R.F.K. Jr.’s Newest Mission: Getting Us Off Antidepressants

From The New York Times, I'm Michael. Barbaro. This is The Daily. >> [music]. >> In his latest public health crusade, Robert F. Kennedy Jr. is asking why. millions of Americans. >> [music]. >> have been taking psychiatric drugs for. far longer than ever intended. >> I have been on Zoloft since I was 8. years old. >> I've continuously been on. antidepressants. >> [music]. >> 27 years. >> I've been on Luvox 30 years. >> I've been on them longer than I've not.

been on them. >> In the process, [music]. he's highlighting an open secret in. medicine. That doctors are much better at starting. drug treatments than at stopping [music]. them. >> I was told to take it daily and I never. questioned that. I don't really think I. even asked or thought about how long I. would be on it. >> I did not know that I was going to be on. them for the rest of my life. [music]. >> And that patients who want to end their. treatment are increasingly. >> [music]. >> taking matters into their own hands.

>> All of a sudden, I felt so strongly that. my brain was like, "You need to get off. [music] this medication.". >> Today, Ellen Barry takes us inside the growing. movement. to de-prescribe. It's Monday, June 22nd. [music]. Ellen, nice to have you on the show.

>> Thank you for having me. >> Let me just start by asking how you came. to this topic of de-prescribing and for. the uninitiated, can you just define. that phrase? >> De-prescribing is the art and science of. carefully tapering off a psychiatric. medication or reducing a psychiatric. medication. I first heard the term really from. patient groups. There has long been a. sort of a subculture of people who talk.

to each other on the internet about. being harmed by medication or feeling. that their medication isn't working. anymore, who sort of compare notes on. how to get off them. And those communities, that's nothing. new. They've been out there for decades, really since the early days of social. media. But what's new is that this group, largely of patients, now has a seat at. the table as federal health policy is. developed. And that's because of RFK Jr.

>> I want to thank President Trump for. entrusting me to deliver on his promise. to make America healthy again. >> Dr. Kennedy made it clear during his. confirmation hearings that one of the. things he was looking at would be. curbing the use of [music] psychiatric. medications in the US. >> 15% of American youth are now on. Adderall or some other ADHD medication. >> He talked specifically about.

antidepressants in those hearings, that. these medications were sort of. dependence-forming, that we prescribe. them too freely. >> Even higher percentages are on SSRIs and. benzos. We are not just over-medicating. our children, we're over-medicating our. entire population. >> And what he was talking about was the. most widely used category of psychiatric. medications, SSRIs. >> Listen, I know people, including members. of my family, who've had a much worse time getting off.

of SSRIs than people have getting off. heroin. >> He said that SSRI antidepressants. [music] are harder to quit than heroin. >> Huh. Is that true? >> No, there's no evidence supporting. [music] that. SSRIs are used by probably around 35. million American adults. These are selective serotonin reuptake. inhibitors like Prozac or Zoloft or.

Lexapro. They're considered so safe to prescribe. that overwhelmingly they're prescribed. by family doctors or GPs rather than. psychiatrists. >> Mhm. >> And they're used for sort of an ever. expanding array of different problems, not just for depression, but also for. all kinds of anxiety disorders, obsessive-compulsive disorder, social. anxiety, PTSD, and that list, you know,

has just continued to get longer. >> Right. And here he is assailing and. questioning the most widely used. medication in basically all of mental. health. >> Right. So, after the confirmation. hearings at the beginning of 2025, I. think we were all watching closely to. see what was he actually planning to do. And at the beginning of May, Secretary. Kennedy appeared at a summit on over. medicalization that was held by the Maha.

Institute and InnerCompass Initiative, which is a support organization for. people going off mental health. medications. The thesis of the entire day was overuse. of SSRIs. And at the end of that day, he. announced a set of regulatory changes. that all kind of aimed to encourage. clinicians to help patients get off. SSRIs. >> Hm. So, he's beginning to articulate a. kind of federal regulatory vision for.

deperscription. What specifically is he. proposing? >> He sent a dear colleague letter, which. is direct communication to hospitals and. doctors. And the dear colleague letter. essentially said, don't default to using. medication for depression and anxiety, look at other modes of treatment. And we. know that lots of things are effective. treatments for depression and anxiety. Psychotherapy is probably the number one.

alternate mode, but also sleep and. exercise and diet and lots of other. things. >> Mhm. >> So, that is sort of common sense advice. It wasn't controversial. >> And just to be clear, he's not a doctor, RFK Jr., but he's basically writing a. letter to colleagues in the world of. public health and the medical community. >> Correct. And then he introduced a. billing code that would allow Medicare. and Medicaid providers to be reimbursed. for helping patients get off. medications.

>> And why is that important? >> It's important because it can be. complicated and time-consuming to help. people quit a psychiatric medication, especially if they've been taking it for. a long time or they're taking a. complicated cocktail of four or five. psychiatric medications. It takes a lot. of time, and usually psychiatrists are. reimbursed for 15-minute med checks. every month. That's just not enough. time. >> So, he's financially attempting to. incentivize doctors to participate in.

deep prescribing. >> Yes. And another thing he set in motion. is what's called a technical expert. panel to develop guidelines for tapering. off SSRIs. And this panel would create a. new set of recommendations for health. care providers on how best to do this. >> And what's the reaction to these. proposals, to this speech from the. Secretary of Health and Human Services. from the world of medical experts out.

there? >> Yeah, I was really curious about that. because it was noticeable that there. were no medical organizations involved. in putting together this sort of day of. policy-making around the use of SSRIs. And when I reached out to them, I think. there was a degree of alarm that they. had somehow been excluded from this. process, which sort of drives it. You. know, one of the central functions of. psychiatry. And I I had an opportunity. to find out a little bit more about that.

because the American Psychiatric. Association held its annual meeting 10. days later. >> That is extremely convenient. journalistically. I'm going to assume. you went. What did you find? >> What was kind of two-fold. Some people. that I talked to were worried that this. was just the first step in a much more. ambitious plan on the side of Secretary. Kennedy that would lead to a bigger. discrediting of psychiatric treatments. >> So their fear is that whatever this is, it's just the beginning, maybe a side.

door into greater government, what. perhaps restrictions on these drugs? >> So a lot of doctors who I interviewed in. the hallways outside sessions at the APA. said that SSRIs are the foundation of. their practice, that they are so safe. that they've been using them for so many. years and that they turn people's lives. around, they make the difference between.

being able to get up in the morning and. get dressed and get to work and not. being able to do those things. So a lot. of them were kind of passionate about. saying what they have seen with. patients. And I think the worry is that. people are going to be driven away from. taking medications or that somehow their. access will be restricted. >> How many doctors at this conference were. open to or even in agreement with what. RFK Jr. is talking about here when it.

comes to de-prescription? >> Yes, so there was a second big takeaway. that I had from this gathering, which is. that a substantial number of doctors. there. agreed that this is an area where we. could do a lot better. That is, training of psychiatrists. focuses a great deal on putting people. on medications, but much less on what it. means to take them off and what a. challenge it can be. And a number of.

people I interviewed expressed. frustration over that. In one of the panels that I attended, a. Dr. Ronald Winchell from Columbia. University School of Medicine. said that when he looked back at his. long career. one of the things that he most regretted. is. not taking patients off medications. until. later than he should have. >> Mhm. >> That is, hesitating for various reasons, even when he thought that the medication.

was no longer needed or no longer. effective. >> It sounds like the second group of. doctors you're talking to feel like RFK. Jr. has identified a problem in their. world that everyone should be more. focused on. >> Yeah, I think there was a lot of. discussion of de-prescribing at this. conference. There was a number of panels. on de-prescribing different classes of. medications. There was a new. de-prescribing handbook and it was. selling. a lot downstairs in the exhibition hall.

And in conversations with doctors, a. number of them acknowledged that this is. an area where we could do a lot better. at supporting patients. >> One thing we haven't talked about here. is objective research that would. clarify the questions. we're discussing. If only the assumption. now is that doctors aren't talking. enough about getting off these drugs, that's certainly the case RFK Jr.'s. making, some doctors are making it, too.

The implication is that people are on. these drugs for too long. So, what does. the research tell us about long-term use. of SSRIs? >> The reality is that there isn't all that. much research on that. >> Huh. >> Most of the clinical trials we have on. these drugs are efficacy trials, and. they're shorter term, like 6 to 8-week. trials that are necessary for FDA. approval. There's some longer-term work, but.

very little that tells us what happens. after 3 years or 5 years or 10 years. And I think when SSRIs were first. introduced in the 1980s, it wasn't anticipated that people would. be taking them for years and years. The clinical guidelines say, "Once. someone's symptoms are in remission, that you should discontinue the. medication after 6, 9, 12 months, and. just go back off." But I think we see in.

reality that for a lot of people, that's. just not happening. So, one study found. that the median duration of treatment. with an SSRI is 5 years, and for many, it's a lot longer than that. >> That amazes me, to be honest, that we. don't have much of any long-term. research on what has become for so many. people long-term treatments. I mean, if. millions and millions of people are. taking these. prescription drugs for years and years.

and years, it's deeply surprising that. we don't know clinically what the impact. of that is. >> Right. That kind of research just hasn't. been a priority. >> So, in the weeks since RFK Jr. introduced these ideas, and once the medical health world began. to absorb them, what has actually. happened to these proposals? >> Well, the incoming president of the APA. is going to have a seat on one of the.

technical expert panels that will be. developing guidelines in this area. There's also a psychiatrist from the. American Society of Clinical. Psychopharmacology. So, there are going. to be representatives of sort of major. professional groups at the table. >> Got it. So, a lot of these medical experts decided. that even if they were skeptical of RFK. Jr.'s agenda here, that they wanted to be a part of it. If. you can't beat them, join them, shape.

them. >> They wanted a seat at the table. >> [music]. >> I mean, as this de-prescribing project. gets off the ground, it's involving both. establishment mainstream psychiatry and. across the table representatives of a. totally different group that has been. watching psychiatry critically from the. outside. for a long time. >> [music]. >> And that includes patients who are. saying, "How long are we supposed to be. on these things?

And why haven't we been having these. conversations with our doctors the whole. time?". >> [music]. >> We'll be right back. Ellen, I want to turn to this world of. patients who have been eager for this. de-prescription conversation to reach. the point that it now has, where the. federal government is broaching it and.

medical experts are now joining the. conversation. And in particular, I want. to better understand the specific. reasons that patients are giving for. wanting to get off these medications and. the specific experiences. that lead them to that decision. >> Well, you know, whenever I write about. this subject, we really get inundated. with personal stories.

>> [music]. >> And people have different reasons for. wanting to get off a medication. >> I thought like if I get off the. antidepressants, I can see what life is. without this numbness. >> Sometimes they feel like their emotions. have been kind of muffled. >> I wasn't having these anxious thoughts, but I also wasn't experiencing like as. much high good emotions, either. >> There was like delayed sexual side. effects.

>> Sometimes they have side effects. Sometimes they feel that the medication. just isn't working anymore. >> Maybe it's the classic thing. Oh, I feel. great. I must not need my medication. anymore. >> By then, I had been on the medication. for about 25 years. >> [music]. >> And I was just curious, what would my. life be like without this? >> And I've heard from a lot of people who. said, [music] you know, I started taking. this medication when I was a teenager. and. maybe that's what I needed to get. through that period, but now many years.

have passed and I've entered adulthood. not exactly knowing who I was. >> Right, who you would be without those. drugs. >> [music]. >> Exactly. >> It's FOMO. It's like, what am I missing. out on? I want to live in real life. I. don't want to live in black and white. I. want to live in color, you know. >> Like those intense emotions that can. feel so uncomfortable, especially when. you're a very young person, they're also. part of your personality. And I hear. from people who say like, I want to know. who that person is.

>> Once these people you're hearing from. decide that they're going to try to stop. taking these medications, how have they. actually technically been doing that? And who is guiding them through that. process? >> I mean, I think some people work with. their doctors in getting off or tapering. a medication, and some people don't. >> I went in and they were like, "Hey, you. want a refill of your Zoloft?" And I was. like, "Yes, I guess, if I still need to.

be on it." And they were like, "Cool.". >> A lot of the people we hear from [music]. say this conversation about how to get. off isn't happening with their doctor, or if it is happening, it isn't. satisfying. Or for others, they just. don't see their doctor often enough to. get the kind of robust [music] support. that they need. >> Not to say all doctors, but I don't know. if how many doctors really. grasp what it is beyond an. antidepressant. Like, if. you go in there and you're feeling.

depressed, they say, "All right, then. you just raise the medication.". Some are better than others, but. I never really. go to them to get off of it. I did that. myself. >> And in some cases, people just lose. trust in their doctor if they think that. the medication that they've been. prescribed is making them worse. >> I'll be honest, I at this point, because. I have been dismissed about everything. else, I was like, I don't trust these. people. I can [music] make my own health. decisions. >> And those people have been talking to. each other now for years and years with.

a lot of frustration towards organized. medicine. [music]. >> And for those folks who have been trying. to do this essentially DIY, what has been their playbook, for lack. of a better word? What does it look. like? >> I use Dr. Google, and I look at forums. on Reddit and stuff like that, and. people are like, um if you do cold. turkey, it can really destabilize you a. little bit. >> So, the kind of subculture around.

tapering and withdrawing from. medications has been out there since the. early days of social media. One example is a site called Surviving. Antidepressants. And what you would find there is people. exchanging their withdrawal protocols. and it got incredibly technical. People would be talking about reducing. their dosage by a single bead within the. capsule or liquefying it or using. pharmaceutical scales.

And over time, you know, that network. has sort of matured into a real. marketplace of support. >> And that's presumably to avoid the side. effects of abruptly taking yourself off. of one of these drugs. But even when. people are very careful and very. gradual, what are the side effects of. ending these treatments? >> The side effects that you most often. hear about are vertigo, nausea, or.

flu-like symptoms. >> [music]. >> I completely stopped sleeping. >> Insomnia. Something that they call brain zaps. >> Electricity in my head. >> Which are like a twinge or a sense of a. feeling of a sort of a shock-like. sensation in the brain. >> Wow. It's like this. kind of thing. [music]. >> And there's some portion of people who. describe.

the process of withdrawal as really. intolerable. >> Mhm. >> Like jumping out of their skin and it. [music] is its own kind of debilitating. crisis. >> I would like watch a movie and cry. I'd. watch commercial and cry. Read a book and I'd cry. I was listening to the Beach Boys Pet. Sounds album and just [music] tears. coming down my eyes. It felt good for a. while, but then it was like it was like. going like having emotions that were. like a. dripping faucet to like a fire hose. It's too much. >> But what doctors generally say is that.

for most people these symptoms really. only last for a few weeks. And then if after that, you're feeling. dramatic mood changes, you might be. experiencing relapse. >> Essentially, the conditions that may. have prompted you to first go on these. drugs. >> Yes. >> However severe these side effects are, they would seem to buttress the argument.

that the best version of de-prescription. is a medically supervised one, where. you're not trying to do it yourself, and. you're not determining dosages and. tapering, and where the same doctor who. prescribed the drug is the one helping. you get off of them, and aware that. you're trying to do it, and helping you. manage what could be a brain zap or a. resumption of symptoms. It feels like. something that should not be DIY.

>> That's certainly the view from within. medicine, that one of the reasons that. you need supervision if you're doing. something like this is just to guard. against the possibility of a relapse. >> And this would seem to make the case for. the conversation that RFK is pushing the. medical world to have. >> Right. I think there is some. acknowledgement that prescribers aren't. putting the same amount of care and.

attention into landing the plane as. taking off. >> Well, and here I want to acknowledge. that the conversation that RFK is trying. to have, and that we're having here, is. not. theoretical for me, anyway. And here I'm. going to shake my Lexapro. I've been on Lexapro as an anti-anxiety. medication for at least a decade. It was. prescribed by a psychiatrist, but then. just became part of my relationship with.

my general practitioner. I just kind of. get it renewed. And I've not really been. asked to think about how long I should. be on it. And now suddenly having this. conversation with you is making me ask. that question. How long am I supposed to. be on it? What would happen if I stopped. taking it? Would all the white noise of. anxiety that made me want to go on. Lexapro, would that return? Or 10 years. later, have I outgrown that and I just.

don't know it because I've never tried. to taper myself off this to find out who. I would be if I weren't me on Lexapro. I. mean, it's not a simple question. >> I hear so many people asking that kind. of question. Like, is there some. authentic self that I want to go back. to? You know, what would life look like. if I took this medication away? I just. think that question is percolating. And. I feel like what's a little bit more. complicated is if you think it works for.

you, you become sort of, I don't know, psychologically attached to them. >> Mhm. >> And you think, if I quit this, am I. going to spiral? Am I going to feel bad. again? And we know that the placebo. effect is a huge part of the picture. with these medications. And I think it's. the same when you go off. They call it. the nocebo effect, which is if you think. it's essential to you, you may be just. afraid of stopping, afraid of finding. out what that's like. And that could.

sort of contribute to your feeling bad. >> Mhm. >> Michael, in your case, what did you. conclude about stopping? >> Me, I. don't know that I've. ever gotten far enough along in the. conversation with myself to stop. I just. know that. on the. occasions when I have failed to reliably. take Lexapro, I have experienced some. really crippling headaches, which I.

needed a doctor to tell me were from not. taking my Lexapro reliably, but there. was no deeper conversation. There was. no, is it time to think about whether. you should be tapering? How long have. you been on it? It was just an accepted. fact in my conversation with the doctor. that I was on it, and then I'd probably. still be on it for as long as I'm going. to be on it. >> And do you think that that conversation. should have happened. when you first went on? >> I wonder now. But now I'm asking myself. the question of are we all infantilizing.

ourselves in the face of medicine? Should I be asking this question myself? Why should I be waiting for a doctor to. ask it? It's getting a little. existential now. >> Mhm. I mean, some people have multiple. remissions, and what I hear from. physicians is if you've had like three. episodes of depression, then you. probably are going to take an SSRI for. indefinitely as a maintenance treatment. And if it's fewer than three, then no,

then you should try to get off if you. want. But I don't think there's a lot of. energy around having that conversation. >> Right. I mean, we're talking about. de-prescription here because that's the. conversation that RFK Jr. and those. around him want us to be having, but there's also a possibility. that people are going to hear this. conversation, and instead of just de-prescription, they're going to hear, maybe I shouldn't.

ever get a prescription. And I wonder if. that's a risk that RFK Jr. and the. medical experts who are now joining him. in this conversation. are thinking about. >> I mean, because I cover psychiatry and. mental health, I have been doing. interviews all over the country about. people's use of this kind of medication. and I'll tell you that like they're. reaching parts of society that just. wouldn't have gotten any kind of mental. health care in the past. So, I remember.

talking to. I think he was an auto mechanic and I I. was doing interviews in a school parking. lot and he said, you know, like my. father was an angry drunk and because I. take an antidepressant, I know I'm not. going to go that way. >> Mhm. >> And there groups within our society that. are only now for the first time getting. access to a treatment for depression or. a treatment for anxiety. I mean, I think if you look at the. numbers, white people take.

antidepressants at a rate that is twice. as high as any other racial category and. like five times as high as Asian people. So, there's just a huge discrepancy. Some groups take these a lot, some. groups really don't have much access. >> In other words, because of the. demographics of takes these mental. health drugs, there are plenty of people who perhaps. could benefit from them who have never. been introduced to them or are just. starting culturally to accept the idea.

that they can and will be on them and. the over prescription de-prescription. conversation isn't necessarily the right. one for them to be having right now. >> Yeah, I think that's right. >> [music]. >> I mean, it may be that there is no one. message that is appropriate for our. [music] entire society. So, I think RFK. Jr., [music] the secretary, has to be. very careful about encouraging this. conversation about.

>> [music]. >> stopping medication when it's. appropriate without driving people away. from the idea of treatment completely. [music]. >> Right, it's one thing to have a. conversation about de-prescription. It's. another [music] to intentionally or not. stigmatize ever getting a prescription. >> Yeah, I think both of these. conversations need to happen. How to. access treatment [music] that people. really desperately need, and also. how much is enough and how to stop.

>> Well, Ellen, thank you very much. We. appreciate it. >> Thank [music] you. >> [music]. >> We'll be right back. >> [music]. >> Here's what else you need.

>> [music]. >> to know today. As a new round of peace talks started. between the US and Iran on Sunday, the conflict between Israel and. Hezbollah in Lebanon threw a wrench into. the negotiations. >> [music]. >> Fighting between Israel and Hezbollah. prompted Iran to claim it was once again. closing the Strait of Hormuz, a threat. US officials [music] said had not been. carried out. Iran has demanded that fighting in. Lebanon end immediately, >> [music]. >> but ceasefires there have been declared,

broken, and reinstated several times. over the past few weeks. [music]. And. problems with President Trump's $14. million renovation of the Lincoln. Memorial reflecting pool, timed for. America's 250th birthday next month, have become so severe that [music] Trump. said he will have to partially drain the. pool for repairs. Over the past few days, the pool's new.

coat of [music] dark blue paint, applied. by a company that has never before. worked for the federal government, has. begun [music] to visibly peel, and green. algae has spread across the pool, likely because the renovation project. does not fix the pool's malfunctioning. filtration [music] system. Today's episode was [music] produced by. Alex Stern, Jack D'Isidoro, Claire. Tennis and Stella Tan. With help [music] from Anna Foley and.

Olivia Natt. It was edited by M J Davis Lynn with. help from Brendan Klinkenberg and. contains music by Pat McCusker and Dan. Powell. This episode [music] was. engineered by Alyssa Moxley. >> [music]. >> That's it for The Daily. I'm Michael Barbaro. See you tomorrow.

>> [music].