What Kennedy Gets Right, And Wrong, About Antidepressants

Opinion|Prozac Is Nearly 40 Years Old. Why Are There Still Unanswered Questions?

Like every psychiatrist, I have patients for whom antidepressants are transformative, even lifesaving. But I also see a messier, less advertised side of these medications. There are patients with sexual side effects that they hadn’t known could be caused by their antidepressants because previous doctors never warned them. I’ve had patients experience manic episodes or suicidal thoughts with specific antidepressants, and patients who no longer need to take the drugs, but suffer severe withdrawal symptoms when they try to taper off.

The medical community has reacted with alarm to Health Secretary Robert F. Kennedy’s claim that his family members have had a harder time getting off antidepressants than heroin. The American Psychiatric Association and five other psychiatric organizations recently declared that likening antidepressants to Schedule I drugs like heroin was “misleading” and emphasized that antidepressants are “safe and effective.”

But some patients heard Mr. Kennedy’s comments and felt that someone in a position of power was finally speaking for them. On online forums dedicated to helping people withdraw from antidepressants, such as Surviving Antidepressants, patients describe coming “undone” and going through “pure hell” in efforts to get off their medication.

They see in Mr. Kennedy someone who is alert to the seriousness of their problems, after years of neglect by the medical community, and it doesn’t matter to them that their experiences may be relatively rare or that Mr. Kennedy’s health movement, which disregards science and embraces anti-vaccine ideology, is unlikely to serve patients’ best interests.

Selective serotonin reuptake inhibitors, or S.S.R.I.s (the most commonly prescribed form of antidepressant) were originally studied for short-term use and were approved based on trials that lasted only a few months. But people quickly began taking the drugs for extended periods. Now patients are likely to stay on antidepressants for years, even decades. Of those who try to quit, conservative estimates suggest about one in six experiences antidepressant withdrawal, with around one in 35 having more severe symptoms. Protracted and disabling withdrawal is estimated to be far less common than that. Still, in a country where more than 30 million people take antidepressants, even relatively rare complications can affect thousands of people.

This is why it’s a travesty that nearly four decades after the approval of Prozac, there’s not a single high-quality randomized controlled trial that can guide clinicians in safely tapering patients off antidepressants. The lack of research also means that official U.S. guidelines for it are sparse. It’s no surprise that patients have flocked to online communities to figure out strategies on their own, sometimes cutting pills into increasingly smaller fractions to gradually lower their dose over months and years.