Michael Barbaro: From the New York Times, I'm Michael Barbaro. This is the daily. In his latest public health crusade, Robert F. Kennedy Jr. is asking why millions of Americans have been taking psychiatric drugs for far longer than ever intended.

Patient A: I have been on Zoloft since I was 8 years old.

Patient B: I've continuously been on anti-depressants 27 years.

Patient C: I've been on Luvox 30 years. I've been on them longer than I've not been on them.

Michael Barbaro: In the process, he's highlighting an open secret in medicine that doctors are much better at starting drug treatments than at stopping them.

Patient D: I was told to take it daily and I never questioned that.

Patient E: I don't really think I even asked or thought about how long I would be on it.

Patient F: I did not know that I was going to be on them for the rest of my life.

Michael Barbaro: and that patients who want to end their treatment are increasingly taking matters into their own hands.

Patient G: All of a sudden, I felt so strongly that my brain was like, "You need to get off this medication."

Michael Barbaro: Today, Ellen Barry takes us inside the growing movement to deprescribe. It's Monday, June 22nd. Ellen, nice to have you on the show.

Ellen Barry: Thank you for having me.

Michael Barbaro: Let me just start by asking how you came to this topic of deprescribing. And for the uninitiated, can you just define that phrase?

Ellen Barry: Deprescribing is the art and science of carefully tapering off a psychiatric medication or reducing a psychiatric medication. I first heard the term really from patient groups. There has long been a sort of a subculture of people who talk to each other on the internet about being harmed by medication or feeling that their medication isn't working anymore who sort of compare notes on how to get off them. And those communities, that's nothing new. They've been out there for decades, really since the early days of social media. But what's new is that this group largely of patients now has a seat at the table as federal health policy is developed. And that's because of RFK Jr.

Robert F. Kennedy Jr.: I want to thank President Trump for entrusting me to deliver on his promise to make America healthy again.

Ellen Barry: Secretary Kennedy made it clear during his confirmation hearings that one of the things he was looking at would be curbing the use of psychiatric medications in the US.

Robert F. Kennedy Jr.: 15% of American youth are now on Adderall or some other ADHD medication.

Ellen Barry: He talked specifically about anti-depressants in those hearings that these medications were sort of dependence forming that we prescribe them too freely.

Robert F. Kennedy Jr.: Even higher percentages are on SSRIs and benzo. We are not just over medicating our children. We're overmedicating our entire population.

Ellen Barry: And what he was talking about was the most widely used category of psychiatric medications, SSRIs.

Robert F. Kennedy Jr.: Listen, I know people, including members of my family, who've had a much worse time getting off of SSRI than people have getting off of heroin.

Michael Barbaro: He said that SSRI anti-depressants are harder to quit than heroin.

Michael Barbaro: Huh. Is that true?

Ellen Barry: No, there's no evidence supporting that.

Ellen Barry: SSRIs are used by probably around 35 million American adults. These are selective serotonin re-uptake inhibitors like Prozac or Zoloft or Lexapro. They're considered so safe to prescribe that overwhelmingly they're prescribed by family doctors or GPS rather than psychiatrists.

Michael Barbaro: Mhm. And they're used for sort of an ever expanding array of different problems, not just for depression, but also for all kinds of anxiety disorders, obsessivecompulsive disorder, social anxiety, PTSD. And that list, you know, has just continued to get longer,

Michael Barbaro: right? And here he is assailing and questioning the most widely used medication in basically all of mental health.

Ellen Barry: Right? So after the confirmation hearings at the beginning of 2025, I think we were all watching closely to see what was he actually planning to do. And at the beginning of May, Secretary Kennedy appeared at a summit on overmedicalization that was held by the Maja Institute and inner compass initiative, which is a support organization for people going off mental health medications. The thesis of the entire day was overuse of SSRIs. And at the end of that day, he announced a set of regulatory changes that all kind of aimed to encourage clinicians to help patients get off SSRIs.

Michael Barbaro: Hm. So, he's beginning to articulate a kind of federal regulatory vision for deprescribing. What specifically is he proposing?

Ellen Barry: He sent a dear colleague letter, which is direct communication to hospitals and doctors. And the dear colleague letter essentially said don't default to using medication for depression and anxiety. Look at other modes of treatment. And we know that lots of things are effective treatments for depression and anxiety. Psychotherapy is probably the number one alternate mode, but also sleep and exercise and diet and lots of other things.

Michael Barbaro: So that is sort of common sense advice. It wasn't controversial. And just to be clear, he's not a doctor, RFK Jr., but he's basically writing a letter to colleagues in the world of public health and the medical community.

Ellen Barry: Correct. And then he introduced a billing code that would allow Medicare and Medicaid providers to be reimbursed for helping patients get off medications.

Michael Barbaro: And why is that important?

Ellen Barry: It's important because it can be complicated and timeconuming to help people quit a psychiatric medication, especially if they've been taking it for a long time or they're taking a complicated cocktail of four or five psychiatric medications. It takes a lot of time and usually psychiatrists are reimbursed for 15minute med checks every month. That's just not enough time. So he's financially attempting to incentivize doctors to participate in deprescribing.

Ellen Barry: Yes. And another thing he set in motion is what's called a technical expert panel to develop guidelines for tapering off SSRIs. And this panel would create a new set of recommendations for healthcare providers on how best to do this.

Michael Barbaro: Ellen, what's the reaction to these proposals, to this speech from the Secretary of Health and Human Services from the world of medical experts out there?

Ellen Barry: Yeah, I was really curious about that because it was noticeable that there were no medical organizations involved in putting together this sort of day of policym around the use of SSRIs. And when I reached out to them, I think there was a degree of alarm that they had somehow been excluded from this process which sort of drives it. You know, one of the central functions of psychiatry. And I had an opportunity to find out a little bit more about that because the American Psychiatric Association held its annual meeting 10 days later.

Michael Barbaro: That is extremely convenient journalistically. I'm going to assume you went. What did you find?

Ellen Barry: What I found was kind of twofold. Some people that I talked to were worried that this was just the first step in a much more ambitious plan on the side of Secretary Kennedy that would lead to a bigger discrediting of psychiatric treatments.

Michael Barbaro: So their fear is that whatever this is, it's just the beginning maybe a side door into greater government what perhaps restrictions on these drugs.

Ellen Barry: So, a lot of doctors who I interviewed in the hallways outside sessions at the APA said that SSRI are the foundation of their practice that they are so safe that they've been using them for so many years and that they turn people's lives around. They make the difference between being able to get up in the morning and get dressed and get to work and not being able to do those things. So a lot of them were kind of passionate about saying what they have seen with patients and I think the worry is that people are going to be driven away from taking medications or that somehow their access will be restricted.

Michael Barbaro: How many doctors at this conference were open to or even in agreement with what RFK Jr. is talking about here when it comes to deprescription?

Ellen Barry: Yes. So there was a second big takeaway that I had from this gathering which is that a substantial number of doctors there agreed that this is an area where we could do a lot better. That is training of psychiatrists focuses a great deal on putting people on medications but much less on what it means to take them off and what a challenge it can be. And a number of people I interviewed expressed frustration over that. In one of the panels that I attended, a doctor, Ronald Winshell from Columbia University School of Medicine, said that when he looked back at his long career, one of the things that he most regretted is not taking patients off medications until later than he should have. That is hesitating for various reasons even when he thought that the medication was no longer needed or no longer effective.

Michael Barbaro: It sounds like the second group of doctors you're talking to feel like RFK Jr. has identified a problem in their world that everyone should be more focused on.

Ellen Barry: Yeah, I think there was a lot of discussion of deprescribing at this conference. There was a number of panels on deprescribing different classes of medications. There was a new deprescribing handbook and it was selling a lot downstairs in the exhibition hall. And in conversations with doctors, a number of them acknowledge that this is an area where we could do a lot better at supporting patients.

Michael Barbaro: One thing we haven't talked about here is objective research that would clarify the questions we're discussing. If Ellen the assumption now is that doctors aren't talking enough about getting off these drugs, that's certainly the case RFK Junior's making. Some doctors are making it too. The implication is that people are on these drugs for too long. So, what does the research tell us about long-term use of SSRIs?

Ellen Barry: The reality is that there isn't all that much research on that.

Ellen Barry: Most of the clinical trials we have on these drugs are efficacy trials and they're shorter term, like 6 to 8 week trials that are necessary for FDA approval. There's some longer term work, but very little that tells us what happens after 3 years or 5 years or 10 years. And I think when SSRIs were first introduced in the 1980s, it wasn't anticipated that people would be taking them for years and years. The clinical guidelines say once someone's symptoms are in remission that you should discontinue the medication after 6 9 12 months and just go back off.

Ellen Barry: But I think we see in reality that for a lot of people that's just not happening. So one study found that the median duration of treatment with an SSRI is 5 years and for many it's a lot longer than that.

Michael Barbaro: That amazes me to be honest that we don't have much of any long-term research on what has become for so many people long-term treatments. I mean, if millions and millions of people are taking these prescription drugs for years and years and years, it's deeply surprising that we don't know clinically what the impact of that is,

Michael Barbaro: right?

Ellen Barry: That kind of research just hasn't been a priority.

Michael Barbaro: So, in the weeks since RFK Jr. introduced these ideas and once the medical health world began to absorb them, what has actually happened to these proposals?

Ellen Barry: Well, the incoming president of the APA is going to have a seat on one of the technical expert panels that will be developing guidelines in this area. There's also a psychiatrist from the American Society of Clinical Psychopharmarmacology. So there are going to be representatives of sort of major professional groups at the table.

Michael Barbaro: Got it. So a lot of these medical experts decided that even if they were skeptical of RFK Junior's agenda here that they wanted to be a part of it. If you can't beat them, join them, shape them.

Ellen Barry: They wanted a seat at the table. I mean, as this deprescribing project gets off the ground, it's involving both establishment mainstream psychiatry and across the table, representatives of a totally different group that has been watching psychiatry critically from the outside for a long time. And that includes patients who are saying, "How long are we supposed to be on these things? And why haven't we been having these conversations with our doctors the whole time?

Michael Barbaro: We'll be right back. Ellen, I want to turn to this world of patients who have been eager for this deprescription conversation to reach the point that it now has where the federal government is broaching it and medical experts are now joining the conversation. And in particular, I want to better understand the specific reasons that patients are giving for wanting to get off these medications and the specific experiences that lead them to that decision.

Ellen Barry: Well, you know, whenever I write about this subject, we really get inundated with personal stories and people have different reasons for wanting to get off a medication.

Patient H: So, I thought like if I get off the antressants, I can see what life is without this numbness.

Ellen Barry: Sometimes they feel like their emotions have been kind of muffled.

Patient I: I wasn't having these anxious thoughts, but I also wasn't experiencing like as much high good emotions either.

Patient J: There was like delayed sexual side effects that

Ellen Barry: sometimes they have side effects. Sometimes they feel that the medication just isn't working anymore.

Patient K: Maybe it's the classic thing. Oh, I feel great. I must not need my medication anymore.

Patient L: By then I had been on the medication for about 25 years and I was just curious what would my life be like without this

Ellen Barry: and I've heard from a lot of people who said you know I started taking this medication when I was a teenager and maybe that's what I needed to get through that period. But now many years have passed and I've entered adulthood not exactly knowing who I was

Michael Barbaro: right who you would be without those drugs. Exactly.

Patient M: It's FOMO. It's like, what am I missing out on? I want to live in real life. I don't want to live in black and white. I want to live in color. You know,

Ellen Barry: like those intense emotions that can feel so uncomfortable, especially when you're a very young person, they're also part of your personality. And I hear from people who say like, I want to know who that person is.

Michael Barbaro: Once these people you're hearing from decide that they're going to try to stop taking these medications, how have they actually technically been doing that and who is guiding them through that process?

Ellen Barry: I mean, I think some people work with their doctors in getting off or tapering a medication and some people don't.

Patient N: I went in and they were like, "Hey, you want a refill of your Zoloft?" And I was like, "Yes, I guess if I still need to be on it." and they were like, "Cool."

Ellen Barry: A lot of the people we hear from say this conversation about how to get off isn't happening with their doctor or if it is happening, it isn't satisfying. Or for others, they just don't see their doctor often enough to get the kind of robust support that they need.

Patient O: I'm not going to say all doctors, but I don't know if how many doctors really grasp what it is to be on anti-depressant. If you go in there and you're feeling depressed, they say, "All right, they just raise the medication." Some are better than others, but I never really go to them to get off it. I did that myself.

Ellen Barry: And in some cases, people just lose trust in their doctor if they think that the medication that they've been prescribed is making them worse.

Patient P: I'll be honest, I at this point, because I had been dismissed about everything else, I was like, I don't trust these people. I can make my own health decisions.

Ellen Barry: And those people have been talking to each other now for years and years with a lot of frustration towards organized medicine.

Michael Barbaro: And for those folks who have been trying to do this essentially DIY, what has been their playbook, for lack of a better word, what does it look like?

Patient Q: I use Dr. Google and I look at forums on Reddit and stuff like that and people are like, um, if you do cold turkey, it can really destabilize you a little bit.

Ellen Barry: So the kind of subculture around tapering and withdrawing from medications has been out there since the early days of social media. One example is a site called surviving anti-depressants. And what you would find there is people exchanging their withdrawal protocols and it got incredibly technical. People would be talking about reducing their dosage by a single bead within the capsule or liquefying it or using pharmaceutical scales. And over time I you know that network has sort of matured into a real marketplace of support

Michael Barbaro: and that's presumably to avoid the side effects of abruptly taking yourself off of one of these drugs. But even when people are very careful and very gradual, what are the side effects of ending these treatments?

Ellen Barry: The side effects that you most often hear about are vertigo, nausea or flu-like symptoms.

Patient R: I completely stopped sleeping.

Ellen Barry: insomnia, something that they call brain zaps,

Patient S: electricity in my head,

Ellen Barry: which are like a twinge or a sense of a feeling of a sort of a shocklike sensation in the brain.

Patient T: It's like this kind of thing.

Ellen Barry: And there's some portion of people who describe the process of withdrawal as really intolerable,

Patient U: like jumping out of their skin. And it is its own kind of debilitating crisis.

Patient V: I would like watch a movie and cry. I'd watch commercial and cry. I'd read a book and I'd cry. I was listening to the Beach Boys Pet Sounds album and just tears coming down my eyes. It felt good for a while, but then it was like it was like going like having emotions that were like a dripping faucet to like a fire hose. It was too much.

Ellen Barry: But what doctors generally say is that for most people these symptoms really only last for a few weeks and then if after that you're feeling dramatic mood changes, you might be experiencing relapse.

Michael Barbaro: Essentially the conditions that may have prompted you to first go on these drugs.

Ellen Barry: Yes. However severe these side effects are, they would seem to buttress the argument that the best version of deprescription is a medically supervised one where you're not trying to do it yourself and you're not determining dosages and tapering and where the same doctor who prescribed the drug is the one helping you get off of them and aware that you're trying to do it and helping you manage what could be a brain zap or a resumption of symptoms. This feels like something that should not be DIY.

Ellen Barry: That's certainly the view from within medicine that one of the reasons that you need supervision if you're doing something like this is just to guard against the possibility of a relapse. And this would seem to make the case for the conversation that RFK is pushing the medical world to have,

Michael Barbaro: right?

Ellen Barry: I think there is some acknowledgment that prescribers aren't putting the same amount of care and attention into landing the plane as taking off.

Michael Barbaro: Well, Ellen, here I want to acknowledge that the conversation that RFK is trying to have and that we're having here is not theoretical for me anyway. And here I'm going to shake my Lexapro. I've been on Lexapro as an anti-anxiety medication for at least a decade. It was prescribed by a psychiatrist, but then just became part of my relationship with my general practitioner. I just kind of get it renewed and I've not really been asked to think about how long I should be on it. And now suddenly having this conversation with you is making me ask that question. How long am I supposed to be on it? What would happen if I stopped taking it? Would all the white noise of anxiety that made me want to go on Lexapro, would that return? or 10 years later, have I outgrown that? And I just don't know it because I've never tried to taper myself off this to find out who I would be if I weren't me on Lexa Pro. I mean, it's not a simple question.

Ellen Barry: I hear so many people asking that kind of question like, is there some authentic self that I want to go back to?

Michael Barbaro: You know, what would life look like if I took this medication away? I just think that question is percolating and I feel like what's a little bit more complicated is if you think it works for you, you become sort of I don't know psychologically attached to them

Michael Barbaro: and you think if I quit this am I going to spiral? Am I going to feel bad again? And we know that the placebo effect is a huge part of the picture with these medications. And I think it's the same when you go off. They call it the no SIBO effect, which is if you think it's essential to you, you may be just afraid of stopping, afraid of finding out what that's like, and that could sort of contribute to your feeling bad.

Ellen Barry: Mhm.

Ellen Barry: Michael, in your case, what did you conclude about stopping?

Michael Barbaro: me. I don't know that I've ever gotten far enough along in the conversation with myself to stop. I just know that on the occasions when I have failed to reliably take Lexapro, I have experienced some really crippling headaches which I needed a doctor to tell me were from not taking my Lexa Pro reliably. But there was no deeper conversation. There was no is it time to think about whether you should be tapering? How long have you been on it? It was just an accepted fact in my conversation with the doctor that I was on it and then I'd probably still be on it for as long as I'm going to be on it.

Ellen Barry: And do you think that that conversation should have happened when you first went on?

Michael Barbaro: I wonder now. But now I'm asking myself the question of are we all infantilizing ourselves in the face of medicine? Should I be asking this question myself? Why should I be waiting for a doctor to ask it? It's getting a little existential now.

Ellen Barry: Mhm. I mean, some people have multiple remissions and what I hear from physicians is if you've had like three episodes of depression, then you probably are going to take an SSRI for indefinitely as a maintenance treatment.

Michael Barbaro: And if it's fewer than three, then no, then you should try to get off if you want. But I don't think there's a lot of energy around having that conversation, right? I mean, we're talking about deprescription here because that's the conversation that RFK Jr. and those around him want us to be having. But there's also a possibility that people are going to hear this conversation and instead of just deprescription, they're going to hear maybe I shouldn't ever get a prescription. And I wonder if that's a risk that RFK Jr. and the medical experts who are now joining him in this conversation are thinking about. I mean, because I cover psychiatry and mental health, I have been doing interviews all over the country about people's use of this kind of medication. And I'll tell you that like they're reaching parts of society that just wouldn't have gotten any kind of mental health care in the past. So, I remember talking to

Michael Barbaro: I think he was an auto mechanic and I was doing interviews in a school parking lot and he said, you know, like my father was an angry drunk and because I take an anti-depressant, I know I'm not going to go that way.

Ellen Barry: And there are groups within our society that are only now for the first time getting access to a treatment for depression or a treatment for anxiety. I mean, I think if you look at the numbers, white people take anti-depressants at a rate that is twice as high as any other racial category and like five times as high as Asian people. So, there's just a huge discrepancy. Some groups take these a lot, some groups really don't have much access. In other words, because of the demographics of who takes these mental health drugs, there are plenty of people who perhaps could benefit from them who have never been introduced to them or are just starting culturally to accept the idea that they can and will be on them and the overprescription deprescription conversation isn't necessarily the right one for them to be having right now.

Michael Barbaro: Yeah, I think that's right.

Michael Barbaro: I mean it may be that there is no one message that is appropriate for our entire society. So I think RFK Jr. the secretary has to be very careful about encouraging this conversation about stopping medication when it's appropriate without driving people away from the idea of treatment completely.

Michael Barbaro: Right? It's one thing to have a conversation about deprescription. It's another to intentionally or not stigmatize ever getting a prescription.

Ellen Barry: Yeah, I think both of these conversations need to happen. How to access treatment that people really desperately need and also how much is enough and how to stop.

Michael Barbaro: Well, Ellen, thank you very much. We appreciate it.

Ellen Barry: Thank you.

Michael Barbaro: We'll be right back.

Michael Barbaro: Here's what else you need to know today. As a new round of peace talks started between the US and Iran on Sunday, the conflict between Israel and Hezbollah in Lebanon threw a wrench into the negotiations.

Michael Barbaro: Fighting between Israel and Hezbollah prompted Iran to claim it was once again closing the street of Hormuz, a threat US officials said had not been carried out. Iran has demanded that fighting in Lebanon end immediately, but ceasefires there have been declared, broken, and reinstated several times over the past few weeks.

Michael Barbaro: and problems with President Trump's $14 million renovation of the Lincoln Memorial reflecting pool, time for America's $ 250th birthday next month, have become so severe that Trump said he will have to partially drain the pool for repairs.

Michael Barbaro: Over the past few days, the pool's new coat of dark blue paint applied by a company that has never before worked for the federal government has begun to visibly peel. And green algae has spread across the pool, likely because the renovation project does not fix the pool's malfunctioning filtration system.

Michael Barbaro: Today's episode was produced by Alex Stern, Jack Didoro, Claire Tennis, Scattered, and Stella Tan with help from Anna Foley, and Olivia Nad. It was edited by MJ Davis Lynn with help from Brendan Clinkenberg and contains music by Pat McCusker and Dan Powell. This episode was engineered by Alyssa Moxley. That's it for the daily. I'm Michael Boro. See you tomorrow.