I have taken antidepressant medications on and off for many years. I do not seem to be able to stay off of them for very long without experiencing a relapse in my depression. Is it bad for your health to be on these medications for so long?
We used to believe that most people who were experiencing their first clinical depression could be treated with antidepressant medications, have a positive response, and then have the medications stopped after six to eight months of feeling better. We assumed that these people would in a sense be “cured” and that they would go on to do well and never need treatment again.
As we have done more and more research on depression, we now know that at least 50 percent of individuals who have a first depression will go on to have a second depressive episode at some point in the future, usually within two years. Once a person has a relapse, this sets her up to have a chronic course and to have more episodes in the future. This is why it is important to have good follow-up after you have recovered from a depressive episode. You should learn to recognize the early warning signs that you are entering a clinical depression so that you can catch the relapse before it progresses too far.
Some research that has just been completed recently shows an even more important finding: it is not enough to “partially treat” a depressive episode. If a person still has ongoing “residual” symptoms, even after receiving medications — for example, if she still feels mild ongoing fatigue and still has trouble sleeping, even though she is better overall — this person’s long-term outcome will not be as good as the person who has had all of her symptoms eradicated by the treatment.
What this means for both doctors and patients is that we all need to take a very vigorous approach to treating depression. For some patients, this means being followed over the long-term, and being maintained on chronic antidepressant treatment in order to prevent relapses.
This is a long and indirect answer to your question, but my message here is that the situation you describe is not so uncommon. In both the research literature and in my clinical experience, there are some people who need to stay on antidepressant medications indefinitely, and who end up taking them for years. Of the many people I have worked with who have taken these medications for 10 or more years, I have never personally observed any adverse experiences, and none have been reported in the literature. Of course, the antidepressant medications most people take have only been around for 10 years or so, and so we of course cannot say for sure that they will not cause problems if you take them for 30 or 40 years. But at this point, there is no evidence that they are harmful over the long term.
However, we do know for sure that chronic depression is definitely harmful, not just to your mental well-being, but to your physical health as well. Depression worsens the outcome in cardiac disease and other chronic illnesses, is a major factor in substance abuse, and probably plays a role in susceptibility to some infectious agents. This is why I always recommend a treatment approach that is very vigorous, and that includes talking therapy and lifestyle changes as well as medications.