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 m