Jacob Z. Hess, Ph.D.
Between 2005 and 2009, I conducted a dissertation study exploring the contrasting narratives of people on anti-depressants after years of treatment. During my defense, a professor asked me “so why are so many people in Utah on anti-depressants?”
Most people have heard the Salt Lake Tribune explanation, which attributes this pattern largely or entirely to the LDS Church itself, especially to the so-called implicit pathology within the Mormon faith experience (e.g., perfectionism, shame, high standards, busyness). Without denying these as real issues to keep exploring, it’s never felt like these cultural elements quite capture what’s really going on.
So in that moment, I raised another possible answer for my dissertation committee: “Conservative people trust authority! And compared to my liberal friends who pepper doctors with all sorts of questions, when a physician informs my neighbors in Utah that this medication is going to take care of your problem….well, they believe it. And they follow!”
Some immediate fruits of compliance. In many times of life, of course, this “willingness to obey” is a good thing – including even with a doctor’s prescription.
And, indeed, studies show that a certain percentage of people on an anti-depressant can experience some kind of short-term relief (varied figures depending on the study, the sample and the severity of depression), with another group sometimes finding relief in a second or third or fourth attempt. For someone in a desperate place, this bit of relief can mean a lot – and even be life-saving.
I am definitely one who is supportive of people following their intuition and personal sense of what is best in seeking whatever relief they need. That, however, is sometimes where our conversation stops. We talk a lot in our public mental health conversation about moving from a place of fear or stigma – to an openness to receive help. And we focus extensive attention on vivid stories about people finding heartening shifts after starting something like an anti-depressant.
No wonder, then, that people are excited to try something – anything – with a shot of bringing them relief. And it’s totally understandable that we’re grateful when any sort of relief actually comes.
But here’s the question we’re not thinking about: what happens next – after the miracle moment? Curiosity about that long-term picture is what drives much of my own writing and research.
Looking long-term. In 2009, after losing a friend to suicide, one of my colleagues Bob Whitaker started exploring the same question.He gathered together every single medical study exploring long-term outcomes of psychiatric medications, including anti-depressants. And what he found surprised him…no, it shocked him.
As expected, anti-depressants showed short-term improvements for patients (which is why the FDA approved them for public use). But looking long-term, these same medications begin to have more counter-intuitive effects. Similar to other drugs (anti-anxiety, anti-psychotics, and pain-killers), their longer-term results are consistently underwhelming, and even alarming. In particular, the following pattern kept emerging: People on anti-depressants long-term, compared to comparison groups, were more depressed than those not (see pages 164 -169, in particular).
You don’t need to believe me on that! Several different research indicators point in the same direction (see also pages 157-163). Generally speaking, people taking anti-depressants long-term don’t fare so well. That’s the simple truth.
I can’t live without you. If that’s true, then why do people stay on them long-term? Because they become convinced they cannot live without them – and the withdrawal effects they experience in attempting to taper seem to only confirm that.
In my own study, I found that when people tried to get off, they often tapered so quickly that withdrawal effects overwhelmed them. Rather than see this turbulence as reflecting withdrawal effects, however, most people interpreted them as the “return of depression.” That, in turn, became evidence of how much “I really need this” – even though, by this point, many people seemed to experience little to no real therapeutic effect. After many years, in other words, many people end up essentially deciding to stay on the drug to avoid the bad effects that sometimes arise when they taper (which they interpret as a “return of the depression”).
One woman told me, “I’m grateful that I was born in this day and age where I could get the medication that I need so that I wouldn‘t be locked up in the attic somewhere, or indisposed all the time (laughs).” Another person added commented, “I’d really like to be off the meds, but the person off the meds is scary” (p. 90).
As reflected here, many people learn at some point that they cannot be okay without the anti-depressants. What may have been a helpful message to prompt people to get help in the first place, seems ironically to contribute to a longer-term dependency on the medication. And indeed, many professionals now just assume that depression has a natural long-term course – without questioning why so many people seem to be finding that to be true now, compared to previous eras.
Another way forward. But it doesn’t have to be this way! The medical research confirms literally hundreds of potential contributors to depression, alongside hundreds of things people can do to begin moving in a direction of long-term healing.
To be very clear: If an anti-depressant has helped you move towards healing, wonderful!! All I’m adding here is that anti-depressants were never intended (or tested or proven) to be a long-term remedy. So appreciate whatever help they have offer you now; and be sure to leverage that time to create an infrastructure for longer-term healing. As part of that plan, consider the possibility of tapering off anti-depressants as a part of your sustainable healing package.
When that time is right (and you and your loved ones are the best ones to know that, ideally in consultation with a doctor), you can begin the task of tapering off anti-depressants. For people who have been taking anti-depressants for years, this will not (and typically cannot) be a quick process, with a need for careful medical management and support. The time and way of doing that needs to be carefully considered – and hopefully with the supervision of a doctor.
And please read this important caution: The purpose of this blog is to raise a question and point towards a possibility. This is not to be confused for medical advice. The information contained here does not constitute medical advice and should not be relied on as advice for specific medical conditions that depend on a medical examination by a doctor licensed to practice medicine. Although I have received a doctorate with a focus on this area of research, I can only make general statements – and do not have authority to make any particular prescriptive recommendations. This means I cannot say whether or when it’s right for any given individual to consider the possibility of tapering off anti-depressants. I am simply raising this possibility and question as something each person (ideally in consultation with a doctor or other medical professional) can consider for themselves. Furthermore, these are my own thoughts and do not represent any institution or person with whom I have collaborated.
I acknowledge (and expect) that some will see this as a dangerous possibility to raise – especially those convinced that patients have an inherent need for the medication. Clearly it’s not time for everyone to taper off Prozac – since for some, it may be an important part of their well-being for awhile. I acknowledge that possibility here.
To not acknowledge this other possibility however – the possible benefits of tapering off at some point (and the possible detriments to not doing so) – is I believe unethical. In a moment when one in 10 Americans (and one in four middle-aged women) is on an anti-depressant and the burden of chronic mental illness only accelerating, the last thing we want to do is foreclose fresh possibilities.
Indeed, this could be phenomenally good news for people facing long-term depression. Instead of looking forward to yet-another-year simply “managing or coping with their depression,” this invites space to at least consider higher levels of well-being potentially available to that person. And indeed, the good news is that it’s not only possible, but that long-term, people can start to feel more themselves again after getting off anti-depressants.
For those interested in hearing more about this broader approach to working with mental/emotional distress, check out this free online course available here – Mindweather 101: Creative ways to work with intense thoughts and emotions. drawing on insights from many professionals and researchers.
For those who remain skeptical at any of this and see it as falling somewhere on the spectrum from silly to dangerous, I leave two challenges:
- Read this chapter summarizing the historical and scientific case behind this very concern
- Watch this 6 minute video on Learned Hopelessness.
After doing both, ask yourself the following: “Is it dangerous to let people know of the possible benefit of deep, long-term healing available (and not exclusively dependent on medication) or is it dangerous NOT to inform them of this?
In order to expand my own understanding, I’m gathering stories of people’s long-term experiences with depression (whether on or off anti-depressants, whether doing well now or not so well). If you have a story you’d be willing to share, contact me at Jacob@alloflife.org. I would like to better understand more of people’s long-term experience – especially those who have interest or experience pursuing tapering after many years.
I welcome any and all questions and inquiries.
 The evidence for this contention comes from a single 2002 study that has been widely cited and more often than not taken to be definitive causal proof that Mormonism is causing people to be depressed.
 For instance, this conclusion from one 2010 meta-analysis: “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”
What exactly it means for a treatment to be “successful” or “effective” is another point of sharp disagreement, however, as Jeff Lacasse and I explore here: “What Does It Mean for an Intervention to ‘Work’? Making Sense of Conflicting Treatment Outcomes for Youth Facing Emotional Problems”
 Physicians often make the same interpretation – “see? That just shows why you need to say on this medication.” Dr. Joseph Glenmullen, associated with Harvard University, was one of the first doctors to suggest another interpretation – namely, that withdrawal effects were at play in these negative effects arising after people begun tapering (and that these were often being misinterpreted as a simple return of depression.”
 In previous eras, depression was taken for granted to be time-limited – with early reports consistently suggesting high rates of people finding recovery (See Bob Whitaker’s summary of the history)
 Our own review of the medical literature has pointed towards numerous factors contributing to serious depression – each suggesting a possible point of intervention and adjustment.
If true, of course, this would be a possibility for anyone on anti-depressants, Latter-day Saint or not (with the latter the primary audience of my blog).
So what does this have to do with mindfulness anyway? Mindfulness is about increasing our awareness – of body, mind, heart and the world around us. I raise this as an area of exploration with vastly insufficient awareness currently – hoping that greater awareness will be helpful to individuals and families who are struggling.
 But what if you cannot find a doctor willing to supervise you? This is especially common given how many doctors have been fully convinced of the long-term chronicity of depression. Despite that, there are doctors willing to work with people interested in tapering, and who will support individuals following their sense of what is best. It is ideal when professionals support individuals in families in following their intuition of what is right, rather than overriding that by strong counsel.
 Read all you can about the process to get informed. I will only provide this guideline written by a doctor I trust at Harvard Medical School, since I want to stay far from the line of any specific recommendations. But with enough searching online, you can find various additional recommendations for a thoughtful wise, gradual, stepped, withdrawal plan.
 There are very different views of the physiological basis of mental/emotional problems. Depending on the view taken, it leads to very different conclusions about treatment. For an academic length treatment of this question, see this peer-reviewed paper published with several academics across the country: “Narrating the Brain Investigating Contrasting Portrayals of the Embodiment of Mental Disorder”
 This comes from an analysis by Elizabeth Kantor at Harvard University of a survey of nearly 40,000 adults, from 1999 to 2012. She found that the percentage of Americans on antidepressants had doubled over this period .
 There are, of course, very different views about recovery from depression and serious mental/emotional challenges: What exactly does it mean? What is realistic to expect, either short- or long-term? In collaboration with a set of diverse (and disagreeing) collaborators, we explored these questions in this peer-reviewed article here: “’Is There a Getting Better From This, or Not?’ Examining the Meaning and Possibility of Recovery from Mental Disorder.”