Dangers of Antidepressants: Life Savers or Hidden Hazards?

Americans are taking antidepressant medications in huge numbers and the trend is upward. The most recent data show that: “Overall, antidepressant use increased from 9.8% in 2019 to 11.4% in 2023″ (Cureus, May 28, 2025). Over that time frame, women taking antidepressants went from 13.3% to 15.3%. There are lots of mental health challenges these days that that could partially account for the increased prescribing of antidepressant medications: anxiety, stress, obsessive compulsive disorder (OCD), fibromyalgia, long COVID, nerve pain, financial concerns, politics, and other health problems, to name just a few. At the same time, concerns about the dangers of antidepressants have never entirely disappeared.

The debate about antidepressant drugs intensified recently when Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. suggested that many patients might benefit from “deprescribing” such medications.

On May 4, 2026 HHS released this plan to “CURB PSYCHIATRIC OVERPRESCRIBING:”

“As the closing speaker, HHS Secretary Robert F. Kennedy, Jr. laid out a new action plan to promote appropriate psychiatric prescribing and drive deprescribing when clinically indicated.

“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications—especially among children,” said Secretary Kennedy. “We will support patient autonomy, require informed consent and shared decision-making, and shift the standard of care toward prevention, transparency, and a more holistic approach to mental health.”

Not surprisingly, his comments generated strong reactions from psychiatrists, patients and mental health advocates. There may be no right or wrong answer to this challenging issue.

The Stats Are Startling!

The last time we searched we discovered some fascinating numbers. Here are some annual statistics for popular antidepressants:

• Sertraline (Zoloft)             9.4 million patients and 43 million prescriptions
• Fluoxetine (Prozac)         5.7 million patients and 28 million prescriptions
• Escitalopram (Lexapro)  8.8 million patients and 37 million prescriptions
• Venlafaxine (Effexor)      3.0 million patients and 13 million prescriptions
• Duloxetine (Cymbalta)   4.3 million patients and 18 million prescriptions
• Paroxetine (Paxil)            1.8 million patients and    10 million prescriptions
• Trazodone (Desyrel) is a serotonin modulator and works a bit differently. It is also very popular with 5.6 million patients and 25 million prescriptions
• Bupropion (Wellbutrin) also works differently than SSRI-type antidepressants: 6.3 million patients and 30.3 million prescriptions
• Citalopram (Celexa)       3.2 million patients and 14.8 million prescriptions
• Desvenlafaxine (Pristiq)  2.6 million patients and 0.5 million prescriptions
• Amitriptyline (Elavil) is a trycyclic antidepressant with 1.7 million patients and 7.6 million prescription

We have calculated that at least 50 million Americans are currently taking antidepressant medication. That’s up substantially from our last analysis.

The FDA and Antidepressant Approvals

We suspect that most people assume antidepressant medications are quite safe. After all, these drugs have all been approved by the FDA and the condition for such approval has historically been that the medicine must be proven “safe and effective.” The trouble is that the FDA’s definition of safe and effective is relative. The agency routinely approves medications that have potentially serious or even life-threatening side effects.

Moreover, it is not uncommon for the FDA to approve a drug that is barely better than placebo. In other words, if a sugar pill relieved depression in 30% of patients with depression and a new drug relieved depression in 40% of patients with depression, the FDA might well consider it effective. That, despite an absolute benefit that may only be 5 to 10% better than a sugar pill.

If you think we pulled those numbers out of a hat, check this research. Studies have reported placebo response rates of 31-45% in the treatment of depression. That compares to a roughly 50% response rate with antidepressant medications (Walsh et al, JAMA, April 10, 2002; Stolk et al, Annals of Pharmacotherapy, Dec. 2003; Kirsch et al, PLoS Medicine, Feb. 2008).

How Effective Are Antidepressants?

The effectiveness of antidepressants has been controversial for decades. One of the most influential studies was the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression), published in the New England Journal of Medicine (March 23, 2006).

Researchers evaluated what happened when people failed to respond to an initial antidepressant. Patients were switched to medications such as bupropion, sertraline or venlafaxine.

The investigators reported:

“After unsuccessful treatment with an SSRI, approximately one in four patients had a remission of symptoms after switching to another antidepressant.”

That finding can be viewed in different ways. Some observers conclude that a 25% remission rate is disappointing because three out of four patients did not experience substantial improvement. Others might conclude that one in four hard-to-treat cases of depression recovered thanks to an antidepressant.

Another way to assess antidepressant effectiveness is by analyzing the “number needed to treat” (NNT). In other words, how many people would need to take a medicine for one person to get benefit? The Cochrane Database of Systematic Reviews is considered one of the world’s most independent and reliable sources for such information.

One Cochrane review titled “Antidepressants versus placebo for depression in primary care” analyzed data from 14 studies. The authors concluded that for old-fashioned tricyclic antidepressants the the NNT was 9 and for “more modern” SSRI-type antidepressants the NNT was 7. Translated, that means somewhere between 7 to 9 patients would need to take an antidepressant for 1 to get benefit.

On the other hand, many people find antidepressant medications can be very helpful.

Some People Find Antidepressants Life Changing

One thing we have learned over the decades is that it is almost impossible to predict who will benefit from which antidepressant.

Catherine shared her experience:

“After years on sertraline it seemed to lose effectiveness. Six months ago, I went to see my doctor. She prescribed citalopram and the effects are remarkable. I haven’t felt this good in years.”

Cel describes the benefits of medication for her situation:

“Quite frankly, life was getting unbearable for me due to my anxiety, depression, and PTSD, and this medication, even with the side effects, has been life-changing for me.

“Although I am a bit foggy sometimes, and I do have restless legs, I have finally been doing the things that I love again. I draw daily, I have a great time talking to my friends, I study daily without too much struggle to get motivated, and I wake up feeling… happy to be alive for once.”

We have heard from many readers who tell us that antidepressants made life worth living. For such individuals, the benefits outweigh the risks!

Reader Experiences Also Highlight the Dangers of Antidepressants

Unfortunately, not everyone has a positive experience.

One reader wrote:

“I was on an antidepressant for a few months during a very stressful time. It flattened my emotions—no highs, no lows. Zombie town.

“And then it dawned on me—sexual dysfunction, lowered libido, erection difficulties, lack of orgasm. That’s it! I developed other coping skills that allow me to deal with life in healthier ways.”

Sexual side effects are among the most commonly reported complications associated with SSRI antidepressants.

Another reader experienced an even more troubling reaction:

“While I was navigating a painful divorce, my PCP prescribed an antidepressant which I later found out had a known side effect of suicidal ideation. She was trying to be helpful and honestly had no way of knowing that I would experience that adverse effect. (Doctors thought only teenagers were susceptible to that reaction.)

“The fact that I was a psychology student AND worked in pharmaceutical research tipped me off when I wondered, ‘Where are all of these self-destructive thoughts coming from?’

“Thankfully, the bleak, morbid, brooding mood vanished when I stopped the drug.”

She later added:

“I was very lucky. Over the next few months, I met the mothers of four young adults who had taken the same drug. They had succumbed to suicidal impulses and killed themselves. Antidepressants can have SERIOUS side effects.”

Could the Dangers of Antidepressants Include Sudden Cardiac Death?

A study presented at the European Heart Rhythm Association meeting in Vienna (March 30-April 1, 2025) raised fresh concerns about the long-term cardiovascular effects of antidepressants.

Researchers analyzed approximately 6,000 cases of sudden cardiac death and evaluated antidepressant use among those individuals.

People who had been taking antidepressants for one to five years experienced a 56% higher risk of sudden cardiac death. Those who had been taking such medications for six years or longer faced more than twice the risk.

Among adults aged 30 to 39, long-term antidepressant use was associated with a five-fold higher risk of sudden cardiac death.

One of the investigators summarized the findings this way:

“Exposure time to antidepressants was associated with a higher risk of sudden cardiac death.”

Of course, such studies cannot prove cause and effect. Nonetheless, the dose-response relationship makes the findings difficult to dismiss and suggests that further research is warranted.

Serotonin and the Dangers of Antidepressants

Many people assume antidepressants act primarily in the brain. What often comes as a surprise is that most serotonin in the body is actually produced in the digestive tract. Serotonin affects far more than mood. It plays important roles in blood clotting, digestion, tissue repair, energy regulation and many other physiological processes.

Researchers writing in Psychotherapy and Psychosomatics (Sept. 14, 2017) noted:

“Indeed, serotonin regulates growth, development, reproduction, thermoregulation, tissue repair, maintenance, electrolyte balance, mitochondrial function, and the storage, mobilization and distribution of energetic resources. By blocking the transporter in the brain and the periphery, selective serotonin reuptake inhibitors (SSRIs), which are the most widely prescribed ADs [antidepressants], could potentially degrade many adaptive processes.”

The study suggested that antidepressants may not be as innocuous as they seem. Researchers conducted a meta-analysis of 17 studies comparing people using antidepressants to those on placebo. They found that those taking antidepressants were 33% more likely to die during the study time frame and 14% more likely to have a heart attack, stroke or other cardiovascular event. People who already had cardiovascular disease, however, were at no higher risk if they took an antidepressant.

The type of antidepressant did not seem to make a difference. The authors of the research pointed out that:

“although each AD [antidepressant] has unique pharmacological effects, they all interact with evolutionarily ancient biochemical systems that regulate multiple adaptive processes throughout the brain and the periphery. Thus, while each AD probably has a distinct symptom profile, there is good reason to suspect that they all degrade the functioning of some adaptive processes in the body.”

Deprescribing Antidepressants Is Easier Said Than Done

The controversy surrounding antidepressants has intensified because of recent calls to reduce their use. But deprescribing is not as simple as stopping a medication.

Many physicians receive limited training in helping patients taper antidepressants safely. Withdrawal symptoms can be surprisingly severe and may include dizziness, nausea, headaches, anxiety, fatigue and the electrical sensations often described as “brain zaps.”

That is why no one should ever discontinue an antidepressant suddenly or without careful medical supervision.

The People’s Pharmacy Perspective

The debate over antidepressants is unlikely to end anytime soon.

For some people these medications are lifesaving. For others they may provide little benefit while causing troublesome side effects. The challenge is not deciding whether antidepressants are universally good or bad. Rather, patients and clinicians must determine whether the benefits outweigh the risks for each individual.

The findings linking long-term antidepressant use to sudden cardiac death suggest that doctors and patients should periodically reevaluate the need for these medications, especially when treatment continues for years.

One thing is certain: decisions about antidepressants deserve thoughtful discussion rather than simplistic answers.

NEVER Stop an Antidepressant Suddenly!

We cannot emphasize this strongly enough. No one should ever stop an antidepressant abruptly. Withdrawal symptoms can be extremely unpleasant and, in some cases, debilitating.

If you would like to learn more about balancing the benefits and risks of antidepressants, we encourage you to read our companion article:

“Balancing the Benefits and Risks of Antidepressants”

This was written by Amy Beausang, Doctor of Pharmacy (PharmD).

You may also find our interviews with Dr. Samantha Boardman and Dr. Peter Gotzsche of interest. Here is a link:

Show 1075: Are Drugs for Mental Illness Safe and Effective?

Finally, here are some practical suggestions in our interview with Drew Ramsey, MD, a board-certified integrative psychiatrist:

Show 1437: Why Modern Life Breaks Our Brains and What We Can Do About It
We sometimes may feel that we are in a circumstance that breaks our brains and undermines our mental health. What skills provide resilience?

Please share your own thoughts and stories about antidepressant medications below in the comment section.