A massive new cohort study just confirmed what many of us have suspected for years: SSRIs accelerate cognitive decline in dementia patients. Let that sink in.
The very drugs we prescribe to improve mental health outcomes might actually be worsening cognition over time. The study, published in BMC Medicine, followed 18,740 dementia patients over several years, tracking their cognitive decline while on SSRIs and other antidepressants. The results?
• Faster cognitive deterioration in SSRI users compared to non-users
• Higher risk of severe dementia, fractures, and all-cause mortality
• Dose-dependent worsening—higher doses = worse outcomes
If SSRIs were truly a long-term solution, we wouldn’t see these outcomes.
Yet, here we are—still prescribing them at record levels, still believing they are safe for lifelong use, still assuming they work in the way we’ve been told.
SSRIs and Cognitive Decline: The Risks We Can’t Ignore
The study found that patients on SSRIs—particularly escitalopram, citalopram, and sertraline—declined faster than non-users. These are the same drugs pushed as the “safest” and “most well-tolerated” options for depression.
So what’s going on here? The reality is, despite previous claimns, SSRIs impact the brain in ways we don’t fully understand. Here’s what we do know:
• Serotonergic Dysregulation – Chronic SSRI use can alter serotonin receptor sensitivity over time. While they boost serotonin initially, the brain compensates by downregulating receptor function, which may explain why people often report SSRIs “stop working” after years of use.
• Anticholinergic Effects – Some antidepressants (including SSRIs at higher doses) have anticholinergic properties, which can interfere with memory and cognition—a major issue for patients already suffering from dementia.
• Neuroplasticity Disruption – Serotonin plays a key role in neurogenesis, but artificially increasing it may disrupt natural feedback loops that regulate brain adaptation and cognitive function.
• Metabolic Dysfunction – SSRIs alter insulin sensitivity, increase weight gain, and can worsen blood sugar regulation, all of which impact brain function and mental health.
• Sleep & REM Disruption – SSRIs interfere with REM sleep, which is crucial for memory consolidation and emotional processing.
Here’s the bottom line: We are prescribing these drugs with the assumption that they help—but when we step back and actually look at long-term data, the picture isn’t nearly as reassuring as we were led to believe.
We Have No Idea How Most Psychiatric Medications Actually Work
It’s time for some radical honesty in psychiatry: We don’t actually know how these medications work.
Do SSRIs work? SSRIs were developed under the chemical imbalance theory—the idea that depression results from low serotonin levels. But even mainstream psychiatry has quietly abandoned this theory because it’s not supported by the evidence. A 2022 umbrella review of decades of serotonin research concluded there’s no consistent link between serotonin levels and depression.
So if depression isn’t a serotonin deficiency, then what exactly are SSRIs fixing?
This is a pattern in psychiatry:
• Antipsychotics were originally thought to work solely through dopamine blockade—turns out, they have complex effects on glutamate, serotonin, and inflammation.
• Benzodiazepines were thought to be non-addictive—we now know they cause profound dependence and cognitive impairment with prolonged use.
• SSRIs were marketed as safe long-term—now we have data linking them to cognitive decline, metabolic dysfunction, and withdrawal syndromes that can last years.
Shouldn’t this make us question whether we really understand the long-term consequences of these drugs?
If we don’t even fully grasp their mechanisms, how can we confidently prescribe them for decades?
Long-Term SSRI Risks: What You Aren’t Being Told
Most people are never informed about the real long-term risks of SSRIs. These include:
• Persistent Withdrawal Syndromes – Long-term SSRI users who try to quit often experience withdrawal lasting months or even years, including brain zaps, emotional numbness, and worsened depression.
• Increased Risk of Dementia – A growing body of research links long-term antidepressant use to higher dementia risk, even in those without prior cognitive impairment.
• Bone Fractures & Osteoporosis – SSRIs increase fracture risk by weakening bone mineral density over time.
• Emotional Blunting – Many users report feeling emotionally numb, unable to fully experience joy, sadness, or deep connection.
• Increased Risk of Suicide in Some Populations – SSRIs can increase suicidality in young adults, a risk often downplayed in clinical settings.
• Weight Gain & Metabolic Dysfunction – SSRIs cause insulin resistance, weight gain, and inflammation, which contribute to both mental and physical health deterioration.
How many psychiatrists explain these risks in full before prescribing?
Why Full Disclosure and Informed Consent Matter
Here’s a radical thought: People deserve to know exactly what they’re taking.
Whether you ultimately choose to take SSRIs or not is your choice, but that choice should be informed.
• Patients should know we don’t fully understand these drugs’ long-term effects.
• Patients should be told about the risks of cognitive decline, withdrawal, and metabolic issues.
• Patients should have a plan for eventually tapering off safely, rather than being placed on SSRIs indefinitely.
Instead, what usually happens?
A five-minute conversation followed by a lifetime prescription—no plan, no discussion of alternatives, no informed consent. That’s not medicine. That’s blind faith in a flawed system.
Metabolic Psychiatry: The Future of Mental Health Treatment
So what’s the alternative? Metabolic psychiatry.
We need to stop treating depression, anxiety, and cognitive decline as medication deficiencies. Instead, we should be asking:
• Is this person’s brain energy metabolism optimized?
• Is their neurotransmission dysregulated due to inflammation or metabolic dysfunction?
• Are they insulin resistant, inflamed, or deficient in key nutrients like magnesium, omega-3s, or B vitamins?
Metabolic psychiatry shifts the focus from pushing pills to optimizing brain health through:
✅ Nutritional Psychiatry: Ketogenic and low-glycemic diets improve cognitive function and emotional stability.
✅ Exercise & Resistance Training: Increases BDNF (Brain-Derived Neurotrophic Factor), neuroplasticity, and resilience.
✅ Targeted Supplements: Omega-3s, magnesium, amino acids, and other targeted, data driven supplementation can support neurotransmitter function naturally.
✅ BONUS Psychedelics for Neuroplasticity: Psilocybin and ketamine (in controlled settings) promote deep neurological rewiring and can be done to jumpstart therapy and with limited use instead of long-term prescription use.
This isn’t wishful thinking. It’s backed by science. And it’s a far more rational approach than throwing SSRIs at every problem and hoping for the best.
A word of caution: start with the safest, most accessible interventions first, then adjust from there. This means change our nutrition and exercise habits with consistency, first, then opt for changes from there. Don't take the prescriptions first without giving an honest, dedicated effort at healthy changes.
Let’s Talk About Your Options
I take an integrative approach to psychiatry—one that prioritizes long-term brain health, not just symptom suppression. If you’re in the Washington, D.C. area, I offer comprehensive psychiatric care that blends metabolic psychiatry with evidence-based interventions. (I am also licensed in other states Colorado, Missouri, New York, Maryland, and others)
📌 Not in D.C.? I also work on a consultative basis for those outside the area, helping clients transition off unnecessary medications, optimize cognition, and improve mental health through science-backed, metabolic-first strategies.
If you’re ready to explore a better way to approach mental health, let’s connect.