To the Editor:
Re “Harm From Antidepressants Is Real. Let’s Not Cede the Conversation to Kennedy,” by Awais Aftab, a psychiatrist (Opinion guest essay, May 7):
As a practicing psychiatrist, I agree with Dr. Aftab’s call for studies of psychiatric drug side effects and withdrawal effects, as well as greater transparency about potential risks and benefits. He describes well the dilemmas faced by psychiatrists in everyday clinical practice.
It is important, though, to point out that a number of studies show that the majority of S.S.R.I. prescriptions are written by primary care providers, not psychiatrists, and by other providers who do not have adequate training or support in treating depression and other serious conditions these medications can address.
Most well-trained psychiatrists do take the time to explain and monitor side effects and withdrawal symptoms. It is not unusual, for instance, to take a year or more to properly taper off these medications. It is the rare primary care physician who has the time and training to do this. The studies Dr. Aftab calls for would not only help guide treatment, but just as important, also mitigate the effects of disinformation about these important medications.
Jeffrey Rubin
Madrid
To the Editor:
While I appreciate Awais Aftab’s concerns about antidepressant side effects and withdrawal symptoms, I believe that there are more pressing and legitimate causes for concern.
First, irresponsible comments by the health secretary, Robert F. Kennedy Jr. — absurdly suggesting, based on anecdotal experience, that S.S.R.I. withdrawal is worse than coming off heroin — risk frightening away those in need of proper mental health treatment, possibly putting them in danger.
Second, the majority of S.S.R.I.s are prescribed by nonpsychiatrists who are trying to fill a primary care function because of the dearth of mental health professionals, particularly in rural areas. Psychotherapy, especially for less severe forms of clinical depression, is a credible and evidence-based treatment and a viable option for many patients receiving S.S.R.I.s — if one can get the help.
Larry S. Sandberg
New York
The writer is a professor of psychiatry at Weill Cornell Medical College and the author of “Psychotherapy and Medication: The Challenge of Integration.”
To the Editor:
Awais Aftab’s guest essay about the real but generally treatable adverse effects of discontinuing antidepressants threatens to do more harm than good. The essay ignores Robert F. Kennedy Jr.’s serious and false assertions that antidepressants are partly responsible for the rise in mass school shootings and suicide, a claim for which there is no evidence. Decades of clinical trials show that the combination of medication and psychotherapy is frequently effective in reducing the symptoms of depression.
In the October 2024 issue of the medical journal Health Affairs, our systematic review of the strongest worldwide evidence shows that even written F.D.A. warnings for children and youths that antidepressants might be linked with suicidal thoughts at the start of treatment had unintended adverse consequences.
The fear and stigma of the warnings reduced use of all mental health care, including medications, psychotherapy and doctor visits for depression; this resulted in increased suicide attempts and abrupt increases in suicide deaths among adolescents and young adults.
Dr. Aftab ignores the policy consequences of the health secretary’s unscientific rants and, in turn, does cede the argument to an administration threatening access to proven mental health treatments and survival in a large, vulnerable population.
Stephen B. Soumerai
Brookline, Mass.
The writer is a professor of population medicine at Harvard Medical School.
To the Editor:
There is one important omission in Awais Aftab’s otherwise excellent discussion of the need for antidepressants to be tested for safety. It is common for psychiatrists (and other health care providers) to recommend that patients start or continue psychotherapy while taking an antidepressant. The combination is more effective than either alone.
Talk therapy is not mentioned in the piece, and it would be important for future studies of the frequency of adverse outcomes resulting from the discontinuation of an antidepressant to take into account whether the patient was in therapy at the time. One finding of such studies may be that someone going off an antidepressant would do well to continue psychotherapy during the transition period.
Seth Wittner
Worcester, Mass.
To the Editor:
I was glad to read Awais Aftab’s essay on the need to take the negative medical effects of psychiatric medication seriously. But I would like to highlight an issue that is far less often addressed: that it can be hard to determine if the drugs are even working in the first place.
Some patients who take psychiatric drugs know that they are better off. They feel lighter, sharper and more capable. But for many, improvement is devilishly hard to measure. To discern what the medication is actually doing can require a deep dive into the murk of subjective experience, where nothing is clear.
“Are you feeling better?” the psychiatrist asks. If you do feel better, is the medication the cause? Is it the work you’re doing in psychotherapy? Is it that you’re eating better and exercising more? Is it a placebo effect?
The confusion creates its own inertia. Once you get it into your mind that you may need psychiatric drugs, it can seem almost impossible to stop taking them. Why run the risk of withdrawal symptoms or the resurgence of your depression or anxiety? In this way, years can pass during which you wonder whether you might feel and function better without the drugs.
The damage here isn’t an empirical matter; it’s a moral one. And it gnaws at many of us, even as, for the umpteenth time, we trudge to the pharmacy to refill our prescriptions.
Daniel Smith
Brooklyn
The writer is a psychotherapist and the author of the books “Monkey Mind: A Memoir of Anxiety” and the forthcoming “Hard Feelings: Finding the Wisdom in Our Darkest Emotions.”
