Doctors should prescribe fewer antidepressants and for shorter periods of time, because of the ongoing uncertainties about their effectiveness and the potential severity and durability of both side effects and withdrawal symptoms, a new review article suggests.

According to the latest data from the US Centers for Disease Control and Prevention, 13.2% of adults used antidepressants in the past 30 days and the percentage of use increased with age, from 7.9% among adults aged 18–39 to 14.4% for those aged 40–59 to 19% (one in five) for those ages 60 and over.

While there might be a role for antidepressants among patients with severe depression, the cons may outweigh the pros in those with mild-to-moderate depression or in those whose symptoms don't yet qualify as depression, the review authors say. Much of the evidence for the effectiveness of antidepressants comes from placebo-controlled trials lasting just 6–12 weeks, and the results don't meet the threshold for a clinically important difference, say the authors. Overall, the review found no clinically relevant difference between these drugs and placebo on depression.

Side effects are also common. Around one in five patients on newer antidepressants, such as selective serotonin reuptake inhibitors, report daytime sleepiness, dry mouth, profuse sweating, or weight gain; at least one in four report sexual difficulties; and about one in 10 report restlessness, muscle spasms or twitching, nausea, constipation, diarrhea or dizziness.

The prevalence of side effects may be even higher among those taking antidepressants for more than three years, and can include emotional numbness and mental "fogginess."

Gradual dose tapering may best help people stop these medications; however, very low doses may not be commercially available. Long-term users may need additional help to support deprescribing, so it's better not to prescribe or use these medications in the first place unless non-drug solutions are ineffective and depression is severe.

To read the full article, published in Drug and Therapeutics Bulletin, click here

For CDC information on antidepressant use, click here

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