe antidepressants for long periods of time and instead focus on people with severe depression.
In some cases, the evidence is not clear on how effective the drugs really are.
There is a lot of uncertainty about the benefits of antidepressants in the short- and long-term, particularly in regard to the lack of a clinically significant difference between placebo and antidepressants.
We should re-visit the widespread and growing prescription of antidepressants in light of this uncertain balance of benefits and harms.
Most clinical trials only look at the efficacy of the drugs over a six- to 12-week study period, according to the review. People are prescribed antidepressants for years in the real world.
Quality of life is one of the outcomes that most studies don't look at.
A fifth of patients on the drug report being sleepy or sweating, according to the review. One in 10 patients report muscle spasms or twitching, and a quarter of patients report sexual problems.
A survey of self-rated side effects in long-term use was even more concerning: 71 percent reported emotional numbness, 70 percent said they felt 'foggy or detached', 66 percent said they experienced sexual difficulties and 63 percent reported drowsiness.
The authors flagged the problem of long-term use of antidepressants starting in childhood.
There is very little evidence that antidepressants work well in teenagers and young adults. In some countries, the number of adolescents prescribed antidepressants is increasing rapidly, and that's because they're one of the most commonly used drugs by girls.
This isn't the first paper to question the effectiveness of antidepressants. There has been debate over whether they offer benefits.
A meta-analysis on the most widely used type of antidepressants found that there was only a 2-point difference between people taking active drugs and a placebo when measuring their outcomes on the Hamilton Depression Rating Scale.
The UK's National Institute for Health and Care excellence says a 3-point difference is needed to make a 'clinical difference', but other studies say it should be at least a 7-point difference if a drug is to be deemed clinically important. Many modern antidepressants fall short.
The latest review doesn't offer new data on the effectiveness of antidepressants. It weighs the benefits against the risks.
The UK Royal College of Psychiatrists gave new guidance on how to stop taking antidepressants in a way that is manageable. It's not talked about a lot, but patients can experience withdrawal symptoms such as headaches, anxiety, insomnia, agitation, fatigue, and diarrhea if they stop their treatment too quickly.
The Royal College of Psychiatrists issued a position paper to alert prescribers to the risk of withdrawal effects from antidepressants, and recommended that patients be informed of this risk.
Reducing the dose gradually is the best way to stop taking antidepressants. There is no guarantee that patients will avoid consequences such as long- lasting sexual side effects or persistent withdrawal symptoms even with a cautious taper.
The current available doses don't go low enough to help patients stop taking them, something that needs to be reexamined as we think about how best to use antidepressants going forward.
There are lots of hard decisions to be made and more research to be done, so this review isn't a final word over the use of antidepressants. There's mounting evidence that the way we currently use these common medications may not be the best, and the more honest conversations we have now, the better care we can offer people with mental health concerns in the future. Potential new treatments include ketamine and psilocybin.
The authors conclude that "increasing knowledge about the difficulty that some patients have in stopping antidepressants should lead to more cautious prescribing practice."
The review has been published.
