Exploring if it's okay to be on antidepressants for life: A guide to weighing the benefits and risks

October 6, 2025 •

4 min read

Antidepressant prescriptions in England have more than doubled in the last decade, with an increasing number of people continuing treatment long-term. For many navigating persistent or recurrent mental health conditions, the question of whether it is okay to be on antidepressants for life is a crucial consideration, weighing the immense benefits of symptom control against potential prolonged risks. This decision involves a careful, ongoing dialogue between a patient and their healthcare provider.

Quick Summary

Long-term antidepressant use is a viable strategy for managing chronic conditions but requires a careful and ongoing risk-benefit analysis. This process involves a patient and their doctor considering factors like a patient's history, treatment response, the potential for long-term side effects, and strategies for discontinuation. Regular evaluation is crucial for personalized care.

Key Points

Not one-size-fits-all: The decision to stay on antidepressants long-term is highly personal and depends on individual health, history, and the risk of relapse.
Chronic illness model: For those with recurrent or severe depression, long-term medication is a valid strategy, similar to managing a chronic physical disease like diabetes.
Potential for side effects: Extended use can lead to side effects such as weight gain, sexual dysfunction, bone density changes, and emotional blunting, requiring regular monitoring.
Combined therapy can be superior: Combining medication with psychotherapy, such as CBT, can be more effective for severe depression and may reduce relapse risk.
Discontinuation requires a plan: Abruptly stopping antidepressants can cause discontinuation syndrome. Any changes to medication dosage or duration should be done slowly under a doctor's guidance.
Ongoing medical supervision is vital: Regular check-ins with a healthcare provider are necessary to evaluate the ongoing risk-benefit profile, monitor for side effects, and re-assess the treatment plan over time.
Patient input is crucial: The patient's own preferences and experience with the medication should be central to the shared decision-making process with their doctor.

When Long-Term Antidepressant Use is Considered

For some individuals with chronic, recurrent, or severe depressive episodes, long-term or even lifelong antidepressant therapy is a legitimate and often necessary treatment strategy. Continuing medication after achieving remission can prevent relapse. For more information on when long-term use may be considered, refer to {Link: Frontiers in Psychiatry https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1415905/full}. Managing chronic mental health conditions with indefinite medication can be compared to managing chronic physical illnesses, where sustained treatment is necessary for well-being.

Weighing the Risks and Benefits of Long-Term Treatment

While effective, long-term antidepressant use has potential drawbacks, requiring a balance between stable mental health and potential chronic side effects.

Potential Risks of Prolonged Antidepressant Therapy

Long-term antidepressant use is associated with several potential risks that require monitoring. This includes weight gain, with some antidepressants like TCAs and mirtazapine being linked to this side effect. There may also be an increased risk of cardiovascular issues, particularly with non-SSRI types, though distinguishing medication effects from depression-related risks is challenging. Long-term use, especially of SSRIs, has been linked to decreased bone density and a higher fracture risk. Research on cognitive function is ongoing, with some studies finding no significant link between long-term antidepressant use and increased dementia risk in cognitively healthy older adults. Sexual dysfunction, such as reduced libido and difficulty with orgasm, is a common and often persistent side effect. Some individuals also report emotional blunting. Stopping or reducing dosage can lead to antidepressant discontinuation syndrome (ADS), which involves withdrawal-like symptoms such as dizziness, nausea, headaches, fatigue, and mood changes. Gradual tapering under medical guidance is essential.

The Role of Psychotherapy and Combined Treatment

Psychotherapy addresses underlying thought patterns and behaviors, and combining it with medication can be highly effective. Combined therapy is often more effective for severe depression than either treatment alone and may reduce the risk of relapse. For mild to moderate depression, psychotherapy can be effective on its own and potentially lead to better long-term outcomes after discontinuing medication.

Weighing Options: Medication vs. Combined Therapy

The table below outlines key considerations when comparing long-term medication use versus a combination of medication and psychotherapy.


Feature	Long-Term Antidepressant Medication	Combined Medication and Psychotherapy
Symptom Management	Directly targets neurochemical imbalances to manage symptoms.	Addresses both neurochemical factors and underlying psychological and behavioral patterns.
Effectiveness	Highly effective for many patients, especially for recurrent or severe depression.	Often more effective for moderate to severe depression; may also reduce relapse risk.
Relapse Risk	Increased risk of relapse if discontinued, especially abruptly.	May offer a longer-lasting effect and lower relapse rate after treatment termination compared to medication alone.
Potential Side Effects	Risk of long-term side effects, including weight gain, sexual dysfunction, and bone health issues.	Potential for side effects from medication, but therapy can help manage behavioral aspects related to mental health.
Discontinuation	Requires careful, supervised tapering to avoid antidepressant discontinuation syndrome.	Discontinuation of medication still requires tapering, but psychotherapy can equip patients with coping strategies for the transition.
Patient Autonomy	Can create a dependency on medication for symptom control.	Teaches skills and strategies that empower patients to manage their mental health independently over time.

Making the Decision: A Collaborative Process

Deciding whether to take antidepressants for life is a collaborative process between a patient and doctor, considering the individual's history, symptom severity, treatment response, and lifestyle. Key aspects include:

Personalized Risk-Benefit Analysis: Regularly review medication effectiveness against side effects. For some, the benefits of stable mood outweigh the risks.
Ongoing Monitoring: Regular check-ups are needed to monitor physical health, assess cognitive function, and evaluate the treatment plan.
Trial Discontinuation: Under medical supervision, a slow taper may be attempted to see if the condition remains stable without medication. This can be combined with psychotherapy.
Patient Preference: The patient's values and preferences are crucial in determining the best long-term strategy.

Conclusion

For some, managing a chronic, relapsing mental health condition lifelong with antidepressants is the most effective and safest path to sustained well-being, similar to managing other chronic illnesses. This involves weighing the benefits against manageable risks. The decision requires open communication with a healthcare provider, and combining medication with psychotherapy often leads to the most robust and enduring recovery. This continuous process ensures the treatment plan aligns with the patient's evolving health, needs, and preferences.

Navigating Lifelong Treatment

For further information on mental health treatments, including medication and therapy, consider resources from reputable organizations like Harvard Health Publishing.

Medication or therapy for depression? Or both?

What are the different types of antidepressants?

Different types of antidepressants work in various ways to balance brain chemicals. Common classes include Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine, sertraline, and escitalopram, and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), such as venlafaxine and duloxetine. Older classes like Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) have more significant side effects. Atypical antidepressants, such as bupropion, represent a newer group.

Frequently Asked Questions

Stopping antidepressants, especially after a prolonged period, can trigger antidepressant discontinuation syndrome. This can cause flu-like symptoms, nausea, insomnia, dizziness, and mood changes. A gradual tapering schedule, supervised by a doctor, is crucial to minimize these effects.

Common long-term side effects of SSRIs can include weight gain, sexual dysfunction, and potential links to changes in bone density. Emotional blunting, or a feeling of numbness, has also been reported by long-term users.

Some studies have suggested an association between long-term antidepressant use and increased risk of heart disease, especially with certain non-SSRI types. However, research is ongoing, and it is difficult to separate medication effects from the cardiovascular risks associated with depression itself.

Discontinuation symptoms typically appear within days to weeks of stopping or tapering medication and can include physical complaints like dizziness. Relapse symptoms tend to develop more gradually over weeks or months and mimic the original depressive symptoms. A doctor can help distinguish between the two.

For many, especially those with mild to moderate depression, psychotherapy can be a highly effective treatment alone. For severe or recurrent depression, a combination of medication and psychotherapy is often recommended and may offer better long-term outcomes than medication alone.

Your treatment should be reviewed regularly with your doctor, not just in the short term. The National Institute of Health and Care Excellence (NICE) recommends reviewing maintenance treatment up to two years, but this should be ongoing, especially if you plan to continue for a longer duration.

A large population study found no association between long-term antidepressant use in cognitively healthy older individuals and increased dementia risk, cognitive decline, or brain atrophy. However, some other studies have had conflicting findings, so close monitoring is recommended.