What Are the Long-Term Effects of SSRIs?
Most long-term effects of SSRIs are side effects that stay while you take them, like sexual problems, weight gain and emotional numbness; after 65, studies also link SSRIs with falls and fractures.
By withClaro Editorial · Medically reviewed by Dr. Jason Tan , Consultant Psychiatrist · 2026-11-09 · 10 min read
Key takeaways In a Dutch study of people on antidepressants long term, 64% still reported side effects. Weight gain builds over years, and in a UK study of nearly 295,000 people the raised risk lasted at least six years. After 65, SSRIs are linked with falls, fractures and earlier death, but this is a link, not proof of cause. Sexual problems that last after stopping, called PSSD, are real, but how often they happen is not yet known. Long-term use is worth reviewing with your prescriber rather than stopping on your own. On this page
What are the long-term side effects of SSRIs? How much of what Mark Horowitz says about long-term SSRI use holds up? Which SSRI side effects last for years, according to people on Reddit? Are SSRIs bad for you long term if you're over 65? Do SSRIs have any permanent side effects? Is it safe to take SSRIs for life? What to ask your prescriber at a long-term medication review Keeping track of how you feel on an SSRI over the years The long-term effects of SSRIs are mostly side effects that last while you take them, like sexual problems or weight gain. In a 2013 Dutch study of long-term antidepressant users, 64% reported side effects. After 65, large studies also link SSRIs with falls, fractures and earlier death, but they show a link, not a cause.
Psychiatrist Mark Horowitz made the case against long-term use in a May 2026 episode of the podcast You Are Not Broken. He co-wrote The Maudsley Deprescribing Guidelines and took antidepressants himself for more than ten years. We checked nine of his claims about long-term effects against the studies behind them.
What are the long-term side effects of SSRIs?
Long-term side effects of SSRIs are mostly the ones people notice in the first months, and many don't fade. The 2013 Dutch study found that side effects known from short-term trials persist during long-term use. Sexual problems, weight gain and emotional numbness are among the ones long-term users report most often.
Women in the 2013 Dutch study were more likely than men to report weight gain. A longer time on the medicine also raised the odds of weight gain a little.
In a 2016 New Zealand survey of 180 people who had taken antidepressants for 3 to 15 years, 71.8% reported sexual problems. Weight gain came up for 65.3%, and 64.5% felt emotionally numb. Yet 89.4% said the medicine had improved their depression.
The Dutch study and the New Zealand survey covered antidepressants in general, not only SSRIs.
Weight gain tends to build slowly, over years rather than weeks. Horowitz puts it this way:
over years of use, 30% of people will go from being normal weight to being overweight or going from overweight to being obese.
He doesn't name a study for this figure. We could not find one showing that 30% of people move up a weight category. The closest large study is a 2018 UK study that followed nearly 295,000 people for ten years. Each year, about 11 in 100 people on antidepressants gained 5% or more of their weight. Among those not on them, it was about 8 in 100.
The risk of moving from a healthy weight to overweight was 29% higher. The higher risk of gaining 5% or more of body weight lasted at least six years. This study also covered all antidepressants, not only SSRIs.
If your appetite has changed or your clothes fit differently since starting, mention it at your next review. A change of dose or medicine is an option to discuss, and you can read more about how weight changes on Zoloft .
How much of what Mark Horowitz says about long-term SSRI use holds up?
Most of what Horowitz says about long-term SSRI use points the right way, but several of his numbers run high. Weight gain, sexual problems and the risks in older people all show up in large studies. His figures for weight, numbness and lasting sexual problems go beyond the data. In adults aged 20 to 64, a large study found no heart attack signal for SSRIs.
He starts from a point most studies support:
In long-term studies of people on antidepressants, most have side effects and many people have multiple side effects.
What Horowitz said What the research found Does it hold up? Most people on antidepressants long term have side effects, often several 64% of long-term users reported side effects, 2.9 on average Yes 50% to 80% develop new sexual problems, depending on the drug 25.8% to 80.3%, depending on the drug. Bupropion and mirtazapine were no different from placebo Partly. The top is right, the bottom is lower Three quarters of people feel emotionally numbed 64.5% in the 2016 New Zealand survey, 67.1% in a 2024 Japanese study of 3,376 people Too high. About two in three Over years, 30% of people move up a weight category The risk of moving up a weight category was 29% higher. That is a relative rise, not 30% of people The direction holds, the figure doesn't Older people on antidepressants have thinner bones and more fractures In a 2020 review of 37 studies, people on SSRIs had about 1.6 times the risk of a fracture Yes, as a link. Falls, also more common on SSRIs after 65, may explain part of it After 65, the yearly risk of death is 7% off antidepressants and 11% on certain ones In people with depression: 7.04% while not taking antidepressants, 10.61% on SSRIs, 11.43% on other antidepressants The figures match. It is a link, as he says Some antidepressants, such as paroxetine, are linked with dementia Antidepressants with anticholinergic effects, at high total doses, came with 29% higher odds of dementia Yes, as a link, for anticholinergic drugs rather than all SSRIs Antidepressants are linked with more strokes and heart attacks In 238,963 adults aged 20 to 64, SSRIs were not linked to stroke, and heart attack risk was lower in the first year. Bleeding inside the skull was 26% more likely on SSRIs Partly. A small bleeding signal. No heart attack signal for SSRIs at ages 20 to 64 Sexual problems after stopping may affect one in seven 13.2% in a 2025 survey of young people, about one in seven or eight. 1 in 216 in a 2023 Israeli study of men Not established
Nearly all of this comes from observational studies, which compare people who take antidepressants with people who don't. Horowitz himself notes there are no long-term placebo-controlled trials, though he doubts depression explains the links. The authors of a 2011 UK study of older adults warn that depression and the reasons people start treatment may explain part of any link.
Each row is a point you can raise about your own medicine at your next review.
Which SSRI side effects last for years, according to people on Reddit?
Weight gain and tiredness came up most, and most people who gave a timeline still had their side effects
Most long-term users on Reddit who said how long their side effects lasted still had them when they wrote. We read 100 threads by long-term users on r/prozac, r/zoloft, r/lexapro, r/effexor and other antidepressant forums, comments included. Of 68 people who gave a timeline, 48 still had their side effects, and another 15 said theirs eased within weeks.
Between the posts and the replies, 259 people wrote about their own experience, and 224 of them named at least one side effect. Weight gain or a bigger appetite came up most often, followed by tiredness.
Most threads were about SSRIs, but some were about Effexor and Cymbalta, which work in a similar way.
Side effect people mentioned People Share of 259 Weight gain or bigger appetite 69 27% Tiredness or sleepiness 55 21% Lower sex drive or trouble with orgasm 34 13% Emotional numbness 26 10% Nausea or stomach trouble 26 10% Said they had none 20 8%
People with side effects are more likely to post about them. So these shares show what people write, not how common each effect is.
One person on r/zoloft who has taken it for years wrote:
After such a long time on it, I will say the side effects I continue to deal with are drowsiness, occasional brain fog/forgetfulness, and it takes forever to orgasm but not impossible.
Others described years without trouble. One person on r/prozac who started it as a child wrote:
To date I haven't had any negative side effects.
If a side effect has stayed with you for months, bring it up at your next review instead of living with it. Your prescriber can look at the dose and at whether the medicine still fits.
Are SSRIs bad for you long term if you're over 65?
After 65, the long-term risks of SSRIs are clearer than in younger adults, though they are still links, not proof. A 2011 UK study followed 60,746 people aged 65 and over with depression. Those taking SSRIs had more falls than those not taking antidepressants, along with more fractures and a higher death rate.
Bones are the best-studied risk: a 2020 review of 37 studies found a clear fracture link. The extra falls on SSRIs in the 2011 study may explain part of it. Horowitz says antidepressants affect blood pressure and dizziness, and that people think the falls come from feeling dizzy.
The FDA label for sertraline, an SSRI, warns that these drugs raise the risk of bleeding. The risk is higher with aspirin, NSAIDs such as ibuprofen, or blood thinners. The label also names older adults among those more at risk of low sodium, which can cause confusion and unsteadiness.
The dementia link is narrower than it sounds. A 2019 UK study compared 58,769 people with dementia with 225,574 people without it. Higher odds showed up for antidepressants with anticholinergic effects, such as paroxetine and older tricyclics, taken at high total doses.
If you are over 65, tell your prescriber about any fall, dizzy spell or new confusion. Ask when your sodium was last checked.
Do SSRIs have any permanent side effects?
A few people report sexual problems, such as genital numbness or low desire, that last months or years after stopping. This is called post-SSRI sexual dysfunction, or PSSD. PSSD is a known condition, but no one yet knows how often it happens, and estimates differ by a factor of more than twenty.
Horowitz puts the risk high:
there's a study that suggests it may be as common as one in seven people on antidepressants, which is really terrifying
That study exists. A 2025 survey of 2,179 young sexual and gender minority people in the US and Canada looked at this. Among past antidepressant users, 13.2% reported lasting genital numbness after stopping. A 2023 Israeli study of men aged 21 to 49 put the risk of PSSD at 1 in 216.
A 2024 paper on PSSD explains why its true rate is hard to measure. The 2025 survey and the 2023 Israeli study asked different people different questions, so neither number fits everyone. If you notice a sexual change that stays after stopping, note when it started and the dose you were on. Raise it at your next appointment.
Is it safe to take SSRIs for life?
Antidepressants can be taken for years, and how long to continue is a decision you revisit with your prescriber. Guidelines suggest continuing for at least six months after you feel better, and longer if depression has come back before.
For some people with recurring depression, long-term treatment is what keeps them well. The decision weighs the risk of relapse against the side effects you live with.
Most side effects don't cause lasting harm, but a few can persist:
Emotional blunting: feeling less of both the lows and the highs. It is common, usually lasts only while you take the medication, and can improve with a lower dose or a different medication. Some situations need monitoring, such as blood pressure on certain medications, heart rhythm (ECG) on some, or blood sodium in older adults. Tell your prescriber about any new long-term symptom instead of putting it down to the medication or to age.
Medical review Medically reviewed by Dr. Jason Tan, Consultant Psychiatrist, on 27 October 2026, this section only. Next review: 27 October 2027.
What matters is whether your SSRI still helps you more than it costs you. NIMH advises against stopping a prescribed medicine without a health care provider's help. To weigh the benefit side, read how well antidepressants work in trials .
What to ask your prescriber at a long-term medication review
A long-term review works best when you bring your history and the changes you've noticed over the years. Your prescriber can then weigh how much the SSRI still helps against what it costs you. These are the points worth raising:
How long you've been on the SSRI, and why you started it. What has changed since then: sex life, appetite, emotions, sleep, memory or energy. Whether depression has come back in the past, and how often. If you are over 65: any falls, dizzy spells, fractures or confusion, and your last sodium test. Every other medicine you take, especially painkillers like aspirin or ibuprofen, and blood thinners. Whether your antidepressant has anticholinergic effects. What lowering the dose would involve, and how you would plan it together. Don't stop or cut down on your own between visits. Our guide on how to prepare for a medication appointment shows what else to bring.
Keeping track of how you feel on an SSRI over the years
Slow changes are easy to miss and easy to blame on age. The withClaro app has a daily check-in for mood, energy, sleep and appetite, and links side effects to your dose. Your entries become a PDF report you can bring to your review.
Download on the App Store Changes on an SSRI can build so slowly that they are easy to miss. The withClaro app lets you log mood, energy, sleep and appetite each day, links side effects to your dose, and turns it into a report for your prescriber.
Frequently asked questions Does your brain return to normal after SSRI? Research hasn't answered this well yet. A small number of people report sexual problems long after stopping, and how often that happens is still unknown. If something hasn't settled months after stopping, tell your prescriber when it began.
Does emotional blunting from antidepressants go away? Usually. Emotional blunting tends to last only while you take the medicine, and a lower dose or a different medicine can ease it. Note since when you've felt flat and on what dose, and raise it at your review.
What is considered long-term SSRI use? There's no fixed definition. A 2016 New Zealand survey of long-term users included people on antidepressants for 3 to 15 years. If you've been on an SSRI for more than a year, ask when it was last reviewed.
Can long-term SSRI use cause dementia? No study has shown that SSRIs as a group cause dementia. The 2019 UK study linked it only to strongly anticholinergic antidepressants, such as paroxetine, in large amounts. Ask your prescriber whether yours is one of them.
Are long-term side effects of antidepressants different for women? Partly. In a 2013 Dutch study of long-term users, women reported weight gain more often than men. Note changes in desire, orgasm or appetite and bring them to your review.
Do SSRIs stop working over time? Long-term research on this question is thin. If your symptoms have crept back, note when and bring it to your review.
Should I stop my SSRI because of long-term risks? Not on your own. Stopping suddenly can bring withdrawal symptoms, and depression can come back. Book a review and decide together whether to continue or lower the dose.
Related articles
Sources Bet PM, et al. Side effects of antidepressants during long-term use in a naturalistic setting. European Neuropsychopharmacology, 2013 Coupland C, et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ, 2011 Horowitz M, interviewed by Kasperson K. 372. Deprescribing Antidepressants. You Are Not Broken, May 24, 2026 Cartwright C, et al. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Preference and Adherence, 2016 Gafoor R, et al. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ, 2018 Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. Journal of Clinical Psychopharmacology, 2009 Kikuchi T, et al. A web-based survey on the occurrence of emotional blunting in patients with major depressive disorder in Japan: patient perceptions and attitudes. Neuropsychopharmacology Reports, 2024 Kumar M, et al. Alliance between selective serotonin reuptake inhibitors and fracture risk: an updated systematic review and meta-analysis. European Journal of Clinical Pharmacology, 2020 Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Internal Medicine, 2019 Coupland C, et al. Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. BMJ, 2016 Jensen MP, et al. The impact of selective serotonin reuptake inhibitors on the risk of intracranial haemorrhage: a systematic review and meta-analysis. European Stroke Journal, 2019 Pirani Y, et al. Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. Social Psychiatry and Psychiatric Epidemiology, 2025 Ben-Sheetrit J, et al. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Annals of General Psychiatry, 2023 r/zoloft: Long-term Zoloft users, I need to hear from you r/prozac: I've been on Prozac for 35 years! Started at 6 years old. Ask me anything! ZOLOFT (sertraline) prescribing information, US Food and Drug Administration via DailyMed Healy D, Mangin D. Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiology and Psychiatric Sciences, 2024 National Institute of Mental Health. Mental Health Medications Claro articles are for self-monitoring and educational purposes only. They are not a medical device, therapist, or diagnostic tool, and do not replace care from your prescribing clinician. If you are in crisis, contact your care team, emergency services, the Samaritans (UK: 116 123), or the Crisis Text Line (US: text HOME to 741741).
