Antidepressants didn’t do David Johnson’s oldest daughter any favors. Or maybe they did. It’s difficult to say when assessing his daughter’s decadelong struggle with depression.

“(She) cycled on and off a lot of the first-line drugs, the second-line drugs, and even some older drugs that they tend not to use anymore, just trying to find the right combination,” he said.

Struggles like these motivated a federal campaign, launched this spring by Health and Human Services Secretary Robert F. Kennedy Jr., to reduce antidepressant use and wean people off the medications. The campaign presents a challenge for doctors who consider antidepressants vital front-line therapies but are starting to rethink the amount and length of some patients’ prescriptions.

Whatever role the drugs played, Johnson does not credit them for keeping his now-27-year-old daughter alive through suicidal impulses. Yet he is leery of Kennedy’s campaign, joining some psychiatrists and mental health advocates who believe it goes too far and could discourage people who might benefit from medications.

“Everyone’s journey is unique. What works for one person doesn’t necessarily work for another,” said Johnson, who lives in the Twin Cities and teaches a parenting course for the Minnesota chapter of the National Alliance on Mental Illness. “I don’t ever give people advice and say, ‘Here’s what you should do.’ And that’s why I’m worried about Secretary Kennedy’s oversimplified framing of mental health medications as, like, either they do or they don’t work.”

Kennedy launched the campaign in early May, calling on doctors to de-prescribe antidepressants and “shift the standard of care toward prevention, transparency, and a more holistic approach to mental health.” The U.S. Department of Health and Human Services followed up by hosting webinars in June focused on the side effects of psychiatric medications and scheduling an expert panel in July to develop guidance on how to taper off the drugs.

The campaign targets an overmedication issue that has been gaining recognition in the U.S., where an estimated 13% of adults take antidepressants and a quarter of people on the medications have taken them for 10 years or longer. Sessions at this summer’s annual convention of the American Psychiatric Association included “Deprescribing Antidepressants and Mood Stabilizers” and “The Much Too Medicated Patient.”

Overuse can happen when people aren’t properly diagnosed and their problems stem from something other than clinical depression, said Dr. Laurel Ries, a family medicine physician in St. Paul. Other people stay on them after their benefits have faded because they are afraid to stop or haven’t talked with their doctors about when and how to do it.

But Ries said she is troubled as well by the sweeping campaign to de-prescribe antidepressants, which are backed by substantial research showing they are safe and effective. Getting people to try them is hard enough in a society that carries a lot of stigma when it comes to mental health, she said.

“Proton pump inhibitors (for acid reflux) are often prescribed longer than they need to be,” said Ries, a past president of the Minnesota Medical Association. “But RFK isn’t targeting those. He is targeting medications that are specifically for mental health.”

Establishing the optimal role of antidepressants is becoming more important.

Suicide deaths in Minnesota have increased over the past two decades, though they have declined since a peak in 2022 amid the COVID-19 pandemic. Federal survey data shows an increase in Minnesota adults who report having ever been depressed — from about 15% in 2010 to more than 24%.

The most common antidepressants are selective serotonin reuptake inhibitors, or SSRIs, which go by brand names such as Prozac and Zoloft and work by blocking the brain’s reabsorption of a hormone that regulates mood, sleep and appetite.

Several studies have found they are most effective when paired with psychotherapy, but they take several weeks to work. Ries and other doctors urge patients to give them a year before reevaluating whether the drugs are still needed.

The efficacy of all depression care can look underwhelming, according to a new analysis of clinic data released this spring by MN Community Measurement. The nonprofit, which tracks the cost and quality of health care, found only 19% of people treated for depression reported clinically significant improvement after 12 months of treatment — as measured by their responses over time to a nine-question survey.

Just 11% achieved a full reversal of depression symptoms with drugs, therapy or a combination of treatments.

Such data can be deceiving. Some patients get better and don’t return for follow-up appointments to chart their progress and improve their clinics’ scores. Others shed depression symptoms but still score poorly on the survey because they have other unresolved problems such as insomnia or stress at work.

“I’ve seen them work. ... But if you’re not depressed, antidepressants are not going to work,” said Mark Schneiderhan, a psychiatric pharmacist at the University of Minnesota Duluth who has treated patients since the mid-1990s.

Nick Hanson has been a spokesperson for 20 years for a variety of Minnesota hospital systems and has seen existing and experimental drugs save lives. But when he tried to overcome his own depression while battling alcoholism, he said he found the drugs didn’t do much other than flatten his mood.

He recalled his time on the medications: “The world is gray all the time. You never laugh. You never cry.”

Hanson just published “A Fragile Utopia: Escaping the Elaborate Façade of Alcoholic Bliss,” a book in which he revealed how his path to sobriety and happiness leaned heavily on diet, exercise, therapy and social support.

He said he struggled the most with benzodiazepine medications, which didn’t make him feel better but doctors kept prescribing “as long as they weren’t making my life worse.”

The medications, including the antidepressants, were memorable for the days his prescriptions ran out and he suffered “paralyzing” withdrawal symptoms that sometimes forced him to miss work, he said.

“I would suffer brain zaps — a jolt running through my head that could stop me in my tracks," he said. “The depression and malaise would come rushing back as well. I felt ill with an ache and sense of uneasiness in the pit of my stomach after a day off SSRIs.”

Withdrawal symptoms occur for around one in five patients who take antidepressants. Most cases resolve in a couple of weeks, although Schneiderhan, the pharmacist, recently published a case report about a woman whose brain zaps and other symptoms lasted two months.

Withdrawal from any drug is often a consequence of the body’s instinctive efforts to achieve balance when someone abruptly stops a medication or cuts the dosage, he said.

But fear of withdrawal shouldn’t be the factor keeping someone on a drug, he said. One strategy is slow tapering, which can reduce the likelihood of withdrawal.

“I wish that was the emphasis from the messaging, not to stop your medication abruptly,” he said. “That could precipitate the problem. That’s my worry.”

It’s unclear how the federal campaign will encourage de-prescribing.

HHS officials in an open letter encouraged doctors to fully explain the risks and benefits of psychiatric drugs and offer them as part of a much wider menu of options that include “psychotherapy, social connection, behavioral approaches, sleep-focused treatments, physical activity interventions, and dietary and nutrition-related strategies.”

Johnson said he is relieved his daughter has stabilized as an adult after being diagnosed with depression at 17 and likely struggling with the condition for years before that. She spent weeks at a time increasing dosages of antidepressants, only to spend more weeks tapering off.

“I don’t feel better. This isn’t helping,” he recalled her often saying. “This isn’t working.”

Many other families have told him about similar struggles in the eight-week support class that he teaches. They need more proven options for treatment, not fewer, he said.

Alternatives are emerging, though some are only available after drugs or initial treatments fail. Allina Health recently doubled capacity at its Fridley clinic to target treatment-resistant depression with a daily series of magnetic pulses to the brain. (The treatment had its roots in clinical trials at the U two decades ago.)

The Wellness in the Woods nonprofit in north-central Minnesota offers trainings on a variety of approaches to mental health, including a self-help program that encourages personal empowerment and discourages negative thoughts.

Executive director Jode Freyholtz-London said she wouldn’t take antidepressants off the table, though.

“Anytime we take away choice,” she said, “we create more barriers around the recovery journey.”

_____

©2026 The Minnesota Star Tribune. Visit startribune.com. Distributed by Tribune Content Agency, LLC