Walk with me, into a fall landscape, the air filled with the trills of migrating sandhill cranes. We won’t get to see them, but scoops of pelicans instead, circling high and eventually resting on what is left of the ponds.

There is yellow around,

and orange/red,

and brown,

and the occasional daily wildlife unexpectedly appearing deep in the woods.

The oaks are taking on a brownish hue, their leaves already falling,

the flickers flitting from one tree to the next.

Farmers are mowing the meadows, and the remaining short grass forms golden, wave-like patterns, a sea minus the threat of drowning.

Nature’s beauty swept away sadness – which brings me to today’s topic, my familiar rant against claiming scientific data when the reported pattern is ambiguous, in this case about getting off longterm anti-depressants. The issue came up during a long car ride when we listened to an NPR Shortwave podcast describing the withdrawal symptoms that some people report after years and years of taking popular antidepressants, SSRIs like Zoloft, Prozac or Lexapro. Below is a summary of our reactions, two psychologists trying to be careful.

First of all, I strongly believe anti-depressants are a valuable and often necessary tool in the fight against depression. They do have occasional side effects during use, but they are life savers, literally, for people living with clinical depression due to biological factors. They also work for people who experience overwhelming sadness due to short term events in their lives, making it possible to return to normalcy after existential threats or losses. Do we have an over-prescription problem, with 1 in 10 Americans currently on anti-depressants? I don’t know. The problem for today’s conversation is what happens when you get off of the meds.

The Shortwave podcast started with a human interest story of an investigative reporter who had been on SSRI’s for 15 years; she had gotten onto them for, as she remembers, mild problems. After all this time, she then did off-ramping with guidance from her doctor, with successively smaller doses across 1 month. (This is the way recommended by the companies who sell the drugs, stressing that the dosage and timing of this off-ramp needs to be proportional to what you took and for how long.) Despite this careful and planned exit from the drug, she was apparently thrown into both psychological and physical horror experiences. Scouring the internet she found many reports of people, now even in support groups, claiming something similar happened to them after long-term use (years, not months). She found no matching reports from people who used the meds for less than a year. Symptoms reported included existential dread, panic attacks, fatigue, dizziness, and diarrhea, among others. She found no longterm epidemiological studies to document these patterns.

So what’s going on here? Do we take these self reports at face value? Do we trust the implication that these drugs have some previously undocumented side effects with long term use, perhaps disrupting some sort of internal system?

Let’s check a bunch of possibilities first:

• We are dealing with self report on the internet and these reports might be sustained, encouraged, and even over-stated, thanks to the patterns of internet culture. We’re also missing a crucial comparison: Are symptoms more frequent among people coming off the drug than they are for randomly selected people in the population of similar age and similar circumstances? The symptoms may be more common for people coming off of SSRI’s, but we don’t know, and this question is clouded by the reliance on self report. Maybe other people, not coming off meds, are experiencing similar problems at a similar frequency, but (with no encouragement and no support groups calling for information) have no reason to come forward and report their experience. In short: Understanding the pattern requires comparison about exactly who is going through these problems and, among other concerns, any reliance on volunteered self report raises the possibility that numbers are inflated by encouragement to report or some sort of band wagon effect.

• Next, do we know if all those reporting followed the tapering required for off-ramping? We have no reliable information about whether some of the people – perhaps many of the people – reporting these problems just stopped abruptly taking the meds. And if it turns out that people did taper off the drug properly, are the problems reported specific to SSRIs or can similar problems be documented for other psychological meds stopped after long-term use? (If so, this is not a problem of SSRI’s, and may not even be a problem somehow linked to anti-depressants per se.)

• Similar concerns attach to the reported difference in experience between long-term users and short-term users. The claim is that these problems are specifically associated with long-term use, and specifically with SSRI’s. We need real data on this before drawing conclusions, and the problems already described – with volunteered self-report – are also a limitation here?

• In addition, the idea here is that people say their symptoms after leaving the drug are much worse than the problems that put them onto the drug in the first place. Can we count on this memory being accurate – especially since people are remembering their initial status years, and perhaps decades, back?

Assuming all of these questions are answered to our satisfaction, – the self reports are real, the frequencies hold, long-term vs short term differences are established, memory serves accurately – there is still a large scale question about cause and effect.

As one complication, during long-term use the person has obviously aged. We know that age changes things in the body, leaving you less resilient. More, external things can get harder with age, including a loss of economic safety, a place in the world, a shrinking of your circle of friends and family due to death. In other words, if your symptoms are worse when you leave the drug, is it possible that your life has gotten objectively worse? Or that your life problems are just as they were “pre-drug,” but your ability to cope is diminished? Add to that that many SSRI patients are female, and many go through menopause during long-term use. In these ways, if the person’s problems after leaving the meds are worse than problems before the meds, this may have nothing to do with the meds themselves!

These are all answer-able questions, and – of course – maybe the withdrawal patterns for some long term users are real, and maybe their frequency is not matched by short term users. Maybe there are good answers to the question of what causes these patterns. The key, though, is that the initial report (the sort of science reporting we all encounter in the news, on social media, leaves out information that is crucial for understanding what’s going on. Scientists generally are alert to this worry, but journalists are not, nor are most members of the public.

So far, it seems that any claims about long-term SSRI use aren’t justified – and, given recent events in the news, we need to be alert to unwarranted claims about medicine or medication.

Should researchers take steps to remove this ambiguity? Yes!

In the meantime, it would be a mistake to forgo the clinical use of medications that we know have helped millions of people. I fear that podcasts like these might be detrimental to people who take the reporting at face value and make medical decisions that would be different otherwise.

Music today a favorite cello concerto. Conductor C. Eschenbach was 80 at the time of this recording.He turned 85 this February and is still actively working.