On May 4, 2026, at a MAHA (Make America Healthy Again) Institute conference, US Department of Health and Human Services Secretary Robert Kennedy announced several initiatives aimed at reining in the prescription of SSRIs. NPR quoted him as saying: “Too many patients begin treatment without a clear understanding of the risks and how long they will stay on these drugs or how to come off of them … And that’s not informed consent. We are going to fix it.” MedPage Today quoted Kennedy as saying: “Psychiatric medicines have a role in care, but we will no longer treat them as the default.”
Kennedy said Americans have a “dependency crisis driven by overmedicalization,” particularly with SSRIs. Although the American Psychiatric Association (APA) supports any plans to better train healthcare providers to safely prescribe and taper patients off antidepressants, the president of the APA said Kennedy’s statement was an oversimplification. “And it really ignores the larger reality, which is that too many patients really cannot access timely, comprehensive care that is much needed for our nation.”
We’re also very much in support of the administration’s plans to further investment in research and the efforts to improve quality, safety [and] evidence-based mental health treatment.
MedPage Today reported the APA also said deprescribing alone was not a sufficient response to this crisis. “We strongly object to framing the nation’s mental health crisis as primarily a problem of ‘overmedicalization’ or ‘overprescribing.’”
In psychiatry, as in all areas of medicine, prescribing and deprescribing occur every day as part of individualized, evidence-based treatment planning between physicians and patients. The solution is not to stigmatize psychiatric medication or impose broad assumptions on clinical care, but to ensure that patients have access to the full range of evidence-based treatments and that decisions are guided by the best available science and each patient’s needs.
The proposed initiatives include new training, clinical guidance, and changes to insurance billing. The intent is to support and train providers on the best ways to safely taper patients off their medications, if they want to do so. In the coming months, the Substance Abuse and Mental Health Services Administration (SAMHSA) will publish new data on prescribing trends and clinical guidance for providers. CMS, the Centers for Medicare & Medicaid Services, will issue billing guidance for providers to help patients taper off drugs. CMS will also expand access to alternative forms of evidence-based treatments such as talk therapy and family support services for children.
The day afterwards, the American Foundation for Suicide Prevention (AFSP) released a statement stressing the importance of SSRIs in helping people with major depression and suicidality. It said there is a robust body of scientific evidence that antidepressants are effective in not only treating acute depressive episodes, but also in preventing future episodes and reducing suicidal thoughts and behaviors. “While all medications carry potential risks, decades of research—spanning clinical trials, population-level studies, and health system data—show that the judicious use of antidepressants reduces suicide risk overall.”
AFSP supports clinicians in working collaboratively with patients and families to tailor treatment plans that reflect individual needs, preferences, and values. Remission and recovery are possible, and more investment is needed to ensure awareness of and access to available help. We urge policymakers, clinicians, and the public to support evidence-based mental health care, expand access and affordability, and address misinformation that may deter people from seeking or continuing mental health treatments. By prioritizing accurate education, comprehensive care, and thoughtful clinical decision making, we can strengthen suicide prevention efforts and save more lives.
Spotlight on Antidepressant Withdrawal
It’s unfortunate that the call to provide access to support and training on the best ways to safely taper patients off their medications became entangled with Kennedy’s MAHA agenda. I’ve referred to concerns with antidepressant withdrawal (“discontinuation syndrome”) or tapering in fourteen previous articles on this website. If you’re interested, here are some examples: “Antidepressant Withdrawal or Discontinuation Syndrome?,” “Following the Leader with Antidepressants,” “Withdrawal or Relapse When Tapering Antidepressants?,” and “Sleight-of-Hand with Antidepressant Withdrawal.” Neuroscience News has also highlighted concerns with antidepressant withdrawal by some British researchers, particularly with long-term antidepressant use.
In “Antidepressant Withdrawal Should Be Taken Seriously,” the author said misinformation about antidepressants was rife and probably fueling their rise in use. He listed several false ideas, including that withdrawal effects are mild and only last 2 or 3 weeks. Any severe symptoms are interpreted as a relapse in depression. “It is now established that antidepressants produce withdrawal symptoms that often last for many weeks, months or even years.” About half of those who stop using antidepressants report experiencing severe withdrawal symptoms.
The longer the drugs are taken, the more severe (and probably long-lasting) the withdrawal effects. Withdrawal effects occur from antidepressants because the brain adapts to their presence. This is often called physical dependence. Dependence occurs even though antidepressants do not make people high or cause craving and compulsion, which is the technical definition of “addiction”. When antidepressants are stopped, the brain “misses” the drug and expresses this as withdrawal symptoms. These symptoms can last months or years because that is how long it can take for the brain to adjust to being without the drug. Since withdrawal can cause emotional symptoms such as anxiety, low mood, crying spells and panic attacks, people often misinterpret these symptoms as a return of their mental health problem – that is, a relapse. Doctors, too, are often unaware of how common and severe withdrawal symptoms can be, and often mistake them for a relapse. This can lead people who started antidepressants following a specific stressful event, like job loss, divorce or physical illness, to conclude that they have a long-term, relapsing illness when they do not.
Advice from the UK’s National Institute for Health and Care Excellence (Nice) and the Royal College of Psychiatrists on how to safely stop antidepressants has changed markedly recently. Guidelines now recommend that after long-term use, antidepressants should be reduced in slow stages (tapering) over months and sometimes years down to very low doses. As these doses are much smaller than can be made with widely available tablets, the guidelines call for the use of liquid versions of drugs (specially made up smaller dose tablets are another option). The approach to tapering recommended by these updated guidelines is called “hyperbolic tapering”. It is based on the fact that very small doses of antidepressants have very large effects on the brain. This is often why the last few milligrams of a drug are the hardest to get off.
In “Long-Term antidepressant Use Tied to Tougher Withdrawal Symptoms,” the author said long-term use (over 2 years) increases the odds of withdrawal symptoms tenfold over those who use antidepressants under six months. Most short-term users saw symptoms resolve within four weeks; and only 7% reported severe effects. However, 25% of long-term users reported severe symptoms, with 12% experiencing symptoms lasting over a year.
The [research] team found that how long someone had been on an antidepressant was the major determining factor for incidence, severity, and duration of withdrawal effects, and whether someone was able to stop taking the medication. The differences between short-term and long-term users were not explained by the severity of the underlying depression or anxiety disorder. The researchers found that the odds of experiencing any withdrawal effects were 10 times greater for those who had been on antidepressants for more than two years, compared to those who had been taking them for less than six months.
Among people who had been taking antidepressants for two years of more, 64% reported moderate or severe withdrawal effects (25% reported severe effects), while among those who had been taking the medication for six months or less, the majority (73%) reported either no withdrawal effects or only mild symptoms, with only 7% experiencing severe withdrawal symptoms. For long-term users, 30% reported withdrawal symptoms lasting more than three months, with 12% experiencing such symptoms for more than a year, while only 10.5% of short-term users experienced withdrawal symptoms for more than three months. For most short-term users, withdrawal symptoms resolved in under four weeks.
Changing Beliefs on Antidepressant Withdrawal
This persistent research brought the problem of antidepressant withdrawal to the attention of some American researchers, who recently published “Exiting Antidepressants: A Needed Spotlight on Withdrawal” in Psychiatric Times. They said antidepressant withdrawal was more common than previously acknowledged, and often misdiagnosed as a recurrence of depression. This was said to lead to prolonged medication use. Traditional relapse prevention trials were said to have methodological flaws, that misrepresented withdrawal symptoms as relapse, and as a result, distorted the understanding of long-term antidepressant use. “Antidepressant withdrawal often mimics relapse; learn why hyperbolic tapering, informed consent, and slow cut-and-hold deprescribing reduce harm.”
Antidepressant use in the United States has tripled over 30 years. It is not just more patients, but longer treatment. The median duration of use is now 5 years, with 60% of patients taking them for 2 or more years. The trend persists despite a weakening scientific foundation, including the 2023 systematic review reiterating the poor evidence for the “serotonin hypothesis” of depression. [See “The Myth of the Serotonin Theory of Depression“] In parallel, the psychiatric view of depression shifted from that of a time-limited, episodic disorder to a “common, chronic, and disabling disease.” This framing encouraged earlier and longer-term pharmacological treatment, creating a practice environment where initiating medication is routine, but clear, safe guidance on stopping has been lacking.
The belief that long-term maintenance therapy with antidepressants is essential to prevent recurrence is built on a foundation of relapse prevention trials that are methodologically flawed. In these trials, patients who respond to an antidepressant are randomly assigned to either continue the drug or be switched to a placebo. The placebo group is frequently discontinued abruptly or tapered rapidly. Unsurprisingly, this group experiences high rates of distress, which the study then codes as “relapse.” These studies do not prove that maintenance therapy prevents recurrence. They support that (1) abruptly stopping an antidepressant causes adverse symptoms, and (2) those adverse symptoms are routinely labeled as relapse. This flawed evidence has distorted our understanding of long-term use and created a significant barrier to safe deprescribing.
The article concluded by saying the clinical understanding of antidepressant withdrawal is undergoing a paradigm shift. “The long-held belief that withdrawal is mild, brief, and rare is being replaced by a more accurate picture of a syndrome that can be complex, severe, and protracted.” Modern psychiatric practice was said to often struggle within the confines of short, pharmacologically focused visits. It has also leaned too heavily on the perceived safety of antidepressants to justify their widespread use.
We’ll have to wait and see what Kennedy’s initiatives ultimately carry out in order to rein in the prescribing of SSRIs, but he may have selected changes that could make America healthy again.
