Author Spotlight
Lucy Stephens
*names changed to protect identity
Unlike most toddlers, then 4-year-old *Melanie Michelle didn’t need her favorite stuffed animal or a night light to go to sleep. She needed a kitchen bowl.
Terrified she was going to throw up, Michelle set the bowl beside her bed every night without fail just in case she puked. It stayed by her side no matter where she went — around her house or to the playground — even if she didn’t even have a stomach ache.
“I never, not once, ever threw up in the bowl I carried around,” Michelle said. “I carried those stupid bowls around because I was convinced that I was gonna have to use it at some point.”
To control her health anxiety, doctors prescribed medication for Michelle when she was 8 years old.
Now a senior, Michelle can’t remember a time in her childhood when she didn’t have anxiety about her health taking over her thoughts. She was horrified of being around cleaners and chemicals for fear she’d ingest them. She’d skip meals, frightened of choking and frequently wash her hands to prevent sickness.
“I don’t have any problems with chemicals anymore,” Michelle said. “I don’t have any problems with food. Those things aren’t issues to me anymore, and I think they still would be if I wasn’t on medication for it.”
And she’s not alone. Nearly half a million children and adolescents are prescribed selective serotonin reuptake inhibitors each year, according to WebMD.
But access to SSRIs for people under 18 is at risk.
On Feb. 13, President Donald Trump signed an executive order permitting the “Make America Healthy Again” campaign by the Secretary of Health and Human Services, Robert Kennedy Jr. This order assesses the threat that potential overuse of these medications can pose to children.
Within 180 days of the order, the HHS will submit its findings regarding SSRI intake in children to the president, according to whitehouse.gov. After this, the Federal Government will respond appropriately.
During his confirmation hearing before the Senate Finance Committee, Kennedy compared SSRIs like Prozac, Lexapro and Zoloft to a heroin addiction.
However, Children’s Mercy Chief of Psychiatry Shalya Sullivant says SSRIs don’t work in the same way addictive medicines or drugs do.
SSRIs block serotonin reuptake, allowing this feel-good chemical to stay longer in the patient’s brain and not be absorbed, according to licensed child and adolescent psychologist Kathryn McConahay. In contrast, addiction occurs when a person needs to have a higher dose of a drug to feel the same effects. Sullivant says SSRIs simply work differently.
These medicines have been proven beneficial for children with depression, anxiety or Obsessive Compulsive Disorder, according to Sullivant.
“SSRIs are the mainstay,” Sullivant said. “We have some good data that suggests that SSRIs tend to be the most effective, especially for young people with anxiety symptoms, but also with depression as well. For the most part, SSRIs are the standard first-choice options.”
These medications can be life-saving for teens going through severe depression, Sullivant said. This is part of the reason the executive order is so alarming to young SSRI users.
For years, junior *Harry Holiday had been experiencing suicidal and self-harming thoughts. He upped his caffeine dosage thinking his “drowsiness” was because he wasn’t sleeping enough — instead it was a tell-tale sign of depression. His psychiatrist suggested working out more and trying different breathing techniques, but none of it worked.
Holiday stayed in a depressive, anti-social state. He began harming himself and considered suicide. His generalized anxiety made it hard to maintain friendships. Holiday stopped enjoying his favorite activities and sports, but he was scared to start taking antidepressants.
“As a male, it’s been viewed in our society a lot more that we’re supposed to not go through this stuff, not feel depressed or not show it and not talk about it,” Holiday said. “I’ve heard people say that to me directly, ‘Oh, you’re a guy. You shouldn’t have to be on [antidepressants], just be stronger.’”
But after months of suffering the same depressive cycle, Holiday started taking an SSRI, escitalopram, the generic form of Lexapro.
After only three months on his SSRI prescription, Holiday reconnected with friends he had previously lost due to his depression. Now, he’s able to have meaningful conversations with people without it feeling like a chore. Holiday’s grades went up and his absences went down, something he struggled with before starting the medicine.
Most of all, the medication stopped his suicidal thoughts.
“[Escitalopram] saved my life, and I can’t stress that enough to people,” Holiday said. “It really helps you realize that it’s just either your anxiety, stress or just depression talking.”
The major concern of SSRI usage in young people, one Kennedy hasn’t brought up in his arguments, is the black-box warning on all prescription SSRIs.
This warning says antidepressant usage in children and adolescents could increase the risk of suicidal thoughts. It was published in 2004 and decreased the number of SSRIs prescribed by primary care doctors. In a study Sullivant did about the warning, she found that after it was issued, psychiatrists still prescribed SSRIs despite the risks because they knew the medicines worked.
Following a decrease in SSRI prescriptions from primary care doctors after the 2004 warning, researchers like Sullivant saw an increase in the suicide rate among young people. This result meant the FDA made a mistake in issuing a warning for all SSRIs according to Sullivant.
“Severely depressed people usually aren’t going to admit to having the suicidal ideation,” East parent and pediatrician Kate Hartman said. “So as we start to make kids feel better, and [the medicines] start to work, they’re more likely to be open about their feelings. So the question is do they truly cause that thought to happen? Or when we’re on them, we are more likely to admit that we’re feeling that way?”
When issuing the warning, the FDA lumped all SSRI medications together, but Sullivant said these medications aren’t the same. Paroxetine, an SSRI, was shown in a study to increase agitation in some young people. The study then linked an increase in agitation to suicidal thoughts.
Most trained child psychiatrists, like Sullivant, don’t use paroxetine as a first, second or third-line medication. But because it could cause an increase in suicidal thoughts, the FDA put a warning on all SSRIs.
Michelle, who is on paroxetine, has never been suicidal and has not experienced suicidal thoughts on the medicine. If anything, it’s improved her quality of life.
“Every medicine has side effects,” Michelle said. “I’ve heard all sorts of reasons why they’re bad for me and why I shouldn’t be taking them. But for me, I probably will never stop taking them.”
There can be downsides when going off an SSRI, including flu-like symptoms, according to Hartman. These symptoms occur because the body becomes accustomed to taking the drug regularly. However, to prevent withdrawal symptoms, patients should gradually lower the dose over time.
Michelle experienced these flu-like symptoms after her prescription wasn’t refilled for five days. She had the chills, was shaky and had zero emotional regulation for the period she was off her paroxetine.
Freshman *Annie Adams forgot her Lexapro prescription for several days in a row, which caused her to experience drowsiness and sleep deprivation. On days she forgets her prescription, Adams said she can sleep for 14 hours and still feel tired.
Senior *Sally Smith also feels moody and easily irritated after being off her Lexapro for multiple days, but after taking it regularly for a few days, her mood stabilizes and improves.
Published reports, according to the U.S. Center for Disease Control and Prevention, have also confirmed the COVID-19 pandemic has negatively affected children’s mental health causing an increase in anxiety and depression.
These drugs alleviate the struggles anxiety and depression can have on young people according to Sullivant even if they have severe warnings and potential side effects.
“We talk about insulin and things like that as life-saving medications, and they are life-saving medications, but I would absolutely say the SSRIs are life-saving medications 100% whether it’s quality of life or physical life,” Michelle said.
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