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'Hot girls on SSRIs': Antidepressants are trending on TikTok. Not everyone is happy about that
In a TikTok video shared with her followers last year, Tiffany Kay described how the antidepressant Lexapro was, “poof,” like magic, making life much better, “which I did not think was possible.”
That cinder block of anxiety no longer weighs on her chest, Kay, 29, recently told National Post. She’s able to sleep at night, less emotional and not overthinking things the way she used to, or getting caught up in the “what-ifs.”
“The real reason I came on here was to tell you, one, that Lexapro is a miracle drug and, two, there is no shame in being on meds,” Kay, a social media manager and content creator living in southern Wisconsin, said in her video hash-tagged #lexaprogang. No good can come trying to cope with crushing anxiety without support, she added. “Anxiety is evil. And If you need to take meds to help with that, so be it.”
Antidepressants are having a TikTok moment, with videos surpassing 1.3 billion views, according to a recent Wall Street Journal report. Most guidelines say the drugs can be helpful in managing moderate to severe depression and experts stress it’s important to normalize the ability to talk about mental illness. But some are uneasy with the casual way drugs that act on the brain are sometimes being touted, particularly to Gen Z women, amid rising rates of antidepressant dispensing to young females.
In videos tagged “pretty girls take SSRIs” and “hot girls on SSRIs” young women describe how the voices in their heads grew quieter, how negative thoughts “felt sucked up into a little bubble” and floated off. “I feel I’m not triggered as much,” one said in her three-month update.
Not all the sharing is glowing. Women have described how the drugs that stopped the panic spirals also left them feeling emotionally flat. Sexual side effects — loss of desire and arousal — are a common complaint with a class known as SSRIs, or selective serotonin reuptake inhibitors, the most often prescribed antidepressants in the U.S. and Canada. In a study by Simon Fraser University researchers that involved mainly LGBTQ young people aged 15 to 29, 13 per cent of past antidepressant users reported persistent reduced genital sensitivity compared to one per cent of past users of other psychiatric meds, like antipsychotics or sedatives.
Other complications can include changes in weight, heart rate and blood pressure, depending on the antidepressant, and withdrawal symptoms like trouble sleeping, “brain zaps” and other physical sensations.
However, side effects often get little or no air time. “Me, since starting Lexapro,” reads the text of one TikTok video while a young woman works out in a gym, swims in the ocean and dances to Billy Joel’s My Life. “Just so you know I had literally no side effects,” another influencer reported while applying makeup. “Why do (people) say antidepressants take away (your) spark. (I’m) having a ball,” another posted, while dancing in her bedroom.
Experts worry that what’s lost in the enthusiasm is that mild depression or anxiety are often normal responses to normal life stressors that can improve with time, support, less stress and/or psychotherapy.
“It’s presented as, ‘this is a happiness pill and you’re going to have this perfect life,'” said University of Calgary neuropsychiatrist Dr. Kimberly Williams.
“It’s kind of sold in a way that’s not realistic.”
Williams, past president of the Federation of Medical Women of Canada, said she’s grateful younger generations are talking about mental illness in ways older generations never did. “We want to see continued reduction in the stigma against mental illness, so that people can speak about their challenges and seek the support they need.” But it’s about trying to figure out a balance, she said. “We don’t know the back stories in a short TikTok video. Did they try therapy already? Did they try other medications? Was this something that they really needed or not?”
Two British authors, Gen Z health professionals themselves, recently warned that the line between normal responses to life’s challenges and genuine symptoms of a mental illness are being blurred and that conversations around mental health are veering into the “realm of romanticization.”
While traditional media — movies and TV — often painted the mentally ill as dangerous and disturbed, “the new-age social media depiction of mental illness carries with it a sense of ‘creative mystique,” the authors wrote, creating a narrative that risks making mental illness “more attractive, interesting, cool, profound or desirable than it really is.”
Calgary child and adolescent psychiatrist Dr. Monique Jericho works in the field of eating disorders, “so this isn’t an entirely new phenomenon from my lens,” she said. Pro-anorexia websites that fuel and play into people’s illnesses have been a thing since the internet’s birth, she said.
In addition to ever-powerful algorithms, part of the pull is that young people are drawn to places and spaces where they can self-identify, self-diagnose and be part of a community, she said. But the spread of what some have dubbed TikTok’s “sick-role subculture” is contributing to the rise in people identifying with mental disorders — and the prescribing that goes along with it.
Jericho, for example, has seen a dramatic increase in young people looking for a diagnosis of autism spectrum disorder. In the early days of COVID, a sudden wave of teens, mostly girls, developed jerky, tic-like movements and outbursts — the so-called “TikTok tic” phenomenon — after watching people with tic disorders online.
“There’s a fascinating mimicry and a sense of belonging — both pieces — that I think are in play,” Jericho said.
Kay shared her journey with Lexapro because “I wanted to be genuine with people,” she said. “Because social media is so fake. I want to be real and honest and raw and show people, ‘This is real life.'”
Kay said she’s struggled with anxiety since she was 21 and going into university. When her marriage broke up last year, the newly single mother of a toddler moved in with her parents. Her anxiety “was through the roof. The worse I’d ever felt, ever.”
Lexapro (whose active drug, escitalopram, is also sold under the brand name Cipralex) “is by far the best medication I’ve taken for anxiety and depression,” said Kay, who said she has not received funding or sponsorship from any drug company.
“Anxiety and depression are horrible…. The way the world is now, it’s unfortunately getting worse for a lot of people, especially people my age. It’s hard to look into the future and see where you might be in the future,” she said.
In fact, a recent paper by two American economists suggests the midlife crisis has been replaced by a youth mental health crisis.
A global pandemic didn’t help. But depression and anxiety rates were rising among young people pre-COVID. The proportion of Canadians 15 and older who met the diagnostic criteria for major depressive disorder, bipolar disorder and generalized anxiety disorder has risen in the past decade, especially among females. Among women aged 15 to 24, the 12-month prevalence for generalized anxiety disorder tripled, from 3.8 per cent in 2012, to 11.9 per cent in 2022, according to Statistics Canada. Major depressive episodes doubled, from nine per cent to 18.4 per cent. In 2022, four times as many young women met criteria for social phobia compared to 2012.
As rates climbed, so, too, did scripts for antidepressants, especially among women: In 2023, women aged 18 to 24 were prescribed antidepressants at more than twice the rate (21.8 per cent versus 7.9 per cent) of men in the same age group, according to data analytics firm IQVIA Canada.
Why the gender difference? “It’s a complex, bio-psychosocial question,” Jericho said.
While there are some subtle differences between boys and girls during childhood, mood and anxiety problems largely affect the sexes equally, she said. Once puberty hits and adolescence begins to play out, “we’ve always seen an increase in rates of these conditions in girls, relative to boys,” Jericho said.
Girls are more apt to express more internalizing disorders when they’re distressed, meaning more anxiety and depression. Boys tend to express more externalizing behaviours, like aggressiveness.
With girls, that biological piece, “that predisposition toward mood and anxiety conditions that we’ve seen historically, dovetails into young women and their tendency around social comparison,” Jericho said.
“It’s part of adolescent brain development. It’s part of how we learn to socialize, how we transition from being kids who are dependent on adults, to adults who are dependent on each other. We go through this phase where we are intensely comparative. We’re looking to one another: ‘Where do I fit? Where do I fit in?'”
Sometimes there’s a sense of safety in having a “disorder” to explain why someone is struggling, instead of something nebulous, like, “I feel stressed” or “I’m not happy.”
However, there’s a sizeable difference between normal responses or emotions and a true anxiety or mood disorder, and Jericho worries we’re losing that boundary between “illness phenomena and social phenomena.”
The “para-social” relationships influencers create are appealing, she added. “Young people think, ‘I can relate to this person.’ They imagine they know this person. But there are absolutely no guardrails. There is nobody saying, ‘This is real, this is what happened, this person isn’t being sponsored or paid for.”
“I know there’s a lot of talk in the world about, isn’t it great to have this open dialogue? Yes, but often times it’s like the most popular person wins, as opposed to the person who has the most knowledge and wisdom to share,” Jericho said.
It’s a pernicious trend that can plant a poignant seed, she said. And if a doctor doesn’t support them, “the story from our side is, we’re not listening. We don’t understand. We’re withholding care,” she said.
“Physicians don’t create these social contexts, but we have to respond to them.”
And doctors are responding, often, and heavily. “The most important cause of SSRI overuse is MDs who are rushed and careless in their prescription habits,” Dr. Allen Frances, an emeritus professor of psychiatry at Duke University, said in an email to National Post.
Frances, who led the development of the fourth edition of the Diagnostic Manual of Mental Disorders published in 1994, said the vast majority of antidepressants are prescribed by primary care doctors, “usually after a 15-minute visit, with patients they barely know, as a means of getting them out of the office as quickly as possible.”
About two million American teens and 22 per cent of university students are on antidepressants “despite little evidence they work well in this age group and much evidence they can cause serious side effects,” Frances said.
“Most teens taking antidepressants don’t need them,” he added. “Their distress arises from situational stress or normal teenage development issues.
“Parents who themselves use meds, and those who worry too much about their kid’s rough patches, also play a part in overmedication,” Frances said. Watchful waiting and/or psychotherapy are better choices “except for kids with clear-cut psychiatric disorders.”
There’s no doubt a lot of 20-somethings are drowning in existential despair, said psychotherapist Marnie Wedlake. “Geopolitically, the world is a disaster. The environment is a disaster. Financially, kids are looking at, ‘Where am I going? I can’t even get a summer job. I’m 100 grand in debt when I come out of university, to what end?’
“But what we’ve done is said, ‘You’re not having appropriate responses to really challenging circumstances. You’ve got these symptoms, and we can get rid of those for you.'”
“There are two mind states we consider acceptable: happy and peaceful,” Wedlake said. “Everything else becomes a symptom we have to get rid of.
“In response to our big feelings we think, ‘Oh my god, I have discomfort, I’m anxious, I’m afraid, I’m sad, I’m obsessing, I’m ruminating.’ Instead of recognizing these as natural and expected reactions to things that are happening in our lives, we think, ‘There must be something wrong with me,'” Wedlake said.
Wedlake is all for questioning authority. “But there are times when we need to say, ‘Are you someone who can offer reliable advice or not?'”
Women’s emotions have forever been pathologized. One popular Victorian belief was that a woman’s “hysteria” was related to her reproductive organs. In the late 19th century, Richard Maurice Bucke, superintendent of the former London Asylum for the Insane, in London, Ont., was a big proponent “of ripping out ovaries and uteruses,” believing it would cure hysteria, Wedlake said.
“We have socialized women to be more in touch, more emotive,” Wedlake said “We’ve socialized men to suck it up and be quiet.
“We have a whole weird and distorted narrative around gender and emotions that goes back decades and decades, and it carries on to this day.” Far more women than men are hospitalized for mental illness, far more women prescribed psychiatric drugs.
“People can say, ‘Well, women report more often.’ Well, why is that? We don’t critically think about this stuff,” Wedlake said. “We don’t ask why. Why are these kids so upset? Why are they so despairing? ‘What’s gone on in your life? What in your history is contributing to this?’ Why are they turning to TikTok influencers to get their needs met?
“If we were really doing right by society, we would recognize when bad things happen, people are going to struggle,” Wedlake said. “That’s not wrong. There’s no reason to pathologize. But we really want to meet them where they’re at and offer up really good supports. And we don’t. There are so many really challenging narratives out there that are dropped in the laps of this group of kids and they’re basically left on their own to figure it out.”
Some TikTokers, including Tiffany Kay, stress the importance of working alongside doctors. Kay said she tried to tough her anxiety out. “I tried to deal with it naturally for so long,” she said. Magnesium, meditation, deep breathing. “Then it got to a point where I could not manage it myself. Nothing was happening.”
A r ecent Canadian-led review found SSRIs and other similar antidepressants are more effective than placebo — pretend pills — at improving anxiety symptoms in adults in the short term (over four to 12 weeks). However, data on long-term impact and harms are lacking.
Wedlake would like to see public health campaigns that normalize emotions — “that make it normal to say if you are frightened, sad or worried. Not a little list of symptoms, but normal and natural responses to some kind of adversity.
“We don’t do that,” she said. “We say, ‘What’s your snapshot (on a depression inventory) right now? Here’s your Prozac. Out the door you go. Hope it goes well for you and, if it doesn’t, okay, we’ll add something else to it.’ And, so begins the avalanche.”
National Post
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