John Yang: For the first time in decades, public health data shows a sharp drop in U.S. deaths from drug overdoses, both accidental and suicidal, but at the same time, numbers from the Centers for Disease Control and Prevention show that overdoses involving antidepressants have been on the rise for the past two decades.

Now, the connection between overdoses and antidepressants is not a simple one.

Alison Athey is a clinical psychologist and a behavioral scientist at Rand, the nonpartisan research organization.

She also teaches at the Johns Hopkins School of Medicine.

So Alison, what is your biggest takeaway from this data?

Alison Athey, Clinical Psychologist: Well, I think it's very heartening to see overdose deaths overall decrease.

Right now, we don't understand totally why the overall numbers decreased or if this trend will be sustained, but it's really hopeful that things are taking a turn.

I think the other big takeaway from these data are that there are important differences between suicidal overdose and unintentional overdose, and we need to tailor our treatments to match the needs of people who are at risk for one the other or for both.

John Yang: Now the fact that the overdoses involving antidepressants have been on the rise.

What do you make of that?

Alison Athey: You know, it's really puzzling.

I think first, an important thing to know is that the CDC data we're looking specifically at rates of antidepressants in overdose deaths.

So the vast majority of suicide deaths in our country, unfortunately, are suicide by firearms.

So the impact of antidepressants on that group is really unknown, but what we do see is there is that change in antidepressants in overdose deaths, whether they're suicidal or unintentional.

What it could mean is that there's some problem related to the drugs themselves, but it could also mean, and I think this might be more likely that people who are depressed are having easier access to antidepressants, so there are more antidepressants out in the world that happen to be available to people who go on to die by suicide or an unintentional overdose.

John Yang: Does that suggest anything about the prescribing of antidepressants and what doctors learn about antidepressants and what they pass on to their patients about them?

Alison Athey: That's a great question.

I think that as more and more people are taking antidepressants, there's unfortunately a strain on our healthcare system, because those who start antidepressants really should be following up with a doctor within a week or two of starting or when they decide to discontinue, because those are the periods of risk.

That being said, I think overall, it seems like antidepressants have helped protect us at the population level against suicide, that they are an effective treatment, but occasionally they don't work for people, and those people are at higher risk for suicide because their depression severity is persistent.

John Yang: Prescriptions for antidepressants went way up during the pandemic.

Alison Athey: That's right.

John Yang: What are patients not being told that they should be told when they're prescribed?

Alison Athey: So a few things.

So first of all, it's important to take medications consistently fluctuations in medication levels in the blood are really terrible for mood and for the body, and so being consistent and also speaking to a doctor before coming off of medications is critically important.

The other thing that patients should know is that if they do start thinking about suicide, that there is help out there, and that their doctor is a great resource who can connect them to mental health professionals, if they're not a mental health professional themselves.

John Yang: Are physicians when they prescribe antidepressants, saying enough that you should also seek therapy.

Should also find good therapists to talk to.

Alison Athey: I think by and large, physicians do really love it when their patients go to therapy because we know that therapy is as effective as antidepressant medication, and that antidepressants plus therapy is the gold standard treatment.

That being said, there simply aren't enough therapists in the community, and it's really hard to find a therapist, especially one who fits the person's needs.

So, physicians aren't at fault here.

I think our system is just not meeting the demand.

John Yang: Starting with the Affordable Care Act, it put physical health and mental health and equal footing in terms of insurance.

Is affordability an issue?

The affordability of finding a therapist?

Alison Athey: I would say it is.

I myself worked both in private practice and now at Johns Hopkins at a public hospital, and access is drastically different in private practice, you can usually get to see someone really quickly, but then people end up paying out of pocket, and it's quite expensive, and it's very difficult to get reimbursement for those fees in public hospital systems.

The opposite is true.

It's really hard to get an appointment, but typically the insurance question when the out of pocket pay is much lower, making it somewhat more accessible, but also inaccessible because of the demand on the system.

John Yang: What can someone do if their friend or loved one is experiencing a mental health crisis and maybe thinking about suicide?

Alison Athey: I think there are three important things that loved ones can do, first of all, and perhaps most importantly, loved ones can make sure that the environment that their loved one is in is safe.

So if you see someone who's riding around in a car without a seatbelt, you tell them to put it on when you're at home.

The way you can make your home safe is by securing firearms and securing medications so that someone in their darkest moment, in a fleeting moment of darkness, doesn't end their life.

So that's a big one.

Another important thing to know is that anyone can call 988, which is a crisis lifeline that's available for people who are in crisis, but also for those who care about them, who want information and connections to resources.

And the third thing that people can do is ask their loved one, are you thinking about ending your life?

And that question is not dangerous.

It doesn't implant that idea in the person's head, but it can allow you to know, is this a mental health emergency, and do we need emergency resources for my loved one?

John Yang: Alison Athey, thank you very much.

Alison Athey: My pleasure.

Thank you.