Q&A: Why Are Antidepressants Underprescribed?

Q. What is approved for postpartum depression and can nursing mothers use it?

A. Zuranolone is only taken for two weeks and is approved for postpartum depression. It’s got a very low dose to the infant in breastfeeding, way below the safety level.

Q. What percentage of the U.S. population would you say is taking antidepressants?

A. About 13% to 14% of people have depression. Women are twice as likely as men to have depression. Some of that has to do with hormonal changes in women, either across their menstrual cycle or across pregnancy, and in perimenopause, when their hormones are fluctuating pretty often. Less than 50% of people with major depressive disorder are diagnosed, with less than 25% treated and even less treated adequately. 

Q. Is there any harm in taking them in perpetuity?

A. No. There’s much more harm in discontinuing them too early or inappropriately. And that sometimes happens with patients doing that because of side effects, but also providers try to do that for patients after six to 12 months in remission. 

Q. How long is it safe to take antidepressants, and are they addictive?

A. The World Health Organization has advised that if you have had three episodes of major depression you should remain on treatment for at least five years. And very often we find that people need to keep taking the medication indefinitely. 

Dr. Anita Clayton is the first woman selected president-elect of the American Society of Clinical Psychopharmacology. It is a six-year term. She ascends to the position in 2025 and will serve two additional years as past president – part of the organization’s leadership transition program. (Photo by Matt Riley, University Communications)

Q. What are the most common side effects of antidepressants?

A. The most common side effects are sexual dysfunction, changes in weight, usually weight gain, sleep disturbances – and that might be sleeping too much or insomnia of some sort. You could have dysfunction where people are not thinking as clearly. Making decisions, planning things out can be affected. 

Q. Based on your experience, do you have a professional opinion on whether patients are being undertreated?

A. Absolutely. And the data supports that dramatically. Depression is underdiagnosed. Doctors often don’t make that diagnosis. That’s why a few years ago, the Centers for Medicare & Medicaid Services required the use of a depression screening. And now we have a suicide screening that we have to do once yearly. 

It may be that primary care doctors are not doing that. And even when they do diagnose depression, unless it’s severe or there’s suicidal ideation, they usually don’t refer patients to a psychiatrist. It’s an incredibly common problem.

Q. Are there any other facts you want people to know about using antidepressants? 

A. Stigma about having depression and taking medication for treatment – this has gotten better, but I cannot say that this is not a problem. We have people all the time whose family members say, “Pull yourself by your bootstraps. You just need to work hard to get over this. Get up off your butt and go exercise,” or whatever they’re saying. And that is stigma. That’s a prejudice against people with mental health issues, but particularly depression, because it’s so common.

Stigma is a huge problem, and we need to get over it.