First, kudos to ns, who was right on the money about the median length of time people stay on antidepressant medications (last week's 'challenge question'). According to a definitive study just published in the American Journal of Psychiatry, about half of all patients stop taking their meds within the first month.
This is a big problem, for a number of reasons:
(1) The vast majority of depressed patients will not achieve full recovery after just one month of treatment, and incomplete recovery is a huge risk factor for the recurrence of full-blown depression. Sadly, depression will return again eventually for 70-80% of all treated depressed patients - and that risk level actually goes up for those who terminate treatment before they're fully recovered.
(2) Because it's routine practice to prescribe antidepressants for at least 4-6 months (often much longer), it's safe to assume that most patients are discontinuing meds against medical advice. In other words, they're just stopping abruptly on their own. Unfortunately, most antidepressant meds have a well-defined withdrawal syndrome - which can include dizziness, nausea, headaches, lethargy, agitation, irritability, and even "electric" shock-like sensations in the head or limbs. Quitting these meds abruptly - without a doctor's supervision - can increase the chances of having these horrible withdrawal effects.
(3) The short-term 'cure rate' of antidepressants is low enough as it is - as low as 28% in the largest study published to date. And that's for the people who actually stay on the meds as prescribed . . . which means that the true cure rate in the real world is considerably lower, given how many patients discontinue treatment early.
But why would so many people stop taking their meds against the advice of their doctor? Although cost may be a factor in a small number of cases, in my clinical experience it's the nasty side effects that are usually the culprit. Sexual side effects - including an inability to experience orgasm and decreased libido - are quite common, especially in the SSRI class of meds that includes best-sellers like Zolft, Celexa, Lexapro, Prozac, and Paxil. Less talked about, but equally common, is the phenomeonon of 'emotional numbing' - a reduced intensity of negative emotions like sadness and anxiety, but also the blunting of positive emotions like joy and excitement (the movie Garden State did a nice job of portraying this phenemenon).
So, although they are truly a godsend for some, antidepressants don't represent a lasting cure for the majority of depressed individuals. Fortunately, there are other treatment options that look more promising for long-term success in the battle against depression, among them: aerobic exercise, omega-3 supplementation, behavioral activation, and interpersonal psychotherapy. I'll plan to elaborate on these in an upcoming post.