Following his nomination as the heads of Health and Human Services, Robert F. Kennedy Jr. sparked conversation around the usage of psychiatric drugs among minors. The Trump leadership launched an initiative named ‘Make our Children Healthy Again Assessment’ in February through an executive order. It aims partly to gauge the scope of harm posed by the prescription of various antidepressants, antipsychotics, mood stabilizers, stimulants, and weight-loss meds within a span of 100 days. Known for his controversial viewpoints, Kennedy, who is not a medical professional, has stated that quitting selective serotonin reuptake inhibitors (SSRIs, a type of psych med) can be more difficult than heroin. He also asserted that school shootings only became common after the initiation of Prozac. These claims, according to several health entities, psychiatrists, and researchers, are riddled with inaccuracies.
The University of Wisconsin-Madison’s professor of psychiatry and pediatrics, Dr. Marcia Slattery, expert in anxiety disorders in patients aged 5 to 18 years, couldn’t elaborate on Kennedy’s claims but did share insightful information about the role SSRIs play in childhood mental health.
So, what exactly are SSRIs and what is their mechanism of action? Serotonin is a neurotransmitter present in our brain and is linked to a range of human functions such as mood and emotions, sleep, digestion, learning, memory, pain perception, and bone health. These neurotransmitters function as communication channels between the brain’s nerve cells, known as neurons.
Commonly, following the communication between neurons, serotonin gets absorbed back into these cells, a process termed ‘reuptake.’ SSRIs interfere with this process, leading to an increased level of serotonin in the brain, thereby enhancing the overall brain function as it carries out everyday activities.
Dr. Slattery further elaborates that emotions play a critical role not only in our ability to think, decipher problems, and concentrate but also impact the brain in broader ways that could help alleviate symptoms of disorders like depression and anxiety. ‘The use of such medication facilitates a healthy and normal functioning of the brain, which eventually enables the child to actively participate,’ says Dr. Slattery.
SSRIs are prescribed mostly in combination with other therapeutic interventions. Dr. Slattery emphasises that prescribing medications isn’t always the first-line treatment approach when it comes to children and adolescent patients.
It’s crucial to understand the child’s environmental factors and background before deciding on a treatment approach. Factors such as a stressful school environment, learning difficulties, and bullying, along with complex family dynamics, can contribute considerably to a child’s mental health. When necessary, medication can help regulate a child’s brain experiencing severe anxiety and depression. This enhances the child’s ability to function more effectively in various areas such as home, school, or social situations.
Dr. Slattery exclaimed, ‘Whenever we resort to medication, it should always be paired with other non-pharmacological interventions. However, people seem to believe that we just prescribe medications as soon as a child seems anxious or depressed, which is far from the actual truth.’
When is it vital to consider prescribing SSRIs for a child? Dr. Slattery highlights that in certain cases, SSRIs can be life-saving.
Just like ignoring a child’s severe asthma would be detrimental, overlooking the signs of severe depression and anxiety, which are directly linked to an increased risk of suicide, substance abuse, academic failures, decreased school performance, and social interaction problems, can have dangerous consequences.
Have SSRIs been overly prescribed? Amidst the pandemic, various pediatric health organizations expressed their concerns about the mental health crisis among the young population.
Based on a study, from January 2016 to December 2022, the rate of antidepressant dispensation increased by 66%. However, another study concluded that the decision to prescribe SSRIs to children and adolescents for depression or anxiety was largely appropriate.
Is it possible for SSRIs to be addictive? SSRIs don’t have an immediate effect on the brain, and they induce gradual changes targeting specific neurotransmitters. ‘These medications aren’t addictive, and it’s not imperative to be on them for life,’ states Dr. Slattery.
Unlike heroin, which activates the brain’s reward system releasing dopamine and causing intense feelings of pleasure — a characteristic of addiction, SSRIs majorly target serotonin and have minimal effect on dopamine. Like with all medications, sudden discontinuation can result in withdrawal symptoms, including mild flu-like symptoms, nausea, and imbalance.
Last but not least, is there any correlation between school shootings and Prozac? The answer is a categorical ‘No.’ Nullifying such claims, studies have shown no causational relationship between SSRIs and school shootings. On the contrary, individuals suffering from untreated serious mental problems are more prone to self-inflict harm or become victims of violence than inflicting harm on others.