Is Psychiatry Corrupt? Aftab and Antidepressants

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AFFIRMING PSYCHIATRY

Long ago, I confessed to being something of a fan of Awais Aftab, MD. Aftab is a psychiatrist who once had a popular series in Psychiatric Times, in which he conducted affable and interesting interviews with a variety of critics of psychiatry. These days, he still contributes to Psychiatric Times, but also writes on his own Substack and occasionally appears in the pages of The New York Times.

On a recent occasion, he weighed in on President Trump’s executive order to Make America Healthy Again (MAHA), which includes a specific investigation into a “threat posed by the prescription of selective serotonin reuptake inhibitors” and other psychiatric medications.¹

Compared with virtually every other treatment of mental health in The New York Times, Aftab’s article is exceptionally even-handed. It is calm and evenly balanced discussion of the pros, cons, and unknowns of taking serotonin-specific reuptake inhibitors (SSRIs). He faithfully embodies his opinion, that “the public deserves advice … that does not oscillate between stupor and alarmism.”

Aftab’s Critique

Regarding antidepressants, Aftab elegantly and accurately alludes to most of the major issues with these medications:

• That SSRIs do help countless individuals with depression and anxiety: Check!
• That SSRIs appear to help prevent the recurrence of depression, but we need much more research on this subject: Check!
• That SSRIs, like all other medications, have potential risks and benefits, so that while some are helped by SSRIs others may experience problematic adverse effects: Check!
• That a substantial number of patients experience discontinuation symptoms coming off of these medications, with a very small minority having severe and prolonged withdrawal symptoms: Check!
• That “if psychiatry refuses to engage seriously with patients’ concerns [about SSRI’s] .. it will lose credibility.” Wait, what? Yes, says Aftab, “we cannot disregard those whose lives have been derailed by psychiatric medications.”
  

Well this is an approach guaranteed to raise a few questions. For instance, just who is this that is disregarding the lives of patients who take psychiatric medications? And just how is psychiatry refusing to engage with patient concerns about SSRI safety? And just what does Aftab mean by his concluding warning that establishment psychiatry is likely to be subject to individuals who will “burn the system to the ground” if it does not speak to their concerns with “humility and scientific transparency”?

Is Psychiatry Dominated by Self-Interest?

I am once again in 2 minds about an Aftab article. On one hand, he is right. We do need to be responsive rather than dismissive about the concerns of critics of our field, even harsh critics. On the other hand, who says that psychiatry has not been responsive? Psychiatry has been by far the most intensively scrutinized and criticized medical specialty for the past 75 years. And, in spite of its many failures, psychiatry has been responsive to its critics. It has moved past subjective and inconsistent diagnosis, past the widespread use of scientifically unvalidated treatments, past the temptation to blame or objectify our patients, and past its history of paternalism and superiority. In spite of now outdated stereotypes, psychiatry (more than any other medical specialty) welcomes other types of professionals to the treatment team, engages in constant self-reflection and self-criticism, recognizes the importance of social determinants of health, and integrates them into a full, whole-person biopsychosocial approach. Patients and patient advocacy groups have had immense influence in research, treatment, and public policy related to our field of mental health, more so than any other specialty.

Where exactly is this prideful and defensive approach that Aftab so sternly warns us to give up? He presents us with 2 examples which he seems to regard as illustrative: Exhibit A is a statement by the American Psychiatric Association (APA) and several other organizations that was issued in response to the MAHA order to investigate the threat of psychiatric medications.² The APA statement declares that psychiatric medications are “safe and effective,” and that statements declaring antidepressants to be addictive are misleading. It does not otherwise mention SSRI withdrawal, which Health and Human Services Secretary Kennedy had compared with opiate withdrawal. Aftab takes this as a sign that the psychiatric establishment is uninterested in the plight of individuals withdrawing from antidepressants, I suppose because there is no mention of the reality that some individuals do suffer when getting off antidepressants.

Exhibit B is the assertion that there has been “not a single high-quality randomized controlled trial” to guide us in tapering patients off antidepressants. This apparently means that psychiatry and the drug companies do not want to find out more about adverse effects of these medicines and are therefore oblivious (or ‘stuporous’ in his terminology) to the risks of these medicines.

Critiquing the Critique

What is so bad about this criticism of psychiatry? Nothing at all, as a set of criticisms directed toward psychiatrists and researchers. But as a set of criticisms of psychiatry directed toward the general public, I think it is problematic. Aftab is not talking to individuals who are knowledgeable about the realistic strengths and weaknesses of psychiatric practice here. He is talking to the readers of The New York Times, readers who consume a steady diet of stories like “Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices,”³ and “Have We Been Thinking About ADHD All Wrong?”⁴ The subtext of most of these stories vacillates between viewing psychiatry as a conventional medical specialty and viewing psychiatry as biologically unreal, therapeutically ineffective, and financially driven.

So what might Aftab’s approach convey to regular readers of this sort of information? That psychiatry as an institution really wants to get individuals on antidepressants and does not care how difficult it can be to get off antidepressants. That psychiatry really does not listen to its critics or want to engage with them. That the description of SSRIs being more addictive than heroin is not an obviously inflammatory exaggeration. That psychiatry disregards the well-being of patients who are hurt rather than helped by our treatments.

All of these general impressions are false. And while Aftab does not believe or directly articulate those impressions himself, he writes about them in a way that risks reinforcing their intellectual respectability among our public. He does little in this article to dispel the image of establishment psychiatry as defensive, corrupt, and blind to other interests than its own.

Instead of saying flatly stating that antidepressants are not remotely as addictive as opiates, Aftab discusses the issue as if it were an open question. Instead of noting that antidepressant discontinuation has never directly killed or inflicted permanent bodily injury on anyone, he talks as if psychiatrists have little interest in the very real suffering of their patients who do experience withdrawal. Instead of highlighting the APA’s observation that stigmatizing distortions of antidepressants have led to tragic and unnecessary deaths by suicide in the past, he makes a great deal of the APA’s failure to mention SSRI withdrawal. Instead of noting that psychiatric illnesses are real biological illnesses which are deadly and disabling, he scolds the establishment for focusing on basic science and pharmaceutical research over questions of clinical practice like antidepressant withdrawal.

I wonder if Aftab as a practicing physician would want to appear so neutral about well-established general medical treatments. Let us take the issue of vaccines as a purely random example. Would Aftab write as if the concerns and criticisms of anti-vaxxers are on an equal scientific footing with the medical establishment? Would Aftab fail to mention that vaccine skepticism has likely resulted in far more deaths than any adverse effects of vaccines? Would Aftab assert that taking the link between autism and vaccines seriously would finally help anti-vaxxers to feel heard?

Concluding Thoughts

The practical point of Aftab’s editorial is entirely correct and well-stated: Private research foundations need to step in and fund research on clinically important questions of how to manage SSRI discontinuation and other adverse effects of psychiatric treatments. More broadly, psychiatry should actively engage its critics in an open and constructive way around such issues. I agree with him 100% about both assertions. But I do not like the way the debate is framed here, a way that exaggerates the negatives and deemphasizes the positives of psychiatry. I am concerned that efforts such as this in a periodical such as The New York Times will ultimately do little to help the cause of mental health. Leaving room for such a skewed view of psychiatry may help Aftab get a hearing from psychiatry’s critics, but it will not help our general public or our public policy. I am not even sure that it will help prevent psychiatry’s critics from ‘burning it to the ground.’

Dr Morehead is a psychiatrist and director of training for the general psychiatry residency at Tufts Medical Center in Boston. He frequently speaks as an advocate for mental health and is author of Science Over Stigma: Education and Advocacy for Mental Health, published by the American Psychiatric Association. He can be reached at dmorehead@tuftsmedicalcenter.org.

Acknowledgment: The author would like to thank Dr Aftab for his helpful comments on an earlier version of this article.

References

1. Aftab A. Harm from antidepressants is real. let’s not cede the conversation to Kennedy. New York Times. May 3, 2025. Accessed May 28, 2025. https://www.nytimes.com/2025/05/03/opinion/antidepressants-withdrawal-rfk.html 

2. American Psychiatric Association, et al. Joint statement on federal concerns about psychotropic medication safety. March 21, 2025. Accessed May 28, 2025. https://www.psychiatry.org/news-room/news-releases/joint-statement-on-federal-concerns-about-psychotr 

3. Morehead D. Are psychiatrists pill pushers? Psychiatric Times. September 21, 2022. https://www.psychiatrictimes.com/view/are-psychiatrists-pill-pushers 

4. Morehead D. The New York Times moves the goalposts on ADHD. Psychiatric Times. May 8, 2025. https://www.psychiatrictimes.com/view/the-new-york-times-moves-the-goalposts-on-adhd