A Few More Lost Pieces of the Antidepressant Discussion

 

There was a lengthy article in the New York Times 2 days ago on antidepressants (1).  The main premise of the article is that millions of children and young adults were prescribed antidepressants.  The antidepressants may have been effective for the crisis but now that they continue on them, they have side effects and want to discontinue them because they feel emotionally blunted and disconnected. The chemical imbalance trope was invoked several times.  The author proceeds to extend the argument to suggest that there are millions of people in this predicament, physicians are unwilling or unable to help, and HHS Secretary Robert F Kennedy (RFK) is going to solve the problem largely by reforming psychiatry purportedly by moving into the “rift between patient and doctor” and promising to “free the mental health of Americans from dependence on pills”.

I have addressed this issue in many places on this blog.  That includes my response to RFKs arguments, RFKs comparison of SSRI withdrawal to heroin withdrawal, and strategies to prevent the problem including exposing only those people to antidepressants who need them, using medications with lower withdrawal risk, and generally being aware of the problem. I have also written about how long the problem has existed, when the first review of the problem was written, and that it is a fundamental skill that all physicians should have. 

In the RFK response I was also able to find out that the detailed antidepressant tapering and transition instructions have been in the premier online medical resource UpToDate for at least 18 years. Any practicing physician with access has those details. The facts as they exist show that RFK does not have a rational or even reasonable approach to the problem.  His idea that antidepressants are overprescribed and impossible to stop obfuscates the real problems of undertreatment and both active removal of treatment resources while promoting more high-risk treatment by the Trump administration.  In brief, the RFK approach to mental health has taken a solvable problem of not enough resources and blown it up into another problem.

To be clear, I am not commenting on the anecdote in the New York Times piece.  I have no personal knowledge of the patients or families mentioned.  I think a presentation of any similar situations in medicine should raise the questions: Why is a treatment being continued if it is not at least partially effective for the symptoms?  Why is a treatment not discontinued if the patient or family would prefer, they not take it?  What other treatments were tried before a medication was tried and what other treatments were tried concomitantly?  Invariably that all comes down to the expertise of the physician and knowing that the primary role to give the best advice to the patient and not make up their mind for them.  It is their job whether to take it or not. Almost everybody I encountered in practice had a preference to not take any medications. They either changed their mind about that after a lengthy informed consent discussion or not.  Either answer was fine with me. 

A confounding factor in any longitudinal analysis of medication effects is how people adapt to medications over time.  The first time I discontinued a maintenance antidepressant was in 1986.  That patient was a blue-collar worker who had been on doxepin for many years for migraine headaches and depression.  When I started seeing him his main problems were fatigue and hypersomnia.  I tapered and discontinued the doxepin.  He did well and eventually told me that he did not realize it at the time but he felt like he had the flu while he was on doxepin and that resolved after it was stopped.

Just as people can be unaware of long-term side effects after years on any medication – they can also get habituated to the therapeutic effects. That is the main reason people need close follow up when medications have been discontinued. Those effects go far beyond treating the primary disorder. People will report not feeling as well, not thinking as clearly, and not being as mentally flexible as when they were taking the medication.  In some cases they will experience a recurrence of a secondary disorder that was treated by the antidepressant like migraine headaches or back pain.  None of the symptoms described are due to withdrawal or a clear recurrence of the primary disorder but they would prefer to stay on the medication.

My main concern with the antidepressant controversy is that it is essentially a polarizing political argument at this point.  As far as psychiatry goes, nobody is talking about psychiatry the way I practiced it, how my colleagues practiced it, or how I trained residents to practice it.  The idea that any medication is good or evil is absurd.  The idea that the prescribers of medication are forcing it on clueless unsuspecting patients for the benefit of the pharmaceutical industry is equally absurd.  The most absurd arguments is that RFK or antipsychiatrists are going to save everyone on an antidepressant or psychiatric medication.  How will that happen when all the evidence is ignored and you have the expertise of a political podcaster?

To end this post, I want to include an important part of the antidepressant argument that I have ignored until now and that is how many people stop taking them.  There is a constant drumbeat of how many people take them and inaccurate suggestions that too many take them, so why would I think people stop taking them?  For many years, I worked for a healthcare company and I was on their Pharmacy and Therapeutics (P&T) Committee.  As such we were gatekeepers for medications that would be listed on the health plan formulary and were available to subscribers. We assessed the scientific data on efficacy but also the cost. At some point we also discussed compliance (now referred to as adherence) to the prescribed medications.  We found that a significant number of people never refilled their second prescription for antidepressants. At that point we began sending out reminder letters about the importance of adhering to the medication until there was agreement with their doctor that they should stop.

This occurred in the time frame of about 1995-2005. It was a health plan wide initiative meaning that most of the antidepressants were prescribed by primary care doctors. Stigma and the stigma of psychiatric medications was still hotly debated. There was still active misinformation about psychiatry and psychiatric medications.  There is always a personal bias to not take medications unless they are absolutely necessary. In terms of pure antidepressant prescribing I am sure that in many cases they were prescribed unnecessarily for self-limited crisis situations.  The important information here is that large number of patients stop taking these medications and that is never discussed.  It would be in opposition to the usual political argument of excessive prescribing and an inability to stop.       

What would that look like at a national and international level?  A commonly cited statistic is that 50% or persons prescribed antidepressants discontinue them in the first 6 months although many of the studies have lower estimates (see table below).  There are also several studies that estimate population wide use of antidepressants as both a percentage of the population (2-4) and absolute numbers (5).  The 2023 National Health Interview Survey found 11.4% of all adults ≥18 took antidepressant medication. The total population is 269.8M people so that is about 31M people.  Based on the available discontinuation percentages of 22 to 42.9% that means in any given year – 6.82 to 13.2 million people stop taking antidepressants.  Considering that as many as half of the antidepressants starts are for conditions other than depression it is likely that as many people are starting antidepressants as stopping them.   At least some of the survey data indicates that some of the reasons for stopping has to do with negative press and misinformation (fear of dependence)  – a known factor in the nocebo effect.

 

The above estimate is just that.  Four of the 5 studies are surveys.  There is no patient level data on a national scale that looks specifically at the antidepressant discontinuation issue.

There is data that looks at what happens at the treatment level.  That comes from a Danish register study of 66,540 older adults aged 65 or greater treated for depression who received a first-time antidepressant prescription between 2006 and 2016 (7).  Register studies are observational but they have the advantage of detailed information at the individual patient level about interventions when the databases are linked to clinical and pharmacy information for nationwide health plans. In this study, 33.7% of patient stopped antidepressants within 6 months, 26.5% gradually stopped over a period of 2 years, and 39.8% were on antidepressants for the entire 3-year period.  They studied the social determinants of this antidepressant use and also compared use to the recommended guidelines for antidepressant treatment in Denmark. Those guidelines suggest at least 6 months of maintenance treatment after initial remission and 2 years of maintenance for recurrent depression.  One of the social determinants was living in a non-urban area and the authors suggest this may be related to access to mental health specialty care.

The interesting aspect of the information in the Danish study was the detailed information across three general trajectories of antidepressant use.  Those trajectories are commonly seen in psychiatric practice and are far more realistic than what is typically portrayed in the media.  That includes the NYTimes article.       

When you read an article like that one or one of the many I have noted in the past – ask yourself what you really learned.  Like all medications antidepressants have side effects.  In fact, I routinely advised patients was that one person in six or seven would not tolerate them at all either due to initial side effects or withdrawal effects.  In clinical practice or real life - I never met a patient who told me they liked taking medications of any type.  Neither of those factors was a deterrent to trying a medication for most people.  The reason is that they were seeing me was for a severe, life changing problem and they had tried many other interventions. The Danish study (7) showed that only about 3% of that sample was ever hospitalized for severe depression.  Those were the patients I was treating.  

The psychiatric treatment of people over time is a dynamic process. It generally involves more than just medication with close attention to psychological factors and necessary lifestyle interventions. It requires a close collaborative relationship between the patient and the psychiatrist that includes a focus on optimizing therapy, minimizing or eliminating side effects and paying close attention to patient preferences. With that general approach, nobody should regret taking a medication longer than they should.  Nobody should put up with significant side effects.  And nobody should take a medication that is not working.  All of that is open for discussion.

Where I come from there is no rift between the patient and the doctor for RFK to fill.  And if there was – he is the wrong man to fill it.  

      

 George Dawson, MD, DFAPA

 

References:

 

1:  Bromley C.  A Generation on Antidepressants Searches for the Exit.  New York Times.  August 7, 2026.

2: Brody DJ, Gu Q. Antidepressant Use Among Adults: United States, 2015-2018. NCHS Data Brief. 2020 Sep;(377):1-8. PMID: 33054926.

3:  Mojtabai R, Olfson M. National trends in long-term use of antidepressant medications: results from the U.S. National Health and Nutrition Examination Survey. J Clin Psychiatry. 2014 Feb;75(2):169-77. doi: 10.4088/JCP.13m08443. PMID: 24345349.

4: Fu G, Li M, Lang X, Luo M, Chen S. Trends in depression and antidepressants use by social determinants of health among adults in the United States: Data from NHANES 2005-2018. J Affect Disord. 2026 Feb 1;394(Pt B):120662. doi: 10.1016/j.jad.2025.120662. Epub 2025 Nov 10. PMID: 41224008.

5:  Chai G, Xu J, Goyal S, et al. Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022. JAMA Psychiatry. 2024;81(4):396–405. doi:10.1001/jamapsychiatry.2023.5045

6:  Elgaddal N, Weeks JD, Mykyta L. Characteristics of adults age 18 and older who took prescription medication for depression: United States, 2023. NCHS Data Brief. 2025 Apr;(528):1-9. DOI: https://dx.doi.org/10.15620/cdc/174589.

7:  Ishtiak-Ahmed, K., Rohde, C., Köhler-Forsberg, O., Christensen, K.S. and Gasse, C. (2024), Depression Treatment Trajectories and Associated Social Determinants: A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark. Int J Geriatr Psychiatry, 39: e70006. https://doi.org/10.1002/gps.70006.

 

Supplementary 1: The decision about medications is common in any country with the availability of advanced therapeutics.  I personally take three medications every day that I would prefer not to take. I have to self-monitor for side effects including blood pressure readings every day.  If a doctor tries to give me a temporary antibiotic prescription – I personally do a drug interaction check and let them know if that medication is compatible.  I decide to take the medication not because it makes me feel better every day but because I know the cumulative effects of not taking it are potentially very bad and therefore, I decide to take it.  I have experienced side effects and complications that I had to figure out myself and that doctors missed.  This is all part of what it means to take a prescription medication. 

All of the steps I take to protect myself are the same steps I took with any medication I prescribed for patients.

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 - 417 rural hospitals at risk for closure from HR 1. -	24-30
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 30: Topchik M, Brown T, Pinette M, Balfour B, Wiesse A, Burnham R.  Data & Analysis: 2026 rural health state of the state.  February 10, 2026:  https://www.chartis.com/insights/2026-rural-health-state-state

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. 

  [3]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. [4-5] 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. [6] 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). [7-8]

• 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 Claim	Scientific & Empirical Reality	Citation(s)
Vaccines cause autism	Long-debunked conspiracy theory; actively promoted by RFK Jr. to undermine public trust in vaccines.	[1]
SSRIs cause mass shootings	Debunked. 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 meds	No 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 heroin	Scientifically 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 autism	Not supported by rigorous sibling-controlled genetic analyses.	[3, 4]
Alcohol is a healthy social beverage	Promoted 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

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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

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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.

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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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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

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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/

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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

30: Topchik M, Brown T, Pinette M, Balfour B, Wiesse A, Burnham R.  Data & Analysis: 2026 rural health state of the state.  February 10, 2026:  https://www.chartis.com/insights/2026-rural-health-state-state