John Read is increasingly alarmed by the number of people in the UK who remain on antidepressants for years. 

For the psychologist and professor of clinical psychology at the University of East London’s School of Childhood and Social Care, the scale of long-term use represents what he calls a “medical disaster” that demands urgent attention.

“We have this false belief that has been sold to health professionals and the public that a chemical imbalance is behind depression, of which there’s no evidence,” Read told Medscape News UK.

“Patients are now using antidepressants for longer and longer. Why is that? It’s largely due to withdrawal. When people try to come off them, they can’t. This was a well-kept secret until recently, but which the drug companies knew about since 1990s.” 

Prescribing on the Rise

Concerns about widespread antidepressant use and the over-medicalisation of mental health in the UK are not new. What has changed is the scale.

In 2024-2025, 8.89 million patients in England were prescribed antidepressants, according to NHS data. Prescribing has risen steadily for years and is expected to continue increasing over the next decade.

Scotland, Wales, and Northern Ireland report similarly high rates. 

There is also growing recognition of the impact that long-term use can have on patients. Around half of people prescribed antidepressants are now considered long-term users, defined as taking them for at least 1 year — a proportion that has more than doubled in recent years. Reports have estimated that 2 million people in England have been taking antidepressants for 5 years.

The National Institute for Health and Care Excellence (NICE) recommends that serotonin reuptake inhibitors (SSRIs) “might need to be taken for at least 6 months after the remission of symptoms, but should be reviewed regularly.”

Why Do Patients Stay on Them?

Dr Joanna Moncrieff, professor of critical and social psychiatry at University College London and a consultant psychiatrist in the NHS, has long challenged the widespread use of antidepressants and argued for greater emphasis on non-medical support.

She told Medscape News UK that rising long-term use reflects several interconnecting pressures in the system. 

“We’re prescribing more and more antidepressants and patients are meant to be reviewed every few weeks,” she said. “But it takes a lot of medical time to review people regularly, so patients get left on them.”

“Another reason for long-term use is that they’re not effective. People don’t get better, they wait for them to work and when they don’t, they go to their GP and the dose is put up.” 

Read agrees, adding that responsibility for mental health is too easily handed over to medication. 

“We like quick fixes,” he said. “If we’re upset about something, and we’re given a choice to try and understand why we’re upset or to take a pill, many of us will go for a quick fix. When you combine this with GPs short on time and withdrawal effects, it’s a recipe for a disaster.” 

A Divided Expert View

Not all experts see long-term use as a problem. Dr Philip Cowen, professor of psychopharmacology in the Department of Psychiatry at the University of Oxford, England, said there are multiple reasons for rising antidepressant use — and not all are negative. 

“There’s a tendency for people to stay on antidepressant treatment longer, and the evidence that long-term treatment prevents relapse is actually quite good,” he told Medscape News UK.

“Other factors include the effectiveness of SSRIs in anxiety disorders, which are as common as depression. Finally, there is extensive use of low-dose amitriptyline for neuropathic pain, and this gets counted in as antidepressant treatment, thereby inflating the figures.”

Cowen points to the ANTidepressants to prevent reLapse in dEpRession (ANTLER) trial, a randomised controlled study of long-term maintenance treatment in primary care. The trial found that patients who discontinued antidepressants faced a higher risk of relapse and withdrawal symptoms, but also that a substantial proportion were able to stop without relapsing. 

The Withdrawal Debate

Beyond relapse risk, a growing body of research suggests long-term antidepressant use can lead to severe and sometimes debilitating withdrawal symptoms. The Royal College of Psychiatrists acknowledges that some people experience symptoms that can last months or more than a year.

“In surveys of people, only about 1%-2% are ever told that they need to come off slowly — and that’s medical neglect as far as I’m concerned,” Read said.

“Unfortunately, then the doctor tells them the withdrawal effects is relapse and that they need more drugs rather than providing support and helping patients to get off them slowly. Our own research found that among people who report withdrawals, half of them classify them as severe.”

Withdrawal symptoms can be physical and emotional, including dizziness, flu-like symptoms, insomnia, aches and pains, and anxiety. They may appear weeks or months after stopping medication and can be mistaken for a return of the original condition, particularly when psychological symptoms dominate. 

Cowen, however, said other recent evidence suggests withdrawal is “not an important problem for most people.”

Rethinking Care

For Read, a key turning point came with the publication last year of the Maudsley Deprescribing Guidelines, which set out how to safely reduce or stop antidepressants, benzodiazepines, gabapentinoids, and z-drugs.

It was a breakthrough, he said, because “British doctors see Maudsley as the Bible.” 

“The task now is to get the information to doctors and to start providing dedicated withdrawal services. The key things are to come off slowly and for a patient to be informed about what’s going on. You can end up in a psychiatric hospital from withdrawal effects if you don’t understand what is happening.” 

Moncrieff recently helped establish a small clinic in London, within the NHS, to support withdrawal from antidepressants and benzodiazepines. The service offers gradual dose reduction alongside peer support. 

“What surprised me is that we were seeing local referrals, referred by a local GP, not particularly people known to have problems coming off,” she said.

“Most had tried but had great difficulties and we had to do it pretty slowly. Our experience so far suggests problems with withdrawals are widespread.” 

Looking Beyond Medication

Moncrieff believes that the ideal model would be embedded in primary care, potentially led by a pharmacist with support from a counsellor, alongside a second-tier service for more challenging cases. 

“But for me, the most important thing to do is stop people from getting onto drugs in the long-term. If we could just use them in the short-term, it would help a lot.”

She suggested incentivising doctors to actively review and taper treatment — an approach that has been effective for other medications.

“We need to give incentives and doctors time to properly review people,” she said. “We need to get rid of the 6 months idea and, if we have to use them, to taper people off as soon as they’re feeling better or if it’s not working.”

Cowen urged GPs to follow NICE guidance, which recommends exercise, cognitive behavioural therapy, and other non-drug interventions as first-line treatment for most people with depression. 

Read said he is encouraged by the growing use of social prescribing, where GPs direct patients to community activities such as volunteering or choirs. 

“We as the public go to the GP for psychological or social problems, partly because there’s nowhere else to go,” he said. “They have 10 minutes and there’s not a lot they can do except prescribe medicines.”

“They need more time and better information, and for psychologists and counsellors to be embedded within a GP’s practice. But quite a few doctors are doing social prescribing now and I think that’s an important milestone because not everyone needs a therapist or medication. Time is a great healer.” 

No relevant conflicts of interest were reported. 

Sophie Cousins, MIPH, is a global health journalist who has reported from more than 20 countries.