Can you take antidepressants forever?
Is Thailand facing an epidemic of depression? According to the Public Health Ministry, more than 180,000 youngsters below the age of 20 sought treatment and were prescribed antidepressants in 2021 alone.
While treatment durations for depression vary, ranging from six months to several years, this uptick raises questions about the long-term implications of relying on such medicines. How long can patients safely depend on antidepressants before encountering adverse effects and is lifelong medication necessary?
When a patient is diagnosed with depression, it often means that they are deficient in serotonin, a neurotransmitter crucial for regulating emotions. Doctors typically prescribe antidepressants or SSRI (selective serotonin reuptake inhibitors) to address this imbalance and extend the presence of serotonin in the body to enhance energy and motivation levels, explained Dr Polaputt Sirodom, a psychiatrist from Chulalongkorn University.
“When patients come in for the first time, psychiatrists usually prescribe medications for six months or even up to a year. If the patient responds well to the medication, they can begin tapering off the prescription. If the tapering off doesn’t work, then the treatment continues. This process can take up to two more years,” Dr Polaputt said.
For patients who experience recurrent major depressive episodes or are unresponsive to medications, long-term treatment may become necessary, potentially for life.
Potential side effects
Extended use of antidepressants can yield several undesirable side effects and complications, particularly if patients exhibit poor responses to certain antidepressants.
“Finding the right medication is like solving a complicated puzzle,” said a graduate student from Chulalongkorn University, opting to remain anonymous.
Recounting her battle with depression since the age of 11, she said: “The side effects were overwhelming. I couldn’t bear the constant hunger and when I put on weight, I would secretly stop taking these pills. It was a long, tough journey, but one I wouldn’t change given how close I was to death.”
Beyond weight gain, Dr Polaputt underscored the necessity for close monitoring of the liver and kidneys in patients requiring prolonged antidepressant use.
A 2013 pharmaceutical research paper on the adverse impacts of depression medications revealed that antidepressants like paroxetine, fluoxetine, and fluvoxamine can cause irreversible damage to the kidney, while atypical antidepressants such as nefazodone, trazodone, duloxetine, bupropion, and sertraline may harm the liver. These medications have also proved to be fatal.
Beyond antidepressants
Dr Polaputt said some patients may require antipsychotics along with antidepressants to regulate their emotions effectively. Echoing this sentiment, the graduate student acknowledged the limitations of antidepressants, saying they did not cover all her symptoms.
“I went through so many adjustments. It’s not like one fits all, especially for me who suffers from depression, as well as anxiety and an eating disorder.”
Beacon of hope
Despite the challenges, the graduate student has managed to stay off medications since last year, even though she still struggles with depression.
“From taking more than 10 pills a day, I can proudly say that now I’m taking zero. In nearly every session I had with my psychiatrists, one thing that always came up was the ‘change of environment’. When I moved overseas for work, I found a local psychiatrist and therapist whom I could talk to every month,” she said.
“Together we worked on lowering my medicines because I felt much better. My psychiatrist overseas and the one back home coordinated with each other and decided I could be taken off the pills. So on one random night in July 2023, I took the last pill for my condition.”
However, the path to recovery comes at a significant cost.
“Every time I visited the clinic, the bill would be for at least 10,000 baht. Twice a month for three to four years, the bills would rack up to more than 100,000 baht,” she said.
National imperative
These narratives underscore a broader mental health landscape in Thailand, where approximately 1.5 million people grapple with depression, according to the World Health Organisation. With women exhibiting a higher prevalence compared to men, addressing mental health challenges emerges as a pressing national priority.
