Chapter 1: What psychiatric drugs are commonly prescribed in America?
I started taking this little happy pill about, I think, a little over four months ago.
On social media, especially TikTok, there's a growing community of young people talking about their antidepressants.
This video is for all of the Lexapro baddies out there. Like my little Prozac girlies, my Wellbutrin girlies, my Zoloft homies.
I started diving down and pretty quickly came across hashtags like Lexa pro-girly and Lexa ho. Oh, TikTok. Yeah, it was just huge. I'm Betsy McKay. I'm a senior writer covering health and medicine for The Wall Street Journal.
And I'm Shalini Ramachandran.
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Chapter 2: How is social media influencing perceptions of antidepressants?
I'm an investigative reporter at The Wall Street Journal.
For over a year now, Betsy and Shalini have been on an investigative journey into some of the most commonly prescribed medications out there, psychiatric drugs.
I mean, we've talked to hundreds of people at this point. We've talked to patients. We've talked to doctors. We've talked to researchers.
As they dug into psychiatric drugs, they found that corner of the internet where thousands of people are sharing their positive experiences. On TikTok alone, the hashtag antidepressants has more than 1.3 billion views.
I feel like one thing that Lexpro has like indirectly done for me is allow me to see a different perspective of like life isn't just all pain. There were a lot of times before I was on medication that I just was not okay, felt hopeless, depressed. So Zoloft is doing what it's supposed to be doing. When I tell you my brain is quiet, it is quiet. Are you also having this experience with this drug?
But over the course of their reporting, Betsy and Shalini found that there's also a dark side to these drugs, especially for some people who've been on them for a long time.
In general, if you were just to look at the most glamorous videos, the most positive ones, you really wouldn't come away thinking...
these drugs can have serious side effects but there is a whole part of the mental health universe that is talking only about very serious side effects you want to know what absolutely nobody told me not even my psychiatrist how bad it is to wean off an antidepressant i feel crazy
As they kept looking into psychiatric medications, not just antidepressants, but also anti-anxiety drugs and others, one big question popped up.
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Chapter 3: What are the potential downsides of long-term psychiatric drug use?
And that started the worst years of my life.
Ativan is the brand name for lorazepam, a popular anxiety medication. It's one of several in a class of drugs called benzodiazepines, and it's commonly prescribed to help people with sleep issues.
We all know somebody who's taken it, and I didn't realize that there are these potentially really debilitating effects.
The executive told Shalini that after being on benzos for his insomnia, he actually started feeling extremely anxious. And when he tried to get off the drugs, he experienced intense withdrawal symptoms.
He even went to one of these very swanky rehab facilities, and they weren't able to help him. And he said he could barely function. He was calling his wife, saying that he couldn't survive.
The executive spent more than $100,000 on treatment for benzo withdrawal. Eventually, he found help at another treatment center. By the time he was telling all of this to Shalini, the executive said his recovery was complete. But his story was about to send Shalini on a new reporting track and straight to Betsy's desk.
You know, I went to Betsy and I was like, Betsy, have you heard about these? She was like, yeah, I was looking into these a few years ago too. So that's kind of how it all started.
benzodiazepines work inside the brain to calm the nervous system. Here's Betsy again.
When we become anxious, it's basically we're overstimulated. And so neurons release this chemical, GABA, and it's meant to sort of quiet everything in your brain. So they basically mimic the calming effect of that substance, GABA. I'm curious, like, how effective are they at doing what they're supposed to do?
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Chapter 4: What is the difference between benzodiazepines and antidepressants?
I would never leave my family and beautiful daughter if I had another option. How much did the patients you spoke to typically know about this going in?
Most of them had no idea, were never warned. Whether it was primary care doctors or psychiatrists, they were not warned that there could be this potential for long-term risk.
That's terrifying. Usually they're told minimal side effects. Oh, boy. Yeah. So the side effects and the problems that we've documented are really from lived real world experience. And one of the problems is that they're not being studied enough.
But what seems to be the gap we're seeing now is that long term use was never studied. And now there's these advocacy groups and things that are trying to get the word out that there's a subset of people for whom there is potential for long-term neurological damage.
So in the last probably seven, eight years, there's been more people who've experienced this banding together saying, holy crap, this is terrible, and like flobbing the FDA and raising the awareness about this to researchers. So that's kind of where some of the data is coming from now.
In 2020, the FDA required drug makers to add a warning on benzodiazepines about the serious risks of abuse, dependence, and withdrawals. It also called for proper guidelines for doctors to help patients taper off the drugs. Still, more than 86 million benzo prescriptions were written just last year in the U.S. Globally, benzos are a multi-billion dollar industry.
North America is its largest market. Shalini and Betsy put their findings about long-term benzo use in a story that they published earlier this year. That was the plan, was to publish one story. But there was a whole other class of widely prescribed psych drugs that they hadn't even begun to look into.
After our story about benzos ran, I mean, we had got a deluge of responses from readers. And many, many, many of the people who wrote in said, I've had the same experience with antidepressants. That's next.
Benzodiazepines and antidepressants are some of the most prescribed psychiatric medications in America. They're so common that they've made a mark on American culture and become household names. It started in the 60s and 70s with one of the earliest benzo drugs to hit the market, Valium.
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Chapter 5: How do benzodiazepines affect the brain?
I mean, we've all heard of the Xanax. It's in pop culture, like, it's in Gossip Girl, it's in, you know, The White Lotus. You should have taken malarazepam. I slept like a corpse.
After benzos, another class of drugs came on the scene, SSRIs, a type of antidepressant that affects serotonin levels in the brain.
Prozac was introduced in 1987, and it was a revolution. Prozac Nation and so forth. Then came other popular antidepressants, like Zoloft and Lexapro. And prescriptions for benzodiazepines have been going down. There's a lot more concern about them now, but prescriptions for antidepressants are going up.
Last year, there were 347 million antidepressant prescriptions written in the U.S. alone, though a lot of people tend to be on multiple medications at the same time. And Betsy says these prescriptions are easier to access than ever, as telehealth clinics like HIMS and HERS are able to prescribe them virtually these days.
In a statement, a HIMS and HERS spokesperson said, quote, We're proud that these efforts have helped people connect with qualified clinicians and get the care they need. But Shalini, you were saying earlier that benzos are not meant for long-term use.
Betsy, is that the same for antidepressants? Yeah, it's very interesting. I mean, again, it's a similar picture to benzos. Most antidepressants have not been studied for long. The average study was about eight weeks long, but the average time... An American is on an antidepressant is five years. That's a huge gap. So nobody really knows. We're kind of a living experiment in that sense.
Betsy found that in the last couple years, more Americans are taking antidepressants than ever, especially young women. And in this living experiment, there isn't a lot of data about long-term use. What there is is a lot of chatter on social media.
So it started kind of in a good place of you're all lonely. We already have so much anxiety in our lives. Which sounds like a good thing, right? Like that's destigmatizing. It is. It's very destigmatizing. And I think that's destigmatizing being open, realizing that you're not alone.
Only, creators that Betsy and Shalini spoke to said that after extended use of antidepressants, they started experiencing downsides. And now, there are TikTok testimonials trending with a very different tone.
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Chapter 6: What challenges do patients face when discontinuing these medications?
If you or anyone you know is struggling, you can reach the Suicide and Crisis Lifeline by dialing or texting 988. That's 988. That's all for today, Wednesday, December 3rd. The Journal is a co-production of Spotify and The Wall Street Journal. Additional reporting in this episode by John West. Thanks for listening. See you tomorrow.