In the first directive since his nomination to secretary of health and human services, Robert F. Kennedy Jr. thrust psychiatric medications and their use among children into the national spotlight.
The Trump administration introduced the initiative “Make our Children Healthy Again Assessment” in a February executive order that aims, in part, to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs” within 100 days.
Kennedy, who is not a physician and has no medical or public health training, has said that the class of drugs known as selective serotonin reuptake inhibitors, or SSRIs, are harder to give up than heroin, and that school shootings became prevalent only after the introduction of Prozac, a common SSRI drug. These statements are riddled with falsehoods, according to health organizations, psychiatrists and researchers.
Dr. Marcia Slattery, a physician and professor of psychiatry and pediatrics at the University of Wisconsin-Madison, focuses on anxiety disorders in patients between 5 and 18 years old. She could not speak to any of Kennedy’s claims, but offered her expertise on SSRIs and their role in children’s mental health.
Here’s what to know.
Serotonin is a neurotransmitter in our brains associated with mood and emotions, sleep, appetite and digestion, learning and memory, pain perception and even bone health. Neurotransmitters carry messages between nerve cells in the brain, called neurons.
Typically, once a signal is passed between neurons, serotonin is reabsorbed in those cells, a process called “reuptake.” SSRIs block this process of reuptake, which increases serotonin levels in your brain. That enables the brain to continue using serotonin to connect more dots as we go about everyday tasks.
Emotions also factor into how we think, problem solve and pay attention, Slattery said, and can affect the brain in ways that go beyond lifting some of the fog of depression and anxiety.
“Taking the medication basically is allowing the brain to operate in a healthy manner, in a normalized manner, that allows the kid to then engage,” Slattery said.
Prescribing medications is never the first step in treating children and adolescents, Slattery said.
The psychiatrist or pediatrician works to better understand the bigger picture of a child’s circumstances before taking out their prescription pad. A child’s school environment may trigger anxiety, learning problems and bullying. Family dynamics can also play a role.
That said, medication helps to normalize the brain of a child experiencing severe anxiety and depression, Slattery said, which can allow a child to move forward and function more effectively, whether at home, at school or in social settings.
“When we do use medication, it still should be in conjunction with all these other non-pharmacological interventions,” Slattery said. “That link gets lost a lot. People think all we’re doing is prescribing medications as soon as a kid comes in and says they’re anxious or they’re depressed. That’s not the case by a long stretch.”
SSRIs can be life-saving medications, Slattery said.
Just as a pediatrician wouldn’t ignore a child’s severe asthma attacks, a psychiatrist or pediatrician isn’t going to ignore signs of severe depression and anxiety, which are associated with higher risks of suicide and substance abuse, academic declines, decreased school performance, and “a lot of peer-social interaction problems,” Slattery said.
During the pandemic, alarms rang out from different pediatric health groups about the youth mental health crisis. COVID exacerbated the burgeoning crisis among children and adolescents.
Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased by 66%, according to a 2024 study from the American Academy of Pediatrics. At the same time, however, the decision to prescribe SSRIs for children and adolescents for depression and/or anxiety was largely found to be appropriate, another study published in the American Academy of Pediatrics concluded.
The use of SSRIs aligns with a grimmer fact: teenagers say they’re more anxious, depressed and suicidal than they were prior to the pandemic. In Wisconsin, more than half of high schoolers reported having anxiety, 35% reported depression, 21% said they’ve intentionally harmed themselves, and 19% have considered suicide, according to the 2023 Youth Risk Behavior Survey.
Taking an SSRI doesn’t have an immediate effect on the brain. It’s a gradual change in the brain that targets a specific neurotransmitter, Slattery said.
“Literature would show that these are not addictive medications, and you’re not on them for life,” Slattery said.
Opiates like heroin activate the brain’s reward system, releasing the chemical dopamine, a hallmark of addiction that inspires feelings of euphoria and bliss.
SSRIs, by and large, only target serotonin and have little effect on dopamine.
Comparing serotonin receptor sites with opiate receptor sites “is night and day,” according to Sean Leonard, a psychiatric nurse practitioner from San Diego who focuses on addiction medicine told USA Today.
As with many medications, abrupt cessation can lead to symptoms of withdrawal according to the Canadian Medical Association Journal and are typically mild, producing flu-like symptoms, nausea and imbalance, among others.
After months of stable functioning in a patient, Slattery said she starts tapering down the dosage. In cases where anxiety crops up during that time, Slattery helps her patient use the skillsets developed in therapy to manage and cope with stress.
Slattery said it’s better to reframe this question. Has severe depression or anxiety changed who you know your child to be?
SSRIs will change a child like any medication would. But Slattery described the change more as a release.
“It’s like being unwrapped from cellophane. Your child is now able to experience the world and feel good about him or herself, and engage in life,” Slattery said. “And so you will notice a difference in your child, but in a healthy way.”
No.
Studies have yielded no causation between school shootings and psychotropic medications like SSRIs. A majority of school shooters had no history of taking these medications.
On the other hand, people with untreated serious mental illness are more likely to be victims of violence or self-inflict harm than be violent toward others.