Do antidepressants work? It’s a question that comes up in the news cycle from time to time. This summer, we got it two-fold: First, there was Tucker Carlson ranting about how selective serotonin reuptake inhibitors were somehow responsible for the uptick in shootings (they are not). More recently, there was a review study that “debunked” the idea that depression is caused by a chemical imbalance—a fact that has been known for a long time, which did not stop the study authors from taking jabs at SSRIs.
What we know from other research (and from personal experience, as well as conversations with our doctors) is that these medications can help many people manage their mental health, when it comes to both anxiety and depression. But they aren’t for everyone—and, they can come with harsh side effects, like a lower tolerance to alcohol, weight gain, and dampening of sexual functioning. They’re also one of the least expensive forms of mental health care, and one that women turn to more often than men. And for all the stigma they carry, a lot of women loudly and proudly take SSRIs.
On a recent episode of the Waves, Slate’s podcast about gender and feminism, we unpacked some of the cultural narratives around SSRIs. Our conversation has been condensed, and lightly edited for clarity.
Mia: One of the things that we don’t talk about very much is how many people are on medication. According to a recent study from the National Center for Health Statistics, around 18 percent of women and 8 percent of men used antidepressant medications in the past 30 days. So that’s really significant, and it’s also significant to note the difference between 18 percent of women and 8 percent of men. In addition to being more likely to use medication to treat mental health, women are more likely to seek counseling. And notably, there was also a study from Sweden that showed that women are prescribed antidepressants without reporting depression more often than men, which the researchers said was possibly a sign of overtreatment for women.
Shannon: That’s so interesting. So the implication from those numbers is that maybe women are more anxious and depressed than men, and also maybe doctors are more likely to see someone for a very short appointment and say, “Ah, you’re just depressed. Take these and you’ll feel better.”
Mia: I want to ask you why you think this is, why we have arrived at this point. I think part of the issue is we don’t have a robust mental health care system, so maybe someone’s only interaction with the mental health system is this 20-minute free appointment at the student health center. If we had a more robust system for folks, maybe we would be able to have more holistic care—but how do you think we’ve gotten to where we are, where these quick appointments and then leaving with a prescription is the norm for people?
Shannon: In addition to taking SSRIs, I’ve done just an absolute fuck ton of talk therapy, and it is so, so expensive and time consuming. Early in my 20s I did cognitive behavioral therapy for my social anxiety specifically, which for me looked like having a therapist design this whole plan where I was exposed to my anxiety trigger, and I acted out a response in a safe setting, and I felt nervous and I talked about it with her—and I did this week after week for months. Those appointments were 40 bucks a pop, which was just an incredibly good deal. But I had to do so much advocacy for myself to get this set up—I think that it’s no wonder that people will turn to medication either to the exclusion of other things or just as this necessary ongoing component of their care.
I want to be really careful here because medication has helped me so, so much, and I am so grateful for it. At the same time: Why does medication have to be something that I rely on forever, and why is it prescribed as the frontline solution? I mean, I would say it has a lot to do with cost and the ease of taking a pill instead of doing other things. Though at the same time, it can work really well for people.
When we were talking about SSRIs earlier at work, you brought up this rah-rah culture around medication that I find fascinating. What are some of the things that you found when you went looking for examples of how influencers are talking about SSRIs?
Mia: If you type in “Lexapro” on Etsy, one of the things that is going to come up is a t-shirt that says, “Coffee. Run. Lexapro. Repeat,” which I thought was really interesting because it plays into this whole grind culture. It’s like an intersection of medication and grind culture, the very culture that for many anxious people worsens our symptoms. So that was one interesting thing. You can also pick up a “Live, Laugh, Lexapro” cross stitch pattern, a “Sponsored by Zoloft” mug, a Prozac pillow, a “Stay sexy take Sertraline” flag.
And on this item in particular, a review caught my eye. And the review was, “This is my favorite purchase I’ve ever made! It fits my personality so well I can’t wait to hang it up.” The word “personality” jumped out at me when I looked at that review, because for many people who have a mental health diagnosis, that diagnosis becomes part of our identity, but then when a medication, but not only medication, but a specific brand of medication becomes part of your identity or personality, that seems like it’s potentially problematic, right?
Of course there are lots of people, influencers, celebrities, who have helped build up this market that we’re now seeing on Etsy and other places. So for example, in 2020, Jezebel ran a story titled, “Drew Barrymore Has Finally Revealed What Drug She’s On.” She’s on Lexapro. But that to me was wild, because we’re all sitting on the edge of our seats waiting to see what drug Drew Barrymore is on, when really that conversation should be a conversation between Drew Barrymore and her doctor. I think it’s great that celebrities and influencers are open about mental health, even are open about medication, but honing in on these very specific drugs feels weird to me.
Shannon: There’s even an almost religious saying about Lexapro.
Mia: Yes, another really classic example of this is the writer Glennon Doyle, who talks a lot about her experience with mental health, but also specifically her use of Lexapro. So she has this saying, “Jesus loves me, this I know, for he gave me Lexapro.”
The way I feel about this is that there are a lot of people who talk about how SSRIs are like insulin. This can be a life-saving drug, but it’s just hard to imagine any other medication that commands this level of cultural attention. I want to be clear that I think the de-stigmatization of medication is great and really important—but it’s brought with it a cultural movement and commercialization that deserves some healthy skepticism.
Shannon: SSRIs are loaded with cultural baggage from all sides, but at the end of the day, what they really are is a tool.