The Wall Street Journal includes an article: “New Concerns Emerge About Long-Term Antidepressant Use; More Americans are taking antidepressants for longer. But doctors say patients should weigh the pros and cons amid new research on risks” by Andrea Petersen.

More Americans are taking antidepressant medications like Prozac and Zoloft for extended periods of time: One-quarter of people on the drugs have used them for a decade or more, according to data from the National Center for Health Statistics. 

But even the longest rigorous studies of antidepressants’ safety and efficacy have followed patients for only a couple of years.

Now, there’s a growing concern among health professionals that some people who are taking the drugs long-term shouldn’t be—needlessly subjecting themselves to side effects and potential health risks. “Sometimes a person gets put on a medicine and it simply gets continued because nobody thinks very hard about it,” says James Potash, psychiatrist-in-chief at Johns Hopkins Medicine.

Some recent studies have suggested serious potential risks. People who used antidepressants had a 14% higher risk of heart attacks and strokes and a 33% greater risk of death, according to findings in a meta-analysis of 17 studies that was published in 2017 in the journal Psychotherapy and Psychosomatics.

The most popular antidepressants, selective serotonin reuptake inhibitors, or SSRIs, affect the action of the neurotransmitter serotonin not only in the brain but throughout the body. And because serotonin is involved in critical processes like growth, digestion and immune function, disrupting serotonin levels could have widespread negative health effects, says Marta Maslej, a postdoctoral fellow at the Centre for Addiction and Mental Health in Toronto and the lead author of the study.

The risks appear to climb as people age.  In older adults, SSRI medications are associated with falls and fractures. Some studies have found a link between SSRI use and a higher risk of dementia . But the science is murky.  

Other studies have found no such association; one study even found that SSRIs may delay the onset of Alzheimer’s disease in people with mild cognitive impairment. 

There is stronger evidence that the long-term use of one particular antidepressant, Paxil, does increase the risk of developing dementia.

Still, these studies are all observational: They don’t prove that SSRIs cause the problems, only that their use is associated with them. And it can be difficult to tell whether the increased risk is due to the medication or the underlying anxiety or depression.

The research comes as use of antidepressants has soared: 13% of Americans age 12 and over said they took the medications in the past month in the NCHS survey conducted from 2011 to 2014. That is up from 7.7% in the 1999 to 2002 survey.

And there’s evidence that antidepressants are overprescribed. In 73% of health care visits where antidepressants were prescribed to medical patients, no psychiatric diagnosis was reported, up from about 60% in 1996, according to a study published in 2011 in the journal Health Affairs.

At the same time, many people who truly do suffer from depression and anxiety don’t get treatment, says Mark Olfson, a professor of psychiatry and epidemiology at Columbia University Irving Medical Center. 

He is the lead author of a paper that found that only 38% of U.S. adults with major depression and 24% of people with anxiety disorders had received treatment within the past year.

“We have big problems of undertreatment and people who may be on these medications longer than they need to be,” he says.