Saturday, August 1, 2026

The MAGA GOP Against Anthony Fauci, MD...


 

The Lie

The Facts

Lie 1: "Fauci lied about masks."

The Claim: repeatedly asserts Fauci intentionally lied to the public to manipulate them or that his changing guidance proved he was deceptive.

In March 2020 (the early weeks of the pandemic), public health officials—including Fauci—advised the general public against buying N95 surgical masks to prevent a severe shortage for front-line healthcare workers, given the initial belief that COVID-19 spread primarily through large droplets and surfaces. As airborne transmission and asymptomatic spread became clear in April 2020, guidance shifted to universal cloth mask-wearing. Scientific adaptation to new data was re-framed by critics as a malicious "lie."

Lie 2: "Fauci created/funded COVID-19 in Wuhan."

The Claim:  Repeated claims state that Fauci personally authorized "gain-of-function" research at the Wuhan Institute of Virology that directly created the SARS-CoV-2 virus.

While the National Institutes of Health (NIH) did fund grants to EcoHealth Alliance for bat coronavirus research in China, independent scientific panels, the NIH, and intelligence reviews clarified that the specific bat coronaviruses studied under those sub-grants were genetically distinct from SARS-CoV-2 and could not have evolved into the pandemic virus. The political rhetoric, however, repeats the "Fauci created the virus" line to frame a public servant as a criminal perpetrator.  Some circles suggest there was homicidal intent.

Lie 3: "Fauci personally forced lockdowns and school closures."

The Claim: characterizes lockdowns, school closures, and business restrictions as unilateral mandates handed down personally by "Dictator Fauci."

Under the U.S. federal system, public health mandates (closing schools, restricting indoor dining, stay-at-home orders) were legally enacted by state governors and local public health departments—not federal advisory scientists. Fauci served as an advisor whose task force issued recommendations, but he lacked any statutory executive power to pass laws or order closures.

Lie 4:  "Fauci lied when he said vaccines stop 100% of transmission."

The Claim: Asserts that public health officials promised the original COVID-19 vaccines would permanently block all infection and transmission, calling subsequent variant breakthrough cases "proof of a lie."

Clinical trials in late 2020 measured efficacy against symptomatic disease (which was ~95% for original strains). While early real-world data showed significant reduction in transmission against original variants, the emergence of mutated variants (like Delta and Omicron) eroded protection against infection while maintaining strong protection against severe illness and death. The shift in viral evolution was reframed as a deliberate institutional falsehood.

Lie 5: “Fauci made millions of dollars directly off the COVID-19 pandemic.”

The Claim:  made millions through secret royalty checks paid by pharmaceutical companies for COVID-19 vaccines. The claim frames him not as an independent public health scientist, but as a compromised figure using federal authority to enrich himself and corporate allies.  In this hearing there was a comments that he was “enriching himself through the use of federal employees.”  There has also been a longstanding complain that Dr. Fauci is the “highest paid federal employee and he makes more than the President.”  That is true but it is full disclosure and according to federal regulations.

-Dr. Fauci holds no patents and receives no royalties related to any COVID-19 vaccines or treatments (including the Pfizer, Moderna, or Johnson & Johnson vaccines).

-FOIA disclosures obtained by watchdog groups showed that the NIH and its scientists received third-party royalties for older, pre-pandemic medical innovations (such as early HIV/AIDS research from decades prior). However, sensationalist headlines falsely claimed that these past, unrelated payments were "COVID-19 vaccine profits."

-Dr. Fauci has repeatedly stated—dating back to interviews with the Associated Press and BMJ in 2004/2005—that he attempted to refuse statutory royalty payments from earlier research (such as an interleukin-2 treatment developed for HIV/AIDS) because he felt it posed a potential conflict of interest.  Because federal law required the agency to issue the funds, Fauci pledged to donate 100% of his royalty payments to charity.

-Federal Salary: As the former Director of the National Institute of Allergy and Infectious Diseases (NIAID) and Chief Medical Advisor, Dr. Fauci was one of the highest-paid federal civil servants, earning a fixed annual government salary (~$480,000 before his retirement in late 2022). This salary was set by federal civil service pay scales, completely independent of vaccine sales or corporate profits.

- Public Filings: Under the Ethics in Government Act, Fauci’s financial disclosures—including his investments, stock holdings, and outside income—are subject to strict federal conflict-of-interest audits and are a matter of public record. His filings show no stock holdings in individual pharmaceutical companies; his personal investments are held in broad mutual funds, municipal bonds, and standard retirement accounts.  income—are subject to strict federal conflict-of-interest audits and are a matter of public record. His filings show no stock holdings in individual pharmaceutical companies; his personal investments are held in broad mutual funds, municipal bonds, and standard retirement accounts.

-In February 2021, Tel Aviv University awarded Dr. Fauci the Dan David Prize for lifetime achievement in public health and his leadership during the HIV/AIDS and COVID-19 crises.  After tax withholdings and administrative fees, the direct deposit received by Fauci totaled $899,960.  The National Institutes of Health (NIH) ethics office has long-standing regulations (5 C.F.R. § 2635.204(g)) that allow federal researchers and doctors to accept bona fide, prestigious awards for scientific achievement from non-profit or educational institutions, provided the award is approved by an agency ethics officer.  Before accepting the Dan David Prize (and other academic honors throughout his 50-year career), Fauci submitted the award for official NIH ethics review, which formally authorized him to accept the cash prize.


I saw the various clips but don’t have to watch the entire debacle.  It was the usual exercise in rhetoric as I watched the US slide farther and farther from reality.  After all this was a debate about the COVID pandemic that officially ran from March 11, 2020 to May 5, 2023.  It has been over for more than 3 years.  The argument can easily be made there are more pressing public health and safety problems at this point ( foodborne illness outbreaks, vaccine preventable disease outbreaks (measles, pertussis), toxicology emergencies (lead poisoning), wildfires, that are direct  products of the policies of this administration and currently endanger thousands of Americans. 

In addition, the elimination of Medicaid and SNAP benefits endanger millions more.  Medicaid is the nation's largest payer of mental health and substance use disorder care, and the primary funding vehicle for addressing Social Determinants of Health (SDOH) (housing, food security, and transportation).  Medicaid is also the single largest payer of maternity care in the US covering 40% of all births. In the midst of those problems the HHS Secretary has decided that he knows something about mental health and has decided he knows more about what medications and treatments people with those disorders need to take.  So why is the pandemic being relitigated while this administration is ironically making American unhealthy again?

The most straightforward answer is because they can.  Trump and his allies have tapped in to strong anti-science, anti-knowledge, and anti-expert biases in the US and used them to their advantage.  They routinely scapegoat and vilify anyone who they consider to be an enemy or outsider and that is a very low bar.  To end up in the enemy camp – all you have to do is disagree with them.  Disagreement is easy when they have produced so many ideological decisions that have no rational basis.  The list of those irrational decisions can fill volumes at this point.  I will focus on the dynamics of the Fauci hearing.   

This hearing was clearly a set up by Paul, and Fauci made that point in his opening statement – specifically that Paul had an unhealthy obsession with him and had threatened to jail him. This is apparently because of Paul’s conspiracy theory that the COVID virus (SARS-CoV-2) was a virus modified in a Chinese lab and accidentally released.  He claims that Fauci knew something about this despite Fauci’s diary entry of 2021 documenting that the latest genetic information made manufacture in a lab an impossibility. The remainder of the hearing was essentially Fauci taking the Fifth Amendment against self-incrimination.  Anyone who knows how the government works would be foolish to start any discussion in such a biased proceeding. That is especially true in the case of Fauci who has a pardon from former President Biden. In this setting it is easy to suggest perjury incidents and file those charges in the absence of any real evidence for the original charge.

At least some of the impetus for these hearings was the personal diary of Dr. Fauci.  Paul apparently was given this access by HHS Secretary Kennedy who discovered it on their servers.  At this point I do not know if it was Dr. Fauci’s naiveté about recording personal notes on a government server or something else.  I do know that it is common sense that diaries are not written for public disclosure.  To publish this as Paul has done shows that it is all part of a general smear campaign and an attempt to suggest that the things nobody says out loud are really “lies”. 

Like almost all of the current governments tactics this all comes down to rhetoric at several levels.  The first is just the usual scapegoating and rage-bating.  Fauci is an intellectual, an elite, etc.  He is not like the rest of us but he likes to tell us all what to do.  This is our chance to rise up and throw him in jail.  Of course, the rage baiting caused more problems than that for Dr. Fauci and his family.  He has been threatened with harm and many of those threats were considered serious.  He had a government security detail from 2022 until it was terminated by Trump on January 24, 2025. It has not prevented further public threats in some cases by public figures who have no idea who Dr. Fauci is or what he has accomplished.  They are generally focused on one of the lies in the above table.

I thought about adding a section here on the academic references to the various rhetorical devices used by autocrats and fascists.  But I will keep it simple.  Trump and his administration use them all to distort reality, provoke anger in his base, and further divide the country.  One of his advisors was very clear about it and called it “flooding the zone.”  There is plenty written about that process in academic references, but you can see how it works in real time just by watching the news every day. Trump promotes the lie that the 2020 election was “stolen” and none of his cabinet nominees will answer that question in Congressional hearings.  Suddenly we have unconstitutional interference with local elections and pending federal legislation that will eliminate tens of thousands of eligible voters.

The pattern is clear.  Initiate a divisive issue, never admit it is false or involves any wrongdoing, and keep repeating it.  Ignore the fallout even if that includes casualties on the streets of Minnesota or in an unnecessary war.  Blame everyone else and never acknowledge mistakes even when they are obvious to everyone else. Academic references about logical fallacies are unnecessary in these scenarios. This is where the lies about Anthony Fauci come from.  When he was coming up with solutions to the horror of the pandemic, Trump and his cohort were suggesting bleach, ivermectin, and hydroxychloroquine – all completely ineffective and in some cases dangerous.  In fact with the “pile on” effect from this hearing one of those cabinet members took to social media to claim he had stockpiles of hydroxychloroquine that would have saved thousands of people.  That is another completely inaccurate claim.     

 In the final analysis. It all comes down to whether or not you are a rational person.  You may feel encapsulated by a Democrat or Republican label.  That clearly does not insulate you from unnecessary wars, the erosion of civil rights, the dismantling of the public health infrastructure, a deteriorating climate and environment, a worsening health care system, diversion of most economic resources to the wealthy, enabling convicted criminals and fraudsters to commit further crimes and trying to reimburse them for jail time, and using government resources to attack innocent American citizens.  It does not insulate you from the fact that we have an administration that has appointed people to serve in the cabinet who have no qualifications.  None of this passes muster as politics as usual much less rational decision-making.

So – be a rational person.  Respond to facts and not rhetoric. Notice when there is an appeal to your emotion rather than your decision-making. Recognize the obvious fallacies when you see them – like the frequent name-calling and witch hunts

Get the USA back on track again…

 

George Dawson, MD, DFAPA 

 

 

Supplementary 1:  The American Public Health Association (APHA) has come out on social media in support of Dr. Fauci.  Several medical organizations have done this in the past related to COVID and HIV controversies. It is time that every physician organization does the same thing and does it now.  I have been an elected official in physician organizations and there is always a “big-tent” concern.  In this case that would mean supporting Dr. Fauci would alienate any dues paying Republicans. As I hope to have pointed out in the above post – this is larger than political labels.  In the above table you can choose to be in column 1 or column 2.  Column 2 is the rational choice.  

Supplementary 2:  If you want to see how some of these lies played out in real time - I have a post here that recorded some of what football star Aaron Rodgers  had to say about Dr. Fauci back in 2024.  Mercifully the video has been taken down but the lies and distortions are still all there.  He goes even further suggesting that both the HIV and COVID pandemics were created to respond to only specific drugs and enrich Dr. Fauci and Pharma.  I am not saying that Rodgers is lying but he certainly is repeating them almost exactly as outlined in the above table.  The information to refute his assertions was widely available at the time and in the case of HIV for decades earlier. 

Supplementary 3:  Commentators on this issue always soft pedal any direct confrontation of the lie.  For exam on Lie #2 - Fauci funded the creation of the pathological COVID virus (already walked back by Sen. Paul to GOF and not the pandemic virus) it is common to hear:  "Well I don't agree with that but I do disagree with the way the pandemic was handled."  First off what part do you disagree with?  Fauci's job was keeping up with the research and trying to change guidance on the fly while hospitals were overwhelmed and tens of thousands of people were dying. Anyone in that situation is going to make what they consider to be the most conservative recommendation to save the most people.  Secondly, by making that hedging statement you are endorsing Lie #3.  Fauci did not personally close down anything.  That was all local officials.  

Supplementary 4:  I have a great interest in airborne viruses.  Because of that interest I documented the transition in thinking about COVID transmission from droplet nuclei to airborne on this blog.  The date was April 8, 2020.  This confirms row 1 in the table. 

Supplementary 5:  Highly recommend the nonpartisan Annenberg Foundation's FactCheck.org to fact check anything this party or administration has to say about Dr. Fauci or the COVID pandemic.

Supplementary 6:  Since I posted this around noon on August 1, 2026 I have heard the following in the media:

"Fauci is responsible for 8 or 9 millions deaths."

"Fauci is worse than Joseph Mengele."

And from a national comedian: "Of course Fauci lied about gain of function."

No he did not.  All of these statements confirm what is said in the body of my post and will probably be repeated every day if you are paying attention.  To be a rational person you have to be intentional.  All of these inaccurate statements cannot be brushed off or in the case of comedians - laughed at.  Pick a column and stay there.

8/2/2026:  Day 2 of the Fauci hysteria.  Many people have taken to social media to reinforce the message of the MAGA Republicans today portraying Fauci as a megalomaniac and blaming him for everything from vaccination side effects to their kid having to wear a dirty mask to school for 8 days in a row.  One of the worst examples I have seen was an excerpt posted about a meeting with a CIA official that supposedly informed him of a lab leak and suggesting he covered this up.  It is clear from the diary entry that he considered both the information and informant unreliable and actually suspicious.  This same author likened the situation to finding out Dick Cheney wrote in his diary that he knew there were no weapons of mass destruction in Iraq.  The huge problem with that comparison is not only what was recorded at the time (unreliable source) - but that genetic analysis of the virus showed it was not produced in a lab.  The real comparison here is from law enforcement and that is:  1:  eyewitnesses are unreliable and this informant would not even qualify as an eyewitness.  According to rules of evidence this is hearsay.  2:  In court - hearsay is not evidence, but genetic analysis is.  

And then there was this interview of RFK, Jr by CCN's Dana Bash.  It was full of misinformation including some of the misrepresentations in the table above.  Ashish Jha, MD provides a bit of commentary at the end and has the stunning disclosure that he now believes the pandemic virus was a lab leak.  I have searched everywhere for what he is basing that opinion on and so far have found nothing.  No matter what side of the issue you are on - all of this agitation does absolutely nothing to address either future outbreaks or the outbreaks that are occurring right now.  

 

References:

1:  Robertson L.  The Wuhan Lab and the Gain-of-Function Disagreement.   FactCheck.org.  Posted on May 21, 2021 | Updated on July 1, 2021  https://www.factcheck.org/2021/05/the-wuhan-lab-and-the-gain-of-function-disagreement/

2:  Robertson J, MacDonlad J.  Fauci and Paul, Round 2.   FactCheck.org Posted on August 11, 2023 | Updated on August 23, 2024  Posted on July 22, 2021 | Updated on August 19, 2021 https://www.factcheck.org/2021/07/scicheck-fauci-and-paul-round-2/

There’s no evidence that Fauci lied to Congress, as Paul asserted in the July 20 hearing, given that the NIH unequivocally backs up Fauci’s statement that the grant-backed research “was judged by qualified staff up and down the chain as not being gain-of-function.”

In a May 19 statement, NIH Director Dr. Francis S. Collins said that “neither NIH nor NIAID have ever approved any grant that would have supported ‘gain-of-function’ research on coronaviruses that would have increased their transmissibility or lethality for humans.”  “

3:  Jaramillio C, and Yandell K.  RFK Jr.’s COVID-19 Deceptions.  FactCheck.org Posted on August 11, 2023 | Updated on August 23, 2024  https://www.factcheck.org/2023/08/scicheck-rfk-jr-s-covid-19-deceptions/

4:  Kaiser J.  Under fire from Republican senators, Fauci takes the Fifth at COVID-19 hearing.  Science July 29, 2026:  https://www.science.org/content/article/under-fire-republican-senators-fauci-takes-fifth-covid-19-hearing

5:  American Society of Microbiology Letter in Support of Dr. Fauci.  July 28, 2026:  https://asm.org/articles/policy/2026/july/asm-letter-to-senate-committee-in-support-of-fauci


 



Saturday, July 18, 2026

A Realistic Comparison of SSRI and Heroin WIthdrawal



With all the quotes in the media about these withdrawal syndromes – I thought I would add a few facts.  These facts are based on science, my 22 years in acute care psychiatry, and another decade at a large facility specializing in substance use disorders.  I have been involved in the care of thousands of people with these disorders, and the care has improved substantially over that period of time largely due to the availability of Medications for Opioid Use Disorder (MOUD).  Before that there was a major problem treating anyone with an Opioid Use Disorder (OUD) if they were not enrolled in a methadone maintenance program. 

To cite a few examples, in acute care psychiatry it is common to receive emergency admissions of people with severe depression or psychosis.  Many have associated drug and alcohol problems.  In the case of heroin and other opioids, there was a rule extending up into the early 2000s that unless a person was enrolled in a methadone maintenance program, only acute detox could be done with methadone.  Additional medications were offered like clonidine to cover hyperadrenergic symptoms of opioid withdrawal.  Clonidine was often the only detox medication. The situation was not better in substance use disorder (SUD) treatment programs who often had an array of “comfort medications” designed to treat all of the peripheral symptoms of withdrawal.  The problem with this approach was twofold: first it was rarely adequate to treat acute withdrawal. Second, when the patient was discharged in a week, they had ongoing symptoms of withdrawal that essentially guaranteed an immediate relapse to opioid use.

The introduction of buprenorphine (Suboxone, Subutex, Sublocade) resulted in a marked improvement in the quality of care in this scenario. The acute and chronic withdrawal symptoms of opioids could be adequately treated and the risk of relapse mitigated. During the time of this transition, the large SUD treatment center where I was working went from using buprenorphine for acute detox to buprenorphine maintenance treatment.  I was responsible for treating depression and anxiety in these patients.  I observed that no matter what treatment I prescribed the anxiety, insomnia, irritability, and depression persisted for months as protracted opioid withdrawal symptoms until they were treated with buprenorphine.  At that point the withdrawal symptoms resolved immediately and completely.  The depression, anxiety, insomnia, and craving for opioids all resolved.  That massive improvement in care cannot be emphasized enough.  I went from discharging people after 1-3 months who I knew would relapse immediately to confidently discharging people who were stable and had a much better chance to recover.

I am posting this introduction because the historical window for this innovation was very brief and I doubt that many physicians ever saw it.  The advantage for patients was so clear that the medical director of the treatment program where I worked changed it from an abstinence-based program to MOUD.  The research at the time was clear.  MOUD saved lives by decreasing relapse rates, accidental overdoses, and decreased risk of infections (HIV, HCV).

In my previous post, I examined the rhetoric of comparing selective serotonin reuptake inhibitor (SSRI) withdrawal to heroin withdrawal.  But what about the popular myths and the science?  The popular view of opioid withdrawal is that once the acute phase is over – it is over.  The popular view promoted with SSRI withdrawal is that it is typically universal, severe, and long lasting.  Neither of those views are accurate.

The time course of symptoms is outlined in the diagram at the top of this post.  Acute symptoms have a characteristic pattern and can start as soon as hours after a last dose of heroin.  In the case of antidepressants, the time course is more dependent on the mechanism of action and half-life of the medication being studied. Since opioids are all mu opioid receptor (MOR) agonists – there are no known medications in this class that do not cause withdrawal, but what accounts for the differences in severity and percentages of people affected is not known. Pharmacokinetics and pharmacodynamics likely play a role – I will defer that discussion to later post.

The main qualitative differences in opioid and SSRI withdrawal are the lack of cravings and observable physical symptoms in SSRI withdrawal.  Opioids reinforce their own use and for that reason have street values.  SSRIs do not and have no street value. The withdrawal symptoms from SSRIs are largely subjective but that does not mean they are not real or serious.  

In the case of SSRIs and other antidepressants, the mechanism precipitating withdrawal is thought to be a precipitous fall in extraneuronal serotonin.  All SSRIs are orthosteric inhibitors of the serotonin transport protein (SERT).  Orthosteric inhibitors act like serotonin at the same binding site on SERT.  Allosteric modulators bind at a site that is topographically distinct from the site that the endogenous ligand (in this case serotonin or 5-HT) binds to.  Escitalopram has an additional effect on SERT as an allosteric modulator.  Trazodone, vilazodone, and nefazodone are all allosteric non-competitive inhibitors of SERT (1-4).  Withdrawal reaction have been described by both but not to the same degree as heroin withdrawal.   

In the case of heroin withdrawal, a series of studies done from 1962 to 1969 showed very high relapse rates (>90%) in heroin users who had been treated in a controlled environment. Thise studies led to early experiments with MOUD and eventually methadone maintenance.  A direct comparison of the likelihood of moderate withdrawal symptoms for each category is 3-31% for SSRIs and 100% for opioids.   Those numbers are qualified by several caveats.  First, opioid withdrawal has been studied for a much longer time, is more well characterized, and fewer medications are involved.  Second, study methodology for the SSRI withdrawal is much more varied from looking at short term randomized controlled studies to surveys of long-term use selected for withdrawal symptoms.  The former will underestimate withdrawal effects but identify a drug attributable effect by subtracting out placebo and the latter will overestimate effects .  The overestimate can be compounded by not subtracting a nocebo effect and publicity effects that may increase nocebo.  In clinical practice, using antidepressants with lower withdrawal risk – I found the incidence to be closest to that of Henzler, et al (7) at about one in six or seven people.    

In conclusion, discontinuing many medications can cause a withdrawal syndrome. Not all withdrawal syndromes indicate an addiction and some can be life-threatening.  They are difficult to study for several reasons.  First, the response to discontinuing the medication varies significantly from person to person even at the same dose and duration of use. That range is significant from no effect to severe and in some cases (alcohol, sedative hypnotics) life-threatening effects.  That includes a placebo response where that can be safely implemented.  Second, there is also a lack of high-quality evidence for many of these syndromes. The best evidence is for alcohol and sedative hypnotics because they are obvious and have been treated for decades.  But even then there are consensus guidelines such as the ASAM guideline on benzodiazepine tapering.  Third, there is limited standardization across guidelines.  Fourth, there are pharmaceutical limitations.  In some cases, very small doses of medication are needed to complete the protocol that may require a liquid form, pill cutting, or substitution with an equivalent medication with a longer half-life.  In some cases, all of these changes may not be enough.  Fifth, in clinical trials where medications were tapered and discontinued there may not be enough reported details to replicate the protocol in clinical practice (5).  Sixth, the outcomes of discontinuation of a medication are complex and include resolution of adverse drug effects, relapse to the treated condition, a unique withdrawal syndrome, or a rebound effect involving the physiological systems that were being treated – like rebound tachycardia after stopping beta-blockers.  Seventh, context is important especially with medications and substances that reinforce their own use.  Adherence to any tapering protocol on an outpatient basis is much less likely to happen.  Eighth, the medicolegal dimension may be a concern.  Because of the all of these factors, there is a lot of uncertainty involved in any tapering and discontinuation protocol.  There is seldom a protocol that will work well for everyone. Because of this risk some guidelines advise clinicians to seek legal or administrative consultation when attempting these protocols.  There is additional risk if relapse to the original condition occurs after a medication has been successfully stopped.

Despite all these concerns tapering and discontinuing medications is foundational medicine in any medical specialty. None of these problems are unique to psychiatry or medication for mental disorders.  As interns most physicians learning how to detoxify acute care patients with substance use disorders – the most common condition remains alcohol use disorder.  In their respective specialties – they learn more about how to do this with specific medications used in their specialty. That has resulted in protocols that can differ from hospital to hospital in the same town. In some cases, the protocols differ in the same hospital over a period of years.  To cite one example, I am aware of a hospital that used oxazepam followed by diazepam and then chlordiazepoxide or phenobarbital as their detox agents from alcohol and benzodiazepines. In some of the standard orders, anticonvulsants were also used to minimize seizure risk.

As more societies and government agencies get involved there is a gradual move to standardization.   Even if we get to that point – individual assessments and close monitoring will still need to be done.  The risk of a withdrawal syndrome from any medication is one that is necessary to medically treat various problems.  It is a decision that physicians and patients do not take lightly.  It is important to discuss that potential risk in the informed consent discussion.    

 

George Dawson, MD, DFAPA

 

References:

1:  Plenge P, Yang D, Salomon K, Laursen L, Kalenderoglou IE, Newman AH, Gouaux E, Coleman JA, Loland CJ. The antidepressant drug vilazodone is an allosteric inhibitor of the serotonin transporter. Nat Commun. 2021 Aug 20;12(1):5063. doi: 10.1038/s41467-021-25363-3. PMID: 34417466; PMCID: PMC8379219.

2:  Sanchez C, Reines EH, Montgomery SA. A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? Int Clin Psychopharmacol. 2014 Jul;29(4):185-96. doi: 10.1097/YIC.0000000000000023. PMID: 24424469; PMCID: PMC4047306.

3:  El-Kasaby A, Boytsov D, Kasture A, Krumpl G, Hummel T, Freissmuth M, Sandtner W. Allosteric Inhibition and Pharmacochaperoning of the Serotonin Transporter by the Antidepressant Drugs Trazodone and Nefazodone. Mol Pharmacol. 2024 Jun 18;106(1):56-70. doi: 10.1124/molpharm.124.000881. PMID: 38769018.

4:  Murray KE, Ressler KJ, Owens MJ. In vivo investigation of escitalopram's allosteric site on the serotonin transporter. Pharmacol Biochem Behav. 2016 Feb;141:50-7. doi: 10.1016/j.pbb.2015.11.010. Epub 2015 Nov 24. PMID: 26621784; PMCID: PMC4724252.

5:  Dirven T, Turner C, Thio SL, Blom J, Muth C, van Driel ML. Room for improvement in reporting of trials discontinuing long-term medication: a systematic review. J Clin Epidemiol. 2020 Mar;119:65-74. doi: 10.1016/j.jclinepi.2019.11.013. Epub 2019 Nov 29. PMID: 31786152.

6:  Goldberg JF, McIntyre RS, Swartz HA, et al. American Society of Clinical Psychopharmacology Task Force on the Deprescribing of Psychotropic Medications. Recommendations for the Deprescribing of Psychotropic Medications: A Consensus Statement From the American Society of Clinical Psychopharmacology Task Force. JAMA Netw Open. 2026 Feb 2;9(2):e260043. doi: 10.1001/jamanetworkopen.2026.0043. PMID: 41739481.

7:  Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024 Jul;11(7):526-535. doi: 10.1016/S2215-0366(24)00133-0. Epub 2024 Jun 5. Erratum in: Lancet Psychiatry. 2024 Sep;11(9):e11. doi: 10.1016/S2215-0366(24)00253-0. PMID: 38851198.


 

 

 

 


Thursday, July 16, 2026

The Politics of Deprescribing: Deconstructing the HHS Mental Health Agenda


Misinformation Claim

Status

References

Vaccines cause autism

Debunked conspiracy theory

1

SSRIs cause mass shootings

Debunked conspiracy theory

1

Diet replaces antipsychotics for schizophrenia

Debunked conspiracy theory

1

SSRIs are more addictive than heroin based on withdrawal symptoms

Debunked misinformation

2

Psychiatric medication overprescribing caused the crisis

Inverts the evidence (undertreatment is the problem)

2

Acetaminophen causes autism

Not supported by sibling-controlled analyses

3-4

MAHA targeting of specific drug classes in children

Misleading framing; omits actual chronic disease drivers

2, 5

MAHA Commission promoting distrust of mental health treatment

Documented concern in psychiatric literature

6

Nutrition/lifestyle as replacement for psychiatric treatment

"Promising" ≠ evidence-based alternative

2, 16

Omission of social determinants of mental health

Fundamental misattribution of the problem

7-8

Termination of NIH/NIMH grants to “reduce budget deficit” – no impact on budget but affects 70K research subjects

Misattribution of the problem and no impact on deficit

10-11

Government's own role in creating the crisis through underfunding

Ignored by HHS framing

12-13

Alcohol as a healthy beverage

"In the best-case scenario, I don't think you should drink alcohol, but it does allow people an excuse to bond and socialize, and there's probably nothing healthier than having a good time with friends in a safe way." Mehmet Oz, MD - Administrator of the Centers for Medicare and Medicaid Services

-Debunked by study designed to update dietary guideline – no safe level of alcohol use.

-Current dietary guideline contains a mix of recommendations from 1-2 drinks per day to “drinking less is better than drinking more”.

14,15

Executive Order 14321 (July 24, 2025), titled Ending Crime and Disorder on America's Streets, mandates that recipients of federal homelessness assistance require unhoused individuals—many of whom are living with substance use disorders and mental health conditions—to utilize rehabilitation and psychiatric services

-Housing first is ended – participation contingent on participation in treatment

-Broadening civil commitment without adding to infrastructure to address homelessness

- Does not address fact that both mental health and SUD homeless were constant and 43% increase was due to other factors

- Does not address lack of affordable housing

-Does not address continued lack of equity despite MHPAEA

 

17

Executive Order 14379 (January 29, 2026), titled Addressing Addiction Through the Great American Recovery Initiative, establishes a federal White House initiative to coordinate and prioritize national policies regarding addiction prevention, treatment, recovery support, and re-entry

-Harm reduction is modified to eliminate test strips for contaminants and medication (MOUD) only programs and annual tapering must be attempted.

-Harm reduction label must be eliminated.

-Provides administrative redundancy without actual increase in resources.

-Effectively suspended the NSDUH survey used to track SUD and mental health trends in the USA

-Sweeping cuts to the federal agencies tasked with carrying out this work—specifically targeting the Substance Abuse and Mental Health Services Administration (SAMHSA)

18

Executive Order 14401 (April 18, 2026), titled Accelerating Medical Treatments for Serious Mental Illness, directs the FDA and HHS to expedite research and approval for innovative psychedelic therapies (such as ibogaine and psilocybin) to treat conditions like PTSD, depression, and addiction.

-Harm reduction is modified to eliminate test strips for contaminants and medication (MOUD) only programs and annual tapering must be attempted.

-Harm reduction label must be eliminated

-Significant safety concerns with underreporting of side effects in many of these studies

-Lack of necessary infrastructure with intense staffing to provide psychedelic therapies

-Immediate access to investigational psychedelics under “right to try” laws.

19-23

HR 1 /One Big Beautiful Bill Act (OBBBA)versus Executive Orders 14321,14379, and 14401 - Mandated treatment while drastically cutting resources.

-false accusations of abuse of the system

-tax cuts for the wealthy rationalized as budgetary necessity

- Medicaid is the nation's largest payer of mental health and substance use disorder care

-Medicaid is the primary intervention to address social determinant of healthcare (SDOH).

-Medicaid is the largest single payer of pregnancy related services and maternity care in the US. (40% of all pregnancies)

- would increase the number of uninsured by 7.6 million and cause an estimated 16,642 medically preventable deaths annually to 16 million newly uninsured would lead to over 140 000 additional deaths.

- cuts taxes by $4.5 trillion over the next decade and partly pays for it with $911 billion in Medicaid spending cuts.

-92% of Medicaid recipients already work and meet eligibility requirements.

-disproportionate impact on rural communities, black and Hispanic, perinatal care, and substance use treatment.

- Medicaid cuts threaten emerging infrastructure that directly addresses social determinants of health (SDOH) — including food insecurity, housing instability, and transportation barriers while worsening the very social conditions that drive poor health outcomes.

-55-66% of people say affordability restrict access to MH and SUD care and 65-72% say they have limited access.

-based on previous cuts in healthcare spending the magnitude of harms may be underestimated

-

 

 

24-29

 

1:  Shim R. Conspiracy Theories Are Incompatible With Effective Health Policies. JAMA Health Forum. 2026;7(4):e261472. doi:10.1001/jamahealthforum.2026.1472

2:  Rubin R. HHS Says Psychiatric Medications Are Overprescribed, but Are They? JAMA. Published online June 26, 2026. doi:10.1001/jama.2026.8946

3:  Gostin LO, Wetter SA, Lurie P. Can a New Commission Make America Healthy Again? JAMA Health Forum. 2025;6(3):e251304. doi:10.1001/jamahealthforum.2025.1304

4:  Cortese S. Pharmacologic treatment of attention deficit–hyperactivity disorder. New England Journal of Medicine. 2020 Sep 10;383(11):1050-6.

5:  Greenhill LL, Pliszka S, Dulcan MK, et al. American Academy of Child and Adolescent Psychiatry. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry. 2002 Feb;41(2 Suppl):26S-49S. doi: 10.1097/00004583-200202001-00003. PMID: 11833633.

6:  Smith WR, Sharfstein SS, Appelbaum PS. The Make America Healthy Again Commission and Mental Health Distrust. Psychiatr Serv. 2026 Jan 1;77(1):70-73. doi: 10.1176/appi.ps.20250228. Epub 2025 Oct 30. PMID: 41163425.

7:  Alegría M, Alvarez K, Cheng M, Falgas-Bague I. Recent Advances on Social Determinants of Mental Health: Looking Fast Forward. Am J Psychiatry. 2023 Jul 1;180(7):473-482. doi: 10.1176/appi.ajp.20230371. PMID: 37392038; PMCID: PMC12096341.

8:  Cotton NK, Shim RS. Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health. J Am Acad Child Adolesc Psychiatry. 2022 Nov;61(11):1385-1389. doi: 10.1016/j.jaac.2022.04.020. Epub 2022 May 6. PMID: 35533798.

9:  Patel VR, Liu M, Jena AB. Clinical Trials Affected by Research Grant Terminations at the National Institutes of Health. JAMA Intern Med. 2026 Jan 1;186(1):126-128. doi: 10.1001/jamainternmed.2025.6088. PMID: 41247710; PMCID: PMC12624462.

10:  Jalali MS, Hasgul Z. Potential Trade-Offs of Proposed Cuts to the US National Institutes of Health. JAMA Health Forum. 2025;6(7):e252228. doi:10.1001/jamahealthforum.2025.2228

11: U.S. Department of the Treasury. Fiscal Service, Federal Debt: Total Public Debt [GFDEBTN], retrieved from FRED, Federal Reserve Bank of St. Louis; https://fred.stlouisfed.org/series/GFDEBTN, July 14, 2026

12:  Jeste DV, Gyan E. Social Determinants of Health in Psychiatric Disorders: Exciting Opportunities for Biopsychosocial Research and Clinical Care. Am J Psychiatry. 2026 Jul 1;183(7):450-460. doi: 10.1176/appi.ajp.20260402. Epub 2026 Jul 1. PMID: 42380754.

13:  Baird S, Choonara S, Azzopardi PS, et al. A call to action: the second Lancet Commission on adolescent health and wellbeing. Lancet. 2025 May 31;405(10493):1945-2022. doi: 10.1016/S0140-6736(25)00503-3. Epub 2025 May 20. PMID: 40409329.

14:  George S, Naimi TS, Keyes K, et al. Alcohol Intake and Health Study: No Protective Effect at Low Levels, With Mortality Increasing to 1 in 25 at 14 Drinks Per Week. J Stud Alcohol Drugs. 2026 Jul;87(4):621-638. doi: 10.15288/jsad.25-00435. PMID: 42420014.

15:  Dietary Guidelines for Americans, 2025-2030:  https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf

16:  Walrath-Holdridge M. RFK Jr. says keto can 'cure' schizophrenia. Can a diet alleviate mental illness?  USA Today Feb 19, 2026:  https://www.usatoday.com/story/news/health/2026/02/19/rfk-jr-keto-diet-cure-schizophrenia/88739528007/

17:  Saunders H, Rudowitz R.  A Look at the New Executive Order and the Intersection of Homelessness and Mental Illness.  KFF.  August 15, 2025:  https://www.kff.org/mental-health/a-look-at-the-new-executive-order-and-the-intersection-of-homelessness-and-mental-illness/

18:  Panchal N, Saunders H.   Tracking Key Mental Health and Substance Use Policy Actions Under the Trump Administration.  KFF.  July 10, 2026: https://www.kff.org/mental-health/tracking-key-mental-health-and-substance-use-policy-actions-under-the-trump-administration/

19:  Cohen IG, Lynch HF, McGuire AL. The Psychedelic Therapies Executive Order: On Approval and Clinical Readiness. JAMA. Published online July 01, 2026. doi:10.1001/jama.2026.11892  

20: Hinkle JT, Graziosi M, Nayak SM, Yaden DB. Adverse Events in Studies of Classic Psychedelics: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2024;81(12):1225–1235. doi:10.1001/jamapsychiatry.2024.2546

 21:  Ghaznavi S, Ruskin JN, Haggerty SJ, King F 4th, Rosenbaum JF. Primum Non Nocere: The Onus to Characterize the Potential Harms of Psychedelic Treatment. Am J Psychiatry. 2025 Jan 1;182(1):47-53. doi: 10.1176/appi.ajp.20230914. PMID: 39741443.

22: Brunt TM. Rare but relevant: Ibogaine and cardiovascular complications-prolonged QT interval and ventricular arrhythmias. Addiction. 2026 Jun;121(6):1616-1621. doi: 10.1111/add.70319. Epub 2026 Jan 20. PMID: 41560340; PMCID: PMC13155281.

23: Edwards EP, Gray LA, Elamin MEMO, Veiraiah A, Thanacoody RHK, Coulson JM. A case series of ibogaine toxicity reported to the United Kingdom National Poisons Information Service (NPIS) over a 10-year period. Clin Toxicol (Phila). 2025 Mar;63(3):212-216. doi: 10.1080/15563650.2024.2447500. Epub 2025 Jan 30. PMID: 39882933. 

24:  Gaffney A, Himmelstein DU, Woolhandler S. Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health. Ann Intern Med. 2025 Sep;178(9):1334-1342. doi: 10.7326/ANNALS-25-00716. Epub 2025 Jun 17. PMID: 40523288.

25:  Cutler DM. The Worst Piece of Health Care Legislation Ever. JAMA Health Forum. 2025;6(8):e254626. doi:10.1001/jamahealthforum.2025.4626

26:  Gaffney A, McCormick D, Bor D, Himmelstein DU, Woolhandler S. What Happens When Coverage is Cut? Looking Backward and Forward From the One Big Beautiful Bill. Milbank Q. 2026 Jun;104(2):324-360. doi: 10.1111/1468-0009.70082. Epub 2026 Apr 30. PMID: 42063224.

27:  Frank RG. Medicaid Reforms in the One Big Beautiful Bill Act and Mental Health Care. Psychiatr Serv. 2026 Jun 24:appips20260012. doi: 10.1176/appi.ps.20260012. Epub ahead of print. PMID: 42337436.

28:  Lin Y, Li H, Nahata MC, Zhang C, Ramey OL, Liu L. Treatment Patterns and Barriers to Care Among U.S. Adults With Co-Occurring Substance Use Disorder and Mental Illness. Am J Psychiatry. 2026 Jul 8:appiajp20251314. doi: 10.1176/appi.ajp.20251314. Epub ahead of print. PMID: 42415254.

29: Berkowitz SA, Archibald J, Yu Z, et al. Medicaid Spending and Health-Related Social Needs in the North Carolina Healthy Opportunities Pilots Program. JAMA. 2025;333(12):1041–1050. doi:10.1001/jama.2025.1042

 


Since May 2026, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has promoted an initiative to restructure U.S. mental health delivery. The plan heavily emphasizes "prevention and holistic treatments" while actively discouraging the use of psychiatric medications, under the premise that they are widely overprescribed—especially in children.

A May 4, 2026 memo outlines the core strategy: addressing the "mental health crisis" by making deprescribing (tapering and discontinuing medications) and annual pharmacological reviews reimbursable services, alongside launching federal webinars to teach clinicians how to taper patients off medications.

While these proposals may sound progressive to the public, they collapse under scientific scrutiny for three primary reasons.

1. The Myth of Overprescribing

The administration's central premise—that the mental health crisis is driven by overmedication—is medically inaccurate.

  • The Reality of Undertreatment: Up to 23% of the U.S. population has a treatable psychiatric condition warranting antidepressants, yet only a fraction of those individuals receive a prescription.  An estimated 90–95% of suicide decedents had a diagnosable psychiatric disorder, but postmortem toxicological screening consistently finds antidepressants in only 12–29% of cases, with particularly low detection rates among men and younger individuals.  Nearly half of suicide decedents had at least one recently dispensed medication undetected at autopsy, directly evidencing non-adherence. 

    Discontinuation of antidepressants is associated with a 1.6-fold increased risk of suicide attempt compared to continued therapy, and the first 28 days after both starting and stopping antidepressants represent periods of peak vulnerability.  At the population level, higher SSRI prescribing rates correlate inversely with national suicide rates, supporting the premise that adequate antidepressant treatment confers a protective effect.  These findings suggest that the problem is not antidepressant exposure but the failure to initiate, maintain, and monitor adequate pharmacotherapy in individuals with depression who are at risk for suicide (15-19). 

  • Non-Psychiatric Indications: Antidepressants are heavily prescribed for non-psychiatric, FDA-approved or clinically indicated conditions, including migraines, tension headaches, chronic pain, fibromyalgia, and smoking cessation. Studies show that 50% to 64% of all antidepressant prescriptions are written for these non-psychiatric diagnoses [4-8].

  • The Gap: When accounting for these physical health prescriptions, only about a quarter of Americans who actually need antidepressants for psychiatric conditions are receiving them. The real crisis is undertreatment, not overmedication [11-13]. Primary care settings miss or misdiagnose depression 40% to 50% of the time, and there is a 90% gap between individuals diagnosed with depression and those receiving clinically effective treatment [14].


2. Redundant "Solutions" to Standard Medical Training

The proposal to have HHS educate doctors on tapering is highly redundant and ignores existing clinical infrastructure.

  • Tapering and Discontinuing Medication is Foundational Medicine: Psychiatrists and primary care physicians are already trained in tapering and discontinuing medications. Clinicians have been acutely aware of antidepressant discontinuation syndrome since the first case report in 1959, and it has been standard textbook material since at least 1993.

  • Complex Cross-Tapering: In practice, stopping a medication rarely happens in a vacuum. Clinicians routinely manage highly complex transitions—such as cross-tapering (stopping one drug while initiating another) or managing patients who arrive with shopping bags full of conflicting medical and psychiatric prescriptions.

  • Existing Resources: Detailed clinical guidance on switching and stopping antidepressants has been readily available in industry-standard databases like UpToDate for over 18 years [9,10]. Rather than funding political webinars, a far more effective HHS initiative would be providing free UpToDate access to all practicing U.S. clinicians.

  • Routine Care vs. Political Incentives: Assessing medication efficacy, side effects, and whether to continue, adjust, or stop a drug is already a mandatory component of every standard psychiatric visit. Rebranding this routine care as a newly incentivized "deprescribing service" is purely rhetorical.


3. The Clinical Danger of Forced Deprescribing

Both the American Psychiatric Association (APA) and the American Foundation for Suicide Prevention (AFSP) have issued sharp responses to the HHS initiative:

  • The APA strongly objects to defining the mental health crisis as an issue of "overprescribing."

  • The AFSP warns that aggressive, medically unsupported "deprescribing" carries severe risks, including increased all-cause mortality, cardiovascular mortality, suicidal behavior, completed suicides, decreased quality of life, and long-term disability.


The Double Standard: Fast-Tracking Psychedelics

While the administration seeks to restrict standard, rigorously studied psychiatric medications, it simultaneously pushes to expedite the review and approval of innovative psychedelics (e.g., psilocybin, noribogaine, and methylone/MDMC) under "Right to Try" laws [19-23].

This presents a glaring policy contradiction:

  • High Risks: These compounds carry documented risks of severe psychiatric, cardiac, and systemic side effects (such as QT interval prolongation and arrhythmias linked to ibogaine) [22,23].

  • No Infrastructure: Administering psychedelic therapy safely requires intensive, highly staffed clinical infrastructure that the current healthcare system does not possess and likely will never adequately fund.

  • Hypocrisy: It is ideologically inconsistent to demand less medication use while fast-tracking high-risk, under-studied substances with relaxed regulatory oversight.


The Broader Landscape of Public Health Misinformation

The antidepressant initiative is part of a broader, systemic pattern of health policy distortion outlined below (and in the lead table):

Scientific Debunking vs. Public Policy (from lead table)

Misinformation ClaimScientific & Empirical RealityCitation(s)
Vaccines cause autismLong-debunked conspiracy theory; actively promoted by RFK Jr. to undermine public trust in vaccines.[1]
SSRIs cause mass shootingsDebunked. Mass shootings correlate heavily with firearm density, not antidepressant use. Meanwhile, the administration is actively rolling back firearm restrictions for the mentally ill.[1]
Diet/Keto replaces schizophrenia medsNo clinical evidence supports this. While RFK Jr. claims a ketogenic diet can "cure" schizophrenia, medical consensus remains that clozapine and standard antipsychotics are the gold standard.[2, 16]
SSRIs are more addictive than heroinScientifically false statements made by RFK Jr. during his confirmation hearings. Retraction was formally demanded by 25 members of Congress in March 2025.[2]
Acetaminophen causes autismNot supported by rigorous sibling-controlled genetic analyses.[3, 4]
Alcohol is a healthy social beveragePromoted by CMS Administrator Mehmet Oz. Directly debunked by modern dietary analyses showing no safe level of alcohol consumption.[14, 15]

The Policy Fallout: Cutting Resources While Mandating Treatment

The administration's legislative agenda, highlighted by H.R. 1 / One Big Beautiful Bill Act (OBBBA) and Executive Orders 14321, 14379, and 14401, represents a systematic defunding of the mental health safety net under the guise of reform.

1. The Homelessness Mandate (EO 14321)

This order effectively ends "Housing First" policies by making federal housing assistance contingent upon unhoused individuals entering mandatory psychiatric and substance use treatment [17].

  • The Error: It ignores the reality that homelessness increases are driven primarily by a lack of affordable housing, not sudden spikes in mental illness.

  • No Support: It broadens civil commitment powers without building the clinical infrastructure or beds needed to house or treat these individuals.


2. Dismantling Harm Reduction (EO 14379 & 14401)

The "Great American Recovery Initiative" restructures national addiction policy by stripping away proven harm reduction tools [18].

  • The Damage: It bans the distribution of fentanyl test strips, defunds medication-assisted treatment (MOUD) programs that do not force annual drug tapering, and bans the very term "harm reduction" from federal programs.

  • Data Blackout: It effectively suspended the National Survey on Drug Use and Health (NSDUH), blinding researchers to national addiction and mental health trends, while imposing sweeping budget cuts on SAMHSA.


3. Stripping Medicaid (OBBBA / H.R. 1)

Medicaid is the nation's largest payer of mental health and substance use disorder care, and the primary funding vehicle for addressing Social Determinants of Health (SDOH) (housing, food security, and transportation) [24-29].

  • The Cuts: The bill slashes $911 billion from Medicaid over the next decade to offset $4.5 trillion in tax cuts.

  • The Toll: Economists estimate these cuts will strip health coverage from 7.6 million to 16 million Americans, resulting in 16,642 to over 140,000 medically preventable deaths annually [24,26].

  • The Demographics: These cuts disproportionately harm rural communities, Black and Hispanic populations, perinatal care, and those seeking addiction treatment—all while 92% of Medicaid recipients already meet work and eligibility requirements.

Conclusion: Rhetoric Over Reality

When health policy is systematically distorted, we must look at the underlying political strategy. The current administration relies heavily on creating rigid in-groups and out-groups, framing public health officials, scientists, academics, and social advocates as "enemies" who are oppressing their core demographic.

The HHS antidepressant and "deprescribing" initiative is not a sincere effort to improve clinical care. It is a rhetorical distraction. By framing the mental health crisis as a personal failure of "overprescribing" doctors and "drugged" citizens, the administration conveniently avoids addressing the structural, economic, and social determinants of health—all while actively dismantling the financial and clinical infrastructure that keeps vulnerable Americans alive.

 

George Dawson, MD, DFAPA

 

Supplementary 1:  Not loving the table.  I tried everything possible to convert my 4 page Word table that is the basis for this post to a single continuous image.  I also tried pasting it directly into this post without any success.  The table alone was too large for the Blogger format and I could not find any way in the HTML to modify the size.  The expected continuous images were too narrow and I could not resize them.  Until I find a way - just click on each table page and it is readable.  The references in the table are in the table and not at the bottom of the post.

Supplementary 2:  A reader pointed out that RFK never explicitly said that SSRIs are “more addictive than heroin.”  That is a common paraphrase and I think if you read any of the following direct quotes it is easy to see how people come to that conclusion. Further his “expertise” only gets him so far.  I happen to be trained in addiction psychiatry and it is a common misconception that opioid withdrawal is miserable but it is over in 4 or 5 days.  In fact, it can persist for 6 months or longer with prominent symptoms of insomnia, anxiety, depression, and cravings that do not respond to usual care.  Those symptoms do respond to Medications for Opioid Use Disorder (MOUD) and it is the main reason that those medications are effective in preventing relapse and accidental overdoses. More details in the next post on this blog. See direct quotes and sources below:    

Direct RFK quotes:

1:  "I happen to be an actual expert on this, because I was addicted to heroin for 14 years... I've watched people come off of SSRIs and it is, it's not even comparable."

 – RFK Jr talks heroin addiction, SSRI views in speech to MAHA.  USA Today May 5, 2026.

2:  “Kennedy reiterated earlier remarks that heroin is easier to come off of than antidepressants. "I happen to be an actual expert on this because I was addicted to heroin for 14 years," he said. He then appeared to get teary speaking about a family member he said was suicidal while she withdrew from an antidepressant. "I've heard that from hundreds and hundreds of people," he said.” 

White LE, McKay B. RFK Jr. Wants to Wean Some Americans Off Antidepressants; HHS will encourage doctors to consider lifestyle changes, not drugs, to treat depression Wall Street Journal. May 4, 2026.

3: .RFK Senate Confirmation Hearing January 30, 2025 direct excerpts

 “Exactly, and that's the solution. 15% of American youth are now on Adderall or some other ADHD medication. Even higher percentages are on SSRIs and benzos. We are not just over medicating our children, we are over medicating our entire population. Half the pharmaceutical drugs on earth are now sold here. 70% of the profits from pharmaceutical companies are from the United States, even though we only have 4.2% of the world's population. Not only that, but a recent study by Cochrane collaboration founder Peter Gøtzsche found that pharmaceutical drugs are the third-largest cause of death in our country after heart attacks and cancers. They're not making us healthier. We need community health initiatives. We need access to treatment, we need exercise, we need better food

“They should have the availability. Listen, I know people, including members of my family, who've had a much worse time getting off of SSRIs than people have getting off heroin. The withdrawal period is… And it's written on the label. It's all documented.”

4:  Address to MAHA Institute May 2026:

“The United States does not just face a mental health crisis, we face a dependency crisis. Driven by overmedicalization. The data is clear. 1 in 6 American adults takes an antidepressant, 1 in 10 children are on prescription medication for their mental health. 30% of college students report using psychiatric medications in the past year, and in nursing homes, more than half of the residents are on prescribed antidepressants.”


References:

1:  WTAS: HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing.  https://www.hhs.gov/press-room/wtas-hhs-launches-maha-action-plan-curb-psychiatric-overprescribing.html

An embarrassing collection of attention seekers and compromisers.  Note how the APA position reads compared with the link above.

2: Centers for Medicare & Medicaid Services.  The Mental Health Parity and Addiction Equity Act (MHPAEA): https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity  (accessed 07/13/2026)

3: Kessler, Glenn (January 23, 2021). "Trump made 30,573 false or misleading claims as president. Nearly half came in his final year". The Washington Post. Archived from the original on January 24, 2021.

4:  Mojtabai R, Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood). 2011 Aug;30(8):1434-42. doi: 10.1377/hlthaff.2010.1024. PMID: 21821561.

5: Rhee TG, Rosenheck RA. Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015. Health Serv Res. 2019; 54: 139–148. https://doi.org/10.1111/1475-6773.13072

6:  Wong J, Motulsky A, Abrahamowicz M, Eguale T, Buckeridge DL, Tamblyn R. Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ. 2017 Feb 21;356:j603. doi: 10.1136/bmj.j603. PMID: 28228380; PMCID: PMC5320934.

7:  Zhang X, Nie X, Shi L. Treatment indications for antidepressants prescribed in primary health care facilities in Beijing, China. Int Psychogeriatr. 2025 Aug;37(4):100057. doi: 10.1016/j.inpsyc.2025.100057. Epub 2025 Mar 12. PMID: 40074596.

8:  Camacho-Arteaga LF, Gardarsdottir H, Ibañez L, Souverein PC, van Dijk L, Hek K, Vidal X, Ballarín E, Sabaté M. Indications related to antidepressant prescribing in the Nivel-PCD database and the SIDIAP database. J Affect Disord. 2022 Apr 15;303:131-137. doi: 10.1016/j.jad.2022.02.001. Epub 2022 Feb 5. PMID: 35134393.

9: Hirsch M, Birnbaum RJ.  Antidepressant discontinuation syndrome and discontinuing antidepressants in adults.  UpToDate.  Accessed 7/15/2026:  https://www.uptodate.com/contents/antidepressant-discontinuation-syndrome-and-discontinuing-antidepressants-in-adults

10:  Hirsch M, Birnbaum RJ.  Switching antidepressant medications in adults.  UpToDate.  Accessed 7/15/2026:  https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults

11:  US Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057–2067. doi:10.1001/jama.2023.9297

12:  Jackson-Triche  ME, Unützer  J, Wells  KB.  Achieving mental health equity: collaborative care.   Psychiatr Clin North Am. 2020;43(3):501-510. doi:10.1016/j.psc.2020.05.008

13:  Wang  PS, Angermeyer  M, Borges  G,  et al.  Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative.   World Psychiatry. 2007;6(3):177-185.

14:  Vigo D, Haro JM, Hwang I, et al. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder. Psychol Med. 2022 Jul;52(10):1948-1958. doi: 10.1017/S0033291720003797. Epub 2020 Oct 20. PMID: 33077023; PMCID: PMC9341444.

15:  Isacsson G, Holmgren P, Druid H, Bergman U. Psychotropics and suicide prevention. Implications from toxicological screening of 5281 suicides in Sweden 1992-1994. Br J Psychiatry. 1999 Mar;174:259-65. doi: 10.1192/bjp.174.3.259. PMID: 10448453.

16:  Gravensteen IK, Ekeberg Ø, Thiblin I, Helweg-Larsen K, Hem E, Rogde S, Tøllefsen IM. Psychoactive substances in natural and unnatural deaths in Norway and Sweden - a study on victims of suicide and accidents compared with natural deaths in psychiatric patients. BMC Psychiatry. 2019 Jan 18;19(1):33. doi: 10.1186/s12888-019-2015-9. PMID: 30658618; PMCID: PMC6339417.

17:  Chitty KM, Buckley NA, Lim J, Ali Z, Schumann JL, Cairns R, Daniels B, Pearson SA, Preen DB, Schaffer AL. Psychotropic and other medicine use at time of death by suicide: a population-level analysis of linked dispensing and forensic toxicology data. Med J Aust. 2023 Jul 17;219(2):63-69. doi: 10.5694/mja2.51985. Epub 2023 May 25. PMID: 37230472; PMCID: PMC10952140.

18:  Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry. 2009 Aug;70(8):1069-77. doi: 10.4088/JCP.08m04943. PMID: 19758520.

19:  Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J. Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database. BMJ. 2015 Feb 18;350:h517. doi: 10.1136/bmj.h517. PMID: 25693810; PMCID: PMC4353276.

20:  White A, Thornton RLJ, Greene JA. Remembering Past Lessons about Structural Racism - Recentering Black Theorists of Health and Society. N Engl J Med. 2021 Aug 26;385(9):850-855. doi: 10.1056/NEJMms2035550. PMID: 34469642

21:  McCoy J, Rahman T, Somer M. Polarization and the global crisis of democracy: Common patterns, dynamics, and pernicious consequences for democratic politics. American behavioral scientist. 2018 Jan;62(1):16-42.

22:  Mason L. Uncivil agreement: How politics became our identity. University of Chicago Press; 2022 Dec 22.

When politics is your identity merged with other identities like race, religion, local culture – the intensity toward out-group hostility intensifies because it seems like an existential threat - but - it is not.


Table References (enlarged):  

 1:  Shim R. Conspiracy Theories Are Incompatible With Effective Health Policies. JAMA Health Forum. 2026;7(4):e261472. doi:10.1001/jamahealthforum.2026.1472

2:  Rubin R. HHS Says Psychiatric Medications Are Overprescribed, but Are They? JAMA. Published online June 26, 2026. doi:10.1001/jama.2026.8946


3:  Gostin LO, Wetter SA, Lurie P. Can a New Commission Make America Healthy Again? JAMA Health Forum. 2025;6(3):e251304. doi:10.1001/jamahealthforum.2025.1304


4:  Cortese S. Pharmacologic treatment of attention deficit–hyperactivity disorder. New England Journal of Medicine. 2020 Sep 10;383(11):1050-6.


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