Approximately 1 in 6 adults in the United States report use of a psychiatric medication. Rates are significantly higher in adults older than 60 years, and long-term use is reported in the majority of cases.
Each medication is different, as is each person. Getting off medication just for the sake of getting off medication is an understandable desire, but should never be done without the close supervision of a doctor who knows your history. Some people are able to take psychiatric medicines short term and do great afterwards, others benefit from long term treatment. It is important to discuss with your medical provider before discontinuing a medication to prevent withdrawal or rebound symptoms that can be avoided with careful tapering of the dose when quitting. People should not try to work all this out for themselves, without consulting with a doctor, especially when they are on multiple prescription medications. Your doctor is likely to have advice about how to approach reducing the dosage safely.
There are different classes of psychiatric medications including stimulants, antidepressants, antipsychotics, mood stabilizers and antianxiety agents. The guidelines for treatment vary based on the disorder being treated and the medication.
Sometimes, medications are not used as recommended. Let’s use the example of the widely prescribed sleeping medication zolpidem. Although the sleeping drug zolpidem, sold under the brand name Ambien, is recommended for short-term use, as many as 68% of patients used zolpidem long term. A review medical publication found long-term use of zolpidem is associated with medication tolerance, substance dependence, rebound insomnia and central nervous system-related adverse effects. It was recommended that zolpidem be used for short periods of time using the lowest effective dose. Zolpidem 10 mg is effective in treating insomnia when used intermittently no more than five pills per week for a period of 12 weeks.
Depressive disorders typically require long-term treatment with antidepressants, psychotherapy, or both. The goal of antidepressant therapy is complete remission of symptoms and return to normal daily functioning. Studies have shown that achieving remission and continuing antidepressant therapy long after the acute symptoms remit can protect against the relapse or recurrence of the psychiatric episode. Many patients, however, inadvertently or intentionally skip doses of their antidepressant, and even discontinue it, if their symptoms improve or if they experience side effects. Antidepressant discontinuation may increase the risk of relapse or precipitate certain distressing symptoms such as gastrointestinal complaints, dizziness, flu-like symptoms, equilibrium disturbances, and sleep disorders.
At some point in the treatment of psychiatric disorders, the question of when to stop medication may arise. Patients or physicians may opt to stop treatment after a symptomatic response is seen, after remission is achieved, after remission and functional improvements have been maintained for a reasonable amount of time, or when intolerable side effects occur or appear to outweigh the benefits of the drug.
Pharmacologic therapy should be continued long enough to sustain remission and avoid relapses and recurrences. Regarding depression, relapse refers to a return of symptoms during the time in which the original depressive episode would have been expected to last (4–9 months). Recurrence refers to a return of depression at a time beyond the expected duration of the index episode (> 9 months after remission). An interval of 6 months has been thought to be the usual duration of antidepressant therapy. New recommendations, however, suggest that treatment should continue for up to 9 months after symptoms have resolved to prevent relapse and for longer to help prevent recurrence. Some experts maintain that antidepressant treatment should continue for 3 to 5 years and possibly for life.
Assessing the need for continuation of pharmacological treatment for a psychiatric disorder is an important issue to be addressed collaboratively between physician and patient. Ultimately, how long a person takes psychiatric medication depends on his or her individual illness, its responses to treatment and their personal situation.
We hope that this helps to answer your question.
Lynsey Segal, Pharm.D.
Roland Segal, M.D., DFAPA