Transcription
If you've been on antidepressants for more than a year, there are five things your doctor probably hasn't told you. And the fifth one is the reason so many people feel worse the longer they stay on them. I'm a psychiatrist and I need to be honest with you.
Most of what I'm about to say was never taught to me in my training. I had to learn it from patients who kept coming back sicker on more meds and being told it was just their illness getting worse. Because maybe you started these drugs during a real crisis, and maybe they helped at first greatly, and maybe for several years they completely transformed your life. But now you're actually feeling tired, foggy, unmotivated, and anxious in a way that you never used to before. And every time you bring it up, the answer is another dose, another add-on, another switch. And there is a chance that you're not just treatment-resistant or developing a new psychiatric condition like your doctor is sharing. You could be having problems with your medication. And I'm here to tell you that you're not the only one that this is happening to.
And so today we're going to cover why these drugs can stop working, why withdrawal often gets misdiagnosed as relapse, what tolerance actually looks like, the side effect profile that no one mentions at the 15-minute med check, and the one thing that I wish every patient knew before they filled their first prescription. And stay with me till the end because if any of this sounds like you, number five might change the next decision you make about your mental health.
Now, the first problem is that we do not know nearly as much about long-term antidepressant safety as most people assume. Most patients are led to believe these drugs have been studied thoroughly for long-term use. And that's not really true. Many people stay on antidepressants for years, but the evidence base gets much thinner the further you go out. The FDA's own chief scientific and medical officer said this last year in a peer-reviewed piece in the American Journal of Medicine. He said, "A substantial discordance exists between the typical 8-week duration of clinical trials and the median 5-year real-world use of antidepressants. This raises important questions about the evidence supporting long-term current prescribing practices." Longer trials are needed to determine optimal antidepressant therapy. This was based on a study where he looked at the 10 most commonly prescribed antidepressants in the clinical trials from 1978 to 2023. And he essentially found that there were no studies there that went any longer than a year. And so here's what I want you to take away from this. When patients are told that these drugs are FDA approved and they're safe and effective, what often gets left out of this is that's for the one year these drugs were studied for. And that after that one year, we really don't know much about who they work for and who they don't work for.
Now, the second thing doctors don't bring up is that these drugs do not correct some chemical imbalance in the brain. Because for years patients have been given the impression that depression or anxiety comes from like a brain or a genetic defect, and that antidepressants are the cure for that. And this framing is completely misleading. I've heard I've even heard doctors try and liken depression to a condition like diabetes where they say, "Oh, you're worried about antidepressants? Well, you wouldn't be worried about a diabetic taking insulin, so why would you be worried about antidepressants?" Guys, it is not the same. Diabetes, we can use a lab test, we can measure low insulin, we can bring it up to the normal level, and when you do that, all of the downstream problems go away. That is not depression, people. Depression is multifactorial. It involves your physical health, it involves your sleep, your relationships, meaning and purpose, substances that you're using. All of these things. It does not come down to a simple low serotonin where you give someone a drug and it fixes that. And so when your doctor tells you this, they're really misleading you and they are robbing you of the opportunity to actually get to the root cause of what's causing your problems.
Now, the third thing that a lot of doctors don't tell patients is that antidepressants work through their drug effects. Now, remember, you know, they're not fixing a chemical imbalance. These produce drug effects that mask your symptoms. And I don't want to diminish this because this drug effect can be absolutely life-changing and helpful for people. If you are being paralyzed by high levels of anxiety and depression, and you take a drug and that drug effect kind of reduces that and you're able to function, you might find that life-saving. That might have even been life-saving for you for years and years and years. But functioning in that way is not the same as actually resolving the primary reason why you were suffering in the first place. And while there are people out there who really have invested a lot in this, they look at their health, they see therapists, you know, they stop using substances, you know, they do all of these types of things. If you still need to be on a drug and you've tried to find the root cause for it, I think that's totally okay, and that's the right option for you. But what I see so often in clinical practice is someone just goes and sees a doctor, they do a 40-minute intake, and they just get put on an antidepressant. And that doctor really doesn't understand much about their life, you know, they really haven't worked on, you know, physical health, you know, relationships, you know, the substances that they're using, that they're not looking at medical conditions, and all of these things. And then they just indefinitely put them on the drug long-term. And in a situation like that, you've essentially just papered over the real problems that are causing issues.
Now, why is that a bad strategy long-term? Well, it's a bad strategy because for many people, they'll actually adapt to the drug over time and then something called tolerance kicks in. And this is where that drug effect actually diminishes over time. And then you need to be on higher and higher doses to maintain the same effect. And this leads me to the fourth thing that many doctors don't tell patients when they get on medications. And that is that long-term use can sometimes leave people worse off. Because what happens is when they build up tolerance, they get on higher and higher doses, and then they need to start adding medications more and more and more. And so you go from this situation where maybe for the first several years of being on the drug, it was helpful and you really still felt like yourself a lot of the time. But as that effect has gone down and you've stacked on more drugs, you now just start feeling like mostly not good all the time. Like you start to feel more fatigued, you start to have worse sleep, you start to have brain fog, you start to have low motivation, you're putting on more weight. The longer you're on these medications and the higher the doses go, the more negative the effects are. And this is really the journey that I see a lot of people on in psychiatric practice. When I used to work in the community health settings, I would see people on three, four, five different medications at a time. And that was really common. And because I see this, I now believe that it is incredibly poor medical practice to just put someone on an antidepressant without having a plan to reassess them, reduce the medications, and find ways to manage it without a drug. Because as a long-term strategy to be on a medication that very well may wear off over time, that's that's just not a sustainable approach to good long-term mental health.
Now, the fifth thing that a lot of doctors don't tell patients on antidepressants is that these drugs can be very hard to stop. Now, this doesn't happen to everyone, you know, I've seen plenty of patients who've been on them for years and come off and they have super elastic brains and they go through a period of bad withdrawal for maybe like five or six weeks and then they're back to themselves. That does not happen for everyone. And even within the same person, I've seen it where the first couple times they've come off was fine, and then like the last time they came off, they got totally rocked.
Now, what I want to make clear to everyone now is that my view is not that antidepressants never have a place. I think they make sense in some situations, especially short-term or when someone has really tried all of the non-drug interventions and nothing has helped, they make sense to use, and I don't think there should be any shame about that. But patients, they really deserve honest informed consent at the start when they get on these drugs. And most doctors don't tell them these fine things. And I've heard from patients that coming off antidepressants can be one of the hardest things that they do in their life. But I've got some good news, and the good news is that it is not impossible. Because the main reasons why most antidepressant tapers fail is that doctors are not trained to do this, and they often do reductions that are far too large, and they do them far too quickly. And if you don't do that and you actually build a highly personalized taper where you do smaller reductions and you do it in line with what you're able to tolerate, there is a way that you can come off these medications, even if you've had really bad withdrawal before, in a way that is comfortable and allows you to maintain your functioning. And if you want to learn how to do that, I've put together a free guide which you can get below this video. It's what I've learned from helping 400 people taper off psychiatric medications over the last 6 years, and it goes through like the number one strategy that I would recommend most people use to come off these meds. And so click the link below if you'd like something like that.