Yves here. New York City, much like other significant urban hubs, exhibits a notable eagerness among primary care physicians to prescribe psychoactive medications. Upon my return from Australia in 2004, I discovered that my excellent primary care physician had taken a position as a medical director in a biotech firm. As a result, I began exploring new doctors. When I expressed my struggles with fatigue, they interpreted my concerns as an invitation for anti-depressants or Adderall.
One of my experiences felt straight out of a Woody Allen film. A friend recommended an MD known for his diagnostic skills yet eccentric demeanor. On a particularly hot summer day, he greeted me in a Hawaiian shirt reminiscent of something Larry Johnson would wear, paired with mismatched dive shorts and dive shoes. I must admit, his legs were indeed worth showcasing.
He bluntly informed me that I reminded him of his mother, whom he apparently despised. Then he declared, “Your only problem is that you lack a smile on your face,” suggesting I should take Adderall, just as he had prescribed to his son for being too gloomy.
That insight was more than enough for me to leave and never return.
This discussion does not delve into the argument by social psychologist Jonathan Haidt, who claims that the rise of smartphones among youth, along with a decrease in unsupervised play, has led to a surge in mental health issues in this demographic. Beyond Haidt’s insights, there’s a clear correlation: societies marked by inequality tend to experience high levels of anxiety and strained social connections, even among the affluent, ultimately contributing to greater mental health challenges.
By Andrew McLean, Clinical Professor of Psychiatry and Behavioral Science, University of North Dakota. Originally published at The Conversation
Antidepressants rank among the most commonly prescribed medications in the U.S., with 1 in 6 American adults using them.
Some health researchers and advocates have voiced concerns that the prevalence of antidepressant use may be excessive, and that individuals wishing to discontinue their use often face challenges in doing so. A notable figure in this discourse is Health and Human Services Secretary Robert F. Kennedy Jr., who initiated an effort in May 2026 urging healthcare providers to seek alternatives to antidepressants and psychiatric medications for treating depression, where feasible.
As a psychiatrist with over 35 years of experience, including a previous role as the medical director of North Dakota’s Department of Human Services, I have witnessed both the advantages and the challenges associated with antidepressants. While I believe there’s some truth to the notion that they are overprescribed, the reality is much more complex.
What Are Antidepressants, and Who Takes Them?
More than half of all antidepressant prescriptions consist of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The first of these, fluoxetine, better recognized by its brand name Prozac, received approval in 1987. Other SSRIs with varying mechanisms of action have since emerged.
Antidepressants can be beneficial for moderate to severe depression, but they are generally not indicated for mild depression, as their side effects may overshadow any potential benefits. For mild depression, several effective non-medication treatments exist.
However, the distinction between mild and more severe symptoms can often blur. In casual conversation, the term “depression” is frequently used to refer to everything from a temporary sense of melancholy to a serious clinical condition that necessitates intervention.
Primary care providers frequently utilize a standardized questionnaire to screen patients for depression. This tool effectively identifies individuals who may require further evaluation or treatment. However, in my experiences, relying solely on this method for diagnosis can lead to misinterpretations.
A person experiencing a rough patch who scores high on a screening test might be prescribed medication unnecessarily. Conversely, this same tool may not catch individuals who truly need assistance. Alarmingly, over a third of those who die by suicide had seen a primary care provider in the month leading up to their death. Among individuals aged 55 and older, this statistic increases to over two-thirds.
Prescribing in General Practice
A 2026 analysis reveals that most prescriptions for antidepressants in the U.S. are written by primary care providers rather than psychiatrists. Some providers, such as nurse practitioners and physician assistants with psychiatric training, do prescribe these medications, but the majority come from primary care physicians who aren’t specialists in mental health.
Clinicians in primary care settings often lack both time and access to alternative treatments for depression, such as talk therapy.
Primary care clinics that employ behavioral health providers and collaborate with psychiatrists generally offer more effective care and a wider range of treatment options. Unfortunately, such collaborative models remain uncommon, although they are gaining prominence.
I recall my father, who practiced as a country doctor, saying that many of his patients’ struggles stemmed from mental health issues, and he felt ill-equipped to support them. Modern primary care providers typically undergo more training in mental health, equipping them to recommend lifestyle adjustments that can significantly benefit those with milder depression.
Nonetheless, human nature suggests that when offered a choice between daily medication and activities requiring commitment and intention, many will opt for the former.
The Opposing Forces of Stigma and Access
Stigma has long posed a significant barrier to seeking mental health care.
Since the COVID-19 pandemic, anxiety and depression have become increasingly common, particularly among adolescents and young adults. This trend is particularly evident among young women, who often experience less stigma regarding mental health concerns.
New regulations implemented during the pandemic have significantly improved access to mental health services—both therapy and medications— through telehealth. This access continues to expand. Prior to the pandemic, only about 1% to 2% of antidepressants were prescribed via telehealth. By 2022, this figure rose to approximately one-third.
In light of these trends, coupled with the tendency of clinicians to prescribe medication for depression regardless of its severity, the rise in antidepressant prescriptions since 2020 is unsurprising. Virtual appointments have allowed patients to navigate stigma more easily and access care conveniently. Many individuals feel more comfortable obtaining help from primary care clinics rather than mental health facilities.
Systemic Issues Drive Prescribing
Considering these factors, I believe antidepressant medications may indeed be overused in certain situations. It is clear that some individuals taking them might not experience any benefits or could address their symptoms through alternative methods.
Conversely, the increased availability of mental health care—including medication—has enabled many who require treatment to receive it. Despite this progress, many Americans with serious depression continue to go untreated or receive insufficient care.
Moreover, I believe this imbalance underscores systemic challenges within the U.S. healthcare system, far more than just prescribing tendencies or patient demands.
While primary care clinics work well for screening mental health issues, appropriate treatment may necessitate specialized care, which remains out of reach for many patients. Additionally, from a business perspective, clinicians receive minimal assistance in guiding patients toward lifestyle modifications and non-pharmacological treatments instead of resorting to medication.
Difficulties in Ditching Antidepressants
Kennedy has argued that for some individuals, discontinuing antidepressants can be more challenging than quitting heroin. Research indicates that such extreme discontinuation effects are rare, albeit not impossible.
Whenever someone remains on medication for an extended period, the brain and body adapt to create a new equilibrium. This phenomenon may occur with various substances—just ask anyone who regularly drinks coffee and suddenly tries to quit.
Those looking to stop antidepressants after prolonged use generally fare better when they gradually taper their dosage over weeks or months, unless a specific reason necessitates more rapid cessation.
Clinicians monitor patients for withdrawal symptoms, including sleep disturbances, flu-like sensations, headaches, and an electrical tingling sensation in the head. A 2024 meta-analysis of numerous studies contrasting the experiences of individuals on antidepressants with those on placebos found that about 25% experienced some withdrawal symptoms, and for 3%, they were classified as severe.
While some antidepressants are more prone to causing withdrawal effects, predicting who will face the most trouble is still elusive. For certain patients, depression presents as a chronic condition requiring indefinite medication.
Nevertheless, the majority of individuals working closely with an experienced clinician can successfully taper off these drugs. Ultimately, the key is that patients should collaborate with a knowledgeable healthcare provider when making such decisions.
