Dr. Charles Raison looks at long term effects of antidepressants

What are antidepressants' long-term effects?
Asked by Sandra Connell, London, Ontario, Canada

What are the effects on your of health using antidepressants for 20 or so years?


Mental Health Expert
Dr. Charles Raison
Psychiatrist,
Emory University Medical School
Expert answer
Dear Sandra, I had already decided to answer your question this week when early this morning I saw a new study suggesting that serotonergic antidepressants may increase the risk of developing cataracts by 15 percent. How timely, in a bad sort of way, for the central message I wanted to leave you with, which is this: We don't fully know the answer to your question yet.

It might seem strange that we don't have more information about the long-term effects of antidepressants, given the millions upon millions of people around the world who have taken, who are taking, and who will take these medications. But humans can know only those things they've looked at, and the truth is that very few long-term studies have been done on antidepressants.

In the absence of long-term studies, we are left with data like the cataract findings that come not from a study per se, but rather from examining the health records of many thousands of people on antidepressants and looking to see which conditions are more common in these people than in folks not on antidepressants. If you think about it for a moment, you can see the weakness with this sort of approach.

The main weakness is this: People take antidepressants because they are already "different." Usually they have depression or some related psychiatric condition. As we are increasingly learning, these conditions are not "health neutral." Indeed, we now know that depression is a risk factor for later developing a host of medical conditions, including heart disease, stroke, diabetes, cancer and dementia. So maybe depressed people not on antidepressants would be as likely, or maybe even more likely, than depressed people on antidepressants to develop cataracts. In this case, the blame would lie with the underlying mood disorder, but antidepressants "take the fall" by being associated with depression.
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What are antidepressants long term effects