Long Term Anti-Depressant Use Doesn’t Always Mean Better Quality of Life

According to the National Institute of Mental Health, about 21 million adults in the United States had at least one major depressive episode in 2020. And statistics show that only 1 in 5 people receive treatment consistent with current practice guidelines.

Depression can be caused by genetics, hormones, seasonal changes, stress and trauma or some combination of any of these factors. And sometimes, the root cause simply isn't understood. To cope and heal, countless people rely on antidepressant medications, which are one of the primary treatments for depression and are some of the most frequently used therapeutic medications in the U.S.

Still, the efficacy of antidepressants has remained controversial. And a new study suggests that, when taken in the longterm, antidepressants aren't linked to a higher health-related quality of life.

The Research

Researchers analyzed data from the United States’ Medical Expenditures Panel Survey, which tracks the health services used by Americans. The study focused on patients diagnosed with depression, which included 17.5 million adults each year from 2005-2016. Just over 57% of these adults received treatment with antidepressant medication, and the survey included two years of follow-up.

Their findings revealed that while antidepressants were linked to some improvements in mental health and social functioning, patients who used antidepressants didn't experience better change in health-related quality of life when compared to patients who didn't use antidepressants.

The study wasn't able to distinguish between subtype or severity of patients' depression, so its authors are careful to note that antidepressant medication can be helpful for countless individuals.

"For these patients we still recommend that they continue using their antidepressant medications but may want to ask their doctors to provide them with other non-therapeutic interventions as this may have additional impact on their [health-related quality of life]," says study author Omar Almohammed.

Clinical psychologist Roberta Ballard, PhD, has treated patients with depression for over 20 years. She's seen individuals that have benefited from antidepressants and relapsed when they stopped taking them, as well as patients whose recovery included no medication at all. At the same time, she's coped with her own chronic depression throughout her life and feels that while medication can help, therapy and other such factors as diet, exercise, social support and avoiding alcohol can play a crucial role in healing.

"I think people are focusing on one part of the study 'OMG! Meds don't work!' and missing the bigger picture," Ballard says. "Meds don't work for everyone, and they're not enough on their own to treat depression."

This could be because there's so much more to mental health issues than simply the chemicals in our brain, notes licensed professional counselor Jessica Frick, LPC.

"Antidepressants are sort of like fertilizer for a flower - they help it to grow, but if that's the only thing you give it, it won't grow," Frick says.

In the study's conclusion, researchers include a point related to this: "Future studies should not focus on the use of pharmacotherapy only, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions, such as behavioral therapy, psychotherapy, social support sessions, education, or combined interventions, on these patients’ [health-related quality of life]."

The Whole-Person Approach to Depression

Psychologist Jennifer Pfeuffer, PsyD, recommends a more integrative or whole-person approach to therapeutic intervention. Each person's body is different. Each will metabolize medication differently and develop a different tolerance, which is why medication alone is not an ideal long-term solution, she says.

"I have worked with individuals who are taking antidepressants and unsure of why, how long they've been taking them for, or even if they are working," Pfeuffer says. "When coupled with other medications for mental health and/or medical conditions, it can be quite a complicated situation."

The whole-person approach emphasizes the mind-body connection, and therapy is a major factor in healing. By focusing on all aspects of a person — physical, emotional, behavioral, social, cultural, spiritual, etc. — clinicians are able to tailor the treatment to the individual in hopes of getting to the root cause of their depression.

"With the whole-person approach, the treatment of depression becomes more expansive and individualized, as care providers can gain a better understanding about a person's history and current challenges associated with depression," Pfeuffer says.

This form of healing doesn't exclude antidepressants, either, Pfeuffer says. But in whole-person healing, practitioners work to understand how the medication impacts all systems within a person's life as a complement to therapy and other treatment methods.