Whopper of the Week: Kennedy Spreads Nonsense about Antidepressants

Whopper of the Week: 

KENNEDY SPREADS NONSENSE ABOUT ANTIDEPRESSANTS 

INTRODUCTION

May is Mental Health Awareness Month. On May 5, Secretary of Health and Human Services Kennedy held a press conference to announce his plan to “confront our nation’s mental health crisis by addressing the overuse of psychiatric medications.” Kennedy was concerned that one in six American adults takes an antidepressant. He said that “The United States does not just face a mental health crisis, we face a dependency crisis. Driven by overmedicalization.” That is a whopper. The idea that reducing the use of drugs will solve our social, institutional and neuropsychiatric problems is nonsense.

WHY IT IS A WHOPPER

Kennedy dislikes people using medicines for mental health care almost as much as vaccines. He has a long history of making wild claims about medicines like selective serotonin reuptake inhibitors (SSRIs). He says they are addictive and that they “contribute to mass violence” and school shootings, which Defend Public Health debunked last November.  His racist statements that “every Black kid” is on psychiatric drugs and should “get reparented” incensed many in Congress. 

Kennedy weaves scary stories about addiction, incorrectly comparing medicines for mental health with street drugs. At the May press conference, Kennedy swerved from talking about kicking his heroin addiction to SSRIs, by saying “withdrawal from SSRIs can be more difficult than withdrawal from heroin,” because tapering takes longer and he knows someone who felt suicidal during the process. One study found 15% of patients who discontinue antidepressants experience withdrawal symptoms. SSRIs are not addictive, but they should not be abruptly stopped. Discontinuation of antidepressants should be done slowly, under medical supervision and with psychological support. Kennedy’s false analogies are disinformation. 

Kennedy explored banning access to selected antidepressants. In the end, Kennedy’s “Action Plan to Curb Psychiatric Overprescribing” focuses broadly on: 1) the development guidance on tapering and discontinuation of psychiatric medications, 2) education about the side effects of psychiatric medications, approaches for deprescribing, and nonmedication treatments, 3) financial incentives for physicians to take patients off psychiatric drugs, and 4) research into non-medication care. 

Sixty million Americans have a mental health condition, the most common being anxiety disorders and major depression. A recent survey found that 16.6% of adult respondents reported current antidepressant use. Antidepressant consumption has risen over time as newer medications were deemed safer, clinical practice for treating depression evolved, and patients became more accepting of diagnoses and treatment. 

Kennedy claims to be particularly concerned about the use of medicines in children but there is little evidence for a crisis in pediatric over-prescribing. A recent government report on Prescription Psychiatric Medication Among Children and Adolescents found that while  “the annual prevalence of U.S. children and adolescents aged 3 to 17 years receiving SSRIs increased from 1.5% to 3.6%, from 2006 to 2023,” it is still fair to say that  “the overall prevalence of psychiatric medication use remained relatively low among youth, with no medication class exceeding 5.3% of the population.”

Kennedy’s proposals to reduce the use of psychiatric medicines represents a radical government overreach into medical care. To swallow this bitter pill, that neither patients nor physicians want, he dangles the promise of better treatment options. In April, for example, he told Congress that ibogaine was “the most promising treatment for depression and PTSD [post-traumatic stress disorder] that anybody’s ever seen." But despite preliminary reports about new treatment modalities, including ketamine for depression, MDMA and psilocybin for PTSD, or AI assisted therapy, the evidence base for their safety and effectiveness, and our understanding of their appropriate use, is still very thin. 
 

WHY IT MATTERS

In the best-case scenario, Kennedy will use the power of the government to support research and clinical training for changing prescribing practices, like those recommended by professional groups like the American Society of Clinical Psychopharmacology (ASCP). Dr. Jonathan Slater, professor of psychiatry at Columbia University, notes that we still lack data on how to stop specific treatments. “Deprescribing is understudied, undertaught, and under-reimbursed.”  

But Kennedy's policies carry risks. The American Psychological Association (APA) issued a statement which objected to Kennedy’s simplistic “framing the nation’s mental health crisis as primarily a problem of ‘overmedicalization’ or ‘overprescribing.’” They noted that Kennedy “ignores the larger reality: too many patients cannot access timely, comprehensive care, while care remains unevenly distributed across our health system.” The APA concluded: “Deprescribing alone is not a sufficient response to this crisis.”

Dr. Aurora Horstkamp, a family medicine physician, warns about the impact on patients: “If Kennedy bans SSRIs or limits prescriptions to psychiatrists, people currently benefiting from SSRIs will have trouble getting their prescriptions filled. If they have to force a wean that may lead to relapses, increased in suicide attempts, or the use alternatives which are as not as evidence-based or effective.”

Representative Andrea Salinas (D-OR), the Chair of the Congressional Mental Health Caucus spoke to why this policy encroaches on the practice of medicine: “The decision for a patient to stop taking an SSRI should be between the patient and their doctor. End of story. SSRIs and other psychiatric medications are life-sustaining care for millions of Americans, and any federal guidance on mental health treatment must be rooted in science, not stigma, ideology, or one man’s personal experience. Secretary Kennedy’s approach risks confusing patients, undermining trust in public health, and disrupting care for people who need support.” 

Contributors: Benedicte Callan, Ph.D., Bruce Mirken, Aurora Horstkamp, M.D., Erica Bersin BCPA, Kathylynn Saboda, M.S.