Opinion: RFK Jr.’s antidepressant deprescribing push gets one thing right — and others dangerously wrong

OpinionFirst Opinion RFK Jr.’s antidepressant deprescribing push gets one thing right — and others dangerously wrong Redirecting patients away from medications is only clinically responsible if alternatives are accessible Manage alerts for this article Email this article Share this article By Jonathan SlaterMay 13, 2026 Slater is a clinical professor of psychiatry at Columbia University Irving Medical Center. I recently helped a woman in her early 60s taper off fluoxetine (often known by the brand name Prozac), which she had taken for over 35 years, followed by bupropion (aka Wellbutrin), which she had taken for over a decade. But Kennedy’s initiative conflates that genuine clinical need with claims unsupported by evidence — and some that are actively dangerous. Advertisement When she came to see me in 2024, she had tried to reduce her fluoxetine twice before — years apart. But each time she needed to return to a higher dose as depression returned. We lowered her fluoxetine gradually, reducing by 5 milligrams every three months and holding an extra month if she felt unstable, with a mood diary, regular therapy visits, and close monitoring. The entire fluoxetine taper took 18 months. We then waited another three months before beginning the bupropion reduction, lowering it by half-doses over months. She tolerated the fluoxetine taper well. But when she halved her bupropion dose during a period of intense professional stress, her anxiety spiked and her blood sugar — previously well-controlled — rose sharply. (Bupropion has modest glucose-lowering effects, and halving the dose may have removed that protection.) We restored the prior dose temporarily and resumed tapering once the stressor resolved. The process was long not because these medications are dangerous to stop, but because deprescribing is a dynamic, individualized process that requires ongoing clinical judgment — not a one-time decision.Advertisement There is a legitimate clinical problem at the center of Health Secretary Robert F. Kennedy Jr.’s initiative to help Americans stop taking antidepressants. Deprescribing is understudied, undertaught, and under-reimbursed. Drug companies have spent four decades funding trials showing that their medications work. Almost none have funded trials showing when and how to stop. But Kennedy’s initiative conflates that genuine clinical need with claims unsupported by evidence — and some that are actively dangerous. The field itself has been doing serious work on this question. In 2025, the American Society of Clinical Psychopharmacology (ASCP) — a leading professional organization of psychiatrists and researchers — convened a summit on antidepressant deprescribing, bringing together 45 international experts who reached agreement on 44 of 50 consensus statements. Their recommendations contain real clinical value: consider deprescribing when medications overlap in function, when improvement has been minimal, when a drug has stopped working, or when side effects outweigh benefits, and make only one change at a time. Importantly, the task force also recognized that deprescribing is not right for everyone — for patients with three or more lifetime episodes of depression, the consensus supports staying on medication indefinitely. These are sound, evidence-based principles, but they require individualized clinical judgment, gradual tapering, psychological support, and accessible alternatives to be carried out safely — elements that no broad federal initiative has yet provided at scale. Redirecting patients away from medications is only clinically responsible if the alternatives are accessible. They are not. A 2025 JAMA Psychiatry study found that recent gains in psychotherapy use were concentrated almost entirely among younger, wealthier, college-educated, urban adults with private insurance. Adults who are older, less educated, uninsured, or rural saw no meaningful increase. That’s one reason roughly 1 in 6 American adults currently take an SSRI. A prescription is accessible in a way that a weekly therapy appointment is not. Nudging clinicians away from prescribing without investing in therapy infrastructure widens that gap.Advertisement The largest meta-analysis to date on discontinuation symptoms found patients who stopped antidepressants experienced, on average, one additional symptom compared to placebo — below the threshold for clinically significant discontinuation syndrome. A companion Lancet Psychiatry analysis found roughly 15% experience symptoms attributable to stopping, with severe symptoms in about 3%. These are real numbers. But they do not support Kennedy’s claim that SSRIs are harder to quit than heroin. Keith Humphreys, who studies addiction at Stanford, put it plainly: Antidepressants and heroin exist in “different universes” when it comes to addiction risk. As the DSM-5 describes, antidepressant discontinuation syndrome involves no drug craving and is unrelated to the reinforcing effects of substance dependence. And Kennedy’s claim that SSRIs have contributed to school shootings has no causal support in the research literature. Stating it from federal authority stigmatizes depression treatment and discourages people from seeking care. The ASCP consensus also notes that long-half-life SSRIs like fluoxetine seldom produce significant discontinuation symptoms — and the pharmacokinetic data supports this. But the FDA label still recommends gradual reduction rather than abrupt cessation. And the 2026 Lancet Psychiatry network meta-analysis of 76 trials found abrupt discontinuation of any antidepressant carried meaningfully higher relapse risk than slow tapering with psychological support. Fluoxetine’s long half-life reduces discontinuation symptoms. It does not eliminate risk of a relapse of depression. Those are two distinct clinical endpoints, and conflating them is where the framing becomes dangerous. Stopping antidepressants roughly doubles the rate of returning depression symptoms — though a 2021 Cochrane review flagged that many trials did not distinguish true relapse from withdrawal symptoms misclassified as relapse. That caveat strengthens the case for structured deprescribing: slow tapering with psychological support was comparable to continuation in preventing relapse, while slow tapering alone did not significantly outperform abrupt stopping. The taper is necessary. The psychological support is not optional.Advertisement For patients with three or more lifetime depressive episodes, the ASCP itself supports indefinite maintenance therapy. A federal deprescribing initiative that reaches this population without individualization represents a real clinical risk. Kennedy’s event, by contrast, featured speakers advocating for phasing out school-based mental health screenings and cigarette-style warnings on antidepressant packaging — ideological, not evidence-based. This does not mean Kennedy’s initiative contains nothing of value: The CMS reimbursement mechanism for deprescribing time is its most evidence-aligned proposal, since inadequate reimbursement and perverse quality-measure incentives are documented structural barriers to deprescribing adoption. But reimbursement works only if clinicians have evidence-based protocols to follow and patients have access to psychological support. The deeper demand belongs at the FDA. Existing guidelines provide general tapering strategies, but what is absent is drug-specific tapering protocols derived from randomized discontinuation trials for each approved medication in this class. The FDA has never required manufacturers to conduct them. This conversation also rarely confronts the workforce problem. The majority of antidepressant prescriptions in the United States are written not by psychiatrists but by primary care physicians — clinicians who manage large numbers of patients, short visits, and limited psychiatric training. Careful, months-long tapering requires a skill set and a time commitment that most primary care settings are not structured to provide. If deprescribing is to happen at scale, it will require either a dramatic expansion of psychiatric consultation capacity or an entirely new clinical infrastructure — neither of which this initiative contemplates. And the FDA question deserves more scrutiny than it typically receives. Some argue that the FDA has never required manufacturers to study how to stop their medications. But it matters whether that is truly unprecedented — or whether the regulatory mechanism exists and has simply never been invoked for this drug class. If the precedent exists somewhere in the FDA’s history, or in the regulatory frameworks of other countries, the barrier is not legal but institutional. Clinical pharmacologists and regulatory historians may have more to say on this than the field has yet asked them.Advertisement Despite four decades of prescribing and 1 in 6 adults on these drugs, we still don’t know how to stop them optimally across the full range of patients. The ASCP task force has the standing to make that demand formally. Psychiatrists should be pressing them to do so. Deprescribing requires gradual tapering, psychological support, careful risk stratification, and accessible alternatives — none of which Kennedy’s initiative provides at scale. Patients who take antidepressants deserve both things: the 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. Jonathan Slater, M.D., is a clinical professor of psychiatry at Columbia University Irving Medical Center. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. FDA, Mental Health, Pharmaceuticals, RFK Jr. Submit a correction requestReprints Jonathan Slater Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended First Opinion May 13, 2026 Access to air conditioning is critical preventive care. But federal policy treats it as optional First Opinion Podcast May 13, 2026 What can ‘blue zones’ really teach us about aging? Advertisement Opinions+ May 12, 2026 STAT Plus: Pharma and biotech leaders are destroying their own industry First Opinion May 11, 2026 What addiction medicine can teach us about depending on AI First Opinion May 11, 2026 AI doctors should be licensed. Here’s a framework to do that Subscriber Picks