The number of patients taking antidepressants long-term has grown, but long-term usage is not supported by clinical evidence
“People are staying on antidepressants longer, and we don’t really have long-term studies that support that.” Professor Wendy Burn, former president of the Royal College of Psychiatrists
More than a quarter of people in England who are on antidepressants have been taking them for at least five years, a freedom of information request by the BBC’s Panorama programme has found.
The number of people taking antidepressants in England has increased from seven million five years ago to eight million today, according to NHS prescribing figures.
Professor Wendy Burn, a former president of the Royal College of Psychiatrists, told the BBC that throughout her long and extensive career, she had seen people benefit from antidepressants: “I see them working in my clinical practice, I see lives being changed by them.” She added, however: “People are staying on antidepressants longer, and we don’t really have long-term studies that support that.”
The effectiveness of antidepressants is hotly debated. A systematic review from the University of Oxford suggests that antidepressants do help some people in the short-term. The effects, however, are relatively modest, and the way people respond varies, with some not responding at all, the research found.
Long-term use may lead to higher risk of withdrawal symptoms
There is also evidence to suggest that long-term antidepressant use may be linked to some health risks, such as heart problems and diabetes, and that long-term use may lead to a higher risk of withdrawal symptoms in some people.
Panorama also found that, 27 years ago, Pfizer, a leading drug company, attempted to conceal possible withdrawal effects caused by its drug sertraline, one of the class of modern antidepressants known as selective serotonin re-uptake inhibitors, or SSRIs. These withdrawal effects include sensory disturbances, sweating, nausea, insomnia, tremors, agitation and anxiety.
A copy of a confidential 1996 memo from Pfizer shows employees discussing what the drug company would tell regulators in Norway. “We should not volunteer to describe the withdrawal symptoms, but have an agreed list prepared in case they insist,” the memo says.
A spokesperson for Pfizer, which no longer produces sertraline, told the BBC that the company “monitored and reported all adverse event data” to licensing authorities, in line with its legal and regulatory obligations and updated sertraline labelling as required.”
It added: “Public health organisations and professional medical bodies throughout the world have recognised sertraline and other SSRIs as the treatment of choice for adult depression.”
The Royal College of Psychiatrists published updated information on withdrawal in 2019, overseen by Professor Burn, who was its president at the time. The information was produced after she heard testimony from patients who had experienced severe withdrawal effects.
Before then guidance used by the NHS and the Royal College of Psychiatrists stated that withdrawal was mostly mild and short-lived. Now NHS guidance states that withdrawal symptoms can last many months for some people.
A Royal College of Psychiatrists spokesperson said that medicine “continuously evolves, as does our knowledge of treating mental illness. As a result, the college updates its guidance when new evidence comes to light.”
Dr Mark Horowitz, who tried to stop the antidepressants he had taken for 15 years in 2015, told the BBC: “It led to complete havoc in my life. I would wake up in the morning in full panic, like I was being chased by an animal.”
Horowitz now runs England’s only NHS antidepressant deprescribing clinic, which helps people struggling to stop taking their medication. He currently sees about 25 patients and believes people on antidepressants are still struggling to get tailored advice. Guidance for doctors now recommends that people reduce the dose of their medication in stages, but it does not specify how long it should take, he says. The Royal College of GPs said that workforce pressures made it “increasingly difficult to offer patients the time they need within the constraints of a standard 10-minute consultation.”
NHS figures show that eight million people in England – one in seven – are taking antidepressants. Of these, one in four have been taking them for five years or more. Without evidence to support long-term use, these figures are concerning, particularly as we also know that coming off antidepressants can cause severe withdrawal symptoms in some patients. Pressures on GPs mean that writing another antidepressant prescription is quicker and easier than looking at alternative methods of support, such as therapy or social prescribing. The government needs to take active steps to enable people experiencing depression and anxiety to access that type of support easily, so that antidepressants are not treated as the default solution to those problems.