Most years, when thousands of psychiatrists gather for the annual meeting of the American Psychiatric Association, they walk past a scattering of protesters. There are Scientologists with megaphones; Falun Gong groups doing their exercises; and, often, former patients, saying they have been harmed by medications or electroconvulsive therapy.<\/p>\n
This year, though, the profession is facing criticism from the highest levels of the federal government. The American Psychiatric Association gathered just 10 days after Health Secretary Robert F. Kennedy Jr. announced a set of policies to encourage doctors to deprescribe, or assist patients in stopping, the most widely prescribed class of antidepressants.<\/p>\n
A current of anxiety ran through the meeting, held here this week. Many physicians in the crowd said they worried that Mr. Kennedy\u2019s statements would prompt people to refuse medications, or to quit them and relapse. The plenary session erupted in applause when Dr. Marketa Wills, the organization\u2019s chief executive, declared, \u201cWe will never support governmental interference in the practice of medicine.\u201d<\/p>\n
\u201cWe are standing tall for evidence-based care,\u201d she continued. \u201cWe are standing tall against stigma, oversimplification, and anything that would move patients further away from the care that they need.\u201d<\/p>\n
But there were also signs that the field\u2019s leaders are engaging, albeit cautiously, with Mr. Kennedy\u2019s effort to curb overprescribing. Numerous sessions offered training in helping patients taper off medications. In July, the association\u2019s president will take part in a panel convened by the Department of Health and Human Services to develop clinical guidance on tapering antidepressants.<\/p>\n
In an interview, Dr. Wills said she had been \u201cencouraged\u201d by the invitation to participate in the panel, and she credited the administration with \u201cputting mental health front and center.\u201d<\/p>\n
\u201cIt feels like the beginning of a conversation, one that we welcome,\u201d Dr. Wills said. She added, \u201cIt would be odd to have that conversation without psychiatrists at the table.\u201d<\/p>\n
Outside in the corridors, some rank-and-file attendees were less diplomatic.<\/p>\n
Many providers took issue with Mr. Kennedy\u2019s negative characterization of selective serotonin reuptake inhibitors, or S.S.R.I. s, the most widely prescribed class of psychiatric medications. Clinical trials have found that most patients\u2019 depressive symptoms improved with S.S.R.I.s<\/a>, and they are considered safe enough to be prescribed by general practitioners.<\/p>\n A 2026 study found that 16.6 percent of U.S. adults<\/a>, or roughly one in six, reported currently taking an S.S.R.I.<\/p>\n \u201cHe just doesn\u2019t like S.S.R.I.s,\u201d said Dr. Sung Hyon, a psychiatrist from Pasadena, referring to Mr. Kennedy. Dr. Hyon said S.S.R.I.s had been \u201cfoundational\u201d in his practice \u2014 \u201cboring drugs that are well established, have good safety evidence and have zero chance to cause addiction.\u201d He called them \u201cGod\u2019s gift to psychiatry.\u201d<\/p>\n And patients know it, he added. \u201cSo many millions\u201d of Americans already take S.S.R.I.s, he said, and the vast majority are fully aware of their downside, like sexual side effects and withdrawal symptoms.<\/p>\n \u201cAnd they say, \u2018You know what? It\u2019s worth it,\u2019\u201d Dr. Hyon said. \u201cBecause there are so many of them, it would be a pretty big political firestorm if he really tried to restrict access. And there is very, very little medical evidence to do so.\u201d<\/p>\n Dr. Marketa Wills, the American Psychiatric Association\u2019s chief executive, said she was encouraged that she was invited to take part in a panel developing guidance on how to taper antidepressants.Credit…Arturo Holmes\/Getty Images for ESSENCE<\/p>\n Mr. Kennedy has long signaled<\/a> that curbing the use of psychiatric drugs was a goal of his. Earlier this month he began taking steps<\/a> in that direction, announcing guidelines and regulatory changes meant to provide an incentive for clinicians to help patients taper off psychiatric medications. The steps would not affect patients\u2019 access to antidepressants.<\/p>\n Andrew Nixon, a spokesman for the Department of Health and Human Services, said the agency had had no discussions about banning S.S.R.I.s., \u201cand any claims suggesting otherwise are false.\u201d The aim of the new initiative, he said, is to \u201cpromote appropriate psychiatric prescribing and drive deprescribing when clinically indicated.\u201d<\/p>\n Some psychiatrists said they worried that Mr. Kennedy\u2019s deprescribing initiative was the beginning of a wider effort that might, in later stages, discredit psychiatry more broadly and restrict access to care.<\/p>\n \u201cI think it is actually putting more questions in people\u2019s minds about whether psychiatric treatment is safe or effective,\u201d said Dr. Eric Rafla-Yuan, who chairs the A.P.A.\u2019s caucus on the social determinants of health. \u201cThe data has not changed on S.S.R.I.s. It\u2019s the narrative that has changed.\u201d<\/p>\n He said the A.P.A. should be pushing back forcefully against Mr. Kennedy\u2019s claims about psychiatric treatments, and should steer clear of seeming to endorse any part of the initiative.<\/p>\n \u201cIt\u2019s a fine line between having a seat at the table and being used as a tool to legitimize their agenda,\u201d he said.<\/p>\n \u2018Much Too Medicated\u2019<\/p>\n At the same time, deprescribing seemed, at the meeting, to be on everyone\u2019s lips. A new book, \u201cStahl\u2019s Deprescriber\u2019s Guide,\u201d was selling like hot cakes in the exhibition hall. There were panels titled, \u201cDeprescribing Antipsychotics,\u201d \u201cThe Much Too Medicated Patient\u201d and \u201cStimulants for A.D.H.D.: Did We Get It Wrong?\u201d<\/p>\n Dr. Chris Aiken, who delivered an address about multidrug cocktails, said a generational change is moving through the psychiatric association, as a younger cohort of physicians, in their 30s and 40s, take a more prominent role.<\/p>\n Millennials were part of the first generation to be prescribed stimulants and antidepressants as children and teens, he said, and physicians in that group are more conscious of poor outcomes years later. \u201cMeds are not the answer, and they have seen this in their own lives,\u201d he said.<\/p>\n Some senior physicians had a similar message.<\/p>\n \u201cIf I have any regrets about my recommendations as a physician, it\u2019s about the medications that I did not withdraw sooner,\u201d said Dr. Ronald Winchel, an assistant clinical professor of psychiatry at Columbia University\u2019s medical school, at one panel.<\/p>\n Books on display at the American Psychiatric Association meeting in San Francisco this month.Credit…Ellen Barry\/The New York Times<\/p>\n He said a number of concerns had prevented him from doing so: Sometimes, patients were taking multiple medications and it was difficult to say which was effective. Sometimes, patients were doing well, and he was afraid of setting them back. And there was a dearth of research on how patients do after they quit medications.<\/p>\n \u201cThe fear of withdrawing medications has really complicated our work,\u201d he said.<\/p>\n Dr. Winchel compared this year\u2019s churning discussion to a watershed moment in the A.P.A.\u2019s history: In 1973, sustained pressure from protesters<\/a> caused the organization to reverse its century-old position and declare that homosexuality was not a mental disorder.<\/p>\n \u201cInstead of getting into a defensive crouch, they looked at themselves and they made progress,\u201d Dr. Winchel said. The same kind of advancement, he added, could result from a rigorous discussion about prescribing practices. \u201cIf some of this agitation is coming from outside,\u201d he said, \u201cwhat is wrong with that?\u201d<\/p>\n In his presentation, Dr. Aiken urged colleagues not to dismiss the stories Mr. Kennedy has highlighted of patients who have encountered serious difficulties quitting antidepressants.<\/p>\n \u201cI don\u2019t really know how common it is, but I do know that when it does happen, it can be quite severe,\u201d he said. \u201cIt may be rare, but let\u2019s take it seriously, because it can really burn people when it happens.\u201d<\/p>\n Others said working with Mr. Kennedy around mental health policies was a matter of simple pragmatism.<\/p>\n \u201cThere\u2019s definitely a need for us to be talking to the people who are making decisions,\u201d said Dr. Hammad Khan of Sacramento. \u201cWe can\u2019t let Joe Rogan decide what the F.D.A. approves or doesn\u2019t approve.\u201d<\/p>\n An Inflection Point<\/p>\n Dr. Awais Aftab, the author of \u201cPsychiatry at the Margins<\/a>,\u201d a popular mental health Substack, said he expects the H.H.S. effort to focus on raising awareness about tapering off medications. There are few pathways for the government to reduce the prescription of drugs like S.S.R.I.s, which have gone through F.D.A.-approval pathways and are widely used by the public, he said.<\/p>\n He described \u201ca sense of alarm\u201d among psychiatrists at the virulent critique of the field coming from Mr. Kennedy\u2019s circle. Psychiatry, he said, has been late to acknowledge the complaints of patients like Laura Delano, an author and activist<\/a>, who say they were overmedicated as children or teenagers and got little support from doctors when they wanted to reduce or stop the drugs.<\/p>\n \u201cThe mainstream psychiatric community has been fairly insulated, and suddenly they are hearing now about this issue,\u201d said Dr. Aftab, a psychiatrist at Case Western Reserve University.<\/p>\n He added that he believes that the use of antidepressants in the United States may have reached a natural limit. \u201cThe demand is going to, at some point, go into an equilibrium with the reality of the lack of effectiveness and the reality of the tolerability issue,\u201d he said.<\/p>\n But the experience of some other countries suggests that the demand for antidepressants may continue to rise, even amid warnings about overprescribing.<\/p>\n In 2017, Britain commissioned a major report on overprescribing<\/a> and then followed up with a series of reforms, including updating clinical guidelines to require regular prescribing reviews and instituting a national audit program to monitor drug use.<\/p>\n