The longer someone takes antidepressants, the harder it can be to stop As an overworked medical school student, Mark Horowitz started taking an antidepressant 20 years ago to lessen his gnawing anxiety about his future. The pill, escitalopram, helped, and he didn’t give it much thought as he took the medication every day for the next 10 years. He decided to stop after reading an article suggesting antidepressants' effects tend to wear off over time, and tapered his dose carefully over several months.

Even so, he says, his life “exploded”. He started having panic attacks, terror, dizziness and insomnia. His surroundings felt “dreamlike”, like he were losing touch with reality.

The withdrawal was so much worse than the difficult but manageable depression that had prompted him to start on the medication. Horowitz eventually returned to the drug – not because he thought it was helping him, but because he found the withdrawal symptoms so unbearable. He’s not alone.

Escitalopram and other selective serotonin reuptake inhibitors (SSRIs) are common medications, billed as a safe way to mitigate depression with minimal side effects. However, growing numbers of people are speaking out about the problems of trying to reduce or stop their dose. These concerns raise bigger questions about whether we have been misled about antidepressants’ harmlessness and become overly reliant on them as a way to treat depression, anxiety and other mental health challenges.

Horowitz is now a psychiatry research fellow within the National Health Service (NHS) in England, and a leading voice pushing against the current approach to antidepressants. A spate of recent research – including his own – supports his experiences, and this growing evidence is finally having an impact, changing how we treat depression. How SSRIs became so popular In the nearly four decades since SSRIs were approved for medical use, they have embedded themselves into everyday life.

More than 16 per cent of people in the US now take antidepressants, the majority of which are SSRIs, according to an analysis of census data published in January, along with nearly 15 per cent of those living in the UK and 14 per cent of Australians. SSRIs weren’t the first antidepressants, but they became blockbuster drugs precisely because they are safer and have fewer side effects than other medications approved to treat depression. Earlier antidepressants like tricyclics served as effective treatments, but they also come with complex risks such as irregular heartbeats and tremors, and can be toxic at high doses.

SSRIs, by contrast, result in less serious side effects, including nausea, sleep disturbances and sexual dysfunction. Because of this lower risk profile, they quickly became the go-to treatment for depression and anxiety. There are good reasons to support their use.

A survey published last year of nearly 20,000 people in the UK taking SSRIs found that nearly three-quarters felt they were useful, though this figure is likely to be inflated by the placebo effect. Still, a 2024 analysis of more than 670,000 people with depression found the drugs had small to moderate effectiveness. SSRIs are widely used and often beneficial, but some psychiatrists say their downsides have been minimised But because SSRIs are purportedly so much safer than earlier antidepressants, clinicians and those taking them haven't monitored their use to the same extent as their predecessors.

As a result, SSRIs have been widely prescribed for decades with little advice on how or when to revisit prescriptions. A 2022 study reviewed clinical practice guidelines issued by national health authorities in countries including the US, UK, Australia and Canada and found that none provided concrete instructions on how to reduce dose or manage withdrawal symptoms. This means that, when people start taking antidepressants, they are often on the drugs for the long haul – whether they intended to be or not.

A study published last year showed th...