RFK Jr. launches plan to address ‘overuse’ of psychiatric medications

By Kristen Rogers, CNN

(CNN) — US Health and Human Services Secretary Robert F. Kennedy Jr. announced a plan to reduce “overprescribing” of psychiatric medications and support alternative treatment options and discontinuation of medications when needed.

“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications, especially among children,” Kennedy said Monday at a MAHA Institute summit on mental health and overmedicalization. “We will support patient autonomy, require informed consent and shared decision-making, and shift the standard of care toward prevention, transparency and a more holistic approach to mental health.”

The announcement follows recent work by psychiatry professionals to support more research, training and consideration of when discontinuation is appropriate, such as the American Society of Clinical Psychopharmacology’s guidelines on these issues that were published in February.

Some psychiatry experts generally welcomed the new federal efforts toward improving psychiatric healthcare but also noted concerns, including potential overemphasis on overprescribing while access to mental healthcare remains inadequate.

Psychiatric medications, especially antidepressants, have been one of the targets of Kennedy’s “Make America Healthy Again” movement since he took office last year. The secretary has claimed that the drugs are overused and that they may be linked with violence and mass shootings, with serious risks to developing fetuses when women take them during pregnancy, with withdrawal worse than that from heroin, and with harms to children. Although some slight risks of harms have been found in some of these situations, these medications have been deemed by the US Food and Drug Administration as generally safe and effective for mental health disorders including depression, anxiety, eating disorders, substance use disorder and obsessive-compulsive disorder.

Overprescribing refers to the idea of clinicians prescribing medications to patients who may not “need” them, depending on the causes or severity of their symptoms or whether they have first tried other nonmedication interventions that may be helpful enough. The concept also describes someone taking medications longer than necessary or that aren’t effective for them.

Deprescribing “simply means that if any treatment is not proving itself to be beneficial, or if problems with tolerability substantially outweigh efficacy, it makes sense to discontinue that treatment and replace it with a more effective viable alternative,” said Dr. Joseph F. Goldberg, clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City.

“As with all areas of medicine, we should be concerned about both overprescribing and underprescribing,” said Dr. Jonathan Alpert, the Dorothy and Marty Silverman Chair of the department of psychiatry and behavioral sciences at Montefiore Medical Center in New York City. “In some instances, antibiotics or diabetes medications are overprescribed and cause unnecessary side effects, cost and other harms. In many other instances, they can be lifesaving. So too with psychiatric medications such as antidepressants or antipsychotics.”

For the new efforts, HHS agencies plan to work together to “evaluate prescription patterns for psychiatric medications, their benefits and potential harms, and elevate the role of nonmedication treatments and scalable, evidence-based solutions to improve mental health,” according to a news release. Those treatments and solutions include family support, dietary changes, therapy and physical activity.

The department added that its approach will also include education and outreach, program and policy actions, and efforts to increase the ability of research to influence clinical practice.

Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association, said the group supports the administration’s plans for further investment, research and clinical training.

“However, we do have an issue with the framing of mental health as a primary problem of overmedicalization,” Rivera added. “This type of characterization really oversimplifies a very complex, larger issue.”

Remaining gaps in care

Experts expressed concern that an emphasis on overprescribing, specifically, is somewhat unbalanced given the population of people who lack access to care for serious mental health conditions.

“Depression remains the leading cause of disability in the world,” said Goldberg, formerly president of the American Society of Clinical Psychopharmacology.

In recent years, only about 40% of adults and adolescents with depression in the United States received counseling or therapy, and 11.4% of adults took prescription medication for depression. Goldberg also noted that suicide rates in the United States rose 35% between 2000 and 2018.

Rivera agreed that care for mental health in general “remains unevenly distributed.”

“This oversimplification of our mental health does not take into account things like persistent workforce shortages, limited psychiatric beds, inadequate visit time, barriers to psychotherapy and social support, and insufficient integration of psychiatric expertise in primary care,” added Rivera, who is also a clinical professor of psychiatry at Rutgers Robert Wood Johnson Medical School.

In the process of being thoughtful about prescribing, it’s also important to not stigmatize or reduce access to treatments for those who need them, Alpert said.

He added that support for research that better identifies who would benefit most from medications and that provides innovative alternative treatments would also be helpful in guiding care. About a third of US-based adults with depression do not benefit from validated, conventional treatments.

In the meantime, Rivera encourages doctors to do a comprehensive clinical assessment when patients report mental health symptoms and decide on care plans together with patients.

For anyone who may be concerned about a medication they’re taking, Rivera noted that quitting medications on your own is unsafe and may have serious consequences, such as side effects or a relapse of your condition.

“Don’t do it without physicians being involved,” she said.

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