If you’re wondering which pills and how many of them Americans have relied upon to make ourselves feel better since COVID-19 arrived, the answer, in short, is yes.

“I should have gone back on medication sooner in the pandemic than I did,” said Leah Bellow-Handelman, 36. Bellow-Handelman, a nurse who lives in Brooklyn with two small children, has been on and off Prozac for anxiety since her 20s. Shortly before the pandemic, she had weaned herself off in time for her first pregnancy.

So, she wasn’t taking anything when the pandemic struck, even though her life was operating in full crisis mode: She worked at the urgent care center at Memorial Sloan Kettering in Manhattan, a cancer hospital. The emergency room is dedicated to current and former cancer patients, and many of the patients admitted to the urgent care had especially severe cases of COVID and needed oxygen or intubation right away.

“We just put our heads down and did what we had to do,” she said. “We were in such autopilot disaster mode in the spring, that by the summer, that was when we really realized how intense that spring really had been.” She also felt isolated; many friends had left the city, and of those who remained some were hesitant to see her because she worked in health care.

By August 2020, her husband encouraged her to go back into therapy.

After a complicated second birth, she decided she needed more than just talk. Her therapist, she said, “was never opposed to me going back on medication, but she was trying to get me to do mindfulness and meditation — stuff that I just don’t do.”

She turned to Prozac again. Now, she said, “I’m a different person.”

The reasons behind the decision to start or restart psychiatric medication are often not reducible to simple cause and effect.

“I’m definitely medicated because of COVID, but I’m also medicated because I’m a woman who was a nurse who had babies in the middle of COVID, and a traumatic birth,” Bellow-Handelman said.

She is one of millions of Americans who have started or restarted psychiatric medication during COVID’s long and dreary run. Tracking exactly which pills Americans are swallowing these days is difficult because much of this information is privately held.

But, from companies that provided data to The New York Times and from other existing research, it is possible to begin to assemble a picture of our medicine cabinets and, by extension, our mental health.

First, the broad strokes: In 2019, the Centers for Disease Control and Prevention estimated that 15.8% of American adults took prescription pills for mental health. During the pandemic, the National Center for Health Statistics teamed up with the Census Bureau to carry out quick online “pulse” surveys and tracked mental health prescription pill use.

The numbers they turned up echo what we already sense: We are depressed, anxious, tired and distracted. What’s new is this: Almost a quarter of Americans over 18 are now medicated for one or more of these conditions.

More specifically, according to data provided to the Times by Express Scripts, a pharmacy benefits manager, prescriptions across three categories of mental health medications — depression, anxiety and ADHD — have risen since the pandemic began. But they have done so unevenly, telling a different story for each age group and each class of medication.

Antidepressants continue to be the most commonly prescribed of these medications in the United States, and their use has become only more widespread since the pandemic began, with an 8.7% rate of increase from 2019 to 2021, compared with 7.9% from 2017 to 2019, according to Express Scripts.

IQVIA, a global health technology and clinical research firm, found that in 2021, nearly 337.1 million prescriptions were written for antidepressants in the United States, representing a steady annual increase since 2017, when that number had been nearly 313.7 million.

But for some age groups, that change has been more pronounced. Since 2017, there has been a 41% increase in antidepressant use for the teenagers included in the Express Scripts data (which consists of roughly 19 million people). For this same 13- to 19-year-old bracket, in the first two years of the pandemic, there was a 17.3% change in anxiety medications. It had been a 9.3% rate of change between 2017 and 2019.

One 13-year-old rising eighth grader in Colorado currently takes the antidepressant Paxil and the stimulant Adderall. (She also takes melatonin, a nonprescription supplement, to help her sleep.)

Before the pandemic, she had started taking Adderall to help with ADHD, but when her school switched to remote learning, she struggled. “It just felt like one of those days where you sit at home and you don’t do anything,” she said. “It felt like that was every day, like I was stuck in some endless cycle of sitting in one place. For me, everything felt a lot more pointless. It didn’t feel like I was in school; I just felt like I was in a dream. So I didn’t feel like I needed to do my assignments, because I didn’t feel like anything I did at that time actually mattered.”

Sitting with her puppy helped, but her teachers told her it was too distracting on-screen. Ultimately her mother decided to try her on Paxil.

“She’s an anxious person,” said the teenager’s mother, Ellie. “She gets stuck in her own head, and her thoughts loop. She gets frustrated with schoolwork, and she doesn’t want to do it if she doesn’t think she can do it perfectly.”

“It was affecting her mental health, and she was cranky and depressed, and she got her period early,” she added. “It was just so many things at once.”

Their pediatrician recommended she come off the Adderall to determine whether the Paxil worked. While she was off the Adderall, her grades slipped. She recently started taking it again. She said the main downside of Adderall came at meal times. “Last year, when I was on it,” she said, “I couldn’t eat anything, so my sister would make me smoothies so I didn’t have to chew.”

“I just felt too productive to eat,” she added. “I had no appetite, instead, my brain was like, ‘You have to do everything right now.’ My body was hungry, but my mind was not.”

These rising medication numbers aren’t necessarily caused only by a worsening of mental health in this country (although we know that rates of anxiety and depression have increased). Part of the uptick could be explained by the fact that, stuck at home, people finally had time to seek out the health care they had been delaying. But patients seeking help are doing so against a backdrop of isolation, restriction, uncertainty and grief.

“There’s less of a barrier culturally around using medications,” said Dr. Cecil R. Webster Jr., a psychiatrist in Boston and a lecturer at Harvard Medical School and McLean Hospital. At the same time, life in the digital age means that people expect immediacy: immediate replies, immediate delivery, immediate improvement. “We have no tolerance for slow change,” he said. “But many of the problems we are faced with demand slow change.”

Yet we’ve always had problems — and for everyone alive today, we’ve always had pills. The tranquilizers that first became popular in Eisenhower’s America were, within a few years, so commonplace as to be called “mother’s little helpers,” until they were shown to be dangerously addictive.

“The 1950s and ’60s were widely framed as the age of anxiety,” said Anne Harrington, the author of “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness” and a historian of science at Harvard. “And the ’80s and ’90s became the age of depression. And yet it’s unclear that people’s symptoms actually changed.”

The Rise of the Antidepressant

Prozac arrived in 1987, and just seven years later there was Elizabeth Wurtzel, the Harvard grad with the big, doleful eyes, staring out from the cover of her blockbuster book, “Prozac Nation.” An early devotee of such pills, she reported from the front lines of the new pharmacological war on sadness, an avatar of Gen X anguish and hope. (Wurtzel died in 2020 from breast cancer.)

Prozac set a new standard for the treatment of depression, but its success was tied to its predecessors. Long before there was Prozac, there was iproniazid, developed for tuberculosis but applied to depression after doctors observed the cheering effect on a group of TB patients in a hospital on Staten Island. (The often-told story has it that they danced in the hallways.) Iproniazid did not cure TB, but it came onto the market as something with potentially wider application: the long-sought “psychic energizer,” as Dr. Nathan Kline, a psychoanalyst who was one of its earliest champions, put it.

Prozac was developed to answer what was then the prevalent theory of depression: that it was caused by a chemical imbalance in the brain, specifically too little serotonin. Prozac and similar drugs are called selective serotonin reuptake inhibitors, meaning they block the reabsorption of serotonin in the brain.

“When these drug companies began to market SSRIs as drugs repairing a so-called chemical imbalance, if you look carefully at the early ads, they say, ‘depression may be caused by’ or ‘we actually don’t know what causes depression,’ in the fine print,” Harrington said. But the Food and Drug Administration made it easier for drug companies to advertise directly to consumers, and the language of “chemical imbalance,” according to Harrington, “had a really big impact on how we made sense of our mental distress.”

As psychiatrist Dr. Peter Kramer put it in “Listening to Prozac,” his landmark 1993 book that helped crystallize the cultural moment, “Prozac was on ‘Nightline’ when you went to sleep and on the ‘Today’ show when you woke up.” Within the first two years of Prozac’s existence, 650,000 prescriptions were written for it per month.

In 1993, Kramer was asking careful questions about who should use Prozac and why, but almost 30 years later, he recognizes that the dispensing of antidepressants has grown significantly more casual. Prozac, and its cousins like Zoloft and Lexapro — given out to treat depression but also anxiety, obsessive-compulsive disorder and other disorders — are now a banal sight in American medicine cabinets, between the Band-Aids and the Tylenol.

“I think the reason doctors are more blase about prescribing these medicines is that they’ve now been around for a long time and they can prescribe them without getting into trouble,” Kramer said. But there’s one more reason, too, he thinks: our growing “intolerance” for “more mild levels of depression and neurosis.”

Debates rage on the efficacy and safety of antidepressants. In a recent article in The Nation, writer P.E. Moskowitz, echoing a long-standing concern of some prominent skeptics, points out that antidepressants are much more difficult to get off than advertised and that the chemical-imbalance theory of depression on which it all rests has never been proved.

In a study published this year in JAMA, a team of researchers led by Dr. Sadaf Milani of the University of Texas Medical Branch found that antidepressant use during the pandemic differed across genders.

Looking at data pooled from 15 million to 17 million Americans during the initial months of the pandemic, she said, her team found that rates of serotonergic drugs (prescribed for both depression and anxiety) used by women increased to a 15.18% prevalence rate by October 2020 (compared with 12.77% in January 2018). For men, there was a bump in antidepressant use in the first weeks of the pandemic — with a 6.73% prevalence rate in April 2020 (compared with 5.56% in January 2018). For men and women, rates of antidepressant use dropped off slightly in 2021, but remained higher than they were in 2018.

Depression and Distraction

Adderall, a medication that hit the U.S. market in 1996, was created to treat attention deficit disorder, and its very name, as Alan Schwarz reports in “ADHD Nation,” was inspired by the phrase “ADD for All.”

Adderall was nothing new: The same chemical compound had been used in previous decades as a weight-loss drug, then called Obetrol. But from a pharmaceutical perspective, it was a name well chosen. Within 10 years, more than 9 million Adderall prescriptions were written. And from 2006 to 2016, use of prescription stimulants doubled.

During the pandemic, even as stimulant use among the youngest Americans leveled off slightly, the most recent data from Express Scripts suggests that these pills are being given at increasing numbers to young adults. Among Americans ages 20 to 44, numbers of ADHD medications went up 7% from 2017 to 2019, but they increased by 16.7% from 2019 to 2021. According to IQVIA, just under 77 million prescriptions were written for ADHD stimulant medications in 2021, nearly 6 million more than in 2020. In 2017, that number was just over 66.6 million.

In some ways it’s easy to understand why, as millions of people are burned out, lethargic and forced to focus all day on computer screens with little to no true social connection (to say nothing of exhausted parents stranded with no child care, no school and no help).

Emergency legislation, passed in the early days of pandemic, may have helped to ease the pathway to an Adderall prescription even further. The new rules lifted the requirement that doctors see patients in person in order to prescribe them certain controlled substances, including Adderall.

New telehealth companies like Cerebral, which was founded in 2020, provided customers with stimulant prescriptions after a 30-minute, online-only consultation.

The Wall Street Journal reported that the Cerebral Medical Group was recently subpoenaed. The company’s president and chief medical officer, Dr. David Mou, canceled an interview with the Times that same weekend.

What the Therapists Say

For many psychologists and psychiatrists, these numbers aren’t exactly surprising. Clinicians across the country describe the same patterns: their practices filled to capacity; patients who are in significantly worse shape than before; patients who had been stable for years, now in need of hospitalization or intensive outpatient treatment; patients who had been in psychotherapy for years, suddenly needing medication for the first time, or higher doses of the meds they were already on.

Dr. Robert Ashley, a psychiatrist in Los Angeles, said that “everyone, every day, just wakes up with 10% extra pressure on them.” Ashley described a practice saturated with “people who have been stable for years in therapy and they have reached a point during the pandemic where their therapist thinks they should be evaluated for medication.”

When Ashley puts patients on an antidepressant, his typical plan is to wait until they feel better, or “normal,” which can take four to six weeks, then keep them on the medication for six to 12 months, at which point he will start to look for a good time to take them off.

“We’re hoping that the depression was an aberration in their lives and not part of a recurring pattern,” he said. “Seventy percent of my patients who are taking antidepressants are in therapy of one form or another. So the hope is also that the medication lifts them enough out of the depression that they can engage better in their psychotherapy.”

In some ways, Ashley’s vision for the ideal use of antidepressants is the exception to the rule of how antidepressants are more commonly prescribed in the United States: in a primary care setting, by a family doctor or internist, unaccompanied by talk therapy. A 2013 study found that more that 79% of antidepressant prescriptions were written by primary care physicians.

Without the tools of talk therapy, one could wonder what the logic is of the prescription. Are the pills in and of themselves a cure, that you take for a certain amount of time, then find yourself transformed? Or are they a treatment that works only as long as you are still taking them, if they work at all? Existing research paints an inconclusive picture as to how effective antidepressants are compared with a placebo.

Back in Colorado, the teenager has no plans to discontinue meds. Her mother isn’t concerned about the implications of the medications long term. She herself is used to the idea of taking prescription pills over years, even decades.

“I have been on Lexapro and Prozac for as long as I can remember,” she said. “I started taking Prozac as a senior in college, and I’m turning 50 this year. I would not be able to function without it.”

This article originally appeared in The New York Times.

© 2022 The New York Times Company