We’re living in a moment when it’s reasonable — even healthy — to question the wisdom of “experts.” The United States was built on the idea that authority rests with the people, not with a select class of specialists. Our courts reflect this: experts may explain complex information, but it is the judge or jury who ultimately make the decision. They are the trier of fact — the ones who weigh the evidence, decide what is credible, and ultimately determine what is true.
Recently, we’ve seen a troubling rise in violent acts where mental illness plays a role. This is exactly the kind of moment when we should re‑examine long‑held assumptions in psychology, psychiatry, and psychopharmacology. Science is never “settled.” It evolves. And sometimes the most honest conclusion is, “I’m still not sure.”
One topic worth revisiting is the use of Selective Serotonin Reuptake Inhibitors, or SSRIs. These medications are widely prescribed, including to young people, and many recent cases of aggressive or criminal behavior have involved individuals taking them. That doesn’t prove causation — but it does make the question worth asking. More broadly, it’s still worth examining where SSRIs fit in our therapeutic landscape and how effective they truly are over time.
SSRIs carry a black box warning for people under 24, the strongest warning the FDA can issue short of banning a drug. It states that antidepressants may increase suicidal thoughts or actions in some young people. The irony is that the original clinical trials excluded anyone with suicidal thoughts, because giving such a person a placebo would have been unethical. Later attempts to analyze suicidal behavior were inconsistent because “suicidal” wasn’t uniformly defined across studies.
The FDA Faced a Dilemma
Do nothing and risk harm, or issue a warning that might scare people away from treatment they genuinely need. The black box was formally added in 2004, and its effects on prescribing and suicide rates unfolded between 2003 and 2005. Instead of prompting closer monitoring — the FDA’s hope — prescribing dropped, and teen suicide rates actually rose during those years, reversing a prior downward trend.
And it’s worth remembering the moment in which that warning was issued. In 2004, the FDA was broadly trusted — and they had earned that trust. Their guidance carried real weight with clinicians and the public. When the agency issued a warning, people listened. Today, trust in institutions of all kinds has eroded. People are more skeptical, more fragmented in where they get information, and more likely to question whether any single authority has the full picture. That shift matters when we talk about how warnings are interpreted — and how they’re acted on.
So Where Does That Leave Parents, Patients, and Clinicians?
Right where the 2004 FDA intended: with the need for careful, consistent follow‑up. Not a ten‑minute check‑in. Not a rushed refill. A real evaluation, with detailed questioning and collateral information when the patient is a child.
Now consider the young person who ends up prescribed an SSRI. They were already struggling — for example, perhaps they were failing in school, becoming isolated from peers, or showing disruptive or aggressive behavior. The medication didn’t appear out of nowhere; it was a response to distress.
But we have to step back — we have to zoom out, because none of this happens in isolation.
The Toxic Environment Our Kids Are Growing Up In
If we’re going to talk honestly about the struggles young people face today, we have to look beyond medication and into the environment they’re living in. Because the truth is, many children are growing up in conditions that are psychologically toxic in ways no previous generation has faced.
Children today are exposed to a nonstop stream of information — much of it dark, sensational, or emotionally overwhelming. And unlike adults, they don’t yet have the developmental tools to filter, contextualize, or dismiss what they’re seeing. Their brains are still wiring themselves, still deciding what the world is and how safe it feels.
Much of this content comes from trusted sources: teachers, influencers, celebrities, peers, even well‑meaning adults who share alarming material — and often inaccurate material — without realizing the impact. When a child hears something frightening from someone they trust, it lands deeper. It becomes part of their internal map of reality.
And it’s not just the internet. Many families are stretched thin — two working parents, limited time, chronic stress, and little bandwidth for the kind of slow, steady emotional presence children rely on. Schools are introducing topics that may be emotionally heavy and not appropriate for their stage of development — and in some cases may never be appropriate for a school environment at all. Social media amplifies every insecurity. Online conflict is constant. Privacy is nonexistent. Comparison is relentless.
This is the backdrop against which a struggling child walks into a doctor’s office.
How Toxic Content Rewires the Developing Brain
The brain doesn’t simply react to what we see online; it rewires itself. When kids are repeatedly exposed to dark, dramatic, or threatening material, the brain’s danger‑detection circuits fire again and again. That repeated firing flips certain genes on, prompting neurons to build new proteins. Those proteins become receptors — the tiny switches that determine how easily a neuron fires.
With enough repetition, the brain installs more threat‑sensitive receptors and fewer calming, regulating ones. It’s microscopic remodeling: new proteins, new receptor patterns, new wiring. Over time, the brain becomes quicker to spot danger, faster to react, and harder to settle. Not because a child is “too sensitive,” but because their neural machinery has been quietly re‑tuned by what they consume.
SSRIs Also Rewire the Brain — Which Is Why Follow‑Up Matters
And while we’re talking about brain remodeling, it’s important to remember that SSRIs also change the brain. That’s their purpose. They alter receptor activity, gene expression, and the way certain circuits communicate. In adults, this can be stabilizing under the right circumstance. But in a developing brain — one already reshaped by stress, online toxicity, and chronic overstimulation — those same shifts may land differently. It doesn’t mean SSRIs are “bad”; it means they are powerful, and powerful interventions require careful follow‑up.
Layer onto this the stress many families face — two working parents, limited time, schools introducing material that may be confusing or alarming, and children accessing content far beyond their developmental stage, often from trusted adults.
So What’s Really Driving the Crisis?
When a young person on an SSRI has a serious behavioral breakdown, what was the true cause?
Was it the medication?
Was it the environment?
Was the SSRI trying to help a system already overwhelmed?
Or did the medication activate or unmask a more severe underlying illness?”
All of these are possible.
But the one thing we can say with confidence is this: careful, consistent follow‑up is the safeguard that mitigates disasters. It’s the piece of the puzzle that was always meant to be there — and too often is missing.
SSRIs can be life‑changing. They are extraordinarily effective for OCD and can be transformative for the right kind of depression and anxiety. But they are not a substitute for time, attention, developmental expertise, or a stable environment. And children, especially, deserve evaluation by clinicians trained specifically in child and adolescent psychiatry — not a ten‑ or fifteen‑minute visit and a prescription; particularly given the Black Box warning. And as with any powerful intervention, we need to keep looking closely at their long‑term effects and make sure that, across all ages and conditions, the benefits truly outweigh the risks
The real story isn’t “SSRIs cause violence.”
The real story is that we are medicating children who are already overwhelmed by a world that is too fast, too toxic, and too adult. Are we following them closely enough to keep them safe? Are we following these molecules closely enough? That work never really ends, because taking these drugs seriously means reckoning with their full impact.
Renee S. Kohanski, MD, is a board‑certified psychiatrist with fellowship training in forensic psychiatry. Her work spans clinical practice, expert testimony, and public commentary. She writes about the intersection of mental health, ethics, and culture, bringing a psychodynamically informed lens to contemporary debates.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.