Rapid Reactions: Psych Congress Faculty Respond to HHS Deprescribing Initiative

Integrative psychiatry and the potential deprescribing of antidepressants and other psychotropic medications entered the national spotlight last week with the publication of a Department of Health and Human Services (HHS) action plan and Dear Colleague Letter targeting “inappropriate prescribing.”

Psych Congress Co-Chairs and Steering Committee members Rakesh Jain, MD, MPH, Charles Raison, MD, and Greg Mattingly, MD, share their expert perspectives on and reactions to the federal initiative, anticipated consensus guidelines, and the clinical realities of balancing medication benefits with risks such as side effects and polypharmacy. They explore practical strategies for safe deprescribing, emphasize patient-centered care, and highlight the importance of lifestyle interventions and neuroplasticity. These insights aim to help clinicians optimize treatment while avoiding both overprescribing and unintended consequences of under-treatment.

Key Clinical Takeaways

• The United States Department of Health and Human Services (HHS) issued a Dear Doctor letter emphasizing widespread antidepressant and psychotropic medication use and the need for appropriate deprescribing conversations, noting that many patients remain on medications longer than necessary due to lack of clinician-patient review, and that prolonged use may lead to withdrawal symptoms when discontinued without proper planning in outpatient mental health care.
• A February 2026 Journal of the American Medical Association (JAMA) consensus guideline developed by 45 experts from the American Society of Clinical Pharmacology recommends once-annual medication reviews, individualized tapering or cross-tapering strategies, and patient-centered shared decision-making, while advising clinicians to change one variable at a time and discontinue medications that are ineffective, poorly tolerated, or no longer clinically indicated to reduce polypharmacy.
• Historical United States Food and Drug Administration (FDA) warnings about antidepressant-associated suicidality in youth were followed by decreased prescribing and a corresponding increase in teenage suicide rates, highlighting the risks of under-treatment and reinforcing that deprescribing should be balanced and cautious, particularly in patients with severe psychiatric conditions such as schizophrenia, bipolar I disorder, or obsessive-compulsive disorder, where ongoing pharmacotherapy may be essential.
• Psych Congress has been a leading voice on the topic of deprescribing and wellness interventions in psychiatric practice for over 15 years, and will continue to offer the latest news and clinical guidance on integrative psychiatry.

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Rakesh Jain, MD, MPH: Recently HHS put out a press release talking about the importance at the national level, at the federal level of a deep conversation regarding antidepressant use in American society and, perhaps, how in appropriate situations these medications can be deprescribed. This is a really important set of news for American society at large but also for psychiatry. So, it's important we have a quick discussion on it.

Overall, I think this conversation, the time is right for it. There is widespread use of antidepressants in America and in most people, I have found them to be quite appropriately used. There are a large number of patients who simply no longer need antidepressants, but they're continuing to be on it because neither they nor their prescribers have had a conversation about how to deprescribe, how to add perhaps even other assets, such as psychotherapy and wellness techniques, to help bridge the gap.

Because such conversations have not happened, very many people chronically stay on these medications when they don't need it and, when they do come off it after a prolonged period of time, suffer from significant withdrawal symptoms. No, not everybody has it, but enough have it that I welcome this conversation at the national level.

I will also say at Psych Congress, we have been leaders in this conversation for well over 15 years. In fact, the very first talk on deprescribing was one I was lucky enough to offer many years ago. We led this conversation years ago because we also think that appropriate prescribing is about the only way to go and excess prescribing or prolong prescribing when it is not necessary is inappropriate.

So what we will do at Psych Congress is stay on top of the news, offer you cutting edge information. There are going to be multiple guidelines that'll come out in due course and we will completely keep you posted on it. Even at this year Psych Congress, we intend to be talking about appropriate prescribing, appropriate deprescribing, and also the use of complementary medicine of all sorts, including wellness interventions.

So thank you for this opportunity to talk to you about this very important set of news emerging at the national level, at the federal level. Goodbye for now.

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Greg Mattingly, MD: This is Greg Mattingly joining you from Psych Congress to discuss recent updates in the Dear Doctor letter that was sent out by the Department of Health and Human Services regarding the role of psychotropic medications and the potential role of deprescribing.

Here at the Psych Congress family, we have been dedicated to holistic mental healthcare for the last several decades. My good friend Rakesh Jain published a series of online interventions called The Wild 5 that promote health and wellness within individuals, individuals struggling with mental health, and individuals trying to live healthier lifestyles. I myself have been part of a series of lectures and articles written about the importance of resilience, how to promote resilience within your own personal life with regards to exercise, nutrition, social connection, sense of purpose, bi-directional link of neuroplasticity and how chronic stress can damage neural networks, but lifestyle interventions and treatment of mental health conditions can all improve neuroplasticity.

As part of that, we see that medications are quite often needed for patients that we take care of with chronic mental health conditions, be those medicines for children with attention deficit disorder, individuals with complex mood disorders, or individuals living with chronic health conditions such as schizophrenia. We know that sometimes patients, though, can be placed on medicines that were only partially effective or have tremendous side effect burden, and sometimes those medicines are inadvertently left, and not discontinued, when we realize they have not become effective. So we see that patients develop a stack of medications, one stacked on top of each other, which perhaps at the beginning made sense, but now in retrospect, you realize this is a stack of medications that should probably be cleaned up, clarified, or some of them discontinued. We then begin the art of deprescribing.

Deprescribing means trying to pull back on medicines that have not been effective. Pull back on medicines that have had unwanted side effects. Pull back on medicines that have been used in combinations where perhaps that combination no longer makes sense, or deprescribing can be a patient who's reached maximal benefit and it's time to see if they still need that medication.

I would like to refer the Psych Congress family and anyone out there who takes care of mental health patients to a very thoughtful article that was published in February of 2026 in JAMA. This was a group of our colleagues that belonged to an organization called the American Society of Clinical Pharmacology. 45 experts in the field—researchers, clinicians, people that believe in holistic care, educators—who got together and said, "Let's develop a consensus guideline on how to safely and appropriately deprescribe medicines when needed.” They talk about the potential of stopping a medicine versus gradually tapering. They talk about the potential of cross-tapering medications. They give specific side effects that can be encountered when trying to discontinue certain medications, such as an SSRI. They talk about holistically taking into account the patient's perspective: “I think this medicine's helping” or “I'm fearful of discontinuing” or “I think this medicine really hasn't done much and I'd like to discontinue based on side effects.”

They recommend at least a once-annual review of a patient's medications to see does it make sense to deprescribe some of the medications the patient is on. They also give us a note of caution and that's to change one variable at a time. Don't try to deprescribe everything, don't stop and start everything, do this in a thoughtful, holistic manner, move one variable to time, and see if you can simplify and adjust and optimize outcomes for your patients through thoughtful consideration of potential deprescribing.

One note of caution that I have, having lived through decades now in the mental health system, is that several decades ago we had a warning issued by the FDA about the possibility of increased suicidality in children taking antidepressants. While that warning was accurate, it created fear amongst many clinicians about appropriately treating young individuals with depression. Over the next several years, we saw the rates of antidepressant prescriptions go down in teenagers struggling with depression. At first, we thought that was hopefully a good thing, but we realized unfortunately it was associated by an increase in teenage suicide completions. That association was a direct relationship correlation to the counties that had the biggest drop in treatment levels with antidepressants had the biggest rise in teenage suicides.

So, I want us to all think about thoughtfully looking at adjusting medications, decreasing medications, not stacking medications that don't make sense or cause unwanted side effects. Go back to that article in JAMA and read up on how to safely deprescribe and consider that at least once a year for your patients. Make sure that patients are on board with informed decision-making and informed consent when starting and stopping medications, but then realize that appropriate mental healthcare has never been more important for the patients we take care of.

At Psych Congress, come join us for our upcoming meetings where we're going to have individual sessions talking about the importance of nutrition, the importance of lifestyle interventions, the importance of neuroplasticity, and the exciting new field of medications that are coming along that may not be chronic daily medicines, but may be intermittent as needed treatments for individuals with mood disorders and other mental health conditions.

This is Greg Mattingly as part of the Psych Congress family and thank you for joining me today.

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Charles Raison, MD: Hey, I'm Dr Charles Raison. I am on the Steering Committee for Psych Congress. I wanted to just say a couple of words about this recent announcement by the Trump administration regarding this intense push to encourage deprescribing from antidepressants and other psychopharmacologic agents.

I have spent the last probably 25 years studying novel ways to treat depression, ways that did not require taking a pill every day because I have been concerned around evidence suggesting that there are prices to be paid for anything that stays on your brain on a daily basis. The brain tends to react not against it, but it pushes back against it and it can set people up for problems such as emotional blunting, side effects, and then perhaps an increased risk of relapse if people stop the medication.

But I am at the same time, and with that knowledge and years of working in this space, I am concerned that we don't go too far the other direction because while there is no such thing as a medication that doesn't come without a cost, on the other hand, I and everybody that works in clinical mental health can think of a thousand stories of people who were profoundly saved, helped, improved by standard agents like SSRIs, like psychostimulants for ADHD.

I think there's this very sensitive balance that I want us to encourage ourselves to think about, which is yes, there are many people that might benefit from coming off an antidepressant, especially if it's not particularly working. But on the other hand, there is just no doubt that there are people whose lives will unwind without the support of psychopharmacologic agents that we already have available, especially for very severe conditions like bipolar I disorder, schizophrenia, people that are struggling with crippling OCD. In many of these conditions, if a person is helped and stable by the medicines, I think many years of research suggests that one of the worst things we could do is just indiscriminately pull them off those medications.

On the other hand, I certainly agree with the administration stance on the value of nutrition, on the value of exercise, on the value of good sleep, on the value of looking at other things like some of the work that we've done in psychedelics and novel treatments like heat as alternatives for daily medication use, or perhaps as agents that can make the daily antidepressants work better.

But again, as a field, I want to suggest that on the one hand, this push by the administration is welcome in that it really encourages us to think about, how do we avoid overprescribing? But on the other hand, I want us to be very careful as a field and stand a little bit tall around the fact that although not perfect, many of the medicines that have been approved for use for mental illnesses have been extremely valuable, not for all patients, but for enough patients that we really want to make sure that we don't start indiscriminately making it more difficult for these people to get the medications that they need.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr Jain served a 3-year residency in psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training by undergoing a 2-year fellowship in child and adolescent psychiatry. In addition, Dr Jain completed a postdoctoral fellowship in research psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.

Greg Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group. He is also a founding partner of St. Charles Psychiatric Associates where he treats children, adolescents and adults. A St Louis native, he earned his medical degree and received a Fulbright scholarship while attending Washington University. D. Mattingly is board certified in adult and adolescent psychiatry and is a Diplomat of the National Board of Medical Examiners. He is an associate clinical professor at Washington University where he teaches psychopharmacology courses for the 3rd year medical students.

Dr Mattingly has been a principal investigator in over 400 clinical trials focusing on ADHD, anxiety disorders, major depression, bipolar disorder and schizophrenia. Having served on numerous national and international advisory panels, Dr. Mattingly has received awards and distinctions for clinical leadership and neuroscience research. Dr Mattingly is the President for APSARD-The American Professional Society of ADHD and Related Disorders and is on the Scientific Advisory Board for the World Federation of ADHD.  Having served on the board of Headway House, a community support program and as a certified evaluator for both the NFL and MLB, Dr Mattingly is firm believer in holistic mental health, education and advocacy.

Charles “Chuck” Raison, MD, is a professor of human ecology and psychiatry in the Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison. Dr Raison also serves as Director of Clinical and Translational Research for Usona Institute, as Director of the Vail Health Behavioral Health Innovation Center, Director of Research on Spiritual Health for Emory Healthcare and as Visiting Professor in the Center for the Study of Human Health at Emory University in Atlanta, GA.

Dr Raison’s research focuses on the examination novel mechanisms involved in the development and treatment of major depression and other stress-related emotional and physical conditions, as well as for his work examining the physical and behavioral effects of compassion training. More recently, Dr. Raison has taken a leadership role in the development of psychedelic medicines as potential treatments for major depression. He was named one of the world’s most influential researchers by Web of Science for the decade of 2010-2019 and has been honored with a Distinguished Alumni Award from Washington University School of Medicine. Dr Raison received the Raymond Pearl Memorial Award from the Human Biology Association “in recognition of his contributions to our understanding of evolutionary biocultural origins of mental health and illness.” Dr Raison has also won the 2024 Emory University Science on Spiritual Health Torch and Trumpet Award “for a career devoted to the mental and spiritual health of humanity by responding and attending to suffering with a compassionate heart and a keen scientific mind.”

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