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ROBYN P. THOM, MD JEANNE L. ALEXANDER, MD DAVID BARON, MSEd, DO AMIR GARAKANI, MD LAWRENCE GROSS, MD JANET H. PINE, MD RAJIV RADHAKRISHNAN, MD ANDREW SLABY, MD✠ CALVIN R. SUMNER, MD

Research Article Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough?

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Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications. They are among the first-line medications for several chronic or relapsingremitting psychiatric conditions, including major depressive disorder and anxiety disorders. The advantages of SSRI use include ease of titration and their tolerability and safety profile. Guidelines for the short-term use of SSRIs are widely available, but there is no well-organized guidance on how and whether to maintain a patient on SSRIs for the long-term. In this article, we discuss the benefits and possible adverse consequences of long-term SSRI use, as well as clinical practice considerations when using SSRIs chronically. The major benefit of long-term SSRI use is relapse prevention. The current literature suggests that the general health risks of longterm SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed. Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome. Recognizing that many patients may remain on SSRIs for many years, there are several factors that prescribers should consider if they choose to use an SSRI when initiating treatment and during long-term monitoring. The decision to continue or to discontinue an SSRI should be an active one, involving both the patient and prescriber, and should be revisited periodically. Patients who remain on SSRIs for the long-term should also have periodic monitoring to reassess the risk-benefit ratio of remaining on the SSRI, as well as to assess the safety, tolerability, and efficacy of the medication. (Journal of Psychiatric Practice 2021;27;361–371)

SSRIs are in the class of antidepressants, almost as many SSRI prescriptions are written for conditions other than depression. Many patients with chronic recurrent mood or anxiety disorders may be on an SSRI for a lifetime, although it should be noted that, in studies of SSRIs, follow-up of participants rarely extends beyond 2 to 3 years. A recent national survey found that over one fourth of the individuals taking an antidepressant had been on the medication for longer than 10 years.1 While guidelines for the management of short-term SSRI use are widely available, there is no well-organized guidance for clinicians on how and whether to maintain a patient on SSRIs for the longterm. This article offers a consolidation of current knowledge about the long-term use of SSRIs and provides clinicians with a framework for effectively managing extended treatment with these medications. The article will discuss SSRIs primarily and may use the term “antidepressant” interchangeably with SSRI, unless referring to another class of antidepressants.

KEY WORDS: antidepressant, selective serotonin reuptake inhibitor (SSRI), psychopharmacology, depression, anxiety, discontinuation syndrome, tachyphylaxis

Selective serotonin reuptake inhibitors (SSRIs) are indicated for the treatment of some of the most debilitating and chronic psychiatric disorders. Although

Journal of Psychiatric Practice Vol. 27, No. 5

THOM: Massachusetts General Hospital, Lurie Center for Autism; Department of Psychiatry, Harvard Medical School, Lexington, MA; ALEXANDER: Private practice, Berkeley, CA; BARON: Western University of Health Sciences, Pomona, CA, and Department of Psychiatry, Keck School of Medicine of University of Southern California, Los Angeles, CA; GARAKANI: Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, and Department of Psychiatry, Yale University School of Medicine, New Haven, CT; GROSS and PINE: Department of Psychiatry, Keck School of Medicine of University of Southern California, Los Angeles, CA; RADHAKRISHNAN: Department of Psychiatry, Yale School of Medicine, New Haven, CT; SLABY: Department of Psychiatry, Yale School of Medicine, New Haven, CT, and Private practice, New York, NY; SUMNER: Department of Psychiatry, Charles E. Schmidt College of Medicine of Florida Atlantic University, Boca Raton, FL

Please send correspondence to: David Baron, MSEd, DO, Western University of Health Sciences, Ofﬁce of the Provost, 309 E. 2nd Street, Pomona, CA 91766 (e-mail: dbaron@westernu.edu). ✠

Deceased.

The authors declare no conﬂicts of interest. DOI: 10.1097/PRA.0000000000000578

September 2021

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