What Clinicians Need to Know About the Federal Push for Deprescribing: A Conversation With Joseph F. Goldberg, MD

CLINICAL CONVERSATIONS

At a MAHA Institute summit on mental health on May 4, 2026, the US Department of Health and Human Services (HHS) announced plans to curb “psychiatric overprescribing.”^1,2 HHS Secretary Robert F. Kennedy, Jr. expressed his feelings on the supposed inappropriate use and overuse of psychiatric medications. In the wake of this announcement, several major psychiatric organizations, including the American Psychiatric Association,³ issued follow-up statements.

Joseph F. Goldberg, MD, a clinical professor of psychiatry at The Icahn School of Medicine at Mount Sinai, the immediate-past president of the American Society of Clinical Psychopharmacology (ASCP), and editorial board member of Psychiatric Times, shared his thoughts as an expert on deprescribing in the following conversation.

Psychiatric Times: Talk to us about the new HHS initiative. What is it you think psychiatrists and mental health clinicians need to know?

Joseph F. Goldberg, MD: The recent HHS MAHA initiative that focuses on the term deprescribing in psychiatry and psychopharmacology is a complicated topic. I want to try to try to break down some of the key points.

One very helpful concept that comes from the comments from HHS is the idea that if someone with a mental health condition is taking a medicine—for example, a selective serotonin reuptake inhibitor (SSRI) for depression—to consider stopping it or deprescribing it if it is not beneficial, which makes common sense throughout all the medicine. If you are taking any medicine, a blood pressure medicine or a cholesterol medicine, and it is not helping, it does not make sense to continue a medicine that is not helpful. But the nuance concept here is it is not just about saying, ‘let's stop the medicine.’ It should be ‘let's then do something else instead.’ I think this is where the HHS comments did not necessarily provide as much clarity to our colleagues as practitioners as one might hope. What do you do then instead?

Here's a sad reality about SSRIs and treatment of depression: Depression is still enormously prevalent. It is the leading cause of disability in the world. Most people with depression do not get properly identified, diagnosed, and treated. Some statistics would say less than 1 in 5 people with depression is getting even minimally appropriate care. Additionally, our medicines are not as dramatically helpful as we wish they were in getting rid of symptoms. There is about maybe a 40% chance of a good success with a first go on an antidepressant, and then maybe a 25% to 30% chance of success with a second. A sizable number of people who struggle with depression may not derive enough benefit from a medicine, even when it is adequately dosed and taken. This is a real dilemma, because the remedy here is not to say, ‘let's just do away with medicines and stop them’ and talk about the idea of overprescribing, so much as this more nuanced idea of saying, ‘if something's not working, move on to something else.’ What is something else?

We have new, emerging treatments in psychiatry and psychopharmacology. Psychiatric Times is very devoted to talking about breakthrough treatments, novel strategy, augmentation approaches, and that includes nonpharmacologic approaches like evidence-based psychotherapies for depression. Here, I think the HHS comments were actually quite helpful in pointing out that we as prescribers, clinicians, and as patients may not always be as aware of the value of evidence-based nonpharmacologic remedies for depression. This, in part, depends on a given patient's presentation. For instance, in mild to moderate depression, exercise is an appropriate first-line treatment. It is not necessarily the best treatment for severe, profound, melancholic, suicidal, catatonic depression, where you cannot get out of bed and put 2 words together. That level of severity is different. That is really important to take into consideration in regard to these HHS comments. We must keep in mind patients’ unique circumstances; their candidacy for appropriate, evidence-based treatments, whether those are pharmacologic, psychotherapeutic, or device based, such as brain stimulation neuromodulation approaches, interventional psychiatry approaches, ketamine, transcranial magnetic stimulation; and aligning the right treatment with the right patient.

The key point that I want to emphasize from the HHS comments is not simply to talk about whether medicines are overprescribed and we should get rid of them, but rather, if the medicine is not helping, we have to acknowledge that and then devise a plan for stopping and replacing that ineffective treatment with something that could work.

PT: You wrote a cover for Psychiatric Times on deprescribing last year, so this is something you have been talking about for quite a while now. Do you feel that there is a misunderstanding of the term deprescribing?

Goldberg: Sadly, there is the potential for misconstruing the terminology, as you say. My article in Psychiatric Times from last May, a year ago, talked about how the term lends itself to misunderstanding. Throughout medicine, the concept of deprescribing does not just mean stop treatment; it means evaluate its relevance and then consider whether it is appropriate to continue it or not. There are lots of reasons why a medicine ought to get deprescribed, but it is not because medicines are bad—that would be an oversimplification of a complicated problem and a wrong and potentially dangerous, if not deadly, approach. Rather, we should ask, is it the right tool for the right job? If I have, for instance, a patient with bipolar disorder, an antidepressant may not be as good an idea as a mood stabilizing drug, or typical antipsychotics. If a patient has cognitive problems, before you assume a stimulant is the way to go, make sure the patient does not have dementia, substance use disorder, or head trauma. We want to be very thorough in evaluating whether the treatment aligns with the condition, whether the treatment is appropriate to the condition, whether it is being dosed properly, whether it is being taken as prescribed, and whether an adequate amount of time has gone by. A lot of factors can interfere with that aspect of appropriateness.

The terminology, then, is no different than anywhere else in medicine. If you are on blood pressure medicine, diabetes medicines, estrogen replacement, migraine treatments, cancer treatments, antibiotics, everything in medicine, if it isn't working, reevaluate. But the misconstrue hazard is, if someone were to take the term deprescribing to mean medicines are bad, rather than they are misapplied. We want to be very, very clear.

The ASCP has been writing a lot about this just the last few months, about sort of reclaiming the term away from its misconception. The misconception is all medicines are bad, in an antipsychiatry way. There is a more nuanced approach: assess whether the fit is appropriate for a given patient's presentation, and if the medicines are not the right fit, move on to something different.

PT: You mentioned the antipsychiatry movement. Are you at all concerned that messages like this will convey to the general public that psychiatry is less clinical than certain other medical fields? What can mental health clinicians do to combat that sort of association?

Goldberg: I think we all should be very concerned about that possibility, because without the proper explanation and nuancing, at face value, one could misconstrue and misinterpret some of these recommendations as if to mean, ‘I shouldn't be on medicine.’ Imagine if that is what a cardiologist said: ‘Well, you have heart disease, but you really should not be taking aspirin. It is a blood thinner. Boy, you know medicines can be dangerous.’

The public and everyone must be very aware that it is an oversimplification to say ‘medicines are bad, do not use them.’ When used properly, the benefits exceed the risks and hazards. If we do not take that approach, yes, one could succumb to the wrong, oversimplified message of ‘let's get rid of medicines,’ as opposed to, ‘let's use them properly.’

PT: Do you have any recommendations to psychiatrists and mental health clinicians on what they should be doing to stay updated on this situation? What are your thoughts on moving forward?

Goldberg: Everybody who prescribes or collaborates with prescribers should be reading the ASCP expert consensus statements that were published earlier this year in JAMA Network Open,⁴ as well as in the British Journal of Psychiatry. We have another paper that is just about to come out in the Journal of European Neuropsychopharmacology on deprescribing stimulants in cases of adult ADHD and identifying endpoints. So one way to stay knowledgeable, is to be aware of the primary literature on this, and the ASCP publications are a good place to start.

It remains to be seen what will emerge from the technical expert panel that is going to be occurring this summer. I am actually a member of that, as is Mark Rapaport, MD, who is the president elect of the American Psychiatric Association (APA). He and I will be very attentively present at that meeting to assure that the trajectory of recommendations is consistent with good care and practice, and does not succumb to all or none thinking or oversimplified conclusions.

Consumers of the media need to listen critically for messages that come across and to digest responses from organized medicine. The APA has just published a commentary in response to the HHS statements. The ASCP is also in the midst of putting together a response to help the public navigate this announcement, so that no one makes conclusions about medicines are good vs bad, and also just to be aware of what is evidence-based. We do not want people with depression going off into left field pursuing non-evidence-based treatments for an illness that that kills 50,000 individuals a year from suicide and is the leading cause of disability in the world. That would just be terrible for the health of Americans.

Dr Goldberg is a clinical professor of psychiatry at The Icahn School of Medicine at Mount Sinai in New York, NY and the immediate-past president of the American Society of Clinical Psychopharmacology.

References

1. HHS launches MAHA action plan to curb psychiatric overprescribing. HHS. News release. May 4, 2026. Accessed May 5, 2026. https://www.hhs.gov/press-room/hhs-launches-maha-action-plan-curb-psychiatric-overprescribing.html

2. Kuntz L. HHS launches action plan to promote “appropriate psychiatric prescribing.” Psychiatric Times. May 5, 2026. https://www.psychiatrictimes.com/view/hhs-launches-action-plan-to-promote-appropriate-psychiatric-prescribing

3. APA welcomes national focus on mental health, urges evidence-based approach and continued focus on access to care. American Psychiatric Association. News release. May 4, 2026. Accessed May 5, 2026. https://www.globenewswire.com/news-release/2026/05/05/3287293/0/en/apa-welcomes-national-focus-on-mental-health-urges-evidence-based-approach-and-continued-focus-on-access-to-care.html

4. Goldberg JF, McIntyre RS, Swartz HA, et al. Recommendations for the deprescribing of psychotropic medications: a consensus statement from the American Society of Clinical Psychopharmacology task force. JAMA Netw Open. 2026;9(2):e260043.