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8 min read<\/p>\n8 min read<\/p>\n
A FEW MONTHS ago, when the morning news was first talking about how HHS Secretary Robert F. Kennedy, Jr. had announced plans to curb \u201cpsychiatric overprescribing,\u201d I immediately thought of my patients. I often do before the sun begins to rise, but this was different. The news continued with Kennedy\u2019s views on SSRIs<\/a>, including that some people have \u201chad a much worse time getting off of SSRIs than people have getting off of heroin,\u201d and that they are in part responsible for an uptick in gun violence. I knew both claims were false, but I was also eerily aware that I am not the one with the bully pulpit.<\/p>\n After a commercial break, analysts weighed in on MAHA\u2019s insurrection of the field I have devoted my professional life to. I listened carefully, but impatiently to journalists and medical correspondents weighing in on the science, as well as the stories and the chatter, and it almost seemed like the idea of staying on an antidepressant was the new radical idea. I suspected we were on the cusp of a controversial mental health shakeup\u2014a blockbuster shift in the culture of antidepressant prescribing we have not seen since the \u201cProzac revolution\u201d of the 1980s. And I had a feeling this one wasn\u2019t going to succumb to the haste of a 24-hour news cycle.<\/p>\n I wish I were wrong.<\/p>\n As a psychiatrist, I sit on the front lines of mental health, not as a policy maker, but as a board-certified physician. I have worked with thousands of patients, many of whom I have helped start (and successfully stop) antidepressants. The news from this summer was just the beginning. Recently, the HHS convened an expert panel to begin developing clinical guidelines for how to help patients discontinue antidepressants. It\u2019s a nuanced concept that at best risks subtle misinterpretation by medical professionals and at worst risks inducing thousands of patients into thinking the medications that are helping them are causing harm. Deprescribing is probably OK for some people, but it can be dangerous for others. Stopping your antidepressant may be in fashion, but I\u2019m here to tell you that staying on it may be OK, too.<\/p>\n Before you call it quits on your antidepressants, here\u2019s what you should know.<\/p>\n Why Overprescribing Matters<\/p>\n ACCORDING TO KENNEDY, the US is facing a \u201cdependency crisis\u201d that is driven by too many people taking antidepressant drugs, including SSRIs like Lexapro, Zoloft, and Prozac. Every year, millions of Americans are prescribed antidepressants, not only for depression, but also for conditions like generalized anxiety disorder, obsessive compulsive disorder, and PTSD. SSRIs may help you feel calmer by allowing the brain to utilize the chemical serotonin more efficiently. There are at least seven SSRIs that are commonly prescribed in the United States. Since the first antidepressants were approved in the 1950s, and SSRIs in the late 1980s, antidepressants are estimated to have saved tens of thousands of lives.<\/p>\n But are they overprescribed? The short answer is \u201cmaybe.\u201d<\/p>\n Antidepressants are among the most prescribed medications in the US and around the world. But that\u2019s because they have been studied, have been proven to work, and most people don\u2019t have severe side effects from them. It is only appropriate\u2013if not humanistic\u2013for a doctor when faced with a patient who is suffering from mental illness, to offer a safe and effective solution. Antidepressants, including SSRIs, are often the gold-standard, or first-choice treatment in these situations. While it\u2019s true that not every patient who is prescribed an antidepressant probably needs to be on one, it\u2019s also true that not every patient who is prescribed an antibiotic needs to be on one either. Such is the nature of medicine. Doctors make the best recommendations they can with the information they have with one goal in mind: to help their patients regain optimal physical and mental health and do it in a way that is safe.<\/p>\n Antidepressants Are Not the Problem<\/p>\n MENTAL ILLNESS IS a public health concern that impacts millions of people. Even though destigmatization campaigns like Love, Your Mind provide accessible mental health guides and resources, and popular telehealth services like Hims make it easier to acquire prescriptions for mental health meds, there isn\u2019t consistent evidence that depression rates are declining over time. If anything, they are rising<\/a>, especially among young people. Depression also remains one of the strongest risk factors for suicide, which is currently the fourth leading cause<\/a> of death for men ages 35 to 44; second among guys 25 to 34. There is nothing radical about taking an antidepressant or staying on one if you need it, because antidepressants aren\u2019t the problem.<\/p>\n The problem is a healthcare system in the United States that limits access to care for so many people who need it. The problem is that even if you have \u201cexcellent\u201d health insurance, oftentimes mental health services are not covered. The problem is that it can take months to secure an appointment with a good psychiatrist. The problem is also a narrative that focuses on getting people off antidepressants, rather than ensuring that the people who need to be on them can access them. Instead of focusing on a dependency crisis, it\u2019s time to shift our attention back to a very real mental health crisis that still sees 130 people die by suicide every day in the United States. Antidepressants are not the problem, they are part of the solution.<\/p>\n What We Know About Long-Term Use<\/p>\n SOME OF MY patients take an antidepressant for months, others for years. I have also worked with patients who have been on antidepressants for decades. Determining the safety of long-term antidepressant use (meaning they take the medication for several years) relies on weighing the risks and benefits. In some patients, antidepressants can cause sexual side effects, upset stomach, or weight gain. However, it\u2019s difficult to predict who will have side effects and many of my patients do not have any side effects at all.<\/p>\n
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