Showing posts with label HHS. Show all posts
Showing posts with label HHS. Show all posts

Thursday, July 16, 2026

The Politics of Deprescribing: Deconstructing the HHS Mental Health Agenda

M



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).

- 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.

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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.


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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.


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