Shrinks In Sneakers

Tag: medical education

  • Psychiatry Is on Trial. We Should Not Plead Guilty to the Wrong Charges

    Psychiatry Is on Trial. We Should Not Plead Guilty to the Wrong Charges

    Psychiatry is on trial. It was probably inevitable. A field that treats suffering, suicide, psychosis, trauma, addiction, violence risk, loneliness, despair, and meaninglessness was always going to be dragged into the political arena. Psychiatry sits at the intersection of medicine, culture, family trauma, public fear, pharmaceutical influence, personal liberty, and moral injury. That makes it uniquely vulnerable to distortion.

    But the current moment feels different.

    With Health and Human Services Secretary Robert F. Kennedy Jr. placing psychiatric medications and “overmedicalization” at the center of federal attention, psychiatry is no longer only being debated in journals, clinics, and academic conferences. It is being litigated in public. Increasingly, it is also being litigated in court. On May 4, 2026, HHS announced a MAHA action plan aimed at curbing psychiatric overprescribing, promoting informed consent, shared decision-making, nonmedication interventions, and deprescribing when clinically indicated.1

    Some of that language is reasonable. In fact, many psychiatrists already agree with it.

    Psychiatric medications should not be the default response to every form of human distress. Patients deserve informed consent. Deprescribing should be part of competent care. Psychotherapy, exercise, sleep, nutrition, family support, social connection, and meaning making should not be treated as decorative add-ons. They are often central to recovery.

    But that is not the same as saying psychiatric illness is not real. It is not the same as implying psychiatric medications are broadly dangerous, unnecessary, or responsible for America’s mental health crisis. And it is certainly not the same as turning painful anecdotes into national policy.

    That is where psychiatry must draw the line.

    The American Psychiatric Association has appropriately pushed back on the idea that the mental health crisis can be reduced to overprescribing, noting that this framing ignores workforce shortages, limited access to care, lack of psychiatric beds, and uneven distribution of evidence-based treatment.2 That is exactly right. Deprescribing may be good medicine in selected cases. But deprescribing is not a national mental health strategy.

    It is a clinical tool.

    There is a dangerous pattern in the current conversation. A public figure describes a deeply personal experience: a family member struggles to discontinue an antidepressant, someone feels emotionally blunted on medication, a young adult regrets being started on an SSRI as a teenager, or a patient develops withdrawal symptoms after stopping too quickly. The story is real. The suffering is real. The problem deserves attention.

    But then the anecdote becomes a theory of psychiatry.

    The assumption becomes: because this happened to someone I love, this must be what psychiatry is doing to the country.

    That is not science. That is narrative capture.

    Psychiatry should not dismiss these stories. We should listen to them. We should admit that antidepressant discontinuation can be difficult for some patients. We should acknowledge that medications are sometimes started without a clear enough plan, continued without adequate review, and stopped too abruptly. We should be honest that some patients are placed on medication when what they needed first was psychotherapy, time, structure, sleep, exercise, substance use treatment, grief work, family intervention, or a change in environment.

    But honesty cuts both ways.

    Some patients are not “overmedicalized.” They are undertreated. Some are not being harmed by psychiatry. They are being harmed by the absence of psychiatry. Some patients do not need fewer medications. They need the right diagnosis, the right medication, the right dose, the right monitoring, the right therapy, and a system that does not abandon them after discharge.

    I work in real-world psychiatry. I have seen patients whose lives were devastated by undertreated depression, bipolar disorder, psychosis, catatonia, OCD, addiction, and trauma. I have also seen patients placed on medications they did not need, for longer than necessary, without enough discussion about risks, benefits, alternatives, or exit strategies. Both realities are true.

    That is the entire point.

    Psychiatry’s critics often want one story. The real world gives us several.

    Psychiatric medications can be overused. They can also be lifesaving.

    Antidepressants can cause side effects. They can also help patients return to work, reconnect with family, survive suicidal depression, and function again.

    Stopping medication can produce withdrawal symptoms. Stopping medication can also reveal relapse of the underlying illness. Clinically, those are not always easy to separate, and the distinction matters.

    Psychiatry has a difficult history. It also remains one of the few medical specialties willing to sit with the most frightening, stigmatized, and disabling forms of human suffering.

    The field does not need denial. It needs precision.

    One of the most important reforms psychiatry should embrace is building the off-ramp into treatment from the beginning. When starting an antidepressant, clinicians should discuss expected duration, criteria for continuation, warning signs of relapse, tapering principles, and what remission means. Patients should know that medication is not a moral failure, not a life sentence, and not something to stop abruptly to prove toughness.

    Abrupt discontinuation is not courage. It is usually bad medicine.

    And it is not only psychiatrists saying so. The American Foundation for Suicide Prevention, responding directly to the HHS action plan, warned that “abrupt discontinuation or inappropriate ‘deprescribing,’ particularly outside a collaborative patient-provider process, can increase risk, including the potential for symptom relapse and elevated suicide risk for some individuals.”3 AFSP also reaffirmed what decades of clinical trials, population-level studies, and health system data have shown: judicious use of antidepressants reduces suicide risk overall.3

    That is the suicide prevention community speaking. Not the pharmaceutical industry. Not organized psychiatry. The organization whose entire mission is keeping people alive.

    If HHS wants to support better tapering education, better informed consent, better access to psychotherapy, and better reimbursement for clinicians who take the time to deprescribe carefully, psychiatry should welcome that. In fact, we should lead it. The HHS action plan specifically emphasizes informed consent, shared decision-making, review of risks and benefits, nonmedication approaches, and tapering when patients are not experiencing clinical benefit.1 Those are not anti-psychiatry principles. Done correctly, they are good psychiatry.

    But the same public conversation has also entertained the claim that psychiatric medications cause mass shootings, a claim that has been repeatedly examined and found to lack credible scientific support. When prominent voices repeat it anyway, the harm is not abstract. Patients hear it. Families hear it. Lawmakers hear it. People already afraid of treatment become more afraid. Stigma grows. Care is delayed.

    And delayed care kills. AFSP said as much in its response to this action plan.3

    Psychiatry should not respond to this moment by becoming reflexively defensive. We should not pretend the field has always gotten it right. We have not. We should not deny withdrawal, side effects, diagnostic uncertainty, pharmaceutical influence, rushed prescribing, or the medicalization of ordinary distress. Those criticisms contain enough truth that ignoring them would be a mistake.

    But we should also refuse to accept a false indictment.

    The problem is not that psychiatry exists. The problem is that too many Americans receive fragmented, rushed, algorithmic, poorly monitored, under-resourced mental health care and then call that psychiatry.

    The problem is not that antidepressants are prescribed. The problem is that they are sometimes prescribed without enough diagnostic clarity, psychotherapy access, follow-up, deprescribing planning, or attention to the difference between illness and distress.

    The problem is not that psychiatrists believe in medication. The problem is that our health care system often reimburses medication management more reliably than psychotherapy, family work, lifestyle intervention, prevention, community support, and time.

    That is not an argument against psychiatry. It is an argument for better psychiatry.

    Psychiatry must be willing to say something politically inconvenient: not all suffering is mental illness, but mental illness is real. Not everyone who is sad needs a diagnosis, but some people with depression will die without treatment. Not every anxious child needs medication, but some children are severely impaired and deserve evidence-based care. Not every patient should remain on an antidepressant indefinitely, but some patients relapse repeatedly when treatment is stopped. Not every psychiatric outcome is preventable, but some bad outcomes occur because systems fail.

    It is possible to do everything right in psychiatry and still have a tragic outcome.

    It is also possible to have a tragic outcome because we did not do enough.

    That distinction is where serious medicine lives.

    This is why psychiatry must reclaim the public narrative. We cannot allow the field to be defined only by its critics, by pharmaceutical marketing, by political theater, or by the most extreme anecdotes on social media. We need to speak plainly to the public.

    Yes, antidepressant withdrawal can happen.

    Yes, some patients are overmedicated.

    Yes, informed consent needs to improve.

    Yes, therapy and lifestyle interventions matter.

    Yes, deprescribing should be part of psychiatric competence.

    And yes, psychiatric medications remain essential treatments for many people with serious and disabling illness.

    The future of psychiatry should not be pill-first. It should not be pill-never. It should be patient-first, diagnosis-first, evidence-first, and humility-first.

    Psychiatry will not survive this moment by going quiet, and it will not survive it by going defensive. It will survive by becoming better, and by saying so out loud.

    We are not the cause of America’s mental health crisis. We are also not its cure. We are physicians treating the most disabling illnesses medicine has ever named, in a system that has never funded us to do it well, in a country that wants the suffering to stop but does not want to pay for the treatment that stops it.

    If HHS wants better psychiatry, psychiatry should be the first to demand it. If patients want safer prescribing, we should be the ones leading it. If the public wants honesty, we should give them more of it than they expected.

    Psychiatry does not need to plead guilty to the wrong charges. But we do need to stop letting other people write the indictment.

    The defense rests when the work begins.

    References

    1. HHS launches MAHA action plan to curb psychiatric overprescribing. US Department of Health and Human Services. News release. May 4, 2026. Accessed May 13, 2026. https://www.hhs.gov/press-room/hhs-launches-maha-action-plan-curb-psychiatric-overprescribing.html

    2. 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 13, 2026.

    3. Moutier CY. AFSP statement on the importance of antidepressants and evidence-based treatment for suicide prevention. American Foundation for Suicide Prevention. News release. May 5, 2026. Accessed May 13, 2026. https://www.prnewswire.com/news-releases/afsp-statement-on-the-importance-of-antidepressants-and-evidence-based-treatment-for-suicide-prevention-302762738.html

    4. Espí Forcén F, Hatters Friedman S. Psychiatry on trial: are psychiatrists responsible for their patients’ criminal behavior? Psychiatric Times. August 27, 2026. Accessed August 29, 2026. https://www.psychiatrictimes.com/view/psychiatry-on-trial-are-psychiatrists-responsible-for-their-patients-criminal-behavior

    Disclaimer: Views are my own not associated with any employer. This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions. All content is created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider. If you think you have a medical emergency, call your doctor, go to the emergency department, or call 911. We do not endorse any specific treatment, tests, or procedures. Reliance on this information is solely at your own risk.

  • Your Day Job Does Not Have to Be Your Life’s Work

    Your Day Job Does Not Have to Be Your Life’s Work

    Why doctors and probably everyone else need work that belongs to them

    Seeing patients all day was never my favorite way to use my skills.

    Even writing that sentence feels strangely uncomfortable. Physicians aren’t supposed to say things like that. We spend more than a decade training to take care of patients. We sacrifice our twenties, accumulate debt, miss weddings, work nights, weekends, and holidays, and build an enormous amount of our identity around becoming a doctor.

    So, once you finally become one, shouldn’t patient care be the thing that gives you the greatest sense of meaning and fulfillment?

    Maybe.

    But what if it isn’t?

    And what if there is nothing particularly wrong with that?

    One of Medicine’s Quiet Expectations

    I enjoy psychiatry. I care deeply about doing good clinical work. I want the people I treat to get better.

    But if you asked me what activities make me lose track of time, they usually aren’t the routine parts of clinical medicine. They are reading. Writing. Teaching. Going down an intellectual rabbit hole because I came across an idea I don’t understand. Reading an old psychiatry paper and wondering why we stopped thinking about the problem that way. Taking something complicated and figuring out how to explain it so another person can actually use it.

    Those have always been some of the most meaningful parts of my life.

    And for years, I almost felt guilty about that.

    There is an unspoken belief in medicine that the ideal physician should receive nearly unlimited emotional and intellectual nourishment from direct patient care. Anything else can sound selfish.

    You want to write? Fine, if you see your patients first.

    You want to teach? Great, if it doesn’t interfere with productivity.

    You want to research an obscure idea, create educational content, study philosophy, build something, or spend three hours thinking about a question nobody assigned you?

    That’s a hobby. Get back to work.

    Then I Heard Someone Say It Out Loud

    Recently, psychiatrist Nassir Ghaemi described an idea during his commencement address to the 2026 Yale psychiatry residency class that immediately resonated with me.

    He called it having a “night job.”

    Your day job is the work you are paid to do. Your night job is the work that satisfies something deeper.

    As Ghaemi put it: “Many people are dissatisfied because their day job doesn’t satisfy them emotionally or intellectually.”

    That doesn’t necessarily mean your day job is bad. It means we may be asking far too much of it.

    We expect a single profession to provide income, identity, purpose, intellectual stimulation, emotional fulfillment, social connection, prestige, and happiness. That is an enormous burden to place on a job. And when it inevitably fails to provide all those things, we conclude that something must be wrong.

    Maybe we chose the wrong specialty. Maybe we are burned out. Maybe medicine has changed. Maybe we aren’t as dedicated as everyone else.

    Sometimes those explanations are true.

    But sometimes your job is simply your job. It can be important. You can be good at it. You can care deeply about doing it well.

    And it still doesn’t have to satisfy every part of you.

    The Night Job

    The term “night job” is a little misleading, because this isn’t about staying up until midnight working on another project. It isn’t another version of hustle culture. The goal isn’t to finish a twelve-hour clinical day and then punish yourself with four more hours of productivity.

    The night job is the parallel pursuit that belongs to you.

    For me, that has meant writing, teaching, and creating — studying psychology, philosophy, neuroscience, and human behavior far outside the narrow boundaries of daily clinical practice. Trying to understand not simply what the treatment guidelines tell us to prescribe, but why people suffer, why treatments work, why they fail, and what we may be getting wrong.

    And then taking those ideas and sharing them.

    That’s a large part of why I created Shrinks in Sneakers. I wanted to talk about psychiatry the way clinicians experience it. I wanted to explain treatments without pretending the evidence is cleaner than it really is. I wanted to challenge conventional wisdom when the conventional wisdom didn’t make sense. And I wanted ordinary people to have access to high-quality psychiatric education without needing a medical degree to understand it.

    Nobody assigned me that job. For most of it, nobody paid me.

    I did it because I couldn’t imagine not doing it.

    That’s the difference.

    Your Greatest Work May Not Be the Work Someone Hired You to Do

    This is the part I think young physicians need to hear.

    Your career does not have to fit neatly inside your employment contract.

    Medicine has become very good at defining our value through measurable units. Patients seen. Notes completed. RVUs generated. Charts closed. Quality metrics achieved. Those things may be necessary to operate a healthcare system.

    But they are terrible measurements of a human life.

    Some of the most important work you ever do may have no billing code. It may be the paper you write because an observation bothered you. The lecture you build because nobody ever taught the topic correctly. The student you mentor. The podcast nobody listens to for the first year. The book sitting half-finished on your computer. The research questions your institution doesn’t care about. Or simply the subject you study because understanding it makes you feel alive.

    Your employer may never reward you for it. The world might not reward you for it either.

    Do it anyway.

    But there is a catch

    There is one major problem with the night job.

    Energy.

    After a full clinical day, there isn’t always much left. This is where I think the idea needs an important modification:

    Protect your best energy for at least some of the work that matters most to you.

    Don’t automatically give your employer every productive hour you have and reserve whatever exhausted fragments remain for the things you supposedly care about most.

    Sometimes that means writing before work. Reading for an hour in the morning. Blocking off an afternoon. Saying no to another committee. Doing slightly less of something that doesn’t matter so you can do more of something that does.

    Ghaemi described doing something similar — stopping at a café before reaching the hospital so he could write while his mind was still fresh. That makes far more sense to me than glorifying exhaustion.

    The night job shouldn’t shrink your life.

    It should make your life bigger.

    You Are Allowed to Be More Than Your Profession

    Medicine has a strange way of consuming identity. First, you are a premed. Then a medical student. Then a resident. Then an attending. Eventually somebody asks who you are, and without realizing it, you answer with your specialty.

    “I’m a psychiatrist.”

    True. But incomplete.

    I’m also someone who writes. Someone who teaches. Someone who creates. Someone who is endlessly curious about why human beings do the things they do. Being a psychiatrist gives me an extraordinary vantage point from which to explore those questions.

    It doesn’t need to be the boundary around them.

    Take your work seriously. Treat people well. Become excellent at whatever profession you choose. But you do not have to surrender the rest of yourself to your job.

    Find the thing you would keep doing even if nobody put it on your performance review. Find the subject you read about when nobody assigned the chapter. Find the work that makes two hours feel like twenty minutes.

    Then build some space for it.

    Call it your night job. Call it a side project. Call it your life’s work. The name isn’t important.

    What matters is recognizing that the work that pays for your life and the work that gives your life meaning do not have to be the same thing.

    And maybe we would all be a little happier if we stopped pretending they did.

    Psychiatry Unfiltered

  • Psych Meds Are Not the Enemy. Bad Medicine Is

    Psych Meds Are Not the Enemy. Bad Medicine Is

    There is a dangerous difference between criticizing bad psychiatric practice and stigmatizing psychiatric illness.

    I have criticized aspects of psychiatry many times. I believe our field should be open to critique. We should question our prescribing habits. We should challenge lazy diagnosis. We should acknowledge when medications are used too quickly, continued too long, or substituted for the deeper work of psychotherapy, lifestyle change, social support, and careful clinical formulation.

    Psychiatry should never be above criticism.

    But criticism of psychiatric practice is not the same thing as denying the legitimacy of psychiatric illness.

    And right now, that line is being blurred.

    Serious Mental Illness Is Real

    One thing you will never hear me say is that psychiatric disease is not real.

    Schizophrenia is real.
    Bipolar disorder is real.
    Severe major depression is real.
    Catatonia is real.
    Psychotic depression is real.
    Obsessive-compulsive disorder can be profoundly disabling.
    Posttraumatic stress disorder can devastate a person’s life.

    These are not character flaws. They are not weakness. They are not simply failures of lifestyle, discipline, resilience, spirituality, or mindset.

    They are legitimate medical illnesses.

    That does not mean every painful experience is a disease. It does not mean every person who is grieving, anxious, overwhelmed, lonely, or struggling needs a diagnosis or a medication. In fact, one of the most important tasks in psychiatry is knowing the difference.

    Some people need medication.

    Some people need psychotherapy.

    Some people need sleep, exercise, nutrition, structure, social connection, housing, safety, meaning, accountability, or community.

    Many people need several of these at the same time.

    The goal is not to medicalize all suffering. The goal is to recognize real illness when it is present and treat it with the seriousness it deserves.

    The Problem Is Not “Medication”

    Psychiatric medications are often discussed as if they are inherently suspicious.

    But medication is not the enemy.

    Bad medicine is.

    A medication can be life-changing when used for the right condition, in the right person, at the right time, for the right reason.

    The same medication can be harmful when used carelessly, without a clear diagnosis, without follow-up, without discussion of risks and benefits, or without a plan for reassessment.

    That is not unique to psychiatry.

    Antibiotics can be lifesaving, but inappropriate antibiotic use causes harm. Opioids can be appropriate in some clinical contexts, but reckless prescribing devastated communities. Steroids can be powerful tools, but long-term unnecessary use can create major problems.

    The issue is not whether medications are “good” or “bad.”

    The issue is whether we are practicing medicine well.

    Deprescribing Matters, But It Is Not a Mental Health Policy

    Deprescribing is important.

    Every psychiatrist I know has experience reducing, simplifying, or stopping medications when the risks outweigh the benefits or when the original indication no longer makes sense.

    This is not a fringe idea. It is part of daily psychiatric practice.

    We stop medications that are not helping.
    We reduce unnecessary polypharmacy.
    We simplify regimens when possible.
    We monitor side effects.
    We reassess diagnoses.
    We talk with patients about what still makes sense.

    Good psychiatry includes deprescribing.

    But deprescribing alone will not solve the mental health crisis.

    People cannot deprescribe their way out of a lack of psychiatric beds. They cannot deprescribe their way out of months-long waitlists. They cannot deprescribe their way out of poverty, homelessness, trauma, addiction, loneliness, or a collapsing continuum of care.

    And they cannot deprescribe their way out of schizophrenia, mania, catatonia, psychotic depression, or severe melancholic depression.

    When we frame the mental health crisis primarily as a problem of overprescribing, we oversimplify a system failure.

    We ignore the shortage of psychiatrists. We ignore the lack of access to psychotherapy. We ignore inadequate visit times, fragmented care, insurance barriers, emergency departments boarding psychiatric patients for days, and the near disappearance of a true continuum of care.

    Those are not solved by telling people to take fewer medications.

    The Risk of Stigma Dressed Up as Reform

    My concern is not that we are talking about prescribing quality. We should be talking about that.

    My concern is that the rhetoric around psychiatric medications often sends a dangerous message to people who already feel ashamed.

    Many patients with serious mental illness already struggle with the idea of needing medication.

    They worry it means they are weak.
    They worry it means they are broken.
    They worry it means they are dependent.
    They worry it means they are not trying hard enough.
    They worry others will see them differently.

    When public conversations frame psychiatric medications as the central villain, those patients hear something very different from “we need better prescribing.”

    They hear:

    You are dependent.
    You are addicted.
    You are taking the easy way out.
    You should be able to fix this naturally.
    You are the problem.

    That is not empowerment.

    That is stigma.

    And for some patients, that stigma can be dangerous. It can lead people to stop medications abruptly, avoid treatment, disengage from care, relapse, or delay help until a crisis occurs.

    Of course patients should be informed. Of course they should understand risks and benefits. Of course they should have a voice in treatment decisions.

    But informed consent should not become fear-based messaging. And reform should not become another way of shaming people with serious psychiatric illness.

    Better Medicine Means Holding Two Truths

    The future of psychiatry depends on our ability to hold two truths at the same time.

    First, psychiatric illness is real and can be devastating.

    Second, psychiatry must be careful not to overdiagnose, overprescribe, or turn normal human suffering into lifelong pathology.

    Both truths matter.

    If we only emphasize the first, we risk medicalizing everything.

    If we only emphasize the second, we risk abandoning people with serious illness.

    Real psychiatric care lives in the tension between those truths.

    It requires humility. It requires careful diagnosis. It requires honest conversations about uncertainty. It requires medication when appropriate, psychotherapy when appropriate, lifestyle intervention when appropriate, social support when appropriate, neuromodulation when appropriate, and deprescribing when appropriate.

    It also requires us to say clearly that some people need medication, and that needing medication is not a moral failure.

    The Goal Is Better Medicine

    The goal is not to prescribe more.

    The goal is not to prescribe less.

    The goal is to prescribe better.

    Better diagnosis.
    Better informed consent.
    Better follow-up.
    Better access to psychotherapy.
    Better use of lifestyle interventions.
    Better systems of care.
    Better deprescribing when medications are no longer needed.
    Better protection for people whose medications are the reason they are alive, stable, working, parenting, studying, and functioning.

    We do not fix psychiatry by pretending psychiatric medications are always the answer.

    But we also do not fix psychiatry by pretending they are the enemy.

    Psych meds are not the enemy.

    Bad medicine is.

  • We say we care about mental health in America

    We say we care about mental health in America

    We say we care about mental health in America.
    But the data—and my front-line experience—say otherwise.

    We are overmedicating, underfunding, and pathologizing poverty, trauma, and stress.
    Instead of addressing why people are sick, we throw pills at symptoms.

    🧠 In my latest article for Psychiatric Times, I make the case that we’ve built a system that profits off disease—not health.
    We’re not solving the problem. We’re institutionalizing it.

    If we want to make America healthy again, we need to stop doing the wrong things.

    👉 Read the full piece here: https://www.psychiatrictimes.com/view/if-we-want-to-make-america-healthy-again-we-are-doing-the-wrong-thing

  • Is Antidepressant Withdrawal Overhyped? What the Evidence Really Says

    Is Antidepressant Withdrawal Overhyped? What the Evidence Really Says

    In my clinical practice, I’ve often found myself scratching my head over the narrative surrounding antidepressant withdrawal.

    I’m not denying that withdrawal is real—it is. And for a small subset of patients, it can be quite distressing. But what I am saying is this: it’s not nearly as common, dramatic, or dangerous as some online circles and sensational stories would have you believe.

    I’ve seen countless patients abruptly stop antidepressants and experience no withdrawal symptoms. I’ve also aggressively tapered antidepressants in patients with bipolar disorder to prevent mood destabilization—again, with little to no evidence of withdrawal. This isn’t a one-off observation. It’s a consistent clinical pattern I’ve noted for years. So, I asked myself: What does the data actually say?

    The Evidence

    A 2024 meta-analysis published in JAMA Psychiatry examined 49 randomized controlled trials and finally gave us some clarity.

    The results?
    ✅ People discontinuing antidepressants reported on average just one more symptom than those who either continued medication or discontinued a placebo.
    ✅ The most commonly reported symptoms in the first two weeks were dizziness, nausea, vertigo, and nervousness—exactly what I’ve seen clinically.
    ✅ Critically, the average number of symptoms fell below the threshold for what’s considered a clinically significant discontinuation syndrome.
    ✅ There was no link between discontinuation and worsening depression, suggesting that if mood symptoms return, it’s likely a relapse—not withdrawal.

    Why This Matters

    There are vocal groups online—often with clear anti-psychiatry agendas—who focus exclusively on rare, severe cases of withdrawal and present them as the norm. The goal is simple: to scare people away from psychiatry and evidence-based treatment using emotional testimonials instead of clinical reality.

    Let’s be honest—those cases do exist, but they are not representative of what most patients experience.

    As clinicians, we should remain cautious and responsible. Yes, we should taper medications thoughtfully. Yes, we should prepare patients for the possibility of withdrawal symptoms. But we also shouldn’t scare them into avoiding treatment—or make them feel trapped on medications for life.

    Bottom Line

    Antidepressant withdrawal can happen. It can be uncomfortable. But it’s rarely severe and almost never dangerous. The fear around it has been overstated by those with an ax to grind. We owe it to our patients to treat based on evidence, not anecdotes.

  • Brexpiprazole + Sertraline: A New Hope for PTSD Treatment

    Brexpiprazole + Sertraline: A New Hope for PTSD Treatment

    We’ve all seen it: PTSD that won’t budge. Patients try sertraline or paroxetine—the so-called “gold standards”—and walk away with little more than side effects and a sense of failure.

    Enter a new contender: brexpiprazole + sertraline.

    A recent Phase 3 randomized controlled trial might finally offer something real for those stuck in the PTSD trenches.

    🚨 The Results

    In a study across 86 sites with over 550 adults, adding brexpiprazole (2–3 mg) to sertraline (150 mg) led to a 5.6-point greater reduction on the CAPS‑5 (the gold-standard PTSD measure) compared to sertraline + placebo. That’s not a marginal win—it’s a clinically significant shift, especially in a treatment-resistant population.

    Responder rates tell the story even clearer:

    • 68.5% of patients on the combo had ≥30% reduction in symptoms
    • Compared to 48.2% on sertraline alone
    • That’s a +20% absolute response rate boost

    And the improvements weren’t just short-lived. Benefits held through 12 weeks, even during a post-treatment observation period. No relapse, no rebound—just stability.

    🧩 More Than Symptom Checklists

    It wasn’t just about PTSD symptoms. This combo also:

    • Improved psychosocial functioning (B-IPF scores)
    • Reduced anxiety and depression (HADS)
    • Lowered global illness severity (CGI-S)
    • Helped with all symptom clusters, including reexperiencing, avoidance, and hyperarousal

    That’s rare. Most meds in psychiatry hit one or two domains and leave the rest hanging. This one made a dent where it counts: function, resilience, and real-world relief.

    ⚠️ What About Side Effects?

    Brexpiprazole is still an atypical antipsychotic, so there’s baggage. But the trial data suggest it’s relatively well-tolerated:

    • Fatigue: 6.8%
    • Weight gain: 5.9%
    • Somnolence: 5.4%
    • Discontinuation due to AEs? Just 3.9%, vs 10.2% in placebo.

    No new safety signals. No psychosis worsening. Not perfect, but not the metabolic disaster zone we see with other agents.

    🚀 What’s Next?

    The FDA is reviewing this combo

    For those of us treating chronic PTSD, this may be a real tool—not just a shiny new molecule with good marketing.

    Until then, it’s worth paying attention. Because when sertraline alone doesn’t cut it—and we know it often doesn’t—this combo could offer a lifeline.

  • Understanding Psychiatry: Science vs. Skepticism

    Understanding Psychiatry: Science vs. Skepticism

    🧠 “Psychiatry is a scam.” “Big Pharma controls your brain.” “Mental illness isn’t real.”

    You’ve heard the takes. Now here’s the truth.

    In my new article for Psychiatric Times, I dive headfirst into the controversy:
    👉 Understanding Psychiatry: Navigating Skepticism and Science
    https://www.psychiatrictimes.com/view/understanding-psychiatry-navigating-skepticism-and-science

    I don’t dodge the hard questions—about overmedication, broken trust, and bad science—but I also push back against lazy anti-psychiatry takes that ignore the very real suffering of patients.

    If you care about the future of mental health care, this one’s worth your time.

  • Reject dogma—embrace nuance in Psychiatry

    🔹 Psychoanalysis should not be treated as sacred doctrine. Freud was a clever and influential thinker, but not a prophet.


    🔹 Biological psychiatry is equally vulnerable to dogma. Not every symptom signals a disease, and not every distress warrants medication.


    🔹 That said, evidence-based pharmacology has its place—especially when medications show clear, replicable benefits in defined clinical conditions.

    The future of psychiatry lies in balanced thinking, not blind allegiance—to Freud, to biology, or to any single model of mind.

  • RFK Jr. Claims He’ll Identify the Cause of Autism by September

    RFK Jr. Claims He’ll Identify the Cause of Autism by September

    In a bold statement this week, Robert F. Kennedy Jr. announced that he will reveal the definitive cause of autism by September. Kennedy, a longtime critic of childhood vaccine programs, did not provide specific scientific details or a research plan, but implied that his administration would prioritize transparency and independent investigations into the condition’s origins.

    The claim has sparked immediate controversy. Autism is a complex neurodevelopmental condition with a strong genetic foundation and a wide range of potential environmental influences—none of which have yielded a singular, definitive cause. The scientific consensus, built over decades of rigorous research, continues to support a multifactorial model rather than a simplistic explanation.

    Many highly intelligent and dedicated scientists have spent years studying autism without identifying a single, unifying cause. One of the recurring issues that arises when politics intersects with science is a resistance to the idea that these are nuanced, multifaceted conditions. It’s not the most satisfying explanation—but it is consistent with the best evidence we have. My fear is that this type of investigation, under political pressure, could prematurely identify a false causal agent—such as vaccines—and reignite a harmful narrative that has already been thoroughly debunked.

    Kennedy’s history of promoting vaccine-autism links adds further concern. The CDC, WHO, and a vast body of peer-reviewed research have all concluded there is no credible evidence connecting vaccines to autism. Suggesting otherwise not only undermines public trust in science and medicine—it risks the health of entire communities by fueling vaccine hesitancy.

    For families and individuals affected by autism, the promise of discovering its origins is understandably compelling. But it’s critical that we approach that pursuit with scientific integrity, not political expediency.

  • 🚨 New Study Links Antidepressant Use to Significant Weight Gain Over 6 Years! 

    🚨 New Study Links Antidepressant Use to Significant Weight Gain Over 6 Years! 

    A recent study published in Frontiers in Psychiatry reveals that individuals using antidepressants experienced notable weight gain over a six-year period.​

    Key Findings:

    • Increased Weight Gain:​
      • Participants who used antidepressants showed an average weight increase of approximately 2% of their baseline body weight compared to non-users.​
    • Higher Obesity Risk:​
      • Those without obesity at the study’s start had double the risk of becoming obese if they used antidepressants throughout the six years.​

    Implications:

    With the widespread use of antidepressants and the global obesity epidemic, integrating weight management and metabolic monitoring into depression treatment plans is crucial.​

    link: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1464898/full