6 things to know about antidepressants

Millions of Americans take antidepressants to help manage everything from depression and anxiety to post-traumatic stress disorder. Now, the Trump administration has announced that these drugs, which have been in use for decades and gone through rigorous testing, will be subject to new scrutiny.

Invoking a burden of chronic disease, including in children, the administration has pledged to, in its words, “assess the prevalence of and threat posed by” certain commonly prescribed medications. In the coming months, its “Make America Healthy Again” commission plans to review a slew of existing medications, including SSRIs, or selective serotonin reuptake inhibitors.

More than 10 percent of U.S. adults took antidepressants over the previous 30 days, data from 2015 to 2018 show. And SSRIs are among the most widely prescribed of those drugs. 

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has long questioned the safety of antidepressants and other psychiatric medicines, making misleading and unsubstantiated claims about the drugs. For instance, as recently as his January confirmation hearings, he likened taking SSRIs to having a heroin addiction. He also has suggested — without evidence — that SSRIs play a role in school shootings. 

With the executive order and statements like these, “it’s implied there is something nefarious or harmful” about antidepressants and related medications, says Lisa Fortuna, chair of the American Psychiatric Association’s Council on Children, Adolescents and Their Families. “People may think that they’re dangerous drugs.”

Like any pharmacological treatment, SSRIs can come with side effects, which can range from mildly annoying but tolerable to rare and serious. And the drugs don’t work for everyone. But there’s strong scientific evidence that they can be very helpful for many people, including children and adolescents, says Fortuna, who’s also a psychiatrist at the University of California, Riverside School of Medicine.

Science News spoke with Fortuna and two other psychiatrists about the science behind SSRIs, what’s known and unknown about the drugs, and how the recent rhetoric — unsupported by mainstream scientific research — can stigmatize people with mental illness. 

SSRIs can treat more than depression

Zoloft, Prozac, Celexa. These are brand names of some common SSRI antidepressants. These drugs are called antidepressants, but they are used for a wide range of conditions, including anxiety, obsessive-compulsive disorder and eating disorders, says psychiatrist Awais Aftab of Case Western Reserve University in Cleveland.

Across all of these disorders, Aftab says, numerous clinical trials have generally shown that SSRIs, which have been around for decades, perform better than a placebo. But nothing in medicine is absolute. With depression, for instance, about half of people who try one or several antidepressants ultimately respond well, Aftab says. Other people see minor improvements and still others aren’t helped. “It’s a kind of mixed bag,” he says. 

Though the drugs often take weeks to work, they can improve people’s mood, ability to sleep and decrease their anxiety, says Giuseppe Guaiana, a clinical psychiatrist at Western University in London, Canada, and the chief of psychiatry at the nearby St. Thomas Elgin General Hospital. His team recently reviewed 37 clinical trials that evaluated antidepressants in people with generalized anxiety disorder. Bottom line: The researchers are highly confident that antidepressants are more effective than placebo, Guaiana’s team reported in January. 

But that doesn’t mean SSRIs are a good choice for every patient. “It’s a little bit more complicated than that,” he says. 

SSRIs have side effects

Before SSRIs, doctors often relied on a class of medications called tricyclic antidepressants. Those came with all sorts of unpleasant side effects, including cardiac issues like sudden drops in blood pressure. 

“Antidepressants are not addictive, because people don’t get high.”

psychiatrist Awais Aftab

SSRIs are a step up from those older drugs, Guaiana says. Still, “no medication is perfect,” he says. SSRIs can cause upset stomachs, headaches and reduced sexual desire. And that’s no small thing. Estimates vary quite a bit; the percent of people taking SSRIs who experience negative sexual side effects, such as a loss of libido, range from 25 to over 70 percent. For context, more than 8 million people in the United States were estimated to take one kind of SSRI, sertraline (sold as Zoloft), in 2022. 

With multiple SSRIs currently available in the United States, doctors can try different options and doses to find a regimen that works — and one that patients find tolerable. That’s standard practice, Aftab says. Much of medicine requires assessing the risks and benefits of a particular treatment. Even something as commonplace as aspirin, for example, can be iffy for some patients and helpful for others. The same trade-offs exist for SSRIs. 

SSRIs are not addictive

Addiction has a specific definition. With drugs like heroin or painkillers or cocaine, Aftab says, “there’s a sense of euphoria, there’s a kind of pleasant, psychoactive effect that the person is seeking and craving.” 

Once people stop using an addictive drug, he says, “they desire that drug, they think about it, they want to obtain it.” People struggling with substance use disorders will often go to great lengths to get their drug of choice, which leads to problematic behavior. That doesn’t happen with SSRIs. 

“So in that classic sense, antidepressants are not addictive, because people don’t get high,” Aftab says. “They don’t get a euphoric feeling. They don’t crave them. They don’t chase them or engage in theft or dishonesty.”

But like many medicines, SSRIs can cause dependency. Think of a heavy coffee drinker going cold turkey, and suffering through splitting headaches. Their body has gotten used to the caffeine; quitting it requires a period of adaptation. 

A similar sort of physical adjustment can happen when some people stop taking SSRIs, Aftab says. Symptoms include depression, anxiety and irritability. That overlap in psychological symptoms can make it hard to distinguish the original illness from signs of withdrawal. There can be physical symptoms too, like nausea, dizziness, restlessness and palpitations. Some people’s symptoms are a bit unusual, Aftab says. “They might experience brain zaps,” unpleasant jolts that feel like electricity. 

Still, these physical symptoms seem to be relatively rare, occurring in only about 15 percent of people who discontinue SSRIs, researchers reported in 2024 in the Lancet Psychiatry. And they are not the same as an addiction. 

What’s more, SSRIs might actually help people avoid addiction to heroin or other drugs, Fortuna says. That’s because mental illnesses like depression and anxiety are risk factors for addiction. If we treat those underlying conditions, she says, that could prevent substance use disorder. 

SSRIs are just one of the tools for treating mental illness

Mental illness among young people is a major problem in the United States. In 2023, more than half of girls in high school reported feelings of hopelessness and persistent sadness; the same was true for over a quarter of boys.

Psychiatrists have many ways to help kids cope. That includes evidence-based options such as individual therapy, family therapy and educational support, as well as medication. And the number of adolescents and young adults on antidepressants has been on the rise. In 2022, pharmacies in the United States dispensed one or more antidepressant prescriptions to nearly 6.8 million people ages 12 to 25. That’s compared with about 4.6 million people in 2016, researchers reported in Pediatrics in 2024. But, Fortuna says, “there’s this misconception that if you come to us, all we’re going to do is push medication.” 

In reality, she takes a comprehensive approach, walking patients and their parents through different treatment options and discussing the risks and benefits of each. Antidepressants, for example, carry what’s known as a black box warning about suicide. According to U.S. Food and Drug Administration analyses, antidepressants were linked to an increase in suicidal thoughts and behavior in people under 25. That sounds scary, but the science isn’t so clear-cut, Fortuna says. The warning has been controversial. What scientists do know is that “untreated depression is definitely related to suicidality,” she says. 

Still, doctors make sure to monitor young patients closely. And overall, she says, “the field is not fast or hasty to provide SSRIs to children and adolescents.”

Mental health stigma still exists today

In many ways, society still struggles to accept depression as a serious medical condition. Naysayers sometimes think that people suffering from depression “just need to suck it up,”Aftab says. 

Treatments often bring judgment too. SSRIs in particular have been questioned since they gained popularity in the 1990s. Perspectives that these drugs create artificial happiness or change a person into someone else still exist. “Stigmatizing attitudes about psychiatric medications are still fairly common,” Aftab says. “We’re in this weird kind of phase where large chunks of the population are pretty comfortable with taking these medications, but we also have large chunks of people that have really negative and stigmatizing views of them.”

SSRIs are medications for mental illness, just like insulin is medication for diabetes, Fortuna says. She’s concerned that the current round of antidepressant negativity could make parents of children on the medications feel like they’re doing something wrong by treating their kids. Mental illness is a medical condition, she says, “and it’s something that our medical profession can treat.”

Guaiana worries that some mentally ill people might avoid treatment and go on to harm themselves. Undertreatment of depression has been linked to suicide, he says. Results from a 2024 study, for example, suggest that SSRIs offer short-term protection against suicidal thoughts. 

There are still unanswered questions about SSRIs

The first SSRI — fluoxetine, or Prozac — was launched in the late 1980s. But scientists still have questions about how this family of drugs works. “We’re not completely in the dark,” Guaiana says, “but there is definitely much more we need to know.” For instance, it’s not clear why these drugs take weeks, or even months, to start helping with symptoms. It’s also unclear how they perform over years of use, or whether long-term use brings its own side effects. And aspects of withdrawal, including how common it is and what the main symptoms are, remain relatively understudied. 

That’s also true for how SSRIs work for people with multiple mental health issues, like severe anxiety combined with a trauma-related disorder. It’s not just an academic question; Guaiana sees and treats patients like that in the clinic. “This is something we need to have more data on,” he says. 

Still, it’s clear that these drugs are essential medicines for many people. What’s not helpful is blanket statements about these drugs’ value, Guaiana says. We shouldn’t say, “antidepressants are wonderful and work for everybody,” or that “antidepressants are horrible and don’t work.” Instead, he says, “we need to be nuanced.” 

If you or someone you know is facing a suicidal crisis or emotional distress, call or text the 988 Suicide & Crisis Lifeline at 988.