SSRIs and Resilience for Young People

Are we over prescribing SSRIs because we aren't mentoring young people?

Photo by Christina Victoria Craft on Unsplash

I recently came across a fascinating New York Times article on people who have had long-term negative sexual side effects of being on SSRIs (the most common form of antidepressants), even after weaning off them. It goes to show that while psychiatric medications can be lifesavers to many people, there’s still a lot we don’t know about how they work or what they are doing to our bodies. Everything is a tradeoff, as my economics trained wife likes to say. But what stood out to me in the article was that almost every person interviewed in the story had been prescribed an SSRI as a teenager for what I would describe as normal life stressors: Cael was prescribed SSRI’s for “the stress of moving out of his family’s home and starting college.” Ruth was prescribed them for “a humiliating incident at school.” Sean was prescribed “as the anxiety he’d been living with became intolerable during final exams at college.” Within 15 minutes of describing how “she was being bullied, including incidents of having rocks thrown at her and being shoved to the ground,” Liz was prescribed an SSRI.

I am an advocate for the proper use of psychiatric medication. I’ve seen it change lives for the better, despite side effects. But I also worry about over-prescription. Consider the statistics cited in the article:

The effects of S.S.R.I.s on young sexuality are all the more relevant because prescriptions for the drugs have soared. Around two million 12-to-17-year-olds in the United States are on S.S.R.I.s. One large 2024 study in the journal of the American Academy of Pediatrics tallied, month by month, the percentage of that age group who filled an antidepressant prescription between 2016 and 2022. During that time, the rate climbed by 69 percent, with the Covid pandemic’s emotional reverberations almost surely playing a part, though a notable rise was underway before then. Among college students in 2023-24, according to a survey with over 100,000 participants, 22 percent had taken an antidepressant during the previous year. This was up from 8 percent in 2007.

I know SSRIs are lifesaving for many people. So this isn’t a criticism of proper uses of these medications. But when prescriptions are “soar[ing],” it’s appropriate to pose the question whether young people are being over prescribed. Or to frame this another way, are we sometimes addressing normal life challenges through psychopharmacology rather than character and virtue formation? Are we failing to provide young people the mentorship and counseling they need to make life transitions and overcome hardships so that they are forced to rely on medication to persevere?

I understand that making sweeping statements about the lives of young people based off of interviews in one New York Times article is tenuous at best, but the article resonated with many other data points for me. In my experience working with younger people, many of them are riddled with anxiety and struggle to overcome challenges in life. Which makes complete sense to me given another reality I have written about before: the general lack of mentorship this generation has received. Because the other thing I know about this generation is that they hunger for guidance and encouragement. They desire to know how to overcome obstacles, but they need wise mentors to help them. Too often, older generations just don’t show up. Or we professionalize mentorship by passing them off to therapy (which of course, has its place). And even there, we face a shortage of mental health care workers, so many young people are often not going to therapy, they are going to their general practitioner and getting a prescription instead of learning skills to deal with embarrassment at school or bullies or exams or transitioning into college. Good cognitive behavioral therapy should teach these skills.

I don’t write all this to shame anyone for taking an SSRI. I know there are various reasons why someone would use these drugs. What I am arguing is that at a societal level we ought to be concerned about the soaring increase in use among youth and what that says about the state of our culture. Because as the examples in the article suggest, the reasons for the use of SSRIs are sometimes circumstantial (I’m not talking about trauma here), and if we can help young people learn how to deal with circumstances in healthy, virtuous ways, then they won’t need to use SSRIs (which according to the article, may cause life-long sex-dulling side effects).

For example, I’m deeply concerned by the number of young people who believe that their efforts in school or an early career define their self-worth. It seems to me that a great deal of anxiety, shame, and depression stems from this false belief (a belief that comes from the idea that we are our own and belong to ourselves, by the way). How many young people would be helped by having wise, loving, present, mentors in their lives who speak words of encouragement and remind them that they are loved and affirmed not because of their efforts or work but because of who Christ is and how he loves them, because they are made in God’s image? This looks like reframing the way we talk about achievement and goals to young people, the kind of pressure we put on them and the way we affirm them. In other words, we older people have a responsibility to change their circumstances (just like we have the responsibility to stop the bullying at school!) to help younger people flourish.

In some cases, young people need more than a wise mentor to encourage them to live virtuously, courageously facing exams and life on their own in college. Sometimes they need to work with therapists who can help them deal with deep depression and anxiety.¹ And maybe SSRIs can help for a time. But I guess my concern in these cases is whether we are pursuing therapy for recovery or we are merely relying on the SSRI to do the heavy lifting. Do we see the medication as the “cure” or as an aide to the real recovery work, which is therapy and learning how to cope with life’s difficulties?

I’m not among those who believe that taking psychiatric medications are a sin or a cop-out. But I do think we need to be careful how and why doctors prescribe them. Most of all, as a society, I think we need to build communities with mentorship that provide the scaffolding so that young people are free to grow and flourish and overcome obstacles with courage. I think as Christians we have an obligation to provide this kind of loving mentorship. I don’t think it will eliminate the use of SSRIs among young people, but I do think that it will help those who struggle with the transition from home to college, who struggle with an embarrassing moment at school, who struggle with exams, and who struggle with bullies. Because these moments aren’t going away. Transitions will continue into adulthood, embarrassment will happen again, you will be examined by someone else in your life, and other people will bully you in one way or another. Learning to be resilient through these moments is critical for a flourishing life. And I worry that we aren’t guiding young people to be resilient.

1. I’m not talking here about those with diagnosed conditions or trauma. That is a separate issue and certainly requires therapy and often medication, but is not the topic here.