Antidepressants Are Hugely Helpful for So Many People—But Is It Safe To Take Them for Years (or Even Decades)?

If you’ve been taking an antidepressant for years, it can become just another daily ritual, as routine as doing the dishes or taking a shower.

In fact, your antidepressant may feel as necessary to you as breathing or eating, because it helps you manage depression or another condition, like anxiety, chronic pain, or insomnia, according to the U.S. National Library of Medicine (NLM). That is: You filled your initial prescription for good reason.

But as you swallow this pill day after day, year after year, you may wonder about side effects over the long term. Some changes, like an increased number on the scale or a dip in your libido, are fairly well-known, and you may have noticed them soon after beginning your prescription. Other common side effects are GI-related issues (think: diarrhea and nausea) and drowsiness, per the NLM. But we know a lot less about the long-term effects of antidepressants.

When we asked readers like you to send us their biggest health questions so we could pose them to a panel of doctors for our Real Talk Rx series, we found many people wondering if it’s safe to take antidepressants for years or even a lifetime, and if doctors would ever recommend getting off these medications. Here’s what the experts had to say.

Are antidepressants safe long term?

“Personally, I work a lot with patients to try to see if they’re able to get off the medication or still need them after being on it for about a year. However, there are individuals who just do not make enough of their own serotonin, the hormone in their brain, to feel normal and feel good. So they need that extra bit of help to keep that neuro-hormone balance correct.

There are certain studies [such as an October 2021 review in Experimental and Therapeutic Medicine] that actually indicate that antidepressants may improve what’s called neuroplasticity, or the brain’s ability to learn and grow. That means there are some antidepressant medications that may help fight off cognitive decline.”

“Whenever we talk about a medication, we always reference the risks and the benefits. And for some people, the benefit of remaining on an antidepressant for a long time might outweigh any potential risk.” —Alexa Mieses Malchuk, MD

“I hear this question all the time from my patients. And unfortunately, there is no one-size-fits-all answer.

The short answer is that it’s a complicated decision to make. And it’s one that every individual should make in tandem with their physician.

People go on antidepressant medications for many different reasons. We call them antidepressants because traditionally, they were used to treat depression, but now this family of medications is also used to treat things like anxiety, ADHD, and certain eating disorders.

Whenever we talk about a medication, we always reference the risks and the benefits. And for some people, the benefit of remaining on an antidepressant for a long time might outweigh any potential risk.

That being said, if you’re looking for something more objective, in research studies there has been no consistent evidence that antidepressants cause harm when taken for a long time. You have to look at each study individually, but we have not reached that consensus where we can say that they’re harmful.”

“The simple answer is, yes, they’re safe. But not every SSRI [selective serotonin reuptake inhibitor] is made for every person.

Some of the common side effects with long-term use of antidepressants are weight gain, sexual dysfunction, libido changes, and mood disturbances. It can cause more depression or more anxiety if it’s not meant for you, essentially.

Let’s say you use Prozac. If it doesn’t work, [you may find] Effexor is better for you, and you may have fewer side effects long term. That’s something your primary care doctors are well aware of. Trial and error is the only way to minimize those long-term side effects.

For certain people with severe major depression, yes, medications should be utilized, but for a lot of people, exercise may actually be a better form [of treatment]. From a medical standpoint, it increases something called brain-derived neurotrophic factor, which is a kind of deep protein that affects you genetically. It can take six to eight weeks for that protein to increase and have a helpful effect. In the meantime, SSRIs can provide a boost, giving you the motivation and discipline to exercise regularly and get healthy. At that point, you may be able to stop taking the medication.

It’s really not a perfect science, and it’s really individualized.”

The takeaway

Current research indicates that it’s likely safe to use antidepressants long term. While there are known short-term side effects to taking antidepressants, such as weight gain or changes to your sexual desire, there’s no consensus that points to harm from long-term use.

So if antidepressants are helping you manage a mental health condition, there’s a lot of potential gain in remaining on them.

If you’re curious if the symptoms and condition that initially prompted you to take antidepressants may be more manageable now than in the past, reach out to your health care provider. They can help you assess the benefits and risks of that decision and also advise you how to safely stop taking the medication if you decide that’s the best choice.

‌Confused about your health? Get answers to more common questions in our Real Talk Rx series.

—reviewed by Jennifer Gilbert, MD, MPH