Make America Depressed Again

Secretary Kennedy is now turning his sights on the overuse of psychiatric medications, specifically selective serotonin uptake inhibitors (SSRI) antidepressants. He has associated the use of SSRIs with the rise in school shootings, and uses his personal experiences with heroin to compare how difficult it is to withdraw from these medicines.

A “Dear Colleague” letter from HHS to clinicians from May 4th states, ”Accordingly, HHS encourages clinicians and provider organizations to support a treatment approach grounded in shared decision-making, patient autonomy, and fully informed consent”. I am beginning to get more than a little frustrated with this language. If a clinician is seeing an adult patient with depression, and you suggest medication, don’t you think that the patient and clinician make a shared decision? And what does patient autonomy mean? We don’t force feed medications. The patient always has a choice to not use any therapy, which unfortunately I have seen to their detriment over my decades of practice. The phrase fully informed consent implies that the patient should sign a legal document before starting to use SSRIs. Should we do this with all medications? All competent clinicians discuss side effects and tell patients not to stop therapy “cold turkey”. By the way, HHS should stop calling me a colleague. I am not.

Here is another brilliant piece from the letter: “Evidence-based non-pharmacological interventions may include, when clinically appropriate, psychotherapy, social connection, behavioral approaches, sleep-focused treatments, physical activity interventions, and dietary and nutrition-related strategies.” Gee, we physicians and other clinicians hadn’t thought of that before. I think every first year medical student knows that psychotherapy and behavioral therapy is helpful. Of course, HHS under Kennedy has to include nutritional treatment. This opens the door to the magical (and I mean magical in the non-rational sense) world of supplements.

Discontinuing SSRI therapy, either because they are not helpful, or the patient wants to stop the medication after many years of use, is something that should be done under medical supervision. In some cases, I have tapered these medications over three months to avoid central nervous side effects such as “brain zapping”. What Secretary Kennedy doesn’t mention is that tapering can sometimes unmask continued underlying anxiety and depression, and the patient needs to go back on therapy.

Why do clinicians need to deal with another unscientific therapeutic missive with the non-medical, animal abusing former heroin addict who snorted illicit drugs from toilet seats?

What do you think psychiatrists and other physicians do with their four years of medical school, three to four years of residency, and ongoing medical learning?

To paraphrase from the band Pink Floyd, Hey, Kennedy, leave us docs alone!