A recent front-page New York Times’ article suggests that many people end up on antidepressants life-long. As a therapist I have seen many patients successfully stop their antidepressants. However, I think there are ways those of us in the field may have failed our patients by not addressing issues related to discontinuation of psychiatric medications and the effects of long-term use.
Patients need much more education about how psychiatric medications work differently from antibiotics or PRN medications. This would include information like it might take 6-12 weeks for the medication to work. Also, unlike many medications, when you are ready to discontinue them, they need to be tapered. They need to know that both initiation and discontinuation have well known side effects. And that having side effects to discontinuation of SSRI’s is a phenomenon that is different than that of withdrawal from addictive medications.
We have failed patients when we have not openly discussed issues like ways the SSRI’s might affect blood platelets or their effect on osteoporosis. There is not enough published peer-reviewed research on this. We really don’t know how often these issues develop in our patients. Still we can discuss the issues with patients from day one, letting them know the limited data available. This is preferable to having a patient hear from her/his surgeon that s/he needs to stop their SSRI a month prior to surgery. It’s preferable that the patient learns about the possible impact of SSRI’s on bone density prior to reading it in the New York Times. We should educate our patients that rigorous studies of long-term use of our medications are limited. However, that is no different from many other of the other prescription and non-prescription drugs they use daily.
Educate the patient that many patients can taper off the medications successfully but that some patients will require medication lifelong. Furthermore at this stage of drug development and research, we cannot predict who can taper their medications successfully and who can’t.
Patient’s tapering their medications need close monitoring similarly to the initiation phase. We should tell patients that most patients need more psychosocial support during the tapering phase. This should be treated as a usual and expectable experience. As opposed to having our patients feel it’s due to the toxicity of the medications.
Psychiatric medications allow many patients to live enjoyable and productive lives. And, in the case of some patients, prevents death by suicide. As such they are critical interventions. We need to continue our work to de-stigmatize mental illness.