The question of whether antidepressants help or harm young people has been debated for decades. On one side, SSRIs—selective serotonin reuptake inhibitors—are credited with saving lives by treating severe depression and anxiety. On the other, concerns persist over their potential side effects, particularly in children and adolescents.
A widely shared post on social media puts the issue bluntly:
“SSRI antidepressants have a black box warning label yet are prescribed to half a million kids.”
It’s a striking claim, and at face value, it’s true. The FDA does require a black box warning—its strongest cautionary label—on all SSRIs, citing a possible increase in suicidal thoughts and behaviors in patients under 25. At the same time, hundreds of thousands of minors in the U.S. are prescribed these medications. The implication, though, is that this widespread prescribing is reckless or dangerous. That’s where the reality gets more complicated.
The FDA first introduced this warning in 2004 after studies suggested a small but measurable increase in suicidal ideation among adolescents taking SSRIs, particularly in the first few weeks of treatment. However, the label does not indicate an increased risk of violence or homicide—despite claims sometimes made in online debates.
Since the warning was introduced, researchers have tried to understand whether SSRIs themselves increase risk or whether the underlying depression—left untreated—poses the greater danger. Some studies have suggested a link between antidepressants and suicidal thoughts, but others argue that restricting access to SSRIs could actually increase suicide rates by leaving young people without effective treatment.
Data from the CDC and National Center for Health Statistics estimate that around 500,000 minors in the U.S. are prescribed SSRIs or other antidepressants. That’s a large number, but whether it reflects overprescription or responsible medical care is a more complex issue.
Rates of depression and anxiety among children and teenagers have risen sharply in recent years. Suicide is now a leading cause of death among teenagers, and for some, medication is a critical part of treatment, often combined with therapy. The challenge is balancing the risks of the medication against the risks of leaving mental illness untreated.
The idea that SSRIs might increase suicidal behavior has been a point of contention for decades. Some studies, including research published in the British Medical Journal (BMJ) and by Mary Ann Liebert, Inc., support the idea that there is a correlation between SSRI use and suicidal ideation in adolescents. Others, such as a study in the Journal of Psychiatry and Neuroscience, argue that the real concern should be ensuring access to treatment without scaring patients away from care.
A report from the National Library of Medicine underscores the complexity of this issue, noting that the highest suicide risks tend to come from unmedicated, severely depressed individuals. Meanwhile, the UK’s National Health Service (NHS) states that SSRIs can help improve symptoms and make patients more receptive to therapy, reinforcing that depression isn’t simply caused by low serotonin but that adjusting serotonin levels can still be beneficial.
The claim that SSRIs have a black box warning yet are widely prescribed to minors is factually correct but lacking critical context. The warning exists for a reason, but it does not mean SSRIs are inherently dangerous or that they shouldn’t be prescribed to young people. Instead, the key issue is careful monitoring and individualized treatment.
SSRIs are neither a cure-all nor a reckless gamble. For some adolescents, they are life-changing medications. For others, they may not be the right approach. The real focus should be on responsible prescribing, close monitoring, and ensuring that mental health care is comprehensive, not just reliant on medication.
This isn’t a simple debate. And it shouldn’t be treated like one.
