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Among the many crusades in his quest to “Make America Healthy Again,” one target of Health Secretary Robert F. Kennedy Jr. is antidepressants. Kennedy has long said that psychiatric drugs like SSRIs (selective serotonin reuptake inhibitors) are harmful, including claiming they cause mass shootings.

Kennedy recently announced at a MAHA Institute mental health summit an initiative to help wean Americans off antidepressants. The announcement sparked a debate among experts over the campaign’s pros and cons.

Stigmatization and lack of access

Kennedy’s perspective on deprescribing SSRIs “really is an oversimplification,” Theresa Miskimen Rivera, the president of the American Psychiatric Association, said to NPR. The health secretary’s view “ignores the larger reality,” which is that “too many patients really cannot access timely, comprehensive care.” Rivera and the American Psychiatric Association support “any plans to better train healthcare providers to safely prescribe and wean patients off antidepressants.”

The health secretary has “no real interest in fixing structural problems that leave people with no choice but to use SSRIs,” Amanda Marcotte said at Salon. On the contrary, Kennedy has a “long history of talking about people on SSRIs in dehumanizing, often racist language” that implies “their actual problem is they’re lazy and need to just work harder — or even work for free.” The problem isn’t “lack of will but lack of access.” The only purpose of Kennedy’s rhetoric is to make it “easier to justify taking away their healthcare.” It is the “same old Republican playbook, just dressed up in a phony mask of compassion.”

There is a “legitimate clinical problem” at the center of Kennedy’s initiative to help Americans stop taking antidepressants, Jonathan Slater, a clinical professor of psychiatry at Columbia University Irving Medical Center, said at Stat News. Deprescribing is indeed “understudied, undertaught and under-reimbursed.”

But the health secretary’s campaign “conflates that genuine clinical need with claims unsupported by evidence, and some that are actively dangerous,” said Slater. Redirecting patients away from medications is “only clinically responsible if the alternatives are accessible. They are not.” Patients on antidepressants deserve two things: an “honest conversation about whether they still need their medication” and a “system equipped to help them stop safely if they do not.” Right now, “we have neither the data nor the infrastructure to deliver that.”

Turning a blind eye to weaning difficulties

For decades, mainstream psychiatry “willfully blinded itself” to the “burden and severity of withdrawal and discontinuation-related difficulties” from antidepressants and other psychiatric drugs, Awais Aftab, a clinical associate professor of psychiatry, said to The New York Times. American Society for Clinical Pathology guidelines only “tinker” toward solutions and “generally recommend maintenance treatment for recurrent depression, bipolar I disorder and schizophrenia, ignoring controversies in these areas.” The guidelines assume that most people are “correctly diagnosed,” when in reality there is “widespread diagnostic chaos and decisions about maintenance are made under considerable uncertainty.”

Kennedy is correct that more “evidence-based care and therapies” should be available, Vera Feuer, a child and adolescent psychiatrist, said to NPR. Some of the health secretary’s recommendations are “completely reasonable.” Everybody should have access to a “detailed, careful assessment.” Prescribers should also not “feel pressured by parents and schools to instantly medicate behaviors that are due to other issues.”

In diagnosing “overmedicalization as a major problem,” the MAHA movement “gets something right,” Khameer Kidia, a physician and anthropologist at Harvard Medical School, said at The Boston Globe. However, the issue “doesn’t begin with physicians and our prescription pads.” As the opioid epidemic has shown, the “problem starts higher up.”

Drug companies have led the public to believe the “drugs corrected a chemical imbalance in the brain,” said Kidia. No such imbalance has been proven, and “many research studies show the drugs are only modestly better than placebos.” Now that so many patients are on SSRIs, “pharmaceutical companies have little incentive to get them to stop.” The problem with “MAHA’s approach to mental health” is the “overarching placement of responsibility with individuals” 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.”