"Anxiety medication use in the U.S. has seen a significant surge, particularly since the pandemic, raising questions about its effectiveness, safety, and the underlying societal factors contributing to this trend."
The landscape of mental health treatment in the United States is shifting, marked by a notable increase in the prescription and use of anxiety medications. Driven by a confluence of societal pressures, greater public acceptance of mental health discussions, and improved access through telemedicine, millions of Americans are now relying on these medications. However, this rise is not without its critics, who raise concerns about potential harms and advocate for alternative approaches, creating a complex and evolving debate within the medical and public health communities.
The Escalating Demand for Anxiety Relief
Sadia Zapp, a 40-year-old communications director from New York, found herself in the throes of profound anxiety following a grueling year of chemotherapy, surgery, and radiation to treat breast cancer. Her anxiety transcended the usual manageable worries, becoming a deep-seated apprehension that shadowed her recovery. "Every little ache, like a knee pain, made me think: this is the end of the road for me," she recalled. This experience placed Zapp among a growing demographic of Americans who have turned to anxiolytics, or anti-anxiety medications, in recent years. For Zapp, Lexapro, a selective serotonin reuptake inhibitor (SSRI) that boosts serotonin levels, proved to be a life-changing intervention. "I love it. It’s been excellent," she stated. "It’s really helped me manage it."
Zapp’s experience mirrors a broader national trend. Data from the Centers for Disease Control and Prevention (CDC) indicates that the proportion of U.S. adults taking anxiety medication rose from 11.7% in 2019 to 14.3% in 2024, with a substantial portion of this increase occurring during the COVID-19 pandemic. This translates to an additional 8 million individuals, bringing the total to approximately 38 million Americans. The surge is particularly pronounced among young adults, college graduates, and individuals identifying as LGBTQ+.
The Debate Over SSRIs: Efficacy vs. Criticism
While psychiatric medications have gained greater public acceptance and are more accessible than ever, largely due to the proliferation of telemedicine, the escalating use of SSRIs, a class of antidepressants commonly prescribed for anxiety disorders, has drawn criticism. Proponents of the "Make America Healthy Again" (MAHA) movement argue that these medications are not only unnecessary but potentially harmful.
Medical professionals and researchers, however, largely defend SSRIs like Prozac, Zoloft, and Lexapro as first-line treatments for a range of anxiety disorders, including generalized anxiety disorder and panic disorder. They emphasize that these drugs have been misrepresented as inherently addictive and damaging, despite extensive evidence supporting their safety for long-term use.
Prominent figures have voiced strong opposition. Robert F. Kennedy Jr., the nominee for Secretary of Health and Human Services (HHS), has been a vocal critic of the increasing reliance on SSRIs. During his confirmation hearing, he asserted that he knows individuals, including family members, who found it more challenging to discontinue SSRIs than to quit heroin. More recently, Kennedy has suggested his agency is investigating a potential link between SSRIs, other psychiatric medications, and violent behaviors, such as school shootings. Similarly, Marty Makary, a commissioner on the Food and Drug Administration (FDA), has raised concerns about the potential for SSRI use in pregnant women to result in adverse birth outcomes.
The common side effects associated with SSRIs can include gastrointestinal upset, difficulty concentrating, and fatigue. Some individuals may also experience a diminished libido and other sexual side effects. However, for many, these side effects are mild and manageable, with the benefits of treating chronic anxiety outweighing the drawbacks. Patrick Kelly, president of the Southern California Psychiatric Society, dismissed criticisms leveled against SSRIs, stating, "The statements about SSRIs were simply not based on any kind of evidence or fact."
Recent studies lend considerable weight to the efficacy of SSRIs. One study found that over half of individuals with generalized anxiety disorder who were taking an SSRI experienced at least a 50% reduction in their anxiety symptoms. While approximately 1 in 12 individuals discontinued the medication due to side effects, the overall therapeutic benefit remains significant. Emily Wood, a psychiatrist practicing in Los Angeles, noted, "When done appropriately and also using appropriate therapy techniques, SSRIs can be really very useful."
MAHA’s Perspective: Lifestyle as the Foundation of Well-being
Advocates of the MAHA movement attribute the rise in various health issues, including anxiety, depression, and other mental health disorders, to poor dietary choices and sedentary lifestyles. They propose a return to fundamental health practices, such as reducing the consumption of ultra-processed foods, which recent studies have linked to increased rates of depression and anxiety, and limiting screen time in favor of regular physical activity.
Psychiatrists generally endorse a healthy diet and exercise as complementary therapies for anxiety and depression. Wood suggested that individuals who can manage their anxiety without medication should also consider talk therapy. The utilization of mental health counseling services in the U.S. has also seen an increase between 2019 and 2024, with teletherapy contributing to this growth, according to federal data. "Anxiety disorders are among the psychiatric disorders that respond best to cognitive behavioral therapy," Wood commented.
However, the conversation around treatment options is nuanced. Studies indicate that the risks associated with SSRI use during pregnancy are low for both mother and child. In stark contrast, Wood highlighted that "depression increases the risk of almost every complication for the mother and the baby," adding that recent governmental pronouncements regarding SSRI use in pregnancy "could be causing real harm to these women."
Concerns about discontinuing antidepressants are also part of the discourse. Some individuals experience withdrawal symptoms such as nausea, insomnia, or other discomforts, particularly if they stop the medication abruptly. Yet, as Kelly clarified, "The concept of addiction simply does not apply to these medications," a stance supported by numerous studies.
The risk of addiction is more pertinent to benzodiazepines, such as Xanax, which are often prescribed as a second-line treatment for anxiety. These controlled substances can also elevate the risk of opioid overdose in patients concurrently using both types of medication. During congressional hearings last year, Kennedy also pointed to the overreliance on benzodiazepines as a significant concern. While benzodiazepines can be effective for acute anxiety, their long-term use requires careful medical supervision. Wood explained, "They are very useful medications for acute anxiety and are not suitable as a long-term treatment, because they can lead to dependence over time." She elaborated that daily use may necessitate escalating doses for the same effect, followed by a gradual tapering process.
An increasing number of individuals are also using beta-blockers, such as propranolol, for anxiety on an occasional basis. While not FDA-approved for anxiety treatment and used off-label, some individuals utilize them to manage physical symptoms like rapid heart rate before public speaking or other high-stakes events. Beta-blockers can cause side effects like dizziness and fatigue, but Wood noted their safety and utility in mitigating autonomic nervous system overactivation, facilitating a shift from a "fight or flight" response to a more neutral state, without the risk of addiction.
Societal Shifts Fueling the Rise in Medication Use
Several theories attempt to explain the escalating use of anxiety medications. Experts and researchers point to factors such as increased social media engagement, greater social isolation, and heightened economic uncertainty. Furthermore, the accessibility of these medications has improved, with many individuals receiving prescriptions from their primary care physicians or after brief telemedicine consultations.
The open discussions about mental health challenges by social media influencers have played a role in destigmatizing these issues, particularly among younger generations, encouraging them to seek help. A recent study indicated that approximately one-third of teenagers access mental health information through social media platforms. However, this increased access to medication, coupled with a tendency towards self-diagnosis based on online information, can be problematic. Online searches for medications like Xanax can yield sponsored ads promising same-day treatment, though often without guaranteed prescriptions. Kelly cautioned, "I think increased access is a positive thing, but it’s not the same as, for example, ordering Xanax off the internet."
Young adults are a primary driver of the surge in anxiety medication use. The proportion of Americans aged 18 to 34 who take these medications increased from 8.8% in 2019 to 14.6% in 2024, according to CDC data. This contrasts with a more modest change among adults aged 65 and older. The COVID-19 pandemic and its associated lockdowns significantly amplified stress levels for many, especially young adults.
Data also consistently shows that women are more likely than men to take anxiety medications. Jason Schnittker, Chair and Professor of Sociology at the University of Pennsylvania, suggests this is due to a greater likelihood of needing these medications, as well as women being more inclined to report feelings of anxiety. He also noted that physicians may be more adept at identifying anxiety in female patients compared to male patients.
Broader generational trends may also be at play. Schnittker’s research indicates a rise in anxiety across successive generations throughout the 20th and 21st centuries. He posits that increasing income inequality may contribute to this trend, as individuals feel pressure to improve their economic standing. Traditional social and religious activities have been supplanted by increased isolation, and a growing distrust of others can foster a sense of unease in social interactions.
For Sadia Zapp, the journey to feeling better with Lexapro was not instantaneous, taking several months to manifest clear results. Once they did, she experienced a reduction in mental clutter, facilitating better concentration. While she also engaged in therapy, her chronic anxiety is now managed primarily through medication. "It definitely helped me get back into my daily routine in a productive way and not just filled with anxiety all day," she concluded.
Holly Hacker, Maia Rosenfeld, and Lydia Zuraw of KFF Health News contributed to this report.