Antidepressants are generally safe for most people and can be taken for years without complications. However, in determining the duration of treatment required for a depressive disorder, we need to consider the following:
- first episode versus recurring episodes of depression;
- any suicidal behaviour;
- any psychotic features;
- any family history of mood disorders;
- any upcoming stressors;
- any feature about the person’s personality that predisposes him or her to have multiple episodes of depression.
We also need to consider the patient’s health status; if there are physical health issues like kidney or liver problems, the person may have problems metabolizing the antidepressant. As a person becomes more mature in age, the dosage of the medicine may also need to be adjusted downwards.
We also need to bear in mind the possibility of drug interactions. For example, SSRIs may increase the risk of bleeding, especially when the person is taking other medications that increase the risk of bleeding, such as:
- nonsteroidal anti-inflammatory drugs (NSAIDs),
- aspirin,
- warfarin,
- other blood thinners.
I have come across the rare situation of serotonin syndrome, where an antidepressant causes high levels of serotonin to accumulate in the body. It most often occurs when two medications that raise the level of serotonin are combined. These include, for example, other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include:
- anxiety,
- agitation,
- high fever,
- sweating,
- confusion,
- tremors,
- restlessness,
- lack of coordination,
- major changes in blood pressure,
- a rapid heart rate.
We also need to exercise caution when using antidepressants during pregnancy or breastfeeding. Some antidepressants may affect the development of the fetus or child. There could be other alternative treatments which are equally effective that can be considered.
