How Long Should You take an SSRI?

I know some people take it only weeks or months and others for years- like me.. which worries me being on it that long or forever. I'm worried about its effects on my brain. Also, because the treatment is so ambiguous- doesn't fully cure- sigh...

I've been on quite a few SSRIs (as you can see in my signature) and you couldn't pay me to take another. I'm still supposed to be on 40 or 50mg of Fluoxetine (trade name Prozac), but I took myself off of it without telling my pdoc.

You start feeling the effects of an SSRI about 4-6 weeks after you start taking it, unless your brain has been exposed to an SSRI in the past, in which it will only take about a week for a new one to kick in.

Not sure what you mean by "how long" you should take it, though. Elaborate a bit?

Hope I can help

I've been on zoloft for about two years one time, and about a year and a half this time. I've heard you can take it forever. I think you're asking how long one can safely be on this medication and about what the long-term effects on the brain are. I'm not sure about this, and honestly don't know if the psychiatric world has a clear answer. I may just ask my pdoc the next time I see him and see what he says. Maybe others who have been on these drugs long-term, for years, might have an oppinion.

I've been told by my current pdoc I will need to be on an antidepressant for the rest of my life unless I want to relapse into depression.

I've heard other places that four-nine months might be enough to treat the illness.

I don't think there's a concensus in the medical community, or at least one that isn't bias toward keeping us on meds. So much of our knowledge comes from sharing experiences places like this. If you're really depressed now and are having good results with a medicine, I would stick with it until you have coping skills and a plan you trust to help you stay well if you go off the meds.

The thought of being on it forever is dreadful.... Guess i'm afraid of the "drugs" as some people call them and all the people against them.. and stuff. ssris never worked like 'amazing' for me, and ive tried a lot.

I also believe that one can generally stay on SSRI's forever if one has really bad depression.

Wait, but wont they eventually STOP working and you just keep switching from one to another?

No, they don't "stop working".
The human body/brain does not build up a tolerance to SSRI's like most other drugs.

Actually, they can stop working; there is even a name for it: tachyphylaxis.

http://www.mayoclinic.com/health/ant...ssants/AN01312

http://www.johnshopkinshealthalerts....ty_3288-1.html

http://www.ncbi.nlm.nih.gov/pubmed/18694599

I have had to switch antidepressants several times due to this problem. It's hard to know why it happens, but in a few patients this can be a problem. Generally, switching to a different AD has corrected the problem quite well.

Also, I think SNRIs (Effexor) have a lesser chance of pooping out.

There's no certainty it will or will not ever happen for you though. Take it one year (or month, whatever you're comfortable with) and see how you feel.

Previous exposure to an SSRI/SNRI increases the initial efficacy and decreases the amount of time it takes the medication to start taking effect on the the serotonin or norepinephrine ruptakes.

Also, your examples include:
1) A single patient on 20mg of Celexa.
2) A single study spanning a total of 83 test subjects
3) A doctor saying that some people may experience a "poop-out effect" (very professional wording) but the entire article explains how it can be attributed to a multitude of other factors.

So I'll stick with my original statement.

JD, You said AD's don't stop working. Clearly, they do stop working in some cases, apparently with enough regularity that they do study this as an issue for some patients. Another study said this isn't a hugely common problem, but it does seem to occur in about 8% of the cases. The doctors use "poop-out" simply because that is the colloquial/layman's term that has been used by patients in the past, and those particular articles were for patients, not doctors. Do they know why it happens? No, not clearly. It may be a number of factors, including some genetic factors. It is a real problem for some patients, myself included.

from what I read here and elsewhere (personal experiences), they do indeed stop working.

This may be hard to believe, but psychiatrists and other prescribers actually do use the term "antidepressant poop-out" among themselves. Not very professional sounding, but it has high communicative value! This phenomenon occurs fairly regularly (thanks farmergirl for the 8% figure, I have previously heard about 20% for poop-out), and they just don't know what causes it. As JD wrote, it is not caused by tolerance. The mechanism is unknown. Switching ADs is the typical solution.

I have heard this too, that ADs acting on more than one neurotransmitter have less chance of pooping out. So SNRIs and TCAs poop out less frequently than SSRIs.

But if it doesnt cure, isnt it like false hope?

in really hard cases in which an AD is not an optional life improvement but a must-have, it is like insulin.

Does insulin cure?

We are told that disorders such as Bipolar are life-long and must be treated, by drugs and I think also by therapy. Sometimes I do think the drugs have too many side effects, but I don't think many of us have much choice. I do wish psychiatrists would keep a better eye on how long they keep people on the same drugs. Even pain meds tend to "poop out" with long-term use or else more and more of the drugs are needed to produce the same effects. I have been on MANY drugs over the years and now only take two just meant for my bipolar, thank goodness.

What about herbs/supplements?

I do not get your logic. I was comparing AD's in hard cases to insulin for insulin-dependent diabetics.

Herbs or supplements are just substances that you ingest; there is not much of a distinction in principle between herbs and medications - you ingest something that you hope would make you feel better. Herbs grow and medications are produced, so there is that little distinction but it is not that big. If you really want to be substance-free, you would want to look at things such as therapy, exercise, improving social functioning, yoga, or whatever of that sort - those things do not involve ingesting substances.

If you want herbs, there is evidence that St John's Wort is more effective than placebo for mild to moderate depression: http://www.ncbi.nlm.nih.gov/pmc/arti...00553-0017.pdf

But it is just like with medications: you have to try it and see if it works for YOU. Clinical trials just show a tendency of the herb to outperform placebo in a group of people but not in every individual case. It gives some hope without a guarantee that it would work for YOU.

Long term use of SSRIs has simply not been researched. There's no definitely answer for how long you should be on them.

I was once described the guidelines for length of AD therapy as such: Around seven months for a first-time depressive episode after full remission of symptoms, two years for a second, indefinite after the third.

I do believe that untreated mental illness is far more deleterious to your brain than an AD. Research the facts: Depression and mental disorders damage certain parts of the brain and can cause a positive feed back cycle increasing the severity of the illness. Longer treatment on ADs before discontinuing them prevent relapse and thus prevent the destruction of mental illness on the brain.

However, if you don't feel completely better on an AD you may not be getting the protection against the effects of a prolonged illness.

Also depression is really bad for cognitive functioning.

i MEANT do certain herbs/supplements work as well as meds? Thats all....

They are less researched but there is evidence in support of SJW that I posted. SJW needs to be discussed with the pdoc, I believe, because it has known drug interactions. But yourquestion vannot be answered in full due to fewer studies of herbs and supplements. There is good though not thoroghly conclusive evidence in support of fish oil for moods on general, and since fish oil is cheap and helps other organs of the body, why not take it? If depression is associated with and sometimes even caused by anemia, iron supplementation is recommended. Vit D helps some people. Vit D is helpful in general, for general health and disease prevention, so sure why not. And some people take more complex supplements.

what you write here has not been proven... it's a theory. Or pharma-backed propaganda. And life on untested drugs after mere three episodes?

IN fact another theory says ADs whack (not protect) your brain. They prevent your brains from producing some chemicals and whatnot naturally, create dependency. Hence why it's hard to get off. Not because of your "illness" (of which there is no proof anyways), but because your brain has been altered by those drugs.
(in addition many people's "illness" is cause by trauma, sucky relationships and sucky jobs and bad place in life. I have yet to be somebody with completely organic depression).

tnlibrarian right here on this board recently: great husband, great kids, great job, originally, and suicidality extraordinaire. It just happens more rarely but sure there is endogenous illness not exacerbated by circumstances. And she recognized herself that anyone else in her situation would have been happy... but she was suicidal. No childhood trauma, either. No exogenous explanation.

Or my friend here: three great daughters, academic husband who does not mind whatever my friend is doing, be it camping with her friends, going to the Stone Age seminars with the children, blogging, defending the rights of tortured prisoners, whatever she wants to do. Enough money from his income. Everything great. Remarkably good diet, remarkably. She exercises and is thin and petite at 50+. She published a good progressive book about fifteen years ago. Basically, an enviable life situation. Still, the usual: anxiety and depression.