| Is it OK to be on antidepressants for years?

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Is it OK to be on antidepressants for years?

Posted: July 26, 2011, 12:07 pm ET

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays,

it’s Dr. Raison, an associate professor of psychiatry and behavioral

sciences at Emory University, and an expert in the mind-body connection for

health.

Question asked by Rose from Arizona

Is it dangerous to be on an antidepressant for several years?

Expert answer:

Dear Rose,

Ten years ago my answer to this question would have been, “Certainly not.â€

A year ago my answer would have been, “Almost certainly not.â€

Now, unfortunately, the most honest answer I can give you is, “I’m not

sure.â€

Coming from a guy who has treated thousands of people over the years with

antidepressants, I have to admit that my uncertainty both shocks and distresses

me.

I should probably get over my sense of shock. One of the glories of science is

that it keeps moving forward, and as it does so, it usually sweeps old

certainties into the dustbin.

Psychiatry’s commitment to the unqualified goodness of antidepressants is one

of those old certainties. That I’m distressed is understandable.

The assault on my certainty about antidepressants comes from several fronts.

Over the last several years, it has become increasingly clear that even newer

antidepressants may pose health risks in certain situations, such as pregnancy

or during childhood.

These sobering findings take their place beside the fact that antidepressants

induce significant side effects in many people, and that some antidepressants

have really troublesome withdrawal syndromes when people try to stop taking

them.

Even more concerning is the fact that a number of recent, high-profile studies

have suggested that antidepressants are not as effective as we once believed

they were when compared with treatment with a placebo (which is a pill that has

no active properties).

Just this weekend, I saw a study that further shook my certainty about

antidepressants. Researchers pulled together data from hundreds of studies

conducted over the last 30 years or so in which people with depression were

randomized to treatment with either an antidepressant or a placebo.

Using this huge database the researchers asked a simple question: Who were more

likely to relapse when they stopped taking the study pill — people who

received an active antidepressant or a placebo?

Are antidepressants glorified placebos?

The answer was clear. People who recovered from their depression with the help

of active antidepressants were significantly more likely to relapse when the

medication was stopped than were people who recovered while taking a placebo.

I’m still trying to digest this fact, but it seems to me that the simplest way

to understand this finding is that when a placebo works it is a better form of

treatment than an active antidepressant.

In Europe in general — and Germany in particular — doctors use placebos to

very good effect for many disease states, including depression. On the other

hand, it is considered unethical in the United States to treat people with a

placebo without their being told that they are receiving an inactive substance,

so it is not likely that we will be handing out sugar pills for depression

anytime soon.

But a clear take-home message from the current state of the science is that we

need to work harder — as patients and clinicians — to get key elements of

placebo into our lives and practices.

These elements include, above all else, a sense of hope, a belief in the

therapeutic relationship and the knowledge that we are doing something positive

to improve the current condition of our thoughts and emotions.

Here is how I currently make sense of things: Like all other medications,

antidepressants have risks and benefits.

We know, for example, that chemotherapy for childhood cancer greatly increases

the risk that children who survive will die of cancer as adults because the

treatments themselves are carcinogenic. Would this keep you from treating a

dying child?

In the same way, there are many times when the risks associated with

antidepressants are more than balanced by the potential benefits. This

risk/benefit equation must be performed for each individual we treat, and it is

an equation you must evaluate in the context of your own life situation.

Posted by: Dr. Raison - CNNHealth Mental Health expert.

Sent via BlackBerry by AT & T

[Guest guest]

http://thechart.blogs.cnn.com/2011/07/26/is-it-ok-to-be-on-antidepressants-for-y\

ears/

/blogs

â 

The Chart

« Back to Blog Main

Is it OK to be on antidepressants for years?

Posted: July 26, 2011, 12:07 pm ET

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays,

it’s Dr. Raison, an associate professor of psychiatry and behavioral

sciences at Emory University, and an expert in the mind-body connection for

health.

Question asked by Rose from Arizona

Is it dangerous to be on an antidepressant for several years?

Expert answer:

Dear Rose,

Ten years ago my answer to this question would have been, “Certainly not.â€

A year ago my answer would have been, “Almost certainly not.â€

Now, unfortunately, the most honest answer I can give you is, “I’m not

sure.â€

Coming from a guy who has treated thousands of people over the years with

antidepressants, I have to admit that my uncertainty both shocks and distresses

me.

I should probably get over my sense of shock. One of the glories of science is

that it keeps moving forward, and as it does so, it usually sweeps old

certainties into the dustbin.

Psychiatry’s commitment to the unqualified goodness of antidepressants is one

of those old certainties. That I’m distressed is understandable.

The assault on my certainty about antidepressants comes from several fronts.

Over the last several years, it has become increasingly clear that even newer

antidepressants may pose health risks in certain situations, such as pregnancy

or during childhood.

These sobering findings take their place beside the fact that antidepressants

induce significant side effects in many people, and that some antidepressants

have really troublesome withdrawal syndromes when people try to stop taking

them.

Even more concerning is the fact that a number of recent, high-profile studies

have suggested that antidepressants are not as effective as we once believed

they were when compared with treatment with a placebo (which is a pill that has

no active properties).

Just this weekend, I saw a study that further shook my certainty about

antidepressants. Researchers pulled together data from hundreds of studies

conducted over the last 30 years or so in which people with depression were

randomized to treatment with either an antidepressant or a placebo.

Using this huge database the researchers asked a simple question: Who were more

likely to relapse when they stopped taking the study pill — people who

received an active antidepressant or a placebo?

Are antidepressants glorified placebos?

The answer was clear. People who recovered from their depression with the help

of active antidepressants were significantly more likely to relapse when the

medication was stopped than were people who recovered while taking a placebo.

I’m still trying to digest this fact, but it seems to me that the simplest way

to understand this finding is that when a placebo works it is a better form of

treatment than an active antidepressant.

In Europe in general — and Germany in particular — doctors use placebos to

very good effect for many disease states, including depression. On the other

hand, it is considered unethical in the United States to treat people with a

placebo without their being told that they are receiving an inactive substance,

so it is not likely that we will be handing out sugar pills for depression

anytime soon.

But a clear take-home message from the current state of the science is that we

need to work harder — as patients and clinicians — to get key elements of

placebo into our lives and practices.

These elements include, above all else, a sense of hope, a belief in the

therapeutic relationship and the knowledge that we are doing something positive

to improve the current condition of our thoughts and emotions.

Here is how I currently make sense of things: Like all other medications,

antidepressants have risks and benefits.

We know, for example, that chemotherapy for childhood cancer greatly increases

the risk that children who survive will die of cancer as adults because the

treatments themselves are carcinogenic. Would this keep you from treating a

dying child?

In the same way, there are many times when the risks associated with

antidepressants are more than balanced by the potential benefits. This

risk/benefit equation must be performed for each individual we treat, and it is

an equation you must evaluate in the context of your own life situation.

Posted by: Dr. Raison - CNNHealth Mental Health expert.

Sent via BlackBerry by AT & T

[Guest guest]

http://thechart.blogs.cnn.com/2011/07/26/is-it-ok-to-be-on-antidepressants-for-y\

ears/

/blogs

â 

The Chart

« Back to Blog Main

Is it OK to be on antidepressants for years?

Posted: July 26, 2011, 12:07 pm ET

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays,

it’s Dr. Raison, an associate professor of psychiatry and behavioral

sciences at Emory University, and an expert in the mind-body connection for

health.

Question asked by Rose from Arizona

Is it dangerous to be on an antidepressant for several years?

Expert answer:

Dear Rose,

Ten years ago my answer to this question would have been, “Certainly not.â€

A year ago my answer would have been, “Almost certainly not.â€

Now, unfortunately, the most honest answer I can give you is, “I’m not

sure.â€

Coming from a guy who has treated thousands of people over the years with

antidepressants, I have to admit that my uncertainty both shocks and distresses

me.

I should probably get over my sense of shock. One of the glories of science is

that it keeps moving forward, and as it does so, it usually sweeps old

certainties into the dustbin.

Psychiatry’s commitment to the unqualified goodness of antidepressants is one

of those old certainties. That I’m distressed is understandable.

The assault on my certainty about antidepressants comes from several fronts.

Over the last several years, it has become increasingly clear that even newer

antidepressants may pose health risks in certain situations, such as pregnancy

or during childhood.

These sobering findings take their place beside the fact that antidepressants

induce significant side effects in many people, and that some antidepressants

have really troublesome withdrawal syndromes when people try to stop taking

them.

Even more concerning is the fact that a number of recent, high-profile studies

have suggested that antidepressants are not as effective as we once believed

they were when compared with treatment with a placebo (which is a pill that has

no active properties).

Just this weekend, I saw a study that further shook my certainty about

antidepressants. Researchers pulled together data from hundreds of studies

conducted over the last 30 years or so in which people with depression were

randomized to treatment with either an antidepressant or a placebo.

Using this huge database the researchers asked a simple question: Who were more

likely to relapse when they stopped taking the study pill — people who

received an active antidepressant or a placebo?

Are antidepressants glorified placebos?

The answer was clear. People who recovered from their depression with the help

of active antidepressants were significantly more likely to relapse when the

medication was stopped than were people who recovered while taking a placebo.

I’m still trying to digest this fact, but it seems to me that the simplest way

to understand this finding is that when a placebo works it is a better form of

treatment than an active antidepressant.

In Europe in general — and Germany in particular — doctors use placebos to

very good effect for many disease states, including depression. On the other

hand, it is considered unethical in the United States to treat people with a

placebo without their being told that they are receiving an inactive substance,

so it is not likely that we will be handing out sugar pills for depression

anytime soon.

But a clear take-home message from the current state of the science is that we

need to work harder — as patients and clinicians — to get key elements of

placebo into our lives and practices.

These elements include, above all else, a sense of hope, a belief in the

therapeutic relationship and the knowledge that we are doing something positive

to improve the current condition of our thoughts and emotions.

Here is how I currently make sense of things: Like all other medications,

antidepressants have risks and benefits.

We know, for example, that chemotherapy for childhood cancer greatly increases

the risk that children who survive will die of cancer as adults because the

treatments themselves are carcinogenic. Would this keep you from treating a

dying child?

In the same way, there are many times when the risks associated with

antidepressants are more than balanced by the potential benefits. This

risk/benefit equation must be performed for each individual we treat, and it is

an equation you must evaluate in the context of your own life situation.

Posted by: Dr. Raison - CNNHealth Mental Health expert.

Sent via BlackBerry by AT & T

[Guest guest]

http://thechart.blogs.cnn.com/2011/07/26/is-it-ok-to-be-on-antidepressants-for-y\

ears/

/blogs

â 

The Chart

« Back to Blog Main

Is it OK to be on antidepressants for years?

Posted: July 26, 2011, 12:07 pm ET

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays,

it’s Dr. Raison, an associate professor of psychiatry and behavioral

sciences at Emory University, and an expert in the mind-body connection for

health.

Question asked by Rose from Arizona

Is it dangerous to be on an antidepressant for several years?

Expert answer:

Dear Rose,

Ten years ago my answer to this question would have been, “Certainly not.â€

A year ago my answer would have been, “Almost certainly not.â€

Now, unfortunately, the most honest answer I can give you is, “I’m not

sure.â€

Coming from a guy who has treated thousands of people over the years with

antidepressants, I have to admit that my uncertainty both shocks and distresses

me.

I should probably get over my sense of shock. One of the glories of science is

that it keeps moving forward, and as it does so, it usually sweeps old

certainties into the dustbin.

Psychiatry’s commitment to the unqualified goodness of antidepressants is one

of those old certainties. That I’m distressed is understandable.

The assault on my certainty about antidepressants comes from several fronts.

Over the last several years, it has become increasingly clear that even newer

antidepressants may pose health risks in certain situations, such as pregnancy

or during childhood.

These sobering findings take their place beside the fact that antidepressants

induce significant side effects in many people, and that some antidepressants

have really troublesome withdrawal syndromes when people try to stop taking

them.

Even more concerning is the fact that a number of recent, high-profile studies

have suggested that antidepressants are not as effective as we once believed

they were when compared with treatment with a placebo (which is a pill that has

no active properties).

Just this weekend, I saw a study that further shook my certainty about

antidepressants. Researchers pulled together data from hundreds of studies

conducted over the last 30 years or so in which people with depression were

randomized to treatment with either an antidepressant or a placebo.

Using this huge database the researchers asked a simple question: Who were more

likely to relapse when they stopped taking the study pill — people who

received an active antidepressant or a placebo?

Are antidepressants glorified placebos?

The answer was clear. People who recovered from their depression with the help

of active antidepressants were significantly more likely to relapse when the

medication was stopped than were people who recovered while taking a placebo.

I’m still trying to digest this fact, but it seems to me that the simplest way

to understand this finding is that when a placebo works it is a better form of

treatment than an active antidepressant.

In Europe in general — and Germany in particular — doctors use placebos to

very good effect for many disease states, including depression. On the other

hand, it is considered unethical in the United States to treat people with a

placebo without their being told that they are receiving an inactive substance,

so it is not likely that we will be handing out sugar pills for depression

anytime soon.

But a clear take-home message from the current state of the science is that we

need to work harder — as patients and clinicians — to get key elements of

placebo into our lives and practices.

These elements include, above all else, a sense of hope, a belief in the

therapeutic relationship and the knowledge that we are doing something positive

to improve the current condition of our thoughts and emotions.

Here is how I currently make sense of things: Like all other medications,

antidepressants have risks and benefits.

We know, for example, that chemotherapy for childhood cancer greatly increases

the risk that children who survive will die of cancer as adults because the

treatments themselves are carcinogenic. Would this keep you from treating a

dying child?

In the same way, there are many times when the risks associated with

antidepressants are more than balanced by the potential benefits. This

risk/benefit equation must be performed for each individual we treat, and it is

an equation you must evaluate in the context of your own life situation.

Posted by: Dr. Raison - CNNHealth Mental Health expert.

Sent via BlackBerry by AT & T