13.2%
of American adults took an antidepressant in the past 30 days.
Kristy King, MD
Treating the signal, not the source
One in six American women took an antidepressant in the last month. For women over 60, it is one in four. Most have been taking it for years. I think we need to talk about that.
The numbers
17.7%
of women. That is more than one in six.
24.3%
of women age 60 and over. About one in four.
68%
of people taking an antidepressant had been on it for two years or more. One in four had been on it for ten years or more.
Among women, use rose from 13.8% to 18.6% in under a decade. Sources: CDC National Center for Health Statistics.
The benefit is smaller than you were told
In 2022, researchers analyzed every antidepressant trial submitted to the FDA between 1979 and 2016: 232 trials and more than 73,000 people. On average, the drugs beat placebo by 1.75 points on a 52-point depression scale. About 15% of people got a substantial benefit beyond what placebo gave them.
A 2017 review of 131 trials and more than 27,000 patients found the difference between SSRIs and placebo fell below the threshold doctors use for a change patients can actually feel. SSRIs also raised the risk of serious adverse events, from 22 to 31 per 1,000 people. The authors concluded: "The potential small beneficial effects seem to be outweighed by harmful effects."
Most of these trials lasted about eight weeks. Most people now take these drugs for years.
The chemical imbalance story
For decades, patients were told depression is caused by low serotonin and that an antidepressant corrects it. Up to 90% of the public still believe this. In 2022, a review of the major studies on serotonin and depression found no support for it. People with depression did not have lower serotonin, and lowering serotonin did not cause depression in healthy volunteers. What did strongly predict depression was stressful life events.
The harms
These are documented in the medical literature and, in some cases, on the drug labels themselves.
Withdrawal
A 2024 review of 79 studies found about one in seven people who stop an antidepressant get withdrawal symptoms caused by the drug, and about 1 in 35 get severe symptoms.
Sexual dysfunction that can last
In 2019, the European Medicines Agency required SSRI and SNRI labels to warn that sexual dysfunction can continue after the drug is stopped.
Older adults
In a UK study of more than 60,000 people over 65, SSRI use was linked to more falls, fractures, strokes and dangerously low sodium. One-year mortality was 10.6% in SSRI users compared with 7% in people not taking an antidepressant.
Young people
Antidepressants carry the FDA's strongest warning, a boxed warning, for increased suicidal thoughts and behavior in children, teens and young adults under 25.
Upstream of the prescription
Conventional medicine is built to treat what shows up downstream. A symptom appears, a drug is matched to it, and when the drug causes a new symptom, another drug is added. The visit ends before anyone asks why the symptom appeared in the first place.
I start further up. Low mood, anxiety, poor sleep and exhaustion are signals, and I want to know what they are pointing to. In my patients that is often one or more of these:
Hormones
Perimenopause, menopause, thyroid and low testosterone change mood, sleep and energy, and are routinely missed or medicated around.
Stress physiology
Years of running on stress hormones wears down the nervous system that regulates mood.
Blood sugar and metabolism
Unstable glucose and insulin resistance affect the brain as much as the body.
Nutrient status
Low iron, B12, vitamin D, magnesium and omega-3s show up as depression and fatigue.
Toxic load and cellular energy
Environmental exposures and strained mitochondria leave cells without the energy they need to function.
When those are measured and addressed, many people find they need less medication, or none.
Symbiotic Medicine
Much of modern psychiatry works against the body: it blocks, suppresses and overrides. Symbiotic Medicine works with it. The body, the mind and the living world around us are built to function together, and health is what happens when they are back in relationship.
Collaboration
You are a partner in your care, not a list of symptoms. I lay out what I find in plain language, and the decisions stay with you.
Integration
Hormones, metabolism, the nervous system and your inner life are treated as one system.
Rhythm and coherence
Sleep, light, movement, breath and heart rhythm training bring the body's own regulation back into sync.
Nature
Whole plant foods, botanicals, time outdoors and the medicines of the earth, used with respect and within the law.
Consciousness
Healing includes the beliefs, stress and stories held in the body, worked with through hypnosis, breathwork and contemplative practice.
Remembering
Much of this is old knowledge. Traditional cultures never forgot that people heal in relationship, with the land and with each other.
Trust
Many people have learned to fear their own bodies. Pain, anxiety and exhaustion are signals from a body trying to protect you. Part of the work is learning to read those signals again instead of silencing them.
Skill
Feeling better is built from skills you can learn: steadying your nervous system, sleeping, breathing, moving, and staying present with hard feelings without being overwhelmed. Medicine can support those skills. It should not replace them.
Every medicine is a relationship
How you relate to a medicine matters as much as the medicine itself. A prescription started in a crisis and never revisited is a very different thing from one taken with a clear purpose and an end in sight. When I prescribe, or when we review what you already take, every medicine gets four things:
A purpose
What it is for, in plain words, and how we will both know it is working.
A skill alongside it
What you are building while you take it, so the medicine is not doing all the work.
A review date
A set point on the calendar when we look at it again, instead of renewing it by default.
An exit plan
How it ends, or why it continues, decided together and written down from the start.
Coming off, with a plan
If you want to reduce or stop a psychiatric medication, I work with you to do it slowly and safely. We look at why it was started, what has changed since, and what your body needs in its place. Then we build a taper around you and adjust it as you go, with the upstream work happening alongside it, so you are not left with nothing when the dose comes down.
Please do not stop on your own
If you take an antidepressant, do not stop it suddenly or without medical support. Coming off safely means a slow taper, planned around you and adjusted as you go. Some conditions, such as bipolar disorder and psychosis, can need medication long term, and that is a decision we make together. If you want to talk about whether your medication still serves you, book 15 minutes with me.
Book 15 minutes with Dr. KingSources
- Brody DJ, Gu Q. Antidepressant Use Among Adults: United States, 2015-2018. NCHS Data Brief No. 377, 2020.
- Pratt LA, Brody DJ, Gu Q. Antidepressant Use Among Persons Aged 12 and Over: United States, 2011-2014. NCHS Data Brief No. 283, 2017.
- Stone MB, et al. Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US FDA. BMJ, 2022.
- Jakobsen JC, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. BMC Psychiatry, 2017.
- Moncrieff J, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 2022.
- Henssler J, et al. Incidence of antidepressant discontinuation symptoms. The Lancet Psychiatry, 2024.
- European Medicines Agency PRAC. Persistent sexual dysfunction after SSRI and SNRI discontinuation, 2019.
- Coupland C, et al. Antidepressant use and risk of adverse outcomes in older people. BMJ, 2011.
- Cipriani A, et al. Comparative efficacy and acceptability of 21 antidepressant drugs. The Lancet, 2018.