This story discusses suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide and Crisis Lifeline at 988.

Tom Streeter clearly remembers the day he nearly died from depression, left untreated for years.??

In the mid-1990s, Streeter was in North Carolina working on his dissertation when his mental health tanked.??

“One day, I found myself sitting in my office, wondering how to kill myself,” said Streeter, now 61. “It occurred to me that maybe I ought to talk to somebody, because if I actually came up with a way that was acceptable, I was going to really be in trouble.”?

Streeter, who’s now lived in Boone County more than 20 years, called a friend who referred him to a psychiatrist. Quickly, he got set up with talk therapy and was prescribed Zoloft, an antidepressant that had been approved by the U.S. Food and Drug Administration a few years prior.?

He’s been on Zoloft ever since and credits it with saving his life.?

“It’s been 30 years,” Streeter told the Lantern. “There’s been all kinds of ups and downs, but I think, frankly, it’s the only reason I’m here.”?

Streeter and other Kentuckians who’ve taken selective serotonin reuptake inhibitors (SSRIs) to treat depression are angry and confused over recent national rhetoric surrounding the drug class. Those who shared their stories with the Kentucky Lantern overwhelmingly said antidepressants improved their lives, and, in some cases, saved them.?

In a February executive order, President Donald Trump called for more research into SSRIs and directed Robert F. Kennedy Jr. to study the “threat” posed by the medications in his role as secretary of the Department of Health and Human Services.?

Kentucky experts agree that more research is always welcome, but say SSRIs are safe and effective at treating depression.?

Still, the federal Make America Healthy Again Commission, which Kennedy will chair, is charged with understanding chronic diseases. It will “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants and weight-loss drugs,” according to the executive order. Kentucky lawmakers have moved to establish a task force aimed at implementing the MAHA principles in Kentucky.?

Kennedy’s comments about SSRIs include saying they can be addictive and worse to quit taking than heroin — statements Kentucky experts say are false.?

“That’s a biologically inaccurate statement, because SSRIs are not addictive. Heroin is addictive,” said Brighid Kleinman, a Louisville psychologist. “Tapering off appropriately, it works every time. You don’t taper off an SSRI and then have a craving to go back on it. That’s not how it works. You might find that your symptoms come back, in which case maybe it is helpful to be on it, but you’re not thinking about it every day. You’re not wishing you had this drug. You’re not doing illegal things to try to get to it.”?

Kentuckians who are on antidepressants to treat mental health issues find the recent rhetoric surrounding the medications upsetting.?

“They are absolutely full of crap,” Streeter said. “Whatever their agenda is, it has nothing to do with anybody’s well-being. I’m not going to listen to a guy who’s had brain worms —? literal brain worms — tell me what should be going in my freaking head. It makes me very angry.”

Streeter was referring to Kennedy’s experience being misdiagnosed with a tumor that turned out to be a brain worm.?

He added: “I don’t know what these people’s agendas are. I don’t care. Just leave me the hell out of it.”?

Kentucky medical experts, doctors and psychologists who weighed in on SSRIs said that overall, the medications are helpful for treating moderate to severe depression.?

Who gets prescribed SSRIs??

SSRIs are used to treat depression, mainly, and may also treat anxiety and obsessive compulsive disorder (OCD).?

Dr. Rif El-Mallakh, a professor of psychiatry and mood disorder expert at the UofL School of Medicine, said a lot is still unknown about the depressed brain.?

“If you have a heart attack, we know that there’s a blood vessel that’s blocked and a piece of the heart dies,” he explained. “But when you get depressed, we don’t actually know what is happening in the brain to create the symptoms.”?

Nevertheless, depression is “clearly a dysfunction” that results in a “cascade of abnormalities” like low energy, sleep disruption, inflammation and more.?

“It’s a physical dysfunction of the body, but it doesn’t produce direct physical symptoms,”? said El-Mallakh. “We can measure physical abnormalities … but the symptoms tend to be more subjective, or at least they seem more subjective.”?

When a person is depressed, they may experience unwanted behavioral changes — like irritability — just like an involuntary sneeze, he explained.?

“We do know that when you’re depressed, that you have difficulty functioning. That is, you’re unable to do your routine tasks. You are less effective in everything,” said El-Mallakh. “You might get up and do the dishes, but it takes you twice as long to do the dishes. You might indeed take care of your kids, but it takes more effort to take care of your kids.”?

Enter antidepressants, which can help regulate emotions, allowing people to better cope with stressors.

“The idea is that your brain is not using the serotonin it has, and it’s using it up too fast, and these medications are helping keep the amount of serotonin stable in your brain,” explained Dr. Fareesh Kanga, a University of Kentucky assistant professor of psychiatry.?

What are SSRIs? How do they work??

Hannah Johnson, who holds a doctor of pharmacy and is an associate professor in the University of Kentucky College of Pharmacy, said people who have depression and anxiety may not be holding onto enough serotonin, a neurotransmitter that helps regulate moods, among other things.?

SSRIs block the serotonin reuptake transporter from “suck(ing) up that serotonin,” resulting in depressive symptoms. In doing so, Johnson explained, the medications “allow more serotonin to hang out in the synapse.”?

Psychologists say the results are clear: their patients who get on antidepressants are often better able to thrive in therapy and handle stress.?

Katie McBride, a Louisville psychologist, said sometimes clients are “stuck,” be that due to complex trauma or severe depression.?

“When I’m talking to clients, I’m saying: ‘you’re functioning, but you’re using all of your energy, like you’re clinging to the side of a mountain, and … because of that, you’re just in a survival mode because your symptoms are so severe.’ And so oftentimes, with the antidepressants, it’s kind of helping to take enough of the edge off, or to kind of get on the landing to some stability,” McBride explained.??

With the medication, she said, “you’re not all the way away from the edge, but you’re not having to use all of your energy to just … stay alive.” With that extra energy, she said, clients can learn about their emotions and develop skills to manage their behavior.?

Because of this, she said: “the gold standard, if you will, is always … psychotherapy plus medication.”?

Dr. Caitlin Briggs, an assistant professor in the Department of Psychiatry at the University of Kentucky, said the medications are “the first line treatments” for both children and adults.?

While Briggs agreed that it’s ideal to have both therapy and medication, she pointed to therapist shortages that can keep people from getting established with a therapist. Other times, symptoms of depression are so severe a person may not be able to participate in therapy right away.?

“Sometimes a kid is severely depressed or severely anxious that it’s difficult for them to even participate or be receptive to the therapy, and a medication can really lighten the load a little bit and allow them to be able to participate better in the therapy treatment,” said Briggs. “And there are kids that, when they’ve had the combination treatment, they’re able to come off of the medication at some point. And that’s always the goal but we understand that that’s not the case for everyone.”??

Kleinman said SSRI experiences among her clients are “overall good.”?

“They’re so mild, right? They are not a dangerous medicine,” Kleinman said. “It is perfectly fine to take an SSRI, and if it doesn’t work for you, stop taking it. It makes sense to prescribe them as a first line of treatment to see if it helps, because there’s so few downsides.”?

Those “downsides” Kleinman referred to — side effects of the medications — can include upset stomach in the beginning and, in some people, sexual dysfunction such as difficulty having an orgasm.?

“Often it’s having or sustaining an erection or feeling pleasure from sex,” she said. “Those are relatively common. Much of the time, doctors will either change your medicine or reduce your medicine, because there’s so many different SSRIs that if you’re having sexual side effects with one of them, you may not with another one.”?

Johnson, the pharmacy expert, said depression itself can cause sexual dysfunction, so it’s sometimes tricky to figure out if the disease is causing the issue or the treatment. The solution will vary person to person, she said.?

Experts agreed: it’s important to have a long taper when stopping an SSRI, and to not quit the medications abruptly or without physician guidance. Stopping abruptly can result in “discontinuation syndrome,” Kanga explained, which can come with some unpleasant side effects that people without medical training sometimes misinterpret as a withdrawal, but is not.

The elephant in the room: the black box warning?

SSRIs come with a “black box warning” from the FDA, which says people younger than 25 may experience a small increase in suicidal thoughts.?

“This was a blanket black box warning that they required all antidepressants to put onto their labeling — so they didn’t specifically look at specific drugs and study specific drugs and assess for suicide or suicidal thinking or behaviors,” Johnson explained. “They just looked back at all of the studies of these medications and saw that there was potentially a small increase in suicidal thinking or behaviors, and then they just … globally labeled it and put it on all of the antidepressants.”?

The black box warning came after the FDA analyzed clinical trials and found a small number of young people experienced more suicidality after starting treatment, according to the Mayo Clinic.?

“The analysis showed that some children and teens taking antidepressants had a small increase in suicidal thoughts, compared with those taking a sugar pill (placebo),” according to the Mayo Clinic. None of the people in the studies ended their lives. Other research shows antidepressants effectively treat depression in this population.?

Experts emphasized: untreated major depression is a high risk factor for suicide. Prescribers will monitor a patient for increased energy when they start treatment.?

This, too, is when talk therapy is helpful. Therapists can help people navigate new feelings and energy that come with treating depression with medication.?

“It’s something that we definitely counsel people on and tell them about,” Johnson said. “But it shouldn’t prevent someone from being able to get one of these medications if they are able to have the support and monitoring for increased suicide risk during that time frame.”?

Kanga pointed out that suicide is already a leading cause of death among children and adolescents. The COVID-19 pandemic and its related breaks from the social interactions of school didn’t help, nor do intergenerational trauma and social media.?

“While, of course, we should put research money into cancer and into improving all aspects of children’s lives,” Kanga said, “if you want to stop having children die as children, we need to stop suicide, and we need to invest in mental health to do that.”?

‘When they’re really working, they don’t feel like anything’?

Not only are SSRIs not addicting, experts say that when they work right, they won’t feel like much of anything.?

While some people might experience an “emotional blunting,” as McBride put it, Johnson said “our goal is to have that full range of emotions” when on antidepressants.?

“If someone’s feeling that numbness, then we’re not treating them with the right medication or the right approach,” Johnson said.?

Streeter thinks the misconception that antidepressants make people numb can be stigmatizing for people, though he is unbothered.?

“Nobody’s going to throw any contempt at me that I haven’t thrown at myself,” he said. “So … I don’t worry a hell of a lot about it. Early on … people would ask, ‘what do they feel like?’ Well, when they’re really working, they don’t feel like anything. That’s the whole point. I would experience emotions in a way that I’d actually … read about in books.”?

Most experts who spoke to the Lantern said there’s no danger in staying on antidepressants longterm. El-Mallakh has some concerns about long-term use, but admits his opinion is a “minority position.”?

A time of ‘terror’ and ‘stigma’?

Matt Milligan, who is from Versailles, first got on an antidepressant in high school. He was suicidal, and he voiced it often.?

His mother took him to a doctor who prescribed Effexor, which he’s been on — with a few breaks — ever since. (Effexor is an antidepressant but in a different drug class than SSRIs).?

Still, Milligan says stigma around mental health is going backwards.?

“In the late ’90s and early 2000s there was an effort to de-stigmatize all this stuff — mental stuff — and now it’s like we’re under the gun again, and we can’t really talk about it,” he said. “It’s like we have to go to our little online message groups or whatever, to just talk about … what we’re feeling or what we’re dealing with.”??

It “makes people like me want to just slide back into the shadows where we can just kind of chill … and not have to worry about too much.”?

Milligan, 42, blames national politics and their trickle-down effect on Kentucky.?

“Currently … politically, it’s okay to be mean and disparaging towards people and … the meaner you are, the louder you are, the better you are,” he said.?

Kleinman has noted “terror” among her clients lately.?

“My patients are terrified that their lifesaving medicines are going to go away, or they’re not going to have access to the thing that allows them to get out of bed or not be too anxious to work,” she said. “I am seeing a lot of fear.”?

Lindsay Fouts, 42, said SSRIs helped her cope with “real bad postpartum depression” and they helped her manage thoughts of suicide. Now, the Louisville woman is worried about the future.?

“I’m anxious about everything happening in Washington right now,” she said. “I’m anxious about everything happening politically right now, very anxious. And I have anxiety, so it doesn’t help.”?

Rob Mattheu, who said SSRIs helped him cope with anxiety and panic surrounding the loss of his father, has a “live and let live” mentality.?

“If you don’t feel they’re right for you, then definitely don’t take them, but don’t dismiss the fact that they’ve helped other people,” the Fern Creek man, 54, said.?

Experts said more research and education on SSRIs are always welcome, but cautioned against buying into misinformation.?

“For the people it works for, it can be life changing,” Kleinman said. “I don’t think we should prescribe less of them. I think that our research needs to get better in terms of figuring out for whom SSRIs will be helpful.”?

Briggs said stigma has improved, but there remain populations who see mental health as something one can choose to believe in or not.?

“It’s not necessarily something that you believe in,” Briggs, the UK psychiatrist, said. “It’s not like Santa Claus, it’s not like the tooth fairy. Mental health is just as important as physical health. And if you don’t treat your mental health, your physical health is not going to be as great.”?

There remain question marks around the future of antidepressants. For now, UofL psychiatrist El-Mallakh said it would be “irresponsible” to “take away something from people that are sick.”?

“I think that it is important to understand that everything we do is associated with potential problems. You can argue that hammers are associated with broken thumbs, right? So we need to eliminate hammers? No. We need to use the tool more effectively,” he said. “We need to understand that everything has its potential harm, and we need to deal with that, minimize that harm as much as possible.”?

Depression, he reiterated, is “a disease that has to be treated.”?

“Taking away the tools to treat our patients is wrong,” he said. “It is ethically wrong, morally wrong, scientifically wrong.”?