Bipolar Me

I saw my psychiatrist this week for a med check and asked him about RFK, Jr.’s crusade against antidepressants. He said a good number of his clients had asked him about it. He reassured them that he was not going to cut them off.

Then Dr. G. said, “They’ll pull up to your house in a black Suburban, with face masks on, and ring your doorbell.” (He was joking.) I replied, “I have a gun.” (I wasn’t.)

Still, the fear is real. I’m not sure if Kennedy has an actual plan to curb what he considers an overprescribing of antidepressants. But those of us who need them are genuinely afraid that he will find some way to take them away from us. Maybe he’ll try to cut down the supply coming from the drug companies. Maybe he’ll invent some system by which doctors will be penalized for writing “too many” prescriptions. Or maybe he’ll put in place his threatened “wellness farms,” where people with mental illness will supposedly be cured by fresh air, organic food, no medication, and hard outdoor labor, much as he has recommended for “reparenting” children on ADHD meds.

The psychiatric community is as alarmed as their clients. At this year’s meeting of the American Psychiatric Association, doctors expressed fears that if Kennedy’s recommendations are put in force—and maybe even if they’re not—people who currently take antidepressants or other meds may decide to quit cold turkey or taper off without their physician’s advice and supervision, both of which are dangerous. Physicians also fear that patients will refuse necessary medications and relapse without them.

Kennedy has particularly targeted SSRIs (Selective Serotonin Reuptake Inhibitors) such as Zoloft (sertraline), Prozac (fluoxetine), Lexapro (escitalopram), and Paxil (paroxetine). Other targeted medications include antipsychotic medications, mood stabilizers, stimulants, weight-loss drugs, ADHD medications like Adderall, and combinations of these drugs. All these, Kennedy says, add up to a “dependency crisis driven by overmedicalization.” He has described the people who take these medications as “addicts.”

Kennedy compared coming off SSRIs to his experiences with trying to curb his heroin addiction: “You just have to steel yourself for 72 bad hours.” (He said that he had tried to quit and gone through withdrawal “a hundred times.”) He has also said, without evidence, that SSRIs are partly responsible for the rise in school shootings and other mass shootings.

The New York Times reported that at the Mental Health and Overmedicalization Summit organized by the MAHA (Make America Healthy Again) Institute, speakers were discussing “a variety of steps to address the overprescription of psychiatric medications, such as phasing out school-based mental health screenings, requiring written informed consent before starting medications, and featuring prominent, cigarette-style warnings on packaging.” It’s also been proposed that clinicians be paid through government programs to “deprescribe” patients. Too, there were discussions about changes in insurance billing and an “expert panel” with the mission to “develop clinical guidelines for deprescribing.” “This summer,” the Department of Health and Human Services says, “The Substance Abuse and Mental Health Services Administration, or SAMHSA, will release training modules focusing on the risks of psychiatric medications and on tapering and deprescribing.”

The risks of coming off psychotropic meds went largely unaddressed. People who have tried to do so without proper medical supervision have reported “brain fog,” as well as “emotional blunting, loss of motivation, suicidal ideation, and difficulty in withdrawing.” Some have also reported “shocklike sensations, flu-like symptoms, insomnia, nausea, and restlessness.”

It’s true that many medications, including some psychiatric medications, have been overprescribed. But they’ve been judged safe enough to be prescribed by primary care physicians as well as psychiatrists. Targeting and demonizing SSRIs and ADHD medications will leave patients with few ways to get the treatment they need. NPR reports that Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association, has said, “It really is an oversimplification. And it really ignores the larger reality, which is that too many patients really cannot access timely, comprehensive care that is much needed for our nation.”

Personally, I have been taking various combinations of these medications, including SSRIs, for decades. My psychiatrists have never recommended stopping them, and I have never wanted to. The medications and the dosages have changed over the years, as needed. Psychotropic medications have literally saved my life as well as my sanity, and allowed me to function well in my relationships, my career, and my other activities. I don’t consider them cure-alls; I still have occasional symptoms of depression and hypomania. But being told by a government agency to quit them, or even to taper off them, scares me. I hope Kennedy’s ideas are never instituted, but given all the other recommendations he has proposed, I’m far from sure that they won’t be.