Three things about antidepressants that almost nobody knows, and each one should bother you more than the last. First: when your doctor says Prozac, Lexapro, or Zoloft is "safe and effective," the honest version of that sentence is "safe and effective for the year it was studied." The FDA's own chief medical and scientific officer, Vinay Prasad, looked at the ten most prescribed antidepressants in America. Not one has a double-blind, randomized, placebo-controlled trial longer than a year. Seventeen percent of the population takes these drugs, many for decades, and beyond year one, nobody actually knows whether the benefits outweigh the risks. The public believes these are among the most-studied drugs in history. Long term, they barely qualify as studied at all. Second: the FDA requires no studies on how to get people off these medications after long-term use. None. Millions of people have been on them for years, and the science of safely discontinuing them is a black hole that no drug company has ever been required to fill. Third, and this is the one I want you to sit with: they aren't even required to make doses you can taper from. Coming off safely means small reductions, far smaller than the tablets that exist. So when people ask me why antidepressant use keeps climbing every year, "the world is more stressful" is only part of the answer. Some of it is simpler and worse: people get on, discover there's no off-ramp built, and stay stuck. We built a system with an entrance and no exit. That's not a mental health epidemic. That's a design flaw.