Recent comments from Health Secretary Robert F. Kennedy Jr. about psychiatric
medication have sparked an important conversation about how antidepressants are
prescribed, monitored and discontinued. After four decades working in addiction and
mental health, I have seen what happens when policy oversimplifies complex clinical
issues. That is what concerns me here.
Patients deserve clear information about the medications they take. They deserve to
understand potential side effects, withdrawal risks, and alternative treatment options.
And for individuals who choose to discontinue psychiatric medication, the mental health
system has not always provided adequate tapering support or clinical follow-up. These
are legitimate concerns supported by growing evidence. A 2024 systematic review
published in the Lancet Psychiatry found meaningful rates of discontinuation symptoms
among patients stopping antidepressants, underscoring the need for stronger clinical
support during that process. Better support for people who want to deprescribe is a
reasonable and overdue goal. On those points, I agree.
But there is an important difference between improving prescribing practices and
pursuing policies that treat psychiatric medication itself as the problem. For people
navigating serious mental health conditions, substance use disorders, trauma, or
combinations of all three, the question of medication is rarely simple. These are
individuals whose treatment needs are complex, whose histories are layered, and
whose care requires a level of clinical nuance that broad policy directives cannot
accommodate.
At Integrity House, nearly 95 percent of the people we serve have co-occurring
substance use and mental health conditions. I have watched our clinical team work
through the complexity of those cases every day for decades. Psychiatric medications
are never approached as a standalone solution. They are one component of a broader
treatment plan that may also include therapy, peer support, medication-assisted
treatment, case management, housing support, and long-term recovery services.
Decisions about medication are informed by each client’s individual history, clinical
needs and circumstances. That is what individualized care actually looks like in practice.
Nationally, millions of people continue to struggle to access any form of behavioral
health treatment at all. According to SAMHSA’s most recent national survey, 41.2% of adults with co-occurring mental illness and substance use disorder in 2024 received
neither mental health nor substance use treatment, while only 14.5% received care for both conditions. At the same time, a 2024 CDC report found that 22% of people who
died of drug overdose in 2022 had a co-occurring non-substance-related mental health
disorder, with depression and anxiety among the most common.
Untreated or undertreated mental health conditions carry serious consequences for real
people. Policy decisions that reduce access to psychiatric medication without ensuring
that comprehensive clinical oversight, individualized assessment, therapy access, and
alternative supports are fully in place first will create additional barriers for people who
are already struggling to stay connected to care. We have seen what happens when the
system fails this population. We cannot afford to repeat it.
Our behavioral health system needs to give clinicians and patients the time, support,
and resources to make informed decisions together. That means investing in integrated
care models, strengthening access to therapy and psychiatric services, improving
reimbursement for medication management and tapering support, and allowing
clinicians the flexibility to determine what approach is most appropriate for each
individual patient. For some people, medication may be essential. For others,
deprescribing may be the right path. Both decisions require careful clinical judgment,
not broad policy assumptions or one-size-fits-all approaches.
Robert Budsock is the CEO of Integrity House, one of the largest non-profit providers of
substance use disorder and mental health treatment in New Jersey.
