An analysis of pharmacy dispensing records covering 85 million children and adolescents in the United States found that antidepressant prescriptions doubled between 2015 and 2025, with SSRI prescriptions in girls aged 12 to 17 increasing by 189% over the decade — a trend researchers attribute to genuine increases in adolescent depression and anxiety rather than overdiagnosis.

The Adolescent Mental Health Crisis

Youth mental health has deteriorated significantly over the past decade. The CDC’s Youth Risk Behavior Survey found that 42% of U.S. high school students reported feeling persistently sad or hopeless in 2021 — a 13-percentage-point increase from 2011. Emergency department visits for adolescent suicidal ideation and self-harm increased by 114% between 2010 and 2020.

Social media use, pandemic-related disruptions to schooling and social connection, academic pressure, and declining rates of outdoor play and physical activity have all been proposed as contributing factors, though establishing causation remains complex.

Prescribing Trends

The study, published in JAMA Pediatrics, analyzed pharmacy dispensing data from the IQVIA National Prescription Audit for patients aged 6 to 17 from 2015 to 2025. Total antidepressant prescriptions increased from 14.2 per 1,000 adolescents in 2015 to 28.6 per 1,000 in 2025 — a 101% increase.

SSRIs dominated prescriptions, led by escitalopram (37%), fluoxetine (29%), and sertraline (22%). Prescribing in girls aged 12-17 rose from 22.1 per 1,000 to 63.9 per 1,000 — a 189% increase that significantly outpaced the 67% increase seen in boys of the same age.

Who Is Prescribing

Pediatricians and family medicine physicians accounted for 61% of adolescent antidepressant prescriptions, with psychiatrists writing only 28% — reflecting both psychiatrist shortages and the normalization of mental health management in primary care settings. Telehealth prescribing accounted for 34% of new SSRI starts in 2025, compared with 4% in 2019.

Are Antidepressants Appropriate?

“The increase in prescribing largely tracks the documented increase in diagnosis rates, which themselves appear to track real increases in suffering,” said co-author Dr. Jennifer Greenberg of Harvard Medical School. “The clinical concern is not so much overprescribing as ensuring that pharmacotherapy is accompanied by appropriate psychotherapy.”

The American Academy of Pediatrics recommends that pharmacotherapy for moderate-to-severe adolescent depression should be initiated alongside cognitive behavioral therapy or interpersonal therapy, with fluoxetine preferred as the SSRI with the strongest evidence base in pediatric populations.

⚕️ Medical Disclaimer: This article is for informational purposes only. It does not constitute medical advice. Always consult a qualified healthcare professional before making health decisions.