What’s the deal with SSRIs?

Examining Antidepressant Medications, Addiction Claims, and Safety Concerns

Recent debates have grown stronger over the possible connection between a specific type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), and violent behaviors, such as mass shootings. In particular, Robert F. Kennedy Jr., the newly appointed Secretary of Health and Human Services, has publicly stated that there is a link between SSRI use and school shootings. During his confirmation hearings, Kennedy pointed to what he called "tremendous circumstantial evidence" supporting this connection. He also referred to individuals on SSRIs as "addicts," a comment that has faced significant criticism from medical experts. For example, the The Autistic Self Advocacy Network (ASAN) expressed disappointment over Kennedy's remarks, stating that his claims about antidepressants contributing to mass shootings are unfounded and not based on evidence. But the question remains: are antidepressants addictive? Can they lead to dangerous behaviors? Are SSRIs equivalent to heroin, as Kennedy implied? Let’s discuss…

This article was led by Dr. Sarah Scheinman, a neurobiologist, with contributions from Dr. Ben Rein, a neuroscientist. We have an episode of the podcast dropping tomorrow (Wednesday, March 12th) where we dig into this topic even further. We thought this topic was best tackled by a couple of brainiacs! ;) In the coming weeks, we'll also be doing a deep dive on an article about SSRIs that is being taken out of context—stay tuned!

What makes a substance addictive?

While there isn’t a single case of addiction – it is a very complex condition – a substantial component of how addiction develops is through changes in brain chemistry. As humans, we are biologically programmed to seek rewards. Many classically addictive drugs like cocaine, alcohol, nicotine, and opioids, trigger the brain’s reward system by releasing a chemical called dopamine. Dopamine is a neurotransmitter linked to the reinforcement of pleasurable activities. This release is associated with feelings of euphoria and satiation, leading the person to repeat the behavior to experience that feeling again. In other words, dopamine is your brain's way of remembering that something is pleasant and helpful, so that you want to go back for more. Thus, taking dopamine-releasing drugs repeatedly may result in addiction.. Furthermore, as the body becomes accustomed to a drug, it may require higher doses to achieve the same rewarding jolt of dopamine. This increase in dose can lead to physical dependency as the person needs the drug to function normally, as well as psychological dependency. These factors, combined with social, environmental, and genetic influences, contribute to the development of addiction, making it difficult for individuals to stop using a substance despite negative consequences.

Are SSRIs Addictive?

SSRIs (Selective Serotonin Reuptake Inhibitors) are not considered addictive in the traditional sense, as they do not create a “high” or lead to cravings that are typically associated with substances that are known to trigger addiction. SSRIs work by inhibiting the reuptake of serotonin, which leads to increased serotonin levels in the synaptic cleft, the tiny gap between two neurons where signals are transmitted using neurotransmitters. As a result, SSRIs increase the level of serotonin-related signals that pass between neurons. This enhancement of serotonin signaling has been linked to and improvements in depression symptoms and anxiety regulation. Unlike addictive drugs like heroin, SSRIs do not activate the brain’s reward pathways in a way that would lead to compulsive use. In fact, recent evidence suggests that serotonin actually blunts the reinforcing properties of dopamine, further invalidating the claim that SSRIs may be addictive . However, abrupt discontinuation of SSRIs can lead to discontinuation syndrome, characterized by symptoms such as dizziness, headaches, irritability, and nausea, due to the brain’s adjustment to the sudden drop in serotonin levels. It is important to note that these symptoms are not the result of addiction withdrawal, but rather a temporary physiological response. As a result, it is recommended that SSRIs be tapered off gradually under medical supervision to minimize these effects and prevent potential relapse of underlying mental health conditions.

Does SSRI use lead to violence?

While some studies have explored potential associations between SSRI use and violent behavior, the evidence does not support a causal link to violence or mass shootings. Clinical trials indicate that in some rare cases, SSRIs may induce agitation, impulsivity, or akathisia, which could theoretically contribute to aggressive behaviors, especially during the initial weeks of treatment or during abrupt discontinuation, however these results are not common. For instance, research published in the Proceedings of the National Academy of Sciences indicated that there might be an increased risk of violent crime during SSRI treatment in a small group of individuals; however, the vast majority of SSRI users do not engage in such behaviors, and the study failed to account for key time-varying factors. Interestingly, a study published in the Proceedings of the National Academy of Sciences (PNAS) examined the impact of local exposure to school shootings on youth antidepressant use. The study found that such exposure led to a significant increase in antidepressant prescriptions among youth, suggesting heightened mental health concerns following these traumatic events. However, importantly, this study does not support the link between SSRI use and school shootings.

In conclusion, while public figures like Robert F. Kennedy Jr. have suggested a link between SSRIs and violent behaviors, the scientific evidence does not support this claim. SSRIs are not addictive in the way substances like opioids or nicotine are, as they do not activate the brain’s reward system to produce compulsive use. While discontinuation syndrome can occur when SSRIs are stopped abruptly, this is a temporary physiological response rather than a sign of addiction.

Furthermore, research on the relationship between SSRIs and violence has not established a causal connection, with the majority of studies indicating that these medications are more likely to stabilize mood and reduce aggression in individuals with mental health disorders. Misrepresenting the effects of SSRIs can contribute to stigma and discourage individuals from seeking necessary treatment for depression and anxiety. For many people, these are life saving medications.

Moving forward, discussions surrounding SSRIs should be guided by rigorous scientific evidence rather than speculation or circumstantial correlations.

Stay Curious,

Unbiased Science

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