Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.

Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).

Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.

I'll raise my hand in agreement. This thread is definitely one of the most disturbing sub-threads I've ever read on HN.

I have many reasons for distrusting physicians, but here's a particularly good one: the large drug companies have been fined repeatedly billions of dollars for illegal schemes to convince doctors to prescribe drugs off-label. From a justice department press release (https://www.justice.gov/archives/opa/pr/pharmaceutical-giant...):

'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Departments of Justice and Health and Human Services’ Health Care Fraud Enforcement Action Team (HEAT) announced today. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.

[..]

The United States alleges that AstraZeneca illegally marketed Seroquel for uses never approved by the FDA. Specifically, between January 2001 through December 2006, AstraZeneca promoted Seroquel to psychiatrists and other physicians for certain uses that were not approved by the FDA as safe and effective (including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness). These unapproved uses were not medically accepted indications for which the United States and the state Medicaid programs provided coverage for Seroquel.

According to the settlement agreement, AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.

[..]

The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.

"Illegal acts by pharmaceutical companies and false claims against Medicare and Medicaid can put the public health at risk, corrupt medical decisions by health care providers, and take billions of dollars directly out of taxpayers’ pockets," said Attorney General Eric Holder. "This Administration is committed to recovering taxpayer money lost to health care fraud, whether it’s by bringing cases against common criminals operating out of vacant storefronts or executives at some of the nation’s biggest companies."

The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute. '

The takeaway is that anytime a physician prescribes you a drug, at the very least you have to check that there hasn't been a gigantic fine levied against the drug maker for illegally tricking your doctor into prescribing it to you.

There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:

Lower bone mineral density, increased risk of fractures, osteoporosis

Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)

extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)

emotional blunting / apathy

slowed thinking, brain fog

increased risk of gastrointestinal bleeding

QT prolongation

Here’s a paper from last year: The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765

‘Highlights

• Antidepressant withdrawal can be severe and protracted.

• It produces characteristic physical and emotional symptoms.

• All symptoms were more severe after stopping than before starting antidepressants.

• We identified the 15 most discriminatory withdrawal symptoms in our sample.

• Withdrawal did not differ between people with physical or mental health diagnoses.’