The federal government has unveiled a sweeping federal effort to curb what Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr, described as the overuse of psychiatric medications.

Speaking at a May 5 MAHA Institute event, Kennedy framed the initiative as a response to a national “mental health crisis” and a broader “dependency crisis driven by overmedicalization.”

The plan brings together multiple federal agencies in a coordinated push to evaluate prescribing patterns and the benefits and harms of psychiatric medications, while expanding efforts to taper or discontinue them when they are no longer clinically beneficial. The plan also aims to elevate the role of nonmedication treatments for psychiatric conditions.

While some psychiatrists welcomed the plan, others voiced concern over the initiative, warning that focusing primarily on overprescribing risks oversimplifying broader problems in mental health care access.

Kennedy said the widespread use of psychiatric medications across populations is a cause for concern.

“That’s not a marginal issue. It’s a system-level pattern. Too many patients begin treatment without a clear understanding of the risks and how long they will stay on these drugs or how to come off of them,” Kennedy said. 

CDC data indicate that 16.5% of US adults reported taking prescription medication for their mental health in 2020, while separate CDC data collected between 2021 and 2023 showed that 16% of US adolescents aged 12-17 reported taking prescription medication to help with emotions, concentration, behavior, or mental health.

HHS Issues ‘Dear Colleague’ Letter

In a “Dear Colleague” letter, HHS urged healthcare professionals to prioritize informed consent and shared decision-making and to regularly review the risks and benefits of psychiatric medications with patients. 

The letter also encourages the use of nonmedication approaches such as psychotherapy, family support, nutrition, and physical activity when clinically appropriate.

Federal agencies are also moving to align financial incentives with these goals. The Centers for Medicare & Medicaid Services released guidance clarifying how clinicians can be reimbursed for deprescribing-related care, including treatment planning, monitoring withdrawal, and coordinating services.

This month, the Substance Abuse and Mental Health Services Administration (SAMHSA) will issue a report on prescribing trends that HHS said would guide efforts to reduce "inappropriate prescribing.” 

Throughout June and July, SAMHSA will host educational webinars for prescribers and other health professionals to increase awareness of the side effects of psychiatric medications and approaches for deprescribing, as well as evidence-based nonmedication treatments, HHS said.

The agency also plans to convene a technical expert panel this summer to develop formal clinical guidelines on appropriate prescribing and deprescribing of psychiatric medications. 

Kennedy emphasized that psychiatric medications should remain part of treatment but should no longer be the default approach. 

“Psychiatric medications have a role in care, [but] we will no longer treat them as the default. We will treat them as one option used when appropriate, with full transparency and with a clear path off when they are no longer effective,” he said.

“Patients must understand the benefits, the risks, and the consequences of long-term use; without that information, consent does not exist,” Kennedy added. 

Deprescribing Alone Is Not Enough 

Allen J. Frances, MD, professor emeritus of psychiatry and behavioral sciences at Duke University School of Medicine, Durham, North Carolina, welcomed the HHS action plan to curb psychiatric overprescribing.

The high rate of antidepressant use “reflects careless overprescribing and insufficient deprescribing,” said Frances. 

“Eighty percent of antidepressants are prescribed carelessly by rushed primary care doctors as the quickest way to get a distressed patient out of the office. Understanding why the patient is distressed and finding alternative solutions takes much more time,” he added. 

“It’s easy to start taking an antidepressant but not always easy to stop because of withdrawal symptoms and fears of relapse,” he added. 

The American Psychiatric Association (APA) praised the increased national focus on mental health but pushed back on the administration’s framing of the issue. 

“While APA supports efforts to improve the quality, safety, and evidence base of mental health treatment, we strongly object to framing the nation’s mental health crisis as primarily a problem of ‘overmedicalization’ or ‘overprescribing,’” the APA said in a statement. 

“That characterization oversimplifies a complex crisis and ignores the larger reality: Too many patients cannot access timely, comprehensive care, while care remains unevenly distributed across our health system,” the APA added.

The APA also cautioned that “deprescribing alone is not a sufficient response to this crisis.” 

A Larger Problem

Joseph F. Goldberg, MD, MSc, clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City, agreed. 

“The goal is not to just stop your treatment. It’s to replace it with something better,” he told Medscape Medical News. There are “real dangers” associated with stopping medication without proper oversight, including relapse and severe outcomes, he added.

Goldberg, who chaired an international task force that recently published clinical guidance on when and whether to discontinue psychiatric medications, questioned whether it’s accurate to say that the problem is overprescribing given that the vast majority of depression in the US goes untreated. The larger problem may be “inadequate oversight and monitoring of treatment regimens,” he said. 

He said patients and clinicians should carefully evaluate whether a treatment is effective and whether any side effects outweigh its benefits, while acknowledging that providers often face significant time constraints.

“I hope one of the goals of the administration is to free up enough time during patient encounters for prescribers to be able to properly go over the risks and benefits and alternatives of every treatment,” Goldberg said.

Goldberg reported receiving consulting fees from AbbVie, Alvogen, Bristol Myers Squibb, Genomind, Luye Pharma Group, Neumora, and Otsuka Pharmaceutical, as well as serving on speakers bureaus with Alkermes, Axsome, Bristol Myers Squibb, Intra-Cellular Therapies, Johnson & Johnson, and Vanda Pharmaceuticals. Frances served as chair of the task force that developed the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.