By George Citroner
Antidepressants are effective in reducing symptoms of generalized anxiety disorder (GAD), a major new review confirms. However, it also reveals a critical gap in research: The long-term effects of these widely prescribed medications remain unclear.
GAD, a condition characterized by excessive worry about various everyday issues, affects millions of people worldwide. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors are commonly prescribed for GAD.
Significant Relief
A Cochrane review analyzed 37 randomized controlled trials involving more than 12,000 participants, comparing the effectiveness of antidepressants to placebo.
Most of the trials were conducted in high-income countries, such as the United States and various European nations, and the participant sample was approximately 60 percent female, aligning with the known clinical prevalence of GAD.
Antidepressants were 41 percent more effective than a placebo in alleviating anxiety symptoms in people with moderate to severe GAD, according to the findings. There was no significant difference in dropout rates between the placebo and treatment groups, suggesting that these medications are generally well-tolerated.
“The research shows that antidepressants are highly effective at treating GAD, at least in the specific circumstances seen in trials,” Dr. Giuseppe Guaiana, associate professor of psychiatry at Western University and senior study author, said in a statement.
Antidepressants effectively reduced anxiety symptoms in people with GAD (and no other conditions) within one to three months, compared to placebo, he noted. This reduction in anxiety levels, as measured by standardized scales, is considered substantial enough to represent a noticeable positive change in a patient’s daily functioning and quality of life.
However, medication may be even more helpful when combined with another non-pharmaceutical approach.
Limited Data on Long-Term Effects
Researchers emphasized the lack of sufficient data on patients with GAD who also experience other mental health conditions, a common scenario in clinical practice.
“We don’t have enough information on the potential long-term benefits and harms of antidepressants, even though people often take them for years,” first author Katarina Kopcalic, who conducted the review at Western University, said in the statement. “This is an area that needs further exploration in future trials.”
Long-term antidepressant use is defined as taking antidepressants for more than 12 months. Many people with depression continue taking antidepressant drugs for months or even years after symptoms have resolved. This is called maintenance therapy, and it’s aimed to reduce the risk of relapse.
The review authors also pointed out that more independent, long-term research is necessary to fully understand the impact of antidepressants, particularly in patients living with multiple conditions.
The Risks of Abruptly Stopping Antidepressants
SSRIs work by increasing serotonin levels in the brain, which can help treat depression and anxiety. Serotonin is a chemical messenger that carries signals between nerve cells in the brain.
There is a withdrawal syndrome that can occur from abruptly stopping an SSRI, Dr. John Christman, a psychiatrist at Northwell Zucker Hillside Hospital in Queens, New York, told The Epoch Times.
Symptoms include nausea, lightheadedness, dizziness (sometimes referred to as “brain zaps”), or a general feeling of sickness.
“It is uncomfortable, but it’s not dangerous, it’s not lethal in any kind of way,” Christman said. “The danger occurs when you have a significant anxiety issue or a depressive disorder, and you’re about to stop the medication.”
In those cases, patients may experience a return of symptoms, which can be very dangerous. “Untreated depression and untreated anxiety are significant risks for bad outcomes in terms of suicide, making poor decisions, and dysfunction in relationships and one’s work environment,” Christman added.
Case Study: Suicide Attempt After Discontinuation
A case study published in The Journal of Clinical Psychiatry reported a 22-year-old woman with a history of depression and anxiety who attempted suicide after abruptly stopping her long-term antidepressant medication (escitalopram/Lexapro) when she ran out and couldn’t see her doctor.
Seven days after stopping the medication, she ingested a half-bottle of acetaminophen and was rushed to the emergency room.
The woman, identified as “Ms. A,” reported experiencing dizziness, muscle pain, and a sensation of electric shock sensations beginning four days after she stopped taking the drug, along with fatigue, loss of appetite, and suicidal ideation. Before stopping the medication, she denied experiencing suicidal thoughts. This case study is the first known report of antidepressant withdrawal causing a suicide attempt, according to the authors.
Antidepressant Discontinuation Syndrome
Ms. A’s case report illustrates a common complication of abruptly stopping antidepressant medication known as antidepressant discontinuation syndrome (ADS).
Estimates vary, but a recent meta-analysis in The Lancet Psychiatry found that about one in three people who stop taking antidepressants experience some discontinuation symptoms, which can include muscle aches, insomnia, restlessness, and brain zaps. There is also a 15 percent chance, roughly one in six to seven people, of experiencing withdrawal symptoms when stopping antidepressants. About 3 percent of patients experience severe withdrawal symptoms when stopping antidepressants.
The case study noted that nearly 35 percent of patients who abruptly discontinued paroxetine (a different antidepressant) in a clinical trial experienced withdrawal symptoms.
After restarting her medication, the woman’s depressive symptoms and antidepressant withdrawal symptoms resolved within four days.
Christman emphasized that the most important thing is to have a discussion with your health care provider before stopping these kinds of medications.
“It’s okay to, at some point, maybe consider to come off an SSRI,” he said. “You don’t have to be on these things necessarily for life. You can come off of them.”
