A Therapist’s Perspective | SSRIs and Mental Health 

RFK Jr. is in the news again—this time, setting his sights on our antidepressant medication. His plan: Getting 1 in 6 Americans currently taking antidepressants off their SSRIs. This ‘deprescribing’ push comes as no surprise to anyone following his work. RFK has long been a critic of antidepressants, blaming them for everything from the rise of mental illness rates to school shootings. He and his supporters view SSRIs as ‘overprescribed’, dangerous, and often unhelpful. 

As a psychologist, I’m not a medical doctor, and I don’t prescribe medication. However, I do work with prescribers as part of a treatment team to support my clients. And I am often in a position to encourage my clients to consider discussing SSRIs or other antidepressants with their doctor. Many of those clients are reluctant to consider that step, or want to do so only as a last resort ‘if therapy doesn’t work.’

So in a time where medication stigma is increasing—and in honor of Mental Health Awareness Month—I wanted to talk about my own perspective about antidepressant medication. I’ll share why it’s often viewed with suspicion, and how it can be our ally in mental health care. 

External Stigmatization

Some of my clients have important people in their lives who are discouraging medication. Parents, partners, family members and friends’ overt or subtle comments matter. Talking about medication as dangerous or shameful can have a big impact on our decisions. Our different communities may also have their own beliefs and fears about what it means to be on an antidepressant. What’s more, they might hold understandable distrust in our medical system to care for them well. And for people in some professions, like aviation or first responders, SSRI use can be a red flag or disqualifying. Meanwhile, our leaders are sharing concern about the use of SSRIs. While it’s not always in line with medical consensus or scientific research, it further contributes to hesitancy and fear.

Concern About Side Effects

Like all medications, SSRIs can have unwanted side effects. Weight gain, loss of libido or sexual function, gastrointestinal issues, and emotional numbing are the side effects that clients usually bring up.

There are also rare but real examples of SSRIs triggering more severe mental health symptoms. Examples include an increase in suicidality (especially in teens) or mania (in people with an underlying predisposition to bipolar disorder).

When and Why I Recommend Considering SSRIs

As a therapist, of course I believe in the use of therapy to treat depression and anxiety. And as a feminist therapist, I respect my clients’ autonomy and decisions about their healthcare.

So why do I find myself encouraging clients to consider (or reconsider) discussing SSRIs with their physician?

To Move Past Therapy Blocks

First and foremost—I’ve seen medication make a world of difference in many of my clients’ lives when they’re stuck in therapy. Sometimes, they’ve been trying and failing to make changes in their self-care, thought patterns, coping behaviors or lifestyle for months in therapy with little benefit. They might lack the energy or motivation that change requires. They might even be forcing themselves to ‘do the work’ but feeling no relief or satisfaction in their efforts. 

Often, these are clients who are really hard on themselves for their lack of progress, seeing their stuckness as a sign that they’re just not trying hard enough. This can create shame, and reinforce their experience of depression as being hopeless, permanent, or just a part of who they are.

That’s why when a client is stuck, I’ll encourage them to discuss medication with their doctor. Medication may not fully resolve depression or anxiety by itself—it’s a tool, not a magic bullet—but it can give us the boost of energy and motivation we need to do the work. And it can help our brains experience the rewards of the efforts we’re making. Our self-care, social connections, and lifestyle changes can start to make a difference in how we’re feeling. 

Incidentally, I’ve seen the flip side of this happen as well: A client who has been doing the work, taking care of themselves mentally and physically, and feeling good goes off their medication. Sometimes tapering off goes great, and they don’t need medication at all for a period of time. Or possibly ever again. Other times, they’re struggling again within a matter of weeks. That’s not, as some would say, “dependence.” It’s a sign that the medication was doing its job to address biological factors contributing to depression.

When someone is experiencing symptoms of depression or anxiety, they can look for support directly from a mental health professional, like a therapist or psychiatrist. But you may be surprised to know that the first point of contact is usually their primary care provider. PCPs are by far the most common practitioners screening, diagnosing, and treating common mental health concerns. They may prescribe medication, refer patients to therapy or other specialist care, recommend lifestyle changes like nutrition and exercise, or some combination of these options. 

In theory, all PCPs should be trained and ready to handle common mental health concerns. In practice, we know that there are a number of barriers to that care. Depression screenings might be blown through by technicians without training on how to create an emotionally safe space.  Physicians are under enormous pressure to see large numbers of clients, making it hard to address complex or sensitive issues with the time and attention they deserve.  Mental health concerns can be dismissed (or on the other hand, used to dismiss other medical conditions, making patients reluctant to disclose). 

SSRIs have their risks and downsides. No one can ignore or dispute that in good faith. That’s why it’s important that patients have access to accurate, stigma-free information about the risks and benefits. Informed consent is key! SSRIs and other mental health medications aren’t perfect, but they can be our allies in our shared goals of healthier lives and better quality of life for all.