Robert Kennedy Jr. is now coming after antidepressants as part of his Make America Healthy Again (MAHA) nonsense.1 He’s claiming that antidepressants are overprescribed and dangerous. He wants them deprescribed. And while it would be great if people didn’t need to take antidepressants — or any other medication for that matter — antidepressants are life-saving and health-creating medications for many. So, let’s take a look at the facts behind antidepressants and violence, danger, and overprescription.
RFK Jr. States Antidepressants Are Dangerous, Overprescribed, and Cause Heroin-Like Withdrawal
It’s a surprise to no one that Kennedy is setting his sights on getting rid of antidepressants. He has been trying to connect them to school shootings and violence for years:
“You know, many of them … have black box warnings that warn of suicidal ideation and homicidal ideation. So we need — we can’t exclude those as a culprit.”
He also has stated that antidepressants are harder to get off of than heroin:
“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than people having getting off of heroin.”
Additionally, he feels they are overprescribed, as stated in his recent Health and Human Services (HHS) statement:
“Today, we take clear and decisive action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications — especially among children.”
Of course, he’s also the person who snorted cocaine off of toilet seats and eats roadkill, so I’m not sure why anyone takes health advice from this guy.
But, of course, people do. He is the Secretary of Health and Human Services, after all. So, let’s take a look at his claims.
Antidepressants and School Shootings and Violence
First off, let’s be clear, black box warnings on antidepressants do not contain a warning about homicidal ideation. Suicidal ideation in youth (under 24), yes, but homicidal ideation, no.
Additionally, I could pull 1000 quotes of psychiatrists talking about how antidepressants do not induce violence or school shootings. But instead, I’d rather look at this evidence-based article written by doctors. This is not an unstudied question.
They have some clear messages about antidepressants and violence:
- ” . . . enhancing serotonergic neurotransmission reduces aggressive behavior in humans . . .”
- “[There is] no convincing evidence to link the use of fluoxetine [Prozac] or other SSRIs with violent or suicidal behavior . . . .On the contrary, there is a considerable body of evidence from the last decade to suggest that fluoxetine may be associated with improvement in anger and aggression both towards oneself and others.”
- “. . . a significant decrease in lethal violence over 15 years of increased SSRI exposure in the community [was reported] . . .”
They also make the very good point that “such narratives [around violence and criminal behavior] are promoted via the internet and social media as a result of confirmation bias, lack of prevalence awareness, and misunderstanding of how FAERS [the US Food and Drug Administration Adverse Event Reporting System] works.”
This is not to say that antidepressants are not linked to an increase in agitation or even aggression in some cases; however, this is a far cry from violence, or, say, a school shooting. (The above article does say that caution is warranted when prescribing antidepressants to those already predisposed to violence, particularly in youth. Fair enough.)
Antidepressants and Difficult Withdrawal
Traditionally, it was thought that antidepressants do not induce withdrawal symptoms. I would say it’s clear this is incorrect. Many antidepressants induce withdrawal effects, and some, like venlafaxine and desvenlafaxine, can, indeed, be hell. (However, there are techniques that make it easier.) Many people get off antidepressants with little to no withdrawal, however.
I would argue antidepressant withdrawal is a far cry from heroin withdrawal; however, as opiate withdrawal can actually kill you.
Antidepressants Are Overprescribed
Here, there is an argument to be made. Many doctors would say that antidepressants are both overprescribed and underprescribed. Allow me to explain.
An antidepressant like fluoxetine can be prescribed for many conditions, including:
- Major depressive disorder
- Eating disorders
- Anxiety disorders
- Obsessive-compulsive disorder
- Premenstrual dysphoric disorder
- Fibromyalgia
- Posttruamatic stress disorder
Most of those uses are approved by the Food and Drug Administration (FDA), while some are off-label. However, if you add up all the people in society who have all those disorders, you get quite a few.
That said, some doctors would say we jump to prescribing antidepressants too quickly, when other treatments might be effective as well. For example, various forms of psychotherapy are highly effective in treating many of the above disorders, and only prescribing medication is doing patients a disservice.
However, if there’s one thing that patients need access to and don’t have, it’s psychotherapy. And if you are a doctor with a distressed and sick patient in front of you, you can often get them effective medication and not psychotherapy, no matter how much they might benefit from the latter. That may technically be “overprescription,” but it’s also harm reduction.
Many people with mental illness, especially serious mental illness, do not even have access to medications, however.
As noted here:
“Roughly two-thirds of Americans with a diagnosed mental health condition were unable to access treatment in 2021, though they had health insurance. And only a third of insured people who visited an emergency department or hospital during a mental health crisis, received follow-up care within a month of being discharged.”
So, while some people who get antidepressants might be well served with other treatments, many who desperately need treatment of any kind can’t get it. That makes Kennedy half right, I guess.
I would prefer to have people on antidepressants who could use other treatments but can’t get them, rather than have them on nothing, though, but that’s me.
Should Doctors Deprescribe Antidepressants Due to Danger and Violence?
Should doctors deprescribe antidepressants? Yes. Should doctors deprescribe antidepressants due to fears about danger and violence? No. Getting a patient off a medication like an antidepressant is a function of a doctor, but only in appropriate cases, and those cases shouldn’t be determined by fear. The problem with what Kennedy is doing with his misleading statements and outright lies is that he’s instilling fear that will no doubt cause people to demand deprescribing even in cases where it should not be done. Decisions will be made by fear instead of science. That is the wrong way to go about medicine, period.
If you feel like you want to get off your antidepressant, you absolutely should discuss it with your doctor. You should also make a plan and be supervised if it’s safe to do so. But you should also recognize that staying on your medication may be, by far, the safest and healthiest thing for you. And Kennedy is not qualified in any way to tell you different.
