Matthias Aizenberg and Ivan Kairatov discuss the shifting landscape of American mental health, focusing on the nearly 38 million adults now utilizing anxiety medications. As a biopharma expert with a deep background in research and development, Kairatov provides a clinical perspective on why certain demographics are seeking help at record rates and how the industry is responding to both innovation and public skepticism. This conversation explores the balance between pharmaceutical intervention, lifestyle modifications, and the regulatory challenges of a post-pandemic world.
Anxiety medication use has increased by several million people since 2019, with the sharpest rise among young adults and the LGBTQ+ community. What specific stressors are driving this shift in these demographics, and how has the growth of teletherapy influenced their willingness to seek prescriptions?
The data is quite striking, showing that the proportion of American adults on these medications jumped from 11.7% in 2019 to 14.3% in 2024, which translates to roughly 8 million additional people. For young adults aged 18 to 34, the usage rate climbed significantly from 8.8% to 14.6%, likely driven by a “perfect storm” of pandemic-induced isolation, heightened economic uncertainty, and growing income inequality. Within the LGBTQ+ community and among college-educated adults, there is often a higher baseline of social stress, but also a greater openness to discussing mental health openly. Teletherapy has acted as a critical bridge here, removing the physical and social barriers of visiting a clinic; when you can connect with a professional from your own home, the friction of seeking a prescription for something like Lexapro or Zoloft is vastly reduced.
While SSRIs like Lexapro and Zoloft are considered front-line treatments, there is significant public debate regarding their safety and potential links to behavior changes. How do you reconcile these concerns with clinical evidence, and what protocols do you use to differentiate between manageable side effects and serious risks?
It is essential to ground this discussion in clinical reality rather than political rhetoric, as recent studies show that over 50% of patients with generalized anxiety disorder see their symptoms reduced by at least half when using an SSRI. While common side effects like upset stomach, brain fog, fatigue, or reduced libido are real, they are typically manageable and far outweighed by the stabilization of the patient’s mental state. We differentiate these from serious risks by monitoring the patient closely during the initial weeks; if the side effects are too intrusive, we note that about 1 in 12 people choose to stop the medication, which is a standard part of finding the right fit. The claims linking these drugs to violent behavior or comparing them to the addictive profile of heroin are simply not supported by the current body of medical evidence.
Some health advocates suggest that mental health struggles are largely products of sedentary lifestyles and ultraprocessed diets. To what extent can physical interventions like exercise and nutrition serve as a replacement for medication, and what are the risks of choosing lifestyle changes over pharmaceutical stabilization?
There is a valid connection between ultraprocessed foods and increased rates of depression or anxiety, and as an expert, I always advocate for exercise and better nutrition as adjunctive therapies. However, for many patients, the anxiety is so distracting and “noisy” that they cannot even begin to engage in a healthy lifestyle without first achieving chemical stabilization. The risk of choosing lifestyle changes alone for severe cases is that the underlying disorder remains untreated, which can lead to a total breakdown in daily functioning or professional productivity. We saw this with patients like Sadia Zapp, who found that while therapy helped, it was the medication that truly allowed her to return to a productive, day-to-day life without being riddled with fear.
Benzodiazepines are effective for acute episodes but carry a higher risk of habit-formation compared to SSRIs or beta-blockers. How do you determine when a patient requires a controlled substance versus a non-addictive alternative, and what steps are necessary to ensure they do not develop a dependency?
Benzodiazepines like Xanax are excellent for “rescue” situations—acute, overwhelming episodes of panic—but they are not intended for long-term, daily management because they are habit-forming. To prevent dependency, we often look to non-addictive alternatives like beta-blockers (such as propranolol), which are very safe for bringing the autonomic nervous system down from a “fight or flight” state to something neutral. If a controlled substance is necessary, it must be prescribed with a strict tapering plan and frequent monitoring to ensure the patient doesn’t keep needing higher doses to achieve the same effect. The goal is always to use the least restrictive and least addictive tool that can still provide the patient with the relief they need to function.
Expectant mothers and survivors of major illnesses like cancer often face heightened anxiety, yet there is conflicting messaging about the safety of medications in these cases. What are the actual clinical trade-offs for these patients, and how does untreated anxiety impact their long-term physical recovery or pregnancy outcomes?
For a cancer survivor, every physical ache—like a sore knee—can feel like a sign that the end of the road is near, creating a level of stress that actually hinders physical healing and immune function. In pregnant women, the clinical consensus is that the risks of SSRIs are generally low, whereas untreated depression and anxiety significantly increase the risk for almost every pregnancy complication for both the mother and the baby. It is a dangerous trade-off to suggest that these women should suffer without help; when anxiety is managed, patients are more likely to adhere to their recovery protocols and maintain the physical stamina needed for long-term health. We must prioritize the mother’s mental stability as a foundational element of her overall medical care.
Social media influencers have helped reduce the stigma surrounding mental health, but this has also led to a rise in self-diagnosis and easier access to drugs online. What are the dangers of this trend, and how can the medical community ensure that patients receive professional guidance rather than just convenient prescriptions?
While it is encouraging that a third of teens now get mental health information via social media, the rise of “sponsored” treatments that promise same-day Xanax prescriptions is deeply concerning. The danger of self-diagnosis is that it skips the essential diagnostic nuance provided by a physician, potentially leading patients to use the wrong medication for their specific underlying condition. The medical community must reinforce that increased access through telehealth should not mean a decrease in clinical rigor or the bypassing of a formal diagnosis. We need to ensure that the “convenience” of an online pharmacy does not replace the safety of a supervised, tapered medical plan directed by a qualified psychiatrist.
What is your forecast for the future of mental health treatment in America?
I believe we are heading toward a more integrated model where the “Make America Healthy Again” focus on nutrition and movement will finally merge with advanced pharmacology and cognitive behavioral therapy. We will likely see a move away from the occasional overuse of benzodiazepines in favor of safer, off-label uses of beta-blockers and more refined SSRI protocols that minimize side effects like brain fog. However, the biggest challenge will be navigating the cultural divide; we must protect the progress made in destigmatizing treatment so that the 38 million Americans currently seeking help don’t feel forced back into the shadows by misinformation. Ultimately, the future lies in personalized medicine that treats the brain as part of the whole body, combining chemical support with the lifestyle changes necessary for true, long-term stability.
