What duration of treatment with antidepressants is ‘appropriate’?

Very sadly, the lead author of this letter, Professor Ian C Reid, died less than 6 months after it was published. I knew Ian Reid well as we both trained in Aberdeen though he was a few years senior to me. His loss has been widely felt and I still miss exchanging views with him by e-mail. Ian had a brilliant mind, was widely read and his orations were not to be missed.

Ian was an impassioned advocate for the ‘appropriate’ use of antidepressant medication.

In our friendly exchanges I often asked Ian this question “what duration of treatment with antidepressants is ‘appropriate’?”

I was surprised that Ian found this question so difficult as he was considered to be the foremost opinion leader on antidepressant prescribing in the British Isles, if not wider.

In our last exchange, shortly before Ian’s death, he replied to my usual question:

“Not sure what your issue is with all this. Can you say?”

At this time 1 in 9 Scots were on antidepressants and many, like me, were taking them long term and often indefinitely. Since 2014, antidepressant prescribing has risen to nearly 1 in 5 Scots. I do wish that Ian was here so we could seek his thoughts on this. I find myself wondering if he would still find this ‘appropriate’?

If you wish to share your own thoughts on this, please do so through comments. If you wish your comment to be anonymous that is fine. Just get in touch with me and I will ensure this.

4 Replies to “What duration of treatment with antidepressants is ‘appropriate’?”

  1. In answer to the question in the title, I am not sure, but I am not a professional in the field of treatment.

    I expected my GPs, psychiatrists and psychologist to tell me without my asking them, but they never did. Nor did I ask – I was just desperate to get better enough to escape the tortures and be able to work and provide for myself and my family.

    Latterly, I have just wanted to feel better to enjoy a hard-earned (I believe), early retirement. (Since 2001 at 56 yrs.)

    I have been under treatment for depressive illness, almost continuously, since 1977 when it descended on me like an all-embracing, vile monster. I was in my prime at 32 years of age, but had been working a very irregular shift roster for 12 years and believe, too, that I had suffered severe trauma in my childhood (ACE) and teenage years.

    Currently, aged 73 years, I am taking Effexor/Venlafaxine XR and have experimented with withdrawal twice. Firstly, in 2006 and most recently during 2016-18, with no lasting success. In fact, the toxin likes you to think you are doing well and all is hunky-dory until you may be down to 25% of your original dose. Then it strikes back and you realise, too late, that despite following the careful advice advocated on at least one AD website, you have seriously overshot the runway and are crashing and burning. Figuratively, I am still crawling, naked, on all fours up the steep, jagged scree, having found once more, despite a much slower taper, that “withdrawal may just not be for me” and “the illness has returned”.

    I have spent more than two years researching widely on the internet, forums, and reading recommended books about the treatment and history of depression. Maybe based on this extra knowledge coupled with my own lived experience, I could answer the question in the title thus?
    “In the first instance, try 9 months to a year on an antidepressant. If a proven, exponentially tapered withdrawal then fails, perhaps the patient needs to take a dose of medication indefinitely.

    PS – It is interesting – and confusing – to read that the late Prof Reid was a strong advocate of the use of ECT. However, the accounts of the ECT treatment by those patients on sites like MIA who have suffered the therapy’s results make it sound like mediaeval torture – – – for an indefinite period.

  2. On the NHS website today. Other advice elsewhere tells us to wait for 6 to 8 weeks to see if the medication is lifting mood.

    “Doses and duration of treatment
    Antidepressants are usually taken in tablet form. When they’re prescribed, you’ll start on the lowest possible dose thought necessary to improve your symptoms.

    Antidepressants usually need to be taken for 1 or 2 weeks (without missing a dose) before the benefit starts to be felt. It’s important not to stop taking them if you get some mild side effects early on, as these effects usually wear off quickly.

    If you take an antidepressant for 4 weeks without feeling any benefit, speak to your GP or mental health specialist. They may recommend increasing your dose or trying a different medicine.

    A course of treatment usually lasts at least 6 months. Some people with recurrent depression may be advised to take them indefinitely.”

    1. Thanks for sharing this.

      The closing paragraph of the NHS website: “A course of treatment usually lasts at least 6 months. Some people with recurrent depression may be advised to take them indefinitely.”

      So are the majority – of the nearly 1 in 5 Scots taking antidepressants – living with “recurrent depression”? As far as I am aware there is absolutely no evidence to support this hypothesis.

      aye Peter

  3. It has been said that 50% of patients suffering from depression also have some pain somewhere.
    Two family members, myself and a friend have been offered, in addition to the usual paracetamol/ibuprofen type of medications, an antidepressant (off-label use?) to cope with the pain of i) endometriosis, ii) hip due replacement, iii) C6 radiculopathy and iv) a severe attack of sciatica.

    I subscribe to the view that badly managed AD treatment and interminable repeat prescriptions are giving chronicity to many of our depressions. Withdrawal cold turkey, or tapers that crash, followed by reinstatement or updosing again and again may not be helpful?

    Regards

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