Are too many Americans taking antidepressants?

As a psychiatrist for over 35 years, including a past role as the medical director of North Dakota’s Department of Human Services, I’ve seen both the benefits and the problems with antidepressants. In my view, there are grains of truth to claims that they are overused, but the full picture is much more nuanced.

What are antidepressants, and who takes them?

Over half of all antidepressant medications prescribed are a type of drug called selective serotonin reuptake inhibitors, or SSRIs. The first SSRI – fluoxetine, better known by its brand name Prozac – was approved in 1987. A handful of other types of SSRIs, which work through different mechanisms, also exists.

Antidepressants can be helpful for moderate to severe depression, but they are typically not warranted for mild depression, as the side effects might outweigh any potential benefits. For mild depression, many effective nonmedication treatments exist.

However, the distinction between mild and more severe symptoms sometimes gets lost. In everyday language, people use the term “depression” to describe everything from a minor sense of the blahs to a serious clinical condition requiring treatment.

Healthcare workers in primary care clinics routinely screen patients for depression using a widely used questionnaire. This tool can be effective in flagging patients who might need further testing or treatment. But in my experience, if used on its own to diagnose, it can be easily misinterpreted.

A person having a bad week or two who scores higher on a screening test might be prescribed a medication that was not necessary. But the tool can also fail to flag people who do need care. Over a third of people who die by suicide have visited a primary care provider in the month before their death. For those 55 and older, it rises to more than two-thirds.

Prescribing in general practice

According to a 2026 analysis, most prescriptions for antidepressants in the U.S. are not written by psychiatrists. In some cases, these medicines are prescribed by nurse practitioners or physician assistants with psychiatric qualifications, but most are written by primary care providers, who are not specialists in mental health.

Clinicians who provide primary care don’t just have less time to evaluate patients’ mental health concerns. They also have less access to ways of treating depression apart from medication, such as talk therapy.

Primary clinics that have behavioral health providers and consult with psychiatrists tend to help patients more effectively and provide more treatment options. These types of collaborative approaches to care are still rare but are becoming more common.

I recall my father, who was a country doctor in general practice, saying that half of his patients’ problems had to do with mental health issues, and he didn’t know how best to help them. Today’s primary care providers do receive more training on mental health issues, and they are often more equipped to recommend lifestyle changes that can be especially helpful for people with less severe depression symptoms.

But it’s simply human nature that when given a choice between taking a daily medication and engaging in activities that require commitment and intention, many will choose medication.

The opposing forces of stigma and access

Stigma has been a long-standing barrier in seeking mental healthcare.

Since the COVID-19 pandemic, anxiety and depression have become more prevalent. That’s particularly true among adolescents and young adults – especially young women, who tend to experience less stigma around mental health issues.

New rules during the pandemic also made it significantly easier for people to access mental health treatment – both therapy and medications – remotely, via telehealth. Such access continues to grow. Before the pandemic, only 1% to 2% of antidepressant medications were prescribed via telehealth. By 2022, it was roughly one-third.

Given these trends, and the fact that clinicians often turn to medication for treating depression regardless of the severity, the uptick in antidepressant prescriptions since 2020 should come as no surprise. Virtual visits allow people to navigate more easily around stigma and find increased and convenient access to care. And many people feel more comfortable getting such care in a primary care clinic rather than a mental health clinic.

Systemic issues drive prescribing

For all these reasons, I would say that antidepressant medications are likely overused in some cases. Undoubtedly, some people who take them either don’t benefit from them or could address their symptoms in other ways.

On the other hand, expanded access to mental healthcare – including medication – has also enabled people who need treatment to receive it. Even now, many Americans with serious depression receive no or limited treatment.

What’s more, in my view, this imbalance reflects systemic problems in the U.S. healthcare system at least as much as physicians’ prescribing habits or patients’ requests.

For example, primary care clinics are a great place to screen for mental health issues, but getting proper treatment may involve more specialized care – which many patients can’t access. And on the business side, clinicians get little support in helping patients with lifestyle changes and nonmedication treatments – rather than prescribing drugs.

Difficulties in ditching antidepressants

Kennedy has claimed that for some people, stopping antidepressants can be harder than quitting heroin. Research suggests such extreme effects of discontinuing medication are rare, though not unheard of.

Any time a person is on a medication for a significant period of time, the brain and body adapt to establish a new balance. This happens with other substances, too – as any regular coffee drinker who has tried abruptly quitting knows.

People who want to stop taking antidepressants after being on them for a long time generally do best when they gradually taper their dose over weeks to months, unless they have a specific reason for stopping more quickly.

For antidepressants, clinicians watch for withdrawal symptoms including sleep problems, flu-like symptoms, headaches and an electrical buzzing sensation in the head. A 2024 review of dozens of rigorous studies that compared the experiences of people taking antidepressants with those taking a sugar pill found that roughly a quarter of people stopping antidepressants experienced some withdrawal symptoms, and for 3%, they were severe.

While certain antidepressants might be more likely to cause withdrawal symptoms, it’s tough to tell who might have the most difficulty. And for some patients, depression is a chronic illness for which they must take medication indefinitely.

However, most people working with an experienced clinician are able to successfully discontinue these drugs. Ultimately, what’s most important is that patients are able to consult with a knowledgeable provider in making that decision.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Andrew McLean, University of North Dakota

Read more:

• Depression too often gets deemed ‘hard to treat’ when medication falls short
• Medication can help you make the most of therapy − a psychologist and neuroscientist explains how
• After the FDA issued warnings about antidepressants, youth suicides rose and mental health care dropped

Andrew McLean has taken part in projects that have included government funded grants related to mental health and substance misuse and holds an Endowed Chair in Neuroscience funded in part by the Neuropsychiatric Research Institute through the UND Alumni Association and Foundation.