The Dose15:58How long should I stay on antidepressants?
Winnipeg resident John Ruhland first began taking medication for his depression in 2000 when a period of enormous stress — both at work and in his personal life — landed him in the hospital.
“It took the antidepressants to bring me to a comfortable level of dealing with the overall situation,” said Ruhland.
His condition improved, allowing him to stop taking medication for roughly a year before his symptoms returned.
When his condition improved again about 15 years later, Ruhland went off the medication under the supervision of his doctor.
However, Ruhland’s symptoms returned once more, and it became clear that he needed to resume treatment.
“I just brought myself to the hospital and said, ‘Here’s what’s going on and I’m pretty sure I need to get back on medication,'” he said.
Roughly 6.6 million Canadians filled prescriptions for antidepressants in 2023, up from 5.8 million in 2019, according to data from health research firm IQVIA.
These drugs — the most common of which are selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) — are well established as treatments for depression.
The Centre for Addiction and Mental Health (CAMH) recommends consulting a physician after experiencing “feelings of sadness, despair and hopelessness, or by excessive worry that is hard to control” for more than two weeks.
But it’s not always clear how long patients should stay on these medications — and what role therapy can play in the process of going off them safely.
Although everyone’s case is different, and changes to medication should be handled under close supervision of a doctor, here’s what the experts CBC spoke to for The Dose want you to know about going off antidepressants.
First, you need to give the medication a chance to work
According to CAMH, for patients experiencing their first depressive episode, an antidepressant is considered to be working if symptoms improve within two to four weeks, with full remission seen around six to 12 weeks.
If a patient’s symptoms don’t improve, physicians may recommend a different medication, or combinations of medication and therapy.
Psychiatrist Dr. Ishrat Husain is a senior scientist at CAMH in Toronto, who also leads the centre’s mood disorders service.
The Canadian Mental Health Association of Waterloo-Wellington launched their Step One campaign to encourage people to take that first step to get help. Colene Allen works for CMHA Waterloo-Wellington as part of the organization’s campaign. She shared her own experience getting mental-health support.
“The guidance is to continue it for up to nine months of that person being well on the medication,” Husain told Dr. Brian Goldman, host of The Dose.
Psychologist Joelle LeMoult, an associate professor at UBC and director of the Depression, Anxiety, and Stress Laboratory there, says cognitive behavioural therapy (CBT) and exercise can also help in tandem with medication.
As Hamilton psychiatrist Dr. Benicio Frey says, antidepressants do come with side effects, including sexual dysfunction or reduced libido , weight gain , reductions in bone density , as well as emotional blunting where people report being unable to feel strong positive or negative emotions.
Other side effects include things like dry mouth, as well as gastrointestinal troubles, says Husain.
He says these side effects tend to be mild and often go away as patients adjust to the medication.
If a patient truly can’t tolerate a medication, a doctor may suggest switching or discontinuing it, but only under medical supervision, says Husain.
Medical supervision is required while tapering off
If a patient responds well to treatment — and it’s their first episode of depression — some guidelines suggest physicians taper patients off the medication around six to nine months after they start to feel beneficial effects, watching to make sure the depression doesn’t return.
“If the symptoms don’t recur, they can probably discontinue the medication,” said Husain.
LeMoult says she encourages “some form of therapy in order to better prevent relapse should [patients] stop taking the medication … Even just to give them an idea about what other alternatives there may be.”
New findings from a meta-analysis published in the journal The Lancet Psychiatry this week support that approach. Looking at more than 17,000 patients whose symptoms were improving, the co-authors found that slowly tapering off of antidepressants, combined with psychological supports like therapy, was just as effective as staying on the pills.
Frey says there’s little evidence to suggest that antidepressants cause any type of addiction after long-term use.
However, patients who stop taking antidepressants can experience symptoms of withdrawal, a condition known as antidepressant discontinuation syndrome (ADS).
“Brain zaps, tingling sensations, dizziness, feelings of increased irritability, may occur when people try to come off the antidepressant,” said Frey.
A 2024 meta-analysis of 79 studies capturing 21,000 patients found that roughly 15 per cent experienced symptoms of antidepressant withdrawal.
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Depression can be a lifelong illness
But as John Ruhland found out, there is a segment of the population for whom depression is a lifelong illness — himself included.
Apart from the brief periods when his symptoms have improved, Ruhland’s been taking antidepressants for more than two decades.
“I was told because of the acuteness of my symptoms that it likely would be a lifelong thing,” said Ruhland.
Today he’s a mental health advocate and peer support worker. Drawing on his own experiences, he helps others come to terms with their depression.
Whether it’s your first bout of depression or not, he says it’s important not to suffer alone.
“If you’re finding that you reach points of overwhelm and you can sense that things don’t feel right, talk to your doctor and say, I’m having difficulty,” he said.
If you or someone you know is struggling, here’s where to look for help:
If you’re worried someone you know may be at risk of suicide, you should talk to them about it, says the Canadian Association for Suicide Prevention. Here are some warning signs:
- Suicidal thoughts.
- Substance use.
- Purposelessness.
- Anxiety.
- Feeling trapped.
- Hopelessness and helplessness.
- Withdrawal.
- Anger.
- Recklessness.
- Mood changes.
