"The proportion of American adults who took anxiety medications jumped significantly, with most of the increase occurring during the COVID-19 pandemic, sparking debate over their safety and efficacy amidst a backdrop of societal shifts."
The United States has witnessed a notable rise in the prescription and use of anxiety medications, a trend amplified by the unprecedented stresses of the COVID-19 pandemic. This surge, from 11.7% of adults in 2019 to 14.3% in 2024, translates to an additional 8 million Americans seeking pharmaceutical intervention for anxiety. The increase is particularly pronounced among younger adults, college graduates, and individuals identifying as LGBTQ+, pointing to a complex interplay of demographic, social, and public health factors. This growing reliance on medication has, however, ignited a contentious debate, with some public figures questioning the safety and long-term implications of widely prescribed antidepressants, while medical professionals and researchers largely defend their efficacy and safety for appropriate use.
Sadia Zapp, a 40-year-old communications director in New York, exemplifies the experiences of many navigating this landscape. Following a challenging year of chemotherapy, surgery, and radiation for breast cancer, Zapp found herself grappling with an overwhelming anxiety that extended beyond her usual manageable levels. The slightest physical discomfort, like a knee ache, would trigger profound fears of a terminal outcome. "Every little ache, like my knee hurts," she recounted, "made me worry that this is the end of the road for me." This heightened state of distress led her to seek professional help and ultimately to Lexapro, a selective serotonin reuptake inhibitor (SSRI). "I love it. It’s been great," Zapp stated. "It’s really helped me manage." Her experience highlights the critical role these medications can play in helping individuals cope with severe anxiety, especially when compounded by other life stressors.
The Centers for Disease Control and Prevention’s survey data reveals a stark increase in anxiety medication usage, with the total number of adults taking such drugs now estimated at approximately 38 million. This upward trend is not uniform across all demographics. Young adults, in particular, have shown a dramatic rise in anxiety medication use, with the proportion of Americans aged 18 to 34 taking these medications increasing from 8.8% in 2019 to 14.6% in 2024. This contrasts with a more stable rate among adults aged 65 and older. Similarly, adults with a college degree and those identifying as LGBTQ+ have also experienced sharp increases, suggesting that societal pressures and unique challenges faced by these groups may be contributing factors.
Despite the growing public acceptance and increased accessibility of psychiatric medications, largely facilitated by the expansion of telehealth services, a vocal segment of the public has expressed concern. Supporters of the "Make America Healthy Again" movement, including prominent figures like Health and Human Services Secretary Robert F. Kennedy Jr., have raised alarms about the widespread use of SSRIs. Kennedy Jr. has gone as far as to suggest that quitting SSRIs can be more challenging than discontinuing heroin and has indicated his agency is investigating a potential link between SSRI use and violent behavior, such as school shootings. Similarly, Food and Drug Administration Commissioner Marty Makary has voiced concerns about potential adverse birth outcomes associated with SSRI use during pregnancy.
These criticisms stand in contrast to the consensus among many physicians and researchers, who view SSRIs like Prozac, Zoloft, and Lexapro as crucial first-line treatments for a range of anxiety disorders, including generalized anxiety disorder and panic disorder. They argue that these medications are often misrepresented as addictive and broadly harmful, despite ample evidence supporting their safety for extended use. Patrick Kelly, president of the Southern California Psychiatric Society, directly addressed Kennedy Jr.’s comments, stating, "The statements about SSRIs were just not grounded in any sort of evidence or fact."
The common side effects associated with SSRIs, such as upset stomach, brain fog, and fatigue, are generally considered mild and manageable for most patients. Some individuals may also experience a reduced libido or other sexual side effects. However, experts like Kelly emphasize that for many, these side effects are a small price to pay for the significant relief and improved quality of life afforded by treating chronic anxiety. A comprehensive review published in the Cochrane Library supports this view, indicating that over half of individuals with generalized anxiety disorder treated with an SSRI experienced at least a 50% reduction in anxiety symptoms. While approximately 1 in 12 individuals discontinued SSRIs due to side effects, the overall benefit-to-risk ratio is often favorable.
Emily Wood, a psychiatrist practicing in Los Angeles, underscores the importance of a holistic approach, noting that SSRIs can be "really, really helpful" when combined with appropriate therapy techniques. She points out that while lifestyle interventions are encouraged, medication remains a vital tool for many. "When it’s being done right and when you’re also using appropriate therapy techniques, SSRIs can be really, really helpful," Wood stated.
The "Make America Healthy Again" movement, however, attributes the rise in anxiety and other mental health issues partly to poor dietary choices and sedentary lifestyles. They advocate for reducing the consumption of ultraprocessed foods, which recent studies have linked to depression and anxiety, and prioritizing exercise over excessive screen time. While psychiatrists generally endorse healthy eating and regular physical activity as adjunctive therapies for anxiety and depression, they also recognize the limitations of these interventions for severe conditions. Wood notes that for those who can manage their anxiety without medication, talk therapy, particularly cognitive behavioral therapy (CBT), is highly effective. The surge in teletherapy has made mental health counseling more accessible, with federal data showing a boom in its use between 2019 and 2024. "Anxiety disorders are amongst our psychiatric disorders that really respond well to cognitive behavioral therapy," she explained.
Concerns about SSRI use during pregnancy have also been raised, with Makary suggesting potential negative birth outcomes. However, Wood strongly refutes this, highlighting that the risks of SSRIs during pregnancy are generally low for both mother and child. Conversely, she points out that untreated depression during pregnancy significantly increases the risk of complications for both. "Depression increases your risk for every complication for a mother and a baby," Wood stated, warning that official statements downplaying SSRI safety during pregnancy could lead to "real harm for these women."
The issue of addiction is another point of contention. While benzodiazepines, such as Xanax, which are sometimes used as a second-line treatment for anxiety, carry a risk of addiction and can increase the danger of opioid overdose when taken concurrently, SSRIs are not considered addictive. Kelly clarified, "The concept of addiction simply does not apply to these chemicals," a claim supported by numerous studies. He acknowledges that discontinuing SSRIs abruptly can lead to withdrawal symptoms like nausea and insomnia, but this is distinct from addiction. Benzodiazepines, while effective for acute anxiety, require careful monitoring and are not ideal for long-term daily use due to their habit-forming potential.
An increasing number of individuals are also turning to beta-blockers, such as propranolol, for anxiety. These medications, primarily used for heart conditions, are prescribed "off-label" to manage the physical symptoms of anxiety, like a racing heart, before public speaking or other stressful events. While beta-blockers can cause side effects like dizziness and fatigue, they are considered nonaddictive and can be effective in calming the autonomic nervous system. Wood described them as "nonaddictive, really helpful for bringing down the autonomic nervous system, going from fight or flight to something more neutral, and really safe."
The drivers behind the increased use of anxiety medication are multifaceted. Physicians and researchers point to several contributing theories, including the pervasive influence of social media, increased social isolation, and heightened economic uncertainty. The COVID-19 pandemic, with its lockdowns and disruptions, significantly exacerbated stress levels for many, particularly young adults. Telehealth has also streamlined the process of obtaining prescriptions, with many primary care physicians and even brief teletherapy appointments leading to SSRI or benzodiazepine prescriptions.
Social media platforms have played a dual role. While influencers discussing their mental health struggles have helped destigmatize seeking help, leading to increased openness among young people, they have also contributed to a trend of self-diagnosis based on social media information. The ease of searching for terms like "buy Xanax online" on search engines, though often leading to disclaimers about prescription requirements, reflects a societal push for immediate solutions. Kelly cautions against this approach, stating, "I think increased access is good, but that’s not the same thing as, you know, ordering Xanax online."
The higher prevalence of anxiety medication use among women compared to men is attributed to several factors. Sociologists like Jason Schnittker of the University of Pennsylvania suggest that women may be more likely to require such medications due to higher reported rates of anxiety. Furthermore, women may be more inclined to report their feelings of anxiety, and clinicians may be more attuned to recognizing anxiety in female patients.
Broader societal trends over the past century also contribute to rising anxiety levels. Schnittker, author of "Unnerved: Anxiety, Social Change, and the Transformation of Modern Mental Health," posits that growing income inequality, increased social isolation, and a decline in community engagement have fostered an environment of pervasive stress and unease. The replacement of social and religious activities with more solitary pursuits, coupled with a growing suspicion of others, has created a climate of heightened anxiety.
For Sadia Zapp, the journey to managing her anxiety involved a combination of medication and therapy. While talk therapy was initially beneficial, she found that her chronic anxiety eventually stabilized on medication alone. After a few months on Lexapro, she experienced a significant reduction in mental noise, allowing for improved focus and a return to productive daily life. "It definitely helped me get back to my day-to-day in a way that was productive and not just riddled with my anxieties throughout the day," she shared. Her experience underscores the profound positive impact that appropriate medical intervention can have on individuals grappling with severe anxiety, particularly when faced with life-altering challenges.