One-sixth of Americans take SSRIs. The data for the Food and Drug Administration approval of these drugs come from short-term (6- to 8-week) studies, yet most patients take them for years. For both patients and clinicians, it’s easier to start an SSRI than it is to stop one. Many patients become dependent, with one-sixth to half of patients who attempt to stop taking an antidepressant developing withdrawal symptoms, such as headaches, dizziness, nausea, insomnia, and “brain zaps,” which feel like electric shocks in the head. It can be hard for clinicians to distinguish between withdrawal and relapse of depression, and so we end up keeping some patients on antidepressants for life. Patients must put up with long-term side effects such as weight gain, emotional numbing, and sexual dysfunction.
Given the nontrivial downsides of starting and stopping medications, clinicians should prescribe them with careful discussion about the risks, benefits, and alternatives — especially since there are many evidence-based treatments for mental illness besides drugs, including psychotherapy, exercise, and peer support.
Some patients are worried they will be forced to stop their antidepressants without consent, but Kennedy promises this won’t be the case. Rather, he argues, this is an issue of patient autonomy. For moderate to severe symptoms, medications can make sense. But many patients in the United States and around the world want to stop medications they feel were unduly prescribed for reasonable reactions to life’s challenges, such as being an unruly child, a heartbroken teenager, or a stressed college student.
Because of this, the British government has released a similar plan to reduce overmedicalization and experts at the Maudsley Hospital in London (one of the world’s premier psychiatric institutions) have developed careful, scientific guidelines for deprescribing psychiatric drugs — frameworks that American policy makers and physicians could learn from.
In diagnosing overmedicalization as a major problem, the MAHA movement gets something right. Overmedicalization, however, doesn’t begin with physicians and our prescription pads. As the opioid epidemic has shown, the problem starts higher up. When drug companies marketed SSRIs, they led the public to believe the drugs corrected a chemical imbalance in the brain. I was surprised to learn in medical school that no such chemical imbalance was ever proven and that many research studies show the drugs are only modestly better than placebos. But now that so many patients are on SSRIs, pharmaceutical companies have little incentive to get them to stop.
To its credit, MAHA calls out the pharmaceutical industry. Yet its policy prescriptions are largely devoid of regulatory measures: It continues to allow the industry to operate in unfettered markets, while aggressive lobbying by drug representatives and direct-to-consumer advertising are banned in most other countries. Instead of regulatory measures, among his mental health prescriptions, Kennedy encourages “strong families, nutrition and fitness, and hope for the future.”
What MAHA doesn’t consider is why so many in the United States — the richest country in the world — are forced into precarious, unhealthy conditions that drive mental illness in the first place. Many Americans work multiple jobs to put food on the table and a roof over their heads. They have little social safety nets and no time or money for the evidence-based lifestyle changes (such as exercise, sleep, and time outdoors) that can improve mental health.
MAHA ignores the fact that overmedicalization is driven, at least in part, by inequality. Even though poverty, violence, homelessness, and overwork are known drivers of mental illness, medications are often the only relief doctors can offer patients who lack the time, money, or motivation for therapy or lifestyle changes. MAHA is even more blind to the structural solutions needed to address these issues—such as housing reform, minimum wage increases, and employment opportunities.
Overmedicalization is a valid concern in the United States, but the problem with MAHA’s approach to mental health is the overarching placement of responsibility with individuals — patients and clinicians — rather than the exploitative systems that create poor mental health. MAHA is half right with the diagnosis, but its prescription conveniently ignores the root causes of the problems it has identified.