Is America on Too Many Psychiatric Drugs?

0:05I started taking this little happy pill about, I think, a little over four months ago. On social media, especially TikTok, there's a growing community of young people talking about their antidepressants. This video is for all of the Lexapro baddies out there, like my little Prozac girlies, my well-butrin girlies, my Zoloft homies. I started diving down and pretty quickly came across hashtags like Lexapro girlie and Lexaho. Oh, TikTok. Yeah, it was just huge. I'm Betsy McKay. I'm a senior writer covering health and medicine for The Wall Street Journal. And I'm Shalini Ramachandran. I'm an investigative reporter at The Wall Street Journal.

0:55For over a year now, Betsy and Shalini have been on an investigative journey into some of the most commonly prescribed medications out there, psychiatric drugs. I mean, we've talked to hundreds of people at this point. We've talked to patients. We've talked to doctors. We've talked to researchers. As they dug into psychiatric drugs, they found that corner of the internet where thousands of people are sharing their positive experiences. On TikTok alone, the hashtag antidepressants has more than 1.3 billion views. I feel like one thing that Lexpro has like indirectly done for me is allow me to see a different perspective of like life isn't just all pain.

1:36There were a lot of times before I was on medication that I just was not okay, felt hopeless, depressed. So Zoloft is doing what it's supposed to be doing. When I tell you my brain is quiet, it is quiet. Are you also having this experience with this drug? But over the course of their reporting, Betsy and Shalini found that there's also a dark side to these drugs, especially for some people who've been on them for a long time. In general, if you were just to look at the most glamorous videos, the most positive ones, you really wouldn't come away thinking these drugs can have serious side effects.

2:22But there is a whole part of the mental health universe that is talking only about very serious side effects. You want to know what absolutely nobody told me, not even my psychiatrist? How bad it is to wean off an antidepressant? I feel crazy. As they kept looking into psychiatric medications, not just antidepressants, but also anti-anxiety drugs and others, one big question popped up. Is America over-medicated? These drugs are so popular, and they've been on the market so long now, that grandparents, parents, and children in the same family now take them. And now there are people who've been on them for decades and are experiencing the repercussions.

3:14Welcome to The Journal, our show about money, business, and power. I'm Jessica Mendoza. It's Wednesday, December 3rd.

3:27Coming up on the show, the overprescription of psychiatric drugs in America.

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4:16Betsy and Shalini's investigation didn't actually start with antidepressants. It began with another kind of psych medication entirely, when Shalini heard something that caught her attention. There was actually an executive who I spoke to who was telling me, well, you know, the worst years of my life was when I was on benzodiazepine withdrawal. And I said, what's that? I had never heard of this thing. And he said, well, I was just routinely prescribed Ativan because I had insomnia. And that started the worst years of my life. Ativan is the brand name for lorazepam, a popular anxiety medication.

4:59It's one of several in a class of drugs called benzodiazepines. And it's commonly prescribed to help people with sleep issues. We all know somebody who's taken it, and I didn't realize that there are these potentially really debilitating effects. The executive told Shalini that after being on benzos for his insomnia, he actually started feeling extremely anxious. And when he tried to get off the drugs, he experienced intense withdrawal symptoms. He even went to one of these very swanky rehab facilities, and they weren't able to help him. And he said he could barely function. He was calling his wife saying that he couldn't survive.

5:35The executive spent more than$100 ,000 on treatment for benzo withdrawal. Eventually, he found help at another treatment center. By the time he was telling all of this to Shalini, the executive said his recovery was complete. But his story was about to send Shalini on a new reporting track and straight to Betsy's desk. You know, I went to Betsy and I was like, Betsy, have you heard about these? She was like, yeah, I was looking into these a few years ago, too. So that's kind of how it all started. Benzodiazepines work inside the brain to calm the nervous system. Here's Betsy again. When we become anxious, it's basically we're overstimulated.

6:16And so neurons release this chemical, GABA, and it's meant to sort of quiet everything in your brain. So they basically mimic the calming effect of that substance, GABA. I'm curious, how effective are they at doing what they're supposed to do? They are highly effective at calming you down, which is why they are so prescribed. And they're highly effective at preventing sort of life-threatening seizures or alcohol withdrawal. And even for certain chronic anxiety disorders, they're considered to be effective. I guess one thing I want to understand, according to medical guidelines, how long should patients be on benzos?

7:04It's no more than like two to four weeks, really. Two to four weeks. And typically how long does someone stay on this drug, at least based on the conversations you had with people? Well, the people we spoke to were, you know, seriously, anything between two weeks and like 20 plus years. Years. There's plenty of people out there who start taking these medications and then, you know, for good reason feel they continue to need them and they just stay on them and doctors continue to prescribe them.

7:43In other words, even though benzos aren't meant to be taken long term, a lot of people do. And as Betsy and Shalini talked to more patients, they began to hear about the problems that emerged from that extended use. Some of them suffer from something called akathisia, which is the inability to stop moving. Others have agoraphobia, I guess the fear of just going out, going outside the house and being around people. And what happens when people tell their doctors about this? Often, I found that, you know, it was often they would go to the doctor and describe their symptoms and their doctor would say, you sound more anxious, you probably need a higher dose.

8:21And so many of the people we talked to were put on dose after dose, sometimes switched to another benzo, as people thought that their anxiety was just rising and they needed more medication. It was ironic. The answer that some patients were getting to help with the side effects from the drugs they were taking was more drugs. And it's only after coming off the medication do they realize that as some of their symptoms got better afterwards, they realized, oh, it could have been, it was that.

8:56And just like with that executive that Shalini spoke to, some people who tried to get themselves off benzos were hit with even more problems, painful withdrawal symptoms, because their brains had become so used to the effects of the drugs. So that's why many people who experience benzodiazepine withdrawal, when they stop taking the drug, they're suddenly in these states of intense agitation. and they call it a chemical anxiety that racks their body. These symptoms could become extreme. One woman Shalini talked to, a mother of five, was prescribed another common benzo, Xanax, for mild insomnia.

9:33The mom said that after two years of taking the drug, she'd started having memory loss and panic attacks like never before. So she tried to quit. And she was hit with these brain zaps, like electric shocks, and she couldn't even shower. She would have these hours-long panic attacks because of how the shower water felt on her skin. She would sort of writhe in pain. And she wrote her daughter a note because she thought she might die amid her journey to get off the drug. Studies show that somewhere between 15 and 44 percent of chronic benzo users experience moderate to severe withdrawal symptoms.

10:11And about 10 to 15 percent have symptoms that continue long after they taper off the drugs. For some, the pain is so bad that they take their own lives. Shalini reported on one woman, a doctor, who spent more than three years trying to stop taking Xanax and later Valium. In March 2024, she killed herself. Her husband later found a note on her phone that read, quote, My body has been completely destroyed. I would never leave my family and beautiful daughter if I had another option. How much did the patients you spoke to typically know about this going in? Most of them had no idea. They were never warned.

10:52Whether it was primary care doctors or psychiatrists, they were not warned that there could be this potential for long-term risk. That's terrifying. Usually they're told, you know, minimal side effects. Oh, boy. So the side effects and the problems that we've documented are really from lived real world experience. And one of the problems is that they're not being studied enough. But what seems to be the gap we're seeing now is that long term use was never studied. And now there's these advocacy groups and things that are trying to get the word out that there's a subset of people for whom there is potential for long-term neurological damage.

11:37So in the last like probably seven, eight years, there's been more people who've experienced this banding together saying, holy crap, this is terrible. And like flobbing the FDA and raising the awareness about this to researchers. So that's kind of where some of the data is coming from now. In 2020, the FDA required drug makers to add a warning on benzodiazepines about the serious risks of abuse, dependence, and withdrawals. It also called for proper guidelines for doctors to help patients taper off the drugs. Still, more than 86 million benzo prescriptions were written just last year in the U.S.

12:14Globally, benzos are a multi-billion dollar industry. North America is its largest market. Shalini and Betsy put their findings about long-term benzo use in a story that they published earlier this year. That was the plan, was to publish one story. But there was a whole other class of widely prescribed psych drugs that they hadn't even begun to look into. After our story about benzos ran, I mean, we had got a deluge of responses from readers. And many, many, many of the people who wrote in said, I've had the same experience with antidepressants. That's next.

13:10Benzodiazepines and antidepressants are some of the most prescribed psychiatric medications in America. They're so common that they've made a mark on American culture. and become household names.

13:24It started in the 60s and 70s with one of the earliest benzo drugs to hit the market, Valium. Valium was very well-known and heavily marketed by pharmaceutical companies. When excessive anxiety and tension are interfering with rehabilitative efforts, Valium, diazepam, can help the transition back to work. I mean, we've all heard of the Xanax. It's in pop culture. like Gossip Girl, it's, you know, the White Lotus. You should have taken melaracepam. I slept like a corpse. After benzos, another class of drugs came on the scene, SSRIs, a type of antidepressant that affects serotonin levels in the brain.

14:05Prozac was introduced in 1987, and it was a revolution. Prozac nation and so forth. Then came other popular antidepressants, like Zoloft and Lexapro. And prescriptions for benzodiazepines have been going down. There's a lot more concern about them now, but prescriptions for antidepressants are going up.

14:29Last year, there were 347 million antidepressant prescriptions written in the U.S. alone, though a lot of people tend to be on multiple medications at the same time. And Betsy says these prescriptions are easier to access than ever, as telehealth clinics like HIMSS and HERS are able to prescribe them virtually these days. In a statement, a HIMSS and HERS spokesperson said, quote, we're proud that these efforts have helped people connect with qualified clinicians and get the care they need. But Shalini, you were saying earlier that benzos are not meant for long-term use. Betsy, is that the same for antidepressants?

15:04Yeah, it's very interesting. I mean, again, it's a similar picture to benzos. Most antidepressants have not been studied for long. The average study was about eight weeks long, but the average time an American is on an antidepressant is five years. That's a huge gap. So nobody really knows. We're kind of a living experiment in that sense. Betsy found that in the last couple years, more Americans are taking antidepressants than ever, especially young women. And in this living experiment, there isn't a lot of data about long-term use. What there is, is a lot of chatter on social media. So it started kind of in a good place of you're all lonely.

15:49We already have so much anxiety in our lives. Which sounds like a good thing, right? Like that's destigmatizing. It is. It's very destigmatizing. And I think that's destigmatizing being open, realizing that you're not alone. Only creators that Betsy and Shalini spoke to said that after extended use of antidepressants, they started experiencing downsides. And now there are TikTok testimonials trending with a very different tone. Zoloft has completely removed me from my identity. Well, my Lexapro girlies. Do we have a sex drive? Because I don't. No one told me that stopping my Lexapro, even after weaning myself off it, that I was going to be crying 10 times a day.

16:33And one of the reasons why it took me so long to get off of it why I didn't do it sooner was because the withdrawal symptoms are just not a fun time. A recent study found that moderate or severe withdrawal symptoms showed up in nearly two-thirds of patients who'd been on antidepressants for more than two years. So there are side effects while taking benzodiazepines. There are side effects while taking antidepressants, and some of them are similar. And the same with withdrawal. It can be a very similar picture. And we haven't figured out how, when we think one pill stops working, what to do next.

17:09It ends up being a different or more pills. Shalini and Betsy found that just like with benzos, people can get trapped in a cycle of prescriptions with antidepressants. Patients experience side effects, so their doctor raises their dose or switches to a new pill or layers on more meds. And if they try to get off the drugs, they experience withdrawal symptoms. Yep, so after going viral for weaning off my Lexapro, guess whose doctors told them they need to go back on it? Me. I know there are a lot of people who are probably in the same situation that I was, where they've been on SSRIs or meds like this long term and want to come off them.

17:47And it's really hard to do, and it can be really scary.

17:55So it sounds like there's still a lot that's not known about these drugs. how effective they are just on their own, and what kind of impact they have on folks long-term. Yeah. I mean, one thing that a lot of people talk about is informed consent, which is making sure that when a prescriber is about to prescribe you a benzodiazepine or antidepressant, they tell you, hey, these kind of things could happen. We don't know if you're one of the people who might experience some of these really adverse side effects, but it's something that we'd like to let you know. And there's all kinds of different things you can do to improve your mental health and life that doesn't always have to be in the form of a pill.

18:33And I think that that's a discussion that maybe often you're not having when you're in the doctor's office.

18:44I just want to say again, many Americans have been helped by psych meds over the years. But the more that Shalini and Betsy looked at these drugs and the hundreds of millions of prescriptions that are filled every year, the more apparent it became to them that these meds are embedded in American culture and that the U.S. has yet to reckon with what it means to use these drugs for far longer than intended or ever studied. The biggest thing I've learned is that there are too few guardrails around these medications, which do help a lot of people. And it's been sort of this under-recognized, untalked about problem for many years.

19:27I think it's just that, you know, we live in a pill-first culture. And it's one that's really deeply baked into our medical system. There are other ways to address the problems that we all struggle with, you know, depression, anxiety. And often we expect something that will help us immediately. That's helped make this pill-first culture a reality for us.

20:04If you or anyone you know is struggling, you can reach the Suicide and Crisis Lifeline by dialing or texting 988. That's 988.

20:18That's all for today, Wednesday, December 3rd. The Journal is a co-production of Spotify and The Wall Street Journal. Additional reporting in this episode by John West.

20:32Thanks for listening. See you tomorrow.