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

What It Covers

NYT reporter Ellen Barry examines RFK Jr.'s federal push to encourage deprescribing of SSRIs, used by roughly 35 million American adults. The episode explores the gap between how doctors start psychiatric medications versus stop them, the patient-led tapering movement, and the risks of both over- and under-treatment.

Key Questions Answered

• •Deprescribing policy levers: RFK Jr. introduced three concrete federal mechanisms to encourage SSRI tapering: a "dear colleague" letter to clinicians recommending non-medication alternatives like psychotherapy, sleep, and exercise; a new Medicare/Medicaid billing code reimbursing providers for tapering consultations; and a technical expert panel tasked with developing formal tapering guidelines for health care providers.
• •The research gap on long-term SSRI use: FDA approval trials for SSRIs run only six to eight weeks, and almost no clinical data exists on outcomes beyond three to five years. Yet the median real-world treatment duration is five years, with many patients on SSRIs far longer — meaning tens of millions take these drugs with no evidence base for their long-term use.
• •Clinical guidelines vs. reality: Standard guidelines recommend discontinuing SSRIs six to twelve months after symptom remission, but this rarely happens in practice. Psychiatrists trained primarily in initiating medication receive minimal training in tapering. One Columbia University physician publicly acknowledged regretting keeping patients on medications longer than necessary throughout his career.
• •DIY tapering risks and methods: Patients tapering without medical supervision use forums like Surviving Antidepressants, reducing dosages by single capsule beads or liquefying pills with pharmaceutical scales. Withdrawal symptoms include vertigo, insomnia, and brain zaps. Doctors note symptoms typically resolve within weeks, but abrupt cessation risks destabilizing patients and triggering relapse of the original condition.
• •Access disparity complicates the narrative: White Americans take antidepressants at twice the rate of other racial groups and five times the rate of Asian Americans. Broad public messaging about overprescription risks discouraging treatment among populations only recently gaining cultural and practical access to mental health care, making a single universal message on SSRIs inappropriate.