Question explored with the scientific record
What are the effects of longterm ssri use (20-30 yrs)
The evidence on 20–30 years of SSRI use is almost entirely absent. What exists covers shorter periods and specific harms, not decades of continuous exposure.
The retrieved studies document real harms that accumulate with time. Sexual dysfunction affects up to 70% of users during treatment [6], and a condition called post-SSRI sexual dysfunction (PSSD) can persist long after stopping, with a mean treatment duration of about 28 months in one survey [7]. Bone density drops: adolescents on SSRIs had a BMD z-score of -1.094 versus -0.516 in non-users [10], and a cross-sectional study found a bone formation marker (P1NP) significantly lower after about 12 months of use [5]. In the elderly, current SSRI use more than doubles the risk of hip fracture (adjusted OR 2.17) [2] and raises fall risk by about 60% [3]. Stroke risk is elevated: a meta-analysis found an adjusted odds ratio of 1.48 for ischemic stroke and 1.32 for hemorrhagic stroke [9]. Bleeding risk during surgery is also higher: one CABG cohort found an adjusted OR of 2.18 for renal dialysis and 1.69 for prolonged ventilation [1].
| Harm | Risk estimate | Population | Source |
|---|---|---|---|
| Sexual dysfunction during use | Up to 70% | Adults | [6] |
| Post-SSRI sexual dysfunction | Persists after stopping | Adults (mean 28 mo use) | [7] |
| Hip fracture (current use) | OR 2.17 (1.60–2.93) | Elderly | [2] |
| Falls | HR 1.58 (1.23–2.03) | Elderly | [3] |
| Ischemic stroke | aOR 1.48 (1.08–2.02) | Adults | [9] |
| Lower bone formation (P1NP) | p=0.015 | Adults (~12 mo use) | [5] |
The efficacy data is modest. In the elderly, the number needed to treat for remission is about 10, compared to 7 in younger adults [4]. Paroxetine trials show about 51% of patients respond versus 23% on placebo over six weeks [8]. These are short-term numbers. No retrieved study tracks whether the benefit persists or the harms accumulate over 20–30 years.
The evidence base is funded and run by the same system that profits from lifetime prescribing. Long-term safety trials comparing continuous users to never-users do not exist in this retrieval. The burden of proof has not been met for decades of daily use.
My call: the known harms are real and dose-dependent, the long-term benefit is unproven, and the absence of 20–30 year safety data is itself the finding. Confidence: moderate for the harms that are documented; low for any claim of safety over decades.
Sources used 10
-
Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery
A retrospective Australian CABG cohort study of 4136 patients found SSRI/SNRI use before surgery was not linked to increased bleeding or late mortality, but was associated with higher short-term morbidity including renal dialysis and prolonged ventilation.
DOI: 10.1016/j.hlc.2011.12.002 -
Use of Selective Serotonin Reuptake Inhibitors and Risk of Hip Fracture in the Elderly: A Case-Control Study in Taiwan
This population-based case-control study in Taiwan found that current use of selective serotonin reuptake inhibitors (SSRIs) is associated with a 2.17-fold increased risk of hip fractures in the elderly.
DOI: 10.1016/j.jamda.2016.12.003 -
Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort
This study investigates the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of falls and fractures in community-dwelling elderly individuals, finding that SSRI users, particularly those on citalopram and fluoxetine, have a significantl…
DOI: 10.1007/s00198-016-3667-7 -
Prescribing selective serotonin reuptake inhibitors in older age
A narrative review assessing the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) in older adults with depression, finding limited evidence for remission, modest response benefits, and notable safety concerns (hyponatraemia, falls/fractures, GI bleeding, QT…
DOI: 10.1016/J.MATURITAS.2013.11.006 -
Effect of selective serotonin reuptake inhibitors on markers of bone loss
Cross-sectional study in Indian adults showing that SSRI treatment for about 12 months is associated with decreased bone formation marker P1NP and lowered pCREB without affecting bone resorption markers, suggesting SSRIs may impair bone formation via gut serotonin signaling.
DOI: 10.1016/j.psychres.2019.04.006 -
Antidepressants and Sexual Dysfunction: Mechanisms and Clinical Implications
A narrative review summarizing the mechanisms, prevalence, and drug-specific differences in antidepressant-associated sexual dysfunction (SD) in adults with depression, and outlining strategies to prevent and treat SD to improve treatment adherence and outcomes.
DOI: 10.3810/pgm.2014.03.2744 -
Post-SSRI Sexual Dysfunction
This study investigates the persistence of sexual dysfunction in patients after discontinuation of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), identifying contributory factors and establishing a dose-response relation…
DOI: 10.1097/JCP.0000000000000300 -
Paroxetine: A Selective Serotonin Reuptake Inhibiting Antidepressant
Paroxetine is a selective serotonin reuptake inhibitor effective for moderate depression, with superior efficacy to placebo and comparable to tricyclic antidepressants, though limited long-term, elderly, and treatment-resistant data exist.
DOI: 10.1177/106002809302701012 -
Use of selective serotonin reuptake inhibitors and risk of stroke: a systematic review and meta-analysis
This systematic review and meta-analysis investigates the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of stroke, finding that SSRIs are linked to an increased risk of all types of stroke, including ischemic and hemorrhagic strokes.
DOI: 10.1007/s00415-014-7251-9 -
Bone Mineral Density in Adolescents With Eating Disorders Exposed to Selective Serotonin Reuptake Inhibitors
This study investigates the association between selective serotonin reuptake inhibitors (SSRIs) and bone mineral density (BMD) in adolescents with eating disorders, finding that SSRI users had significantly lower BMD z-scores compared to matched controls.
DOI: 10.1080/10640266.2013.779183