Why Are So Many Girls On SSRIs?
Sometimes "mental health awareness" feels like a marketing strategy
Throughout May I was inundated with what felt like an endless stream of emails and ads and messages for Mental Health Awareness Month. TikTok started a new mental health hashtag to help me put my well-being first. Maybelline paid TikTok influencers to promote their make-up and pretend it was about “ending the stigma around anxiety”. Even the skincare brand Bioré pitched their pore-strip products as a means to “strip away the stigma of anxiety” (yes, including that influencer who used a school shooting as her sales strategy). But one campaign that stuck with me came from Minded, the women’s medication company, who created a hashtag to help “normalise psychiatric medicine” and “end the stigma” around drugs like SSRIs.
That last one stuck with me because, really, I struggle to see the stigma. Prescriptions for antidepressants, particularly for girls, have soared in recent years. In the US, antidepressant usage has surged by nearly 65% in the past 15 years, with women twice as likely to take them as men. In the UK, antidepressant prescriptions for children aged from five to 12 increased by more than 40% between 2015 and 2021. Here, one in three teenagers have been prescribed them.
And all over the internet, girls are so casual and blasé about these pills, even glamorising and fetishising them. We have antidepressant TikTok filters and SSRI phone cases. We have Prozac-shaped pillows, Hot Girls Take Lexapro sweatshirts and Stay Sexy, Take Sertraline artwork. Under hashtags like #mentalhealth on TikTok, which has nearly 88 billion views, girls describe SSRIs as silly little pills, call brain zaps from Zoloft withdrawal “the zappies” and put their medication in Disney-themed sweets dispensers. And these girls are absolutely convinced that they have a chemical imbalance in their brain, lamenting that they are “wired this way for life" and “won’t ever get better".
Where’s the stigma?? If anything, the fact that all this persists despite ongoing debates about SSRIs’ effectiveness and safety is pretty remarkable. As far as I know the chemical imbalance theory of mental health has never been proven. Drug trials show that antidepressants are barely any different from placebos when it comes to treating depression. And these pills come with serious risks: SSRIs like Lexapro and Zoloft carry a “black box” warning for an increase risked of suicide among adolescents. Other side-effects range from constant nausea to seizures to complete sexual dysfunction. So why—when we can’t definitively conclude that they work or are even that safe—are so many girls on SSRIs? And why are we still convinced they are so stigmatised??
Conspiratorial as it sounds, this cultural emphasis on stigma is very convenient for the pharmaceutical industry. Stigma certainly exists in areas of psychiatry, and undeniably did so in the past. But some of these campaigns today seem less about fighting stigma and more about pushing a specific narrative. They encourage us to see our emotions through a medical lens and take pills for our problems. They expand the meaning of mental illness to encapsulate more and more of the human experience, calling it de-stigmatisation and normalisation while conveniently expanding their customer base. In other words: some of these mental health awareness campaigns feel more like marketing campaigns.
Take the American telehealth company hers, for example. hers is a direct-to-consumer brand that sells “self-care” products for women and girls like hair gummies, skincare creams and psychiatric medication. Heal on your schedule, they promise, with medication shipped straight to your door! According to hers, their site is apparently “so chill” that it’s like “shopping for leggings, not prescription meds.”
For hers, mental health awareness becomes a useful marketing strategy. “Mental health without the stigma and judgment — 𝘁𝗵𝗮𝘁’𝘀 𝘄𝗵𝗮𝘁 𝗛𝗲𝗿𝘀 𝗱𝗼𝗲𝘀,” they proclaim, with links to their products. They are just so passionate about normalising all this stuff for us, kindly offering to “break down your barriers”, remove “the huge roadblock of stigma” and “get you facing the tough stuff faster”.
But in normalising these conversations, hers also medicalise some very common behaviours. There’s Paxil® for social awkwardness. There’s Lexapro® for generalised anxiety. There’s Zoloft® for Premenstrual Dysphoric Disorder (which some medical professionals claim doesn’t actually exist, and was created by pharmaceutical companies). “Nervous about your big date?” asked one ad for hers; well, the cardiovascular medication propranolol “can help stop your shaky voice, sweating and racing heartbeat. No in-person doctor visits, just an online consultation and delivery can be right to the door!” In another ad, a woman vaguely describes her depression—waking up late, not eating enough, eating too much, “whatever it…manifests into”—before medication is described as her “little extra help.”
And hers aren’t the only ones. Other direct-to-door medication companies are all about raising awareness and combating stigma. DoneADHD want drugs like Adderall to be “judgement-free”. Minded is starting a movement to “de-stigmatise mental health medication”. Cerebral (who are facing a lawsuit for over-prescribing ADHD meds) reminds us that it’s okay to medicate (“share or like this once to fight the stigma!”). Plus, each of these companies pays influencers on TikTok—most users of which are young girls—to distill all kinds of behaviours into diagnosable symptoms, from being distracted as a sign of ADHD to being forgetful as a symptom of an anxiety disorder.
To be clear: I think the mental health crisis is real. Which is to say, young girls are cutting themselves, starving themselves, and committing suicide at record rates. Pretty much every person I talk to about my writing tells me a tragic story about a teenage or pre-teen girl they know who is just falling apart. And there are of course times where these girls are suffering so much that serious intervention is necessary, and maybe that involves medication.
But I believe both. I believe that girls are genuinely suffering in the modern world and also that a major part of it is the marketisation and medicalisation of their normal distress. There are girls who are severely mentally ill. But there are also girls who have learnt to see their behaviour in ways that conveniently serve industries like the medical drug sector and better categorise them for online advertisers. And I think we are kidding ourselves if we pretend that condensing every emotion into something diagnosable and solvable with consumption isn’t doing profound psychological damage to Gen Z.
We shouldn’t stigmatise those who are suffering. But we should think carefully about our compassion, where we direct it, and how it can be co-opted. Because I don’t believe for a second that compassion is making serious medication as accessible and convenient as possible to the point it resembles Deliveroo. I don't believe compassion is expanding the pharmaceutical market to include any girl who experiences negative emotions. And nor is it normalising and normalising and normalising diagnoses and drugs until we start to stigmatise how it feels to be human.
The truth is that we are a generation of girls and young women with more drugs available to us than ever before. For every surge of anxiety, sadness, panic, period pain or social awkwardness, there’s Prozac, Paxil, Celexa, Effexor, Zoloft. Diagnosed in five minutes. Prescribed in ten. It’s futuristic. It’s revolutionary. It doesn’t really work. Because the easier they make it to sign prescriptions and swallow pills, and the more Mental Health Awareness months and weeks and campaigns flood our inboxes and app stores and algorithms, the worse we seem to feel.
So that’s my fear. My fear is that in those millions of girls taking SSRIs and other serious medications, many aren’t doing so because of a very successful mental health awareness campaign, but a very successful marketing campaign. And that isn’t something we should ignore. In fact, that is something we really should be raising awareness of.
This is an excellent article which exposes a part of the long history of Big Pharma target marketing women for very dangerous psychiatric drugs which generally at best are active placebos with terrible iatrogenic side effects including many of the same problems the drugs are advertised to treat such as depression and anxiety and suicidal ideation, etc.. Also, a significant percentage of people prescribed these iatrogenic drugs suffer terrible withdrawal symptoms when trying to get off these iatrogenic drugs which are then falsely diagnosed as proof the drug was needed in the first place and which drives an increasing tendency to keep patients on these drugs for longer and longer periods of time and even to add additional iatrogenic psychiatric drugs to try to treat the side effects of the currently prescribed drugs. Again, this is much needed and excellent article.
Thomas Steven Roth, MBA, MD
Christian Minister for Biblical Medical Ethics
I don't know whether the author had this covered with 'complete sexual dysfunction' but, for those who don't know, you can get permanent sexual dysfunction from SSRIs. Post-SSRI Sexual Dysfunction (PSSD) is untreatable and some people get it after only a couple of tablets. Besides genital numbness and sexual anhedonia, sufferers get emotional blunting too. Drs are not warning people of this possibility, despite it having been first reported in 1991, in the medical literature since 2006 and recognised by the European Medicines Agency in 2019. Noone knows the prevalence; Drs who claim it's vanishingly rare are guessing.
The scientific literature about this condition can be found here:
https://www.pssdnetwork.org/literature