Australian researchers find minimal evidence to support long-term use of antidepressants

Fresh concerns have been raised over long-term use of antidepressants with Australian researchers finding little evidence to support the benefits of the medicine.

Researchers from Adelaide University and The University of Queensland reviewed studies on people who had discontinued antidepressants, finding those who struggle after may actually be simply noticing withdrawal effects, not a relapse.

The research also found benefits supporting long-term use of antidepressants may be overstated due to that fundamental flaw in much of the research.

Adelaide University psychiatry associate professor Mark Horowitz said much of the research on use of antidepressants didn’t distinguish between withdrawal and depression symptoms.

“Much of the evidence supporting long-term antidepressant treatment comes from so-called relapse prevention trials,” he said. “These studies typically compare patients who continue medication with those who stop abruptly or rapidly.

“Because they don’t distinguish between withdrawal symptoms and the return of depression, we believe many apparent relapses may actually be withdrawal effects from the medication.”

Nearly one in seven Australians take antidepressants with a third of people staying on them for more than a year.

Withdrawal effects from the medication are very similar to depression including anxiety, low mood and insomnia. Withdrawal symptoms can also often be long-lasting, sometimes persisting for month or even years.

Researchers also found the apparent benefit of long-term treatment may be due to the suppression of withdrawal symptoms rather than actually preventing depression or anxiety.

The research also highlighted growing evidence of risks associated with long-term use of the medication including sexual dysfunction, emotional numbing, cognitive impairment, weight gain, and increased risk of physical health problems in older adults.

Associate professor Horowitz said guidelines needed to be updated to reflect the lack of robust evidence supporting long-term use.

“As these studies do not distinguish between them, they will miscategorise withdrawal as a return of depression as this is the focus of such studies,” he said.

“If the same approach was taken with cigarettes and feeling worse on stopping them was interpreted as evidence that people should continue smoking them, we know that would be absurd, but the same sort of evidence is used to recommend long-term antidepressants.

“Guidelines need to be updated to reflect that there are no good studies, which show that antidepressants are effective in the long term.”

Recommendations included addressing misconceptions about depression being caused by a chemical imbalance, recognition that worsening symptoms on stopping antidepressants may be linked to withdrawal, and wider adoption of gradual weaning strategies when discontinuing medication.