The Dangerous Downsides of Antidepressants

When a new antidepressant made the cover of Newsweek 35 years ago, the headline announced: “Prozac: A Breakthrough Drug for Depression.” It was hoped that this medication (and many others to follow) would revolutionize the treatment of mood disorders. There is now some doubt that these drugs have lived up to the promise, but they have made billions for drug manufacturers. Antidepressants have become one of the most prescribed categories of medicines in the U.S. Our back-of-the-envelope calculations suggest that 44 million Americans are currently taking one of these drugs. Have they been informed about the downsides of antidepressants?

What Are the Downsides of Antidepressants?

What was not anticipated when these medications were approved was the possibility that they would also have some serious side effects. Perhaps the biggest surprise was drug-induced suicidal thoughts (ideation). Most clinicians resisted the idea that antidepressants might trigger thoughts of self harm. Even the FDA was slow to consider this adverse reaction.

We were alerted to this possible problem in the spring of 1990. We contacted the manufacturer, Eli Lilly, and were told not to worry about an association between Prozac and suicidal ideation. The FDA did not seem worried about such a potential association either.

Eventually though, a boxed warning was added to the prescribing information for most antidepressants:

“Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies.

“In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors.”

We can’t prove this, but we suspect that a lot of prescribers do not mention this warning when they write a prescription for an antidepressant. Read more about the downsides of antidepressants at this link.

A Personal Story Speaks Louder Than a Boxed Warning:

Most people do not relate to FDA technical language. That is why we try to share stories from readers.

Here is a poignant tale about the downsides of antidepressants:

Q. I have a very sensitive system and react strongly to medications. After taking Prozac for a week, I became suicidal and was then hospitalized for 10 days.

While I was heavily medicated, I allowed my stockbroker to make irresponsible decisions and lost my life savings. I also shopped and spent indiscriminately when, in the past, I’ve always been a good saver.

This past spring, I’d had enough and spent eight painful, distressing weeks withdrawing from escitalopram. My doctor was “shocked and dismayed” that I was having withdrawal symptoms.

I currently take bupropion which just gives me energy and helps with cravings. Recently, relatives have commented that I am more like my old self, more expressive, brighter and clearer. I know my brain has cleared and that I am thinking more coherently. I wonder why psychiatrists don’t notice the negative consequences of some antidepressants sooner and help more to ease withdrawal.

A. People react differently to medicines, including antidepressants. Most doctors know this, but they don’t always appreciate how it affects their patients’ life experience. We wish that they would pay closer attention when a patient says, as you did, “I react strongly to medications.”

Antidepressants are double-edged swords. They can save lives when they nudge people away from the brink of suicide. Sometimes they even restore the color and flavor to life.

On the other hand, most antidepressants can cause unpleasant or even dangerous side effects in some people, including suicidal ideation in some instances. Patients should be well informed about potential benefits and risks before starting any prescription, and they should feel comfortable sharing any unexpected reactions with the prescriber.

Other Unexpected Downsides of Antidepressants: Weaker Bones:

A totally unexpected complication  of antidepressant drugs is hip fracture (Age and Ageing, July, 2013). Norwegian researchers reviewed data from more than 900,000 people born before 1945. They discovered roughly 40,000 hip fractures (4.4%). People taking newer generation antidepressants had a 60 to 80% increased (relative) risk of such breaks.

Antidepressants Linked to Hip Fracture:

• Citalopram (Celexa)
• Duloxetine (Cymbalta)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Mirtazepine (Remeron)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Venlafaxine (Effexor)

The researchers reached the following conclusions:

“Key Points

• The risk of hip fracture was markedly increased among older people exposed to antidepressant drugs.
• Individuals exposed to SSRIs and other drugs with serotonergic properties were at greatest excess risk.
• About 5% of hip fractures in Norwegian seniors were attributable to antidepressant drug exposure.”

This is a very big deal, since hip fractures are a major cause of disability and death in older people. According to the CDC, nearly 300,000 Americans over the age of 65 are admitted to hospitals each year because of hip fractures. About 1 in 5 will die within one year.

Although it is not clear why antidepressants increase the risk for broken hips, there are two possibilities. One is that drugs with a strong impact on the neurochemical serotonin may reduce bone mineral density and increase the risk for osteoporosis. The other is that antidepressants could make older people more vulnerable to falls. Weaker bones plus unsteadiness is a deadly combination.

A More Recent Study into the Downsides of Antidepressants and Weaker Bones:

Bone loss is not the kind of adverse effect that is likely to show up in a clinical trial. That’s especially true because most clinical trials of antidepressants last only 8-12 weeks (medRxiv (Feb. 28, 2025). That’s not enough time to detect such a problem.

The authors of that study conclude:

“A substantial discordance exists between the typical 8-week duration of clinical trials and the median 5-year real-world use of antidepressants.”

A “systematic review and metanalysis” published in Orthopedic Reviews (Oct. 13, 2022) was titled:

“The use of antidepressants is linked to bone loss“

The authors conclude:

“This systematic review with meta-analysis for the first time provides evidences about the correlation between all antidepressant types use and BMD [bone mineral density], greatly reinforcing the idea of a biological implication of antidepressants in bone turnover.

“Our data suggest that SSRIs are associated with a decrease of BMD. We aim to raise clinicians’ awareness of the potential association between the use of antidepressants and bone fragility to increase monitoring of bone health.”

Another Serious Complication: Bleeding

On April 29^th, 2013, an article in JAMA Internal Medicine reported that SSRI-type antidepressants such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) were linked to an increased risk of post-surgical bleeding. The investigators hypothesize that such medications may affect blood platelets, which are responsible for blood clotting.

Because prior studies suggested that such drugs might pose a bleeding risk if taken around the time of surgery, investigators combed the records of more than half a million patients. Roughly 70,000 (13.7%) had taken one of the mentioned SSRIs or citalopram (Celexa) or escitalopram (Lexapro).

The authors noted:

“Although the implications of bleeding clearly differ according to the surgical procedure, SSRI association with adverse outcomes appeared relatively consistent in a range of patient subgroups. Concern for the potential associations of SSRIs with bleeding outcomes has already been incorporated into available clinical practice references, several of which suggest stopping or holding SSRI therapy for 2 or more weeks before surgery, with particular attention to holding SSRI therapy in patients undergoing neurological or orthopedic surgery.”

That seems sensible enough, but what the researchers don’t seem to appreciate is that stopping antidepressants suddenly can trigger terrible withdrawal symptoms. When the FDA approved these drugs, most physicians and patients did not realize that there could be withdrawal symptoms if the drugs were stopped (“sudden discontinuation syndrome“).

We have heard from hundreds of people who have experienced unbearable symptoms when they discontinued such drugs. This means that if surgeons tell their patients to stop an antidepressant a week or two prior to surgery, there could be hell to pay.

Sudden Withdrawal Symptoms:

• Brain “zaps” (electric shock-like sensations in the brain)
• Dizziness, light-headedness, vertigo, feeling faint
• Headaches
• Anxiety, irritability, hostility
• Nausea, diarrhea, digestive upset
• Tremor, hands shaking, nerve tingles, strange sensations
• Fatigue, tiredness, lack of energy
• Visual disturbances

Here are just a few stories from people who stopped an antidepressant medication suddenly:

Shel reports that sudden discontinuation syndrome was horrific:

“Due to a change in our insurance and lack of communication from our company, I wasn’t able to refill my prescription of Cymbalta. Saturday was my last dose and as of Monday I felt like I was losing my mind but didn’t know why. Ohhhh, how ignorance is NOT bliss in this situation.

“I’m sitting in my office and I think today was the worst physical and emotional roller coaster ride I have EVER been on. I have literally gone from wanting to scream, throw things or hit someone to crying in a matter of minutes…ALL DAY.

“My head is spinning and every 30 seconds or so, I hear this ‘whoosh, whoosh, whoosh’ in my ears (similar to hearing your pulse when you have a bad migraine). I have this creeping crawling feeling going up the back of my neck when I feel an attack coming and need to quickly excuse myself from normal conversations. These are not stressful conversation by any means. Or, I suddenly just start sweating.

“This is absolute craziness!”

Cathy also experienced withdrawal symptoms:

“I took Pristiq for about two years. I tried to taper off as my MD advised. It was over 3 weeks but I experienced terrible brain zaps, anxiety, insomnia and irritability and did not go to work for about 10 days. It was one of the worst experiences I have ever had. I am on a healthier approach to handling life’s stresses: exercise, relaxation, aromatherapy, massage and vitamin support.”

Jess is another victim of sudden discontinuation, but offers a note of optimism:

“I have now been completely sertraline free for over a month, and my withdrawal symptoms are finally gone.

“I had them all: nausea, brain shocks/zaps, vertigo, headaches, digestive problems, numbness/tingling in my hands, feet, and face.

“I’m writing to let you know that it does get better, even on days when you think you cannot possibly survive one more hour of feeling so sick. SSRI withdrawal is painful and scary and, as many others who have commented on this website, if I had known what it would be like to wean off of this drug I would never have taken it.”

Recognized Adverse Reactions from Antidepressants:

There are some serious downsides of antidepressants. Here is a more conventional list:

Antidepressant Side Effects:

• Nausea, stomach pain, constipation, diarrhea, decreased appetite, vomiting
• Dry mouth
• Insomnia, anxiety, tremor
• Dizziness, fatigue, sleepiness
• Sweating, hot flashes
• Blurred vision
• Headache
• Sexual dysfunction, lowered libido, erection difficulties, lack of orgasm
• Liver damage
• Serious skin reactions, rash, hives (requires immediate MD assistance!)
• Glaucoma
• Irregular heart rhythms
• Bleeding problems
• Blood pressure problems
• Interaction with other drugs (leading to serotonin syndrome among other reactions)
• Pneumonia
• Seizures
• Depressed mood, suicidal thoughts and behavior, suicide

For people with major depression, antidepressant medication can be a lifesaver. Such drugs should NEVER be discontinued suddenly or without medical supervision!

Clinical trials have not revealed all the downsides of antidepressants. Paroxetine, for example, interacts dangerously with numerous other medications (Psychopharmacology Bulletin, March 1, 2016). In reviewing these as well as side effects such as problems with male fertility, birth defects, autism, weight gain and suicidality in adolescents, the clinicians titled their article: “Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required.”

Are Antidepressants Overprescribed?

We do worry that antidepressants have been prescribed too casually. A study (Psychotherapy and Psychosomatics, online, March 27, 2013) revealed that as many as two-thirds of the patients diagnosed with depression did not actually meet criteria for major depression. Older people (over 65) were especially vulnerable to overdiagnosis. When people are inappropriately diagnosed as being seriously depressed, they frequently get psychiatric medicine–not just antidepressants but antipsychotic drugs as well.

The author concludes:

“Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.”

Learn More:

To read more about the downsides of antidepressants and learn about other ways to treat the blues, you may find our Guide to Dealing with Depression helpful.

We would also like to hear from you. How well have antidepressants worked? Did you experience side effects or withdrawal symptoms? Please share your story below.