Earlier this month, Health and Human Services Secretary Robert F. Kennedy Jr. kicked off Mental Health Awareness Month with the launch of several initiatives to reduce the prescription of antidepressants. Kennedy announced the plan—which includes new clinical guidelines, training for physicians, publishing new research on prescription trends, and changes in insurance billing—at a daylong mental health summit at the Make America Healthy Again Institute.
“Psychiatric medications have a role in care, but we will no longer treat them as the default. We will treat them as one option, used when appropriate with full transparency and with a clear path off when they are no longer effective,” Kennedy said at the summit.
HHS also issued a “Dear Colleague” letter to providers, encouraging physicians to consider “evidence-based non-pharmacological interventions” for their patients, including psychotherapy, social interaction, exercise, and diet changes. Although the HHS letter does not name any specific medications, Kennedy has previously expressed skepticism about antidepressants known as selective serotonin reuptake inhibitors, or SSRIs.
Experts say that while discussions about mental health treatments are not unwelcome, this new messaging from Kennedy and the HHS risks obscuring the benefit of antidepressants. It also raises larger concerns that most people who struggle with depression or other disorders will not actually receive the assistance that they need.
“I think, if anything, we’re not providing enough care, rather than over-prescribing one class of medicine or another,” said Dr. Mark Rapaport, the president-elect of the American Psychiatric Association.
A survey published this year found that more than 16 percent of Americans reported antidepressant use—although there are significant disparities along racial lines, with Black, Hispanic, and Asian adults far less likely to use the medications than non-Hispanic white Americans. Some research has also shown that Black and Hispanic Americans are less likely to receive treatment for depression overall than their white counterparts, and have longer delays between depressive episodes and antidepressant treatment. Despite depression being the leading cause of disability worldwide according to the World Health Organization, only around 40 percent of adolescents and adults with depression in the United States received counseling or therapy between 2021 and 2023.
Antidepressants can be prescribed to treat a number of serious medical disorders, including depression, generalized anxiety disorder, and obsessive compulsive disorder. They can also be a frontline response for preventing suicide. In 2023, suicide was the eleventh-leading cause of death in the United States overall, and the second-leading cause of death among individuals between the ages of 10 and 34 years old.
When Rappaport began practicing as a psychiatrist, modern antidepressants did not yet exist; the medications for treating mental disorders at the time were, according to his recollection, more difficult to use and had greater side effects. By comparison, SSRIs and SNRIs have been a “godsend,” Rappaport continued, because of their safety and ease of use. This does not mean that everyone who uses antidepressants needs to be on them for an extended period of time, he continued, but for those with severe depression, it can offer life-saving stability. Fifty percent of people who have a single episode of depression will not see a recurrence. However, for those who do see a second episode, they are 70 percent more likely to see a third, and 90 percent more likely to see another afterwards.
Kennedy has long railed against what he believes is the “overprescription” of psychiatric medications, particularly for children, and has claimed—without evidence—that SSRIs are responsible for mass shootings. He has also falsely said that SSRIs are more addictive than heroin. Kennedy believes that these drugs, which include medications like Lexapro, Prozac, Zoloft, and Paxil, are being prescribed to patients who don’t necessarily need them. He has also highlighted how many people who take antidepressants can rely on them for years, or can experience withdrawal symptoms—which can include shock-like “brain zaps” and symptoms akin to the flu—when tapering off the medication. Reuters reported that HHS under Kennedy had explored banning SSRIs, although a spokesperson for the department denied that this was under consideration.
Physicians will emphasize the importance of addressing the needs of patients on a case-by-case basis. Psychiatry professionals from the American Society of Clinical Psychopharmacology issued guidelines for deprescribing this year suggesting that physicians should periodically review their patients’ treatments to “assure that prescribed medications remain relevant, benefits outweigh risks, and patients assume an active collaborative role in shared decision-making.”
If a patient experiences side effects of their current medication, they could also consider other options such as reducing dosage or switching to a different antidepressant. Most experts also emphasize that if a patient does wish to discontinue a medication, it should be done in consultation with their physician, and over an extended period of time.
“[Patients] may have absolutely no discontinuation symptoms when it’s tapered slowly. A few people—and we’re not sure what percentage, but it’s a small number—find it difficult to get off these medications. They have to have a prolonged taper,” said Dr. J. John Mann, the co-director of the Columbia University Center for Prevention and Treatment of Depression. “There’s no evidence, that I’m aware of, of long-term adverse effects.”
Some evidence shows that antidepressants can be most effective in concert with other treatments, such as psychotherapy. But just like prescribing medication for any other long-term medical issue, the treatment can depend on long-term severity. “For mild depression, just therapy alone has been proven to be very effective without medication, but once it reaches the level of moderate to severe … that’s how you determine how long a person needs to stay on medication,” said Dr. Christine Yu Moutier, the chief medical officer at the American Foundation for Suicide Prevention.
But Moutier worries that the administration’s discouragement of prescribing antidepressants could lead to people not receiving the care that they need, in part because they may be unwilling to consider medication as an option. She compared the current skepticism around antidepressants to the early 2000s, when the Food and Drug Administration issued a series of advisories warning that these medications could increase suicidal ideation among children and adolescents, and then required a “black box” warning on the labels of all antidepressants.
Some subsequent studies found that those changes resulted in reduction of antidepressant treatment for children, adolescents and adults as well as declines in depression diagnoses. Another report found that there were simultaneous increases in suicide attempts among young people as antidepressant use decreased.
Antidepressant use among young adults increased in the wake of the coronavirus pandemic; around 4.5 percent of adolescents and young adults have received prescriptions for antidepressants.
“Are there some circumstances where particular children and youth and young adults are being inappropriately misdiagnosed with a mental illness? I’m sure that that does happen,” said Moutier. “When I put that side by side to this much larger problem of unaddressed mental illness, I would say it’s something to pay attention to, but the narrative over-focusing on that is going to lead the public … to have some takeaways that are distorted.”
Given the stigma surrounding mental disorders, depression can be considered less severe than other health issues, contributing to gaps in treatment. Mann compared the prescription of antidepressants to GLP-1 medications, which can be used for diabetes and weight loss. But he noted that when a patient who is taking GLP-1 stops using the drug, the individual can regain much of the weight that they lost. So the person may remain on the medication for an extended period of time to prevent those adverse effects. But HHS isn’t encouraging the deprescription of GLP-1 drugs, despite the adverse effects of stopping these medications.
“They’re more concerned about the medical consequences of obesity than they are about the medical consequences of depression and anxiety disorders,” Mann said.
Still, Rapaport said that he hoped raising conversations about treatment would help destigmatize mental disorders, and encourage collaboration between patients and their physicians for individualized care.
“Being able to have a conversation with the patient and really looking together about whether or not there’s an opportunity or need to simplify medication regimens, or whether there’s an opportunity to discontinue certain medicines together in a thoughtful way, is really an important discussion to have,” he said.
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