In the evolving landscape of mental health treatment, selective serotonin reuptake inhibitors are often at the forefront of discussions about managing depression and anxiety. These medications, widely prescribed for their low risk and effectiveness, have become both celebrated and critiqued for their role in mental health care.

SSRIs are designed to enhance the efficiency of serotonin, a neurotransmitter linked to mood regulation. Contrary to popular belief, SSRIs do not add serotonin to the body, Misha Kleronomos, a health psychologist and instructor at Oregon State University, pointed out. 

Scott Mcfee, a clinical psychologist and professor of practice at OSU, explained that SSRIs function by preventing the reabsorption, or reuptake, of serotonin. These medications ensure that serotonin remains available between neurons, which, in turn, enhances communication between them. 

“(SSRIs) selectively prevent serotonin from going back up into the axon from the neuron it came from,” Mcfee said. “It makes sure that there is more serotonin available between two neurons.” 

Kleronomos said that for SSRIs to work effectively, other biomechanical precursors, such as tryptophan, dopamine and melatonin, need to be present in healthy amounts. 

For mild to moderate depression, Kleronomos advocates for therapy as a first-line treatment. Kleronomos is a cognitive-behavioral therapist and believes in the effectiveness of this method of therapy. 

Kleronomos highlighted several myths surrounding SSRIs that contribute to misunderstandings about their use. One common myth is that SSRIs are a long-term solution for depression. 

In truth, they are intended for short-term use, usually three to six months for severe depression, while therapy addresses the root causes. Prolonged reliance on SSRIs often arises from the mistaken belief that depression is a lifelong condition, requiring indefinite medication.

“When we look at the data, 14% of Americans are taking … an antidepressant, an SSRI,” Mcfee said. “And that number is going up because people are not getting off of them.”

Another prevalent myth is that SSRIs are universally effective. The reality is that these medications only work for about 60% of people within the first three months, according to Kleronomos, with their effectiveness declining over time.

Technological advances, like genetic testing, can help determine which antidepressants are more likely to be beneficial for an individual, challenging the idea of a one-size-fits-all approach. 

A third myth is the notion that SSRIs increase serotonin levels in the brain. Instead of adding serotonin, these medications work by making the body’s existing serotonin more accessible, providing a more nuanced mechanism than is often assumed. 

The stigma around taking medication for mental health has evolved significantly, with SSRIs and other antidepressants now widely accepted.

“In some ways, since COVID, mental health and medications have become destigmatized to the point of being commonplace,” Kleronomos said in an email. 

However, she warns that this normalization can sometimes lead to overprescription, with individuals seeking medication for normal emotional responses rather than clinical depression. 

SSRIs are relatively easy to access, often prescribed by primary care doctors without a thorough mental health evaluation. 

“We do not do a good, informed consent around SSRIs,” Mcfee said. “The doctors that people are seeing are trained in a model that says that SSRIs are what you give for depression. So, when somebody comes in and is depressed or anxious, then the doctor can sort of say, ‘Oh, here’s what you do about it.’” 

This oversimplification in prescribing practices is further emphasized by the ease with which patients are prescribed SSRIs, even without thorough mental health evaluations.

“You can walk into your primary care doctor and say, ‘I’m feeling sad,’ and you will walk out with an SSRI,” Kleronomos said. 

This ease of access contrasts sharply with the difficulty of finding therapy, where long waitlists and limited availability can delay treatment for months.

Kleronomos recommended consulting a psychiatrist or psychiatric nurse practitioner for medication, as they are better equipped than primary care doctors to tailor treatment to individual needs.

While SSRIs can be a vital tool in treating severe depression, they are not a one-size-fits-all solution. Kleronomos emphasized the importance of understanding the root causes of depression and exploring therapy as a long-term solution. 

“There are studies that show numbers like 85% of cases of depression will resolve on their own with no treatment in two years,” Mcfee said. 

For institutions, including universities, Kleronomos advocated for more accessible mental health resources, such as having full-time psychiatric nurse practitioners in counseling centers.