Public Health

The Government Doesn't Know Whether You Need Antidepressants

Against the new war on SSRIs.

Crémieux | 7.15.2026 10:00 AM

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In May, the Department of Health and Human Services (HHS) announced a plan to address what it calls "psychiatric overprescribing." Antidepressants—especially selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, and Lexapro—are likely to become the central test case. They are common, politically salient, and prescribed for conditions ranging from major depression to anxiety, pain, insomnia, and distress that may or may not meet the criteria for a psychiatric diagnosis.

Contrary to the most alarming reports, HHS has not announced an antidepressant ban, and it has not advised current users to hop off their medications. The agency's stated goal is to "promote appropriate psychiatric prescribing" and support "deprescribing when clinically indicated." Although that is unobjectionable as far as it goes, there is a serious danger that the HHS initiative could drift from clinical guidance into potentially devastating access limitations, especially because "better prescribing" and "less prescribing" are easily confused.

HHS says it wants more emphasis on informed consent, more patient participation in prescribing decisions, and regular reviews of risks and benefits. The department would like to see increased use of nonpharmacological treatments, along with supervised tapering and/or discontinuation for patients who don't seem to be benefiting from medication. HHS is also calling for better prescribing reports, improved continuing medical education, dissemination of updated guidance, and Medicare billing clarifications for clinical work related to deprescribing.

The simple story is that HHS Secretary Robert F. Kennedy Jr. wants Americans off antidepressants. Kennedy has said "getting off of SSRIs" is harder than "getting off heroin." He claims there is "tremendous circumstantial evidence" that SSRIs "might be contributing to violence," including mass shootings. "This proliferation of antidepressants…represents so much of what is wrong with healthcare today," writes Calley Means, a senior adviser to Kennedy at HHS. "Antidepressants are a way for the medical system to earn recurring revenue without solving the root causes of what is actually making people depressed."

Whatever Kennedy's personal preferences, it is fair to say that HHS wants to change the default settings for psychiatric treatment. Per HHS, starting an antidepressant should involve a clearer discussion of benefits and side effects, withdrawal symptoms, alternatives, and expected time under treatment. Continuing antidepressants should involve periodic reassessment rather than an indefinite series of automatic refills. Finally, stopping an antidepressant, when appropriate, should be treated as clinical work rather than an afterthought.

On its face, much of what HHS is proposing is eminently reasonable. In many cases, psychiatric prescriptions do act like a one-way door. It is also true that psychiatric medications are easier to start than they are to stop: While a patient can begin taking an SSRI after a short visit to his general practitioner, discontinuing the medication years down the line can require multiple visits, slow and painful dose reductions, burdensome symptom monitoring, and a clinician who can distinguish withdrawal from relapse. If the medical system reimburses initiation more easily than discontinuation, and if clinicians have more experience starting drugs than tapering people off them, it should not be surprising that the system produces more starts than stops.

The concerns underlying the HHS initiative are legitimate. Antidepressants are not harmless mood vitamins. They can—and frequently do—cause sexual dysfunction, nausea, insomnia, weight change, emotional blunting, agitation, and discontinuation symptoms. Withdrawal is real, and existing guidelines tell clinicians not to treat stopping as trivial.

The British National Institute for Health and Care Excellence (NICE), for example, recommends that patients who want to stop antidepressants taper in stages. It notes that dose reductions might need to be done in smaller increments when the initial dose is relatively low, adding that withdrawal can be severe for some patients and last weeks or months for many more. The American Psychiatric Association (APA), the American Academy of Family Physicians, and the Veterans Health Administration offer similar advice.

Ostensibly, HHS wants better prescribing practices, not less antidepressant use per se. The danger is that HHS will conflate those two things. Appropriate prescribing is a quality measure, while lower prescribing has to do with quantity. A system can reduce antidepressant use by improving diagnosis, expanding access to psychotherapy, eschewing medication for mild distress, and helping stable patients taper down. It can also reduce antidepressant use by making doctors leery of prescribing, instilling fear of medication in the hearts of patients, or creating administrative barriers that deter people from treatment that could improve their lives. Prescriptions would fall in both cases, but the welfare effects would be very different.

This distinction is especially important because HHS reportedly has considered steps that go beyond official advice. In May, Reuters reported that HHS officials have explored whether they could restrict or ban some SSRIs. HHS denied that it had considered bans, and Reuters noted that restricting previously approved antidepressants through the Food and Drug Administration (FDA), which is part of HHS, would require strong evidence that the risks of these drugs outweighed their benefits. Taking HHS at its word, it has no plans to ban SSRIs. But even without such drastic steps, promoting a general wariness of antidepressants threatens to hurt the people HHS says it is trying to help.

How Big a Problem Is Overprescribing?

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