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Patient Story
A patient messaged me asking me to “deprescribe” her Lexapro.
She let me know, almost in passing, that she’d already weaned herself off of it. On her own. Before we’d talked about it.
A few things struck me. The word “deprescribe” itself — clinical, specific, the kind of term that shows up in a research paper, not a portal message. The fact that she’d already stopped before we discussed it. And the timing: in our most recent visit together, we had actually talked about increasing her dose, not decreasing it, because her symptoms weren’t fully controlled.
None of that means she was wrong to want off her medication. It means something had shifted in how she was thinking about it — and that shift didn’t start in my exam room. It started somewhere online.
If you’ve spent any time on social media lately, you’ve probably seen some version of this conversation too: that antidepressants are overprescribed, that they’re harder to quit than people are told, that doctors hand them out too easily and don’t warn you what happens when you try to stop. So let’s slow down and actually look at it — what’s true, what’s overstated, and what a thoughtful approach to starting, staying on, or coming off an SSRI actually looks like.
The Claim
The version of this claim that circulates online usually blends several distinct ideas into one narrative. It says antidepressants — SSRIs specifically, though they’re often lumped in with ADHD medications, antipsychotics, and benzodiazepines, which are pharmacologically very different — are dramatically overprescribed, especially in children and teenagers. It says too many people start these medications and stay on them for years without ever being given an exit plan, that they become, as one common framing puts it, “lifelong customers.” It says doctors don’t adequately warn patients that these medications can be difficult to stop, with some versions claiming they’re literally harder to get off of than heroin. A more measured version of that same concern — and one worth taking seriously — is simply that patients aren’t being told enough about discontinuation symptoms before they start. The claim also argues that we’re medicalizing normal human sadness and stress, numbing people who don’t actually have a disorder, and that the whole premise was built on a “chemical imbalance” theory of depression that was oversold and never fully supported by the evidence. Some versions go further still, drawing a line between SSRIs and violence.
Why It’s Going Viral
This conversation isn’t resonating in a vacuum. Depression and anxiety are extraordinarily common — roughly one in five Americans will experience a major depressive episode at some point in their life, and about one in three will experience an anxiety disorder. Both climbed sharply during the pandemic. And with about one in eight Americans taking an SSRI at some point in their lives, this isn’t an abstract policy debate — it’s personal for an enormous number of people, which means an enormous number of people have a story to tell about it.
And some of those stories are genuinely hard ones. SSRIs are a huge medication class with a wide range of possible side effects, and simple math means that the more people who take something, the more people there will be who had a rough experience with it — and those are often the loudest voices online.
This claim also lands inside a broader moment of skepticism toward mainstream medicine and distrust of pharmaceutical companies, much of it amplified during the pandemic. And there’s something else underneath it that matters more than people give it credit for: these medications still carry real stigma. A lot of people have felt, on some level, uneasy about needing them in the first place. So when a message comes along saying you never actually needed that — nothing was wrong with your brain, you just needed sunshine and better food, that doctor was just trying to make a buck — it can feel like validation for a doubt that was already there. And if you struggle with anxiety, it’s not unusual to feel anxious about the idea of taking a medication for it in the first place, which makes a reason to stop especially easy to reach for.
What the Science Shows
There’s a real, evidence-based nugget underneath this conversation, and it’s worth separating from the more sensational claims around it.
For most people, the intended course of an SSRI looks something like this: you start it, titrate the dose over six to twelve weeks, and if your symptoms improve or resolve, you continue for a minimum of six months before considering a taper — longer if you’ve had multiple depressive episodes, with guidelines suggesting a minimum of twelve months after two or more episodes and upward of two years after three or more. For anxiety, the evidence base for exactly how long to continue is weaker, but most guidance points to at least twelve months after symptoms resolve, and sometimes longer.
Here’s the part that doesn’t get said enough: we have very little quality evidence evaluating the safety or efficacy of SSRIs taken continuously for more than two years — and yet more than half of Americans currently taking an SSRI have been on one for longer than five. That’s not evidence that long-term use is harmful. It’s genuinely unclear either way. We just don’t have good data on what happens in year six, or year ten, because most of the trials these medications were approved on ran for a matter of weeks or months.
That evidence gap matters, because even when an SSRI is appropriate and working, it can still come with real downsides — metabolic changes, sexual dysfunction, fatigue, insomnia, dry mouth, nausea — most of which are reversible after stopping. Staying on a medication longer than needed can also mean unnecessary polypharmacy, drug interactions, and what’s sometimes called a prescribing cascade, where a medication’s side effect gets treated with another medication rather than reconsidering the original one.
One study that circulates a lot in this conversation is an Australian survey of patients on long-term SSRIs, which found that more than half no longer met criteria for the diagnosis they were originally prescribed for, and that roughly a third of prescriptions looked inappropriate on chart review. That’s a real and useful finding — it’s part of why deprescribing is a legitimate, growing area of clinical practice. But it deserves an important caveat the study’s own authors raised: the absence of symptoms in people taking these medications may partly reflect that the medications are working, not that they were never needed. A chart review also can’t always capture the full story behind why someone was started on a medication in the first place, or why a decision was made to continue it.
It’s also worth asking what’s driving the underlying rates of depression and anxiety in the first place, because the online “root cause” conversation tends to flatten something that is genuinely complex. Both conditions arise from an interplay of genetics — heritability runs around 40% for major depression and 30 to 50% for anxiety disorders — alongside adverse childhood experiences, major life stressors, chronic illness, sleep, diet, and neurobiological factors involving neurotransmitter systems, the stress-response axis, and increasingly, the gut-brain connection. There isn’t one root cause waiting to be uncovered with the right test.
And SSRIs aren’t the only evidence-based option. Psychotherapy — particularly cognitive behavioral therapy, and acceptance and commitment therapy for anxiety — performs comparably to medication in head-to-head trials, and the combination of the two outperforms either alone, with more durable benefits over time. Regular aerobic exercise, sleep improvement, and a Mediterranean-style diet all have real, if generally adjunctive, supporting evidence. Some supplements, like omega-3s with a higher EPA ratio, have modest supportive data as an add-on to treatment, not a replacement for it. However, a large prevention trial actually found omega-3 supplementation didn’t prevent depression in older adults and was linked to a slight increase in risk in some groups.
What often gets lost in the deprescribing conversation is the flip side of the coin: the vast majority of people with depression or anxiety aren’t overtreated — they’re untreated. Fewer than a third of American adults who screen positive for depression receive any treatment at all, and only about a quarter of adults with a diagnosable anxiety disorder receive disorder-specific care. Underdiagnosis, cost, stigma, and access gaps — particularly for Black and Hispanic patients, men, and young adults — mean that far more people are going without care than are stuck on medication they don’t need.
Clinical Nuance
Deprescribing, done well, is genuinely good medicine. It just isn’t a solo project.
A thoughtful approach to any SSRI — starting one, staying on one, or stopping one — asks the same core questions: what are we treating, is it working, what does the evidence actually support for how long to continue, and what would happen if we stopped? Those aren’t bureaucratic questions. They’re the questions that determine whether someone spends the next several years appropriately treated, needlessly medicated, or destabilized by an abrupt taper.
The reality is that most people who come off an SSRI safely do it gradually, with monitoring, and often with a plan for what to do if symptoms return. Self-directed, rapid discontinuation — the kind that’s easy to feel emboldened to try after a viral video — is the version most likely to cause a rough discontinuation syndrome or a symptom relapse.
None of this means every long-term SSRI prescription is correct, or that no one should ever come off one. It means the decision — in either direction — deserves the same individualized, collaborative process as starting the medication did in the first place.
The Antidote
For Patients
I’m allowed to ask questions about a medication I’ve been on for years, even if nothing is currently wrong.
Wanting to understand why I’m still taking something doesn’t mean I was wrong to start it.
If I feel fine while taking medication, that isn’t proof I never needed it.
A safe way off a medication exists, and it usually isn’t a decision I make alone.
Wanting to stop a medicine doesn’t require me to prove I never needed help.
I can hold two things at once: this medication may have helped me, and it’s reasonable to ask if I still need it.
For Clinicians
“I’m really glad you brought this up — let’s actually look at whether you still meet criteria for staying on this, together.”
“The evidence for how long to stay on this is pretty clear for the first year or two. After that, honestly, we’re in a gray zone — and that’s worth talking through, not ignoring.”
“If we’re going to taper, let’s do it slowly and with a plan, so we can tell the difference between discontinuation symptoms and your original symptoms coming back.”
“The fact that you’re doing well isn’t proof this medication was never necessary. It might be proof that it’s working.”
“Our goal isn’t to keep you on this forever by default, and it isn’t to get you off it by default either. It’s to keep checking in on whether this is still the right call for you.”
Sources and Further Reading
Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671413
Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap https://pubmed.ncbi.nlm.nih.gov/36272761/
Updated trends in the global prevalence and burden of mental disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023 https://pubmed.ncbi.nlm.nih.gov/42167272/
Anxiety or Depression Trends by Disability Status and Demographic Intersections in US Adults, 2019-2023 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2844592
Approaches for Discontinuation Versus Continuation of Long-Term Antidepressant Use for Depressive and Anxiety Disorders in Adults. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013495.pub2/full
Antidepressant Trial Duration Versus Duration of Real-World Use: A Systematic Analysis. https://pubmed.ncbi.nlm.nih.gov/40324551/
Cross-sectional survey of patients in receipt of long-term repeat prescriptions for antidepressant drugs in primary care https://pmc.ncbi.nlm.nih.gov/articles/PMC2777559/
Selective Serotonin Re-Uptake Inhibitors for Premature Ejaculation in Adult Men. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012799.pub2/full
Depression. Review in Lancet. 2026 May https://pubmed.ncbi.nlm.nih.gov/42070574/
Anxiety. Review in Lancet 2016 Dec https://pubmed.ncbi.nlm.nih.gov/27349358/
The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. https://onlinelibrary.wiley.com/doi/10.1111/bdi.13035
Diagnostic and Statistical Manual of Mental Disorders. https://www.appi.org/products/dsm
Assessing the interaction effects of brain structure longitudinal changes and life environmental factors on depression and anxiety. https://onlinelibrary.wiley.com/doi/10.1002/hbm.26153
Depression in Young People. https://pubmed.ncbi.nlm.nih.gov/35940184/
Emotional Roles of Mono-Aminergic Neurotransmitters in Major Depressive Disorder and Anxiety Disorders. https://pubmed.ncbi.nlm.nih.gov/30524332/
Screening for Anxiety in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2022.16936
Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement. https://jamanetwork.com/journals/jama/fullarticle/2806250
Experiential and Genetic Contributions to Depressive- And Anxiety-Like Disorders: Clinical and Experimental Studies. https://pubmed.ncbi.nlm.nih.gov/18423590