In a revealing snapshot of American mental health, the CDC recently reported that nearly 1 in 4 adults in the United States may be taking psychotropic medications. This staggering number should both draw attention and raise questions. Are we truly addressing the root causes of psychiatric illness, or are we sedating a nation in pain?
As a psychiatrist and internist who has worked at the intersection of medicine, trauma, and innovation, I’ve watched this trend evolve with increasing concern. Psychotropic medications have saved lives, improved functioning, and offered relief to countless individuals, including most of my own patients. But over time, I have also observed how these medications, while often necessary, can become long-term prescriptions by default rather than design.
I have observed how many of my patients struggle with discontinuing psychiatric medications (consciously or unconsciously) and how what was once a lifeline became a source of distress. Our evidence-based literature lacks the studies needed to offer medical guidance to assist our patients when attempting to taper off. It is a story that reflects what I have seen far too often in my practice: The lack of an exit strategy for psychotropic medications leading to physiological withdrawal symptoms, and the emotional destabilization that followed. This issue isn’t limited to anecdotes. The National Institute for Health and Care Excellence (NICE) in the U.K.—often considered Britain’s counterpart to the NIH—has formalized guidelines that recognize the difficulty of antidepressant discontinuation. NICE emphasizes the importance of a structured plan for stopping antidepressants, cautioning against abrupt withdrawal and acknowledging that tapering may take months or even years. The absence of equivalent structured guidance in the U.S. is glaring.
And yet, psychotropic medications continue to be prescribed at record rates. According to the CDC’s Household Pulse Survey on Mental Health, psychotropic use surged during the COVID-19 pandemic. Stress, isolation, trauma, and loss drove unprecedented demand for relief. But as the emergency phase of the pandemic wanes, we must now ask: What is the long-term plan?
The American Society of Clinical Psychopharmacology is developing a guide to help physicians identify when and how to discontinue psychiatric medications. There has never been an incentive in the pharmaceutical industry to tell people “When to stop using their product.” It’s a sobering truth and a reminder that the responsibility falls to us, the psychiatrist in the community, to fill that void. Advocates have emerged to help individuals navigate psychiatric medication use and discontinuation, challenging the notion that long-term psychotropic use should be the norm. Instead, they urge patients and providers alike to consider the biopsychosocial roots of suffering—trauma, inequality, isolation—and to integrate more comprehensive care models.
Nonetheless there are systemic obstacles: The structure of our health care system itself. Our system doesn’t provide much support for patients looking to reduce medications. With most psychiatrists pressured into 15-minute “med management” visits, time for nuanced tapering is scarce. And yet, the stakes are profound. As tapering is not a passive act—it requires skill to distinguish between withdrawal symptoms and true relapse. Patients are navigating at vulnerable crossroads, and they need well-trained psychiatrists not only in science, but in stewardship. The main thing is, their psychiatric illness can worsen, and they could kill themselves. This is not just a clinical challenge; it is one of significant moral dimensions.
That’s where a national shift in priorities becomes essential—one that focuses on restoring wellness through prevention, personalization, and purpose, with an emphasis on improving outcomes for patients who are not doing well. At its core, this vision supports:
Medication management and optimization: Reassessing all medications regularly, tapering where possible, and integrating non-pharmacologic supports.
Integrated behavioral health: Making therapy, trauma-informed care, and community resources available and accessible.
Health equity and access: Addressing the social determinants that drive overmedication—poverty, racism, housing insecurity, and chronic stress.
Physician education and accountability: Training prescribers to understand both the pharmacology and the psychology of long-term medication use, and to partner with patients on exit strategies.
This is not a call to abandon psychotropic medications. Rather, it is a call to rethink how we use them and respect their power while remaining critical and thoughtful about their long-term role. Medications should serve recovery, not replace it. When used thoughtfully, they can be an essential part of a broader treatment plan. But when prescribed indefinitely without reevaluation, they risk becoming tools of stagnation rather than healing. As physicians, we must create space for recovery-oriented conversations. That means talking with patients not only about starting medications but also about when, and how, they might safely stop. It means investing in psychotherapy (believe it or not, the government prosecuted me and attempted to put me in jail for doing just that), peer support, nutrition, exercise, sleep hygiene, and spiritual care as meaningful components of treatment. And it means resisting the pressure to medicalize distress without fully exploring its origins.
In my own journey from war-torn Aleppo, Syria to American clinical practice, I have witnessed the consequences of trauma firsthand. Trauma changes brain chemistry, but it also changes identity, relationships, and hope. No pill can restore meaning, but healing relationships, safety, and purpose can. We owe it to our patients to integrate that truth into our care models.
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Let this moment in the history of this nation be a turning point. Benjamin Rush, the father of American psychiatry, signed the Declaration of Independence and ratified the Constitution. The pandemic has unmasked the vulnerabilities in our mental health system. Now is the time to build something better: Starting with intelligent prescribing and compassionate deprescribing. Let’s make America healthy again, not just by treating symptoms, but by healing systems. Not just by writing prescriptions, but by rewriting the story of what mental health care can be. Because sometimes, the bravest act of care is not starting a medication—it’s knowing when, how, and why to stop it.
Muhamad Aly Rifai is a practicing internist and psychiatrist in the Greater Lehigh Valley, Pennsylvania. He is the CEO, chief psychiatrist and internist of Blue Mountain Psychiatry. He holds the Lehigh Valley Endowed Chair of Addiction Medicine. Dr. Rifai is board-certified in internal medicine, psychiatry, addiction medicine, and psychosomatic medicine. He is a fellow of the American College of Physicians, the Academy of Psychosomatic Medicine, and the American Psychiatric Association. He is the former president of the Lehigh Valley Psychiatric Society.
This article is discussed on The Podcast by KevinMD: Addressing America’s reliance on psychotropic medication.
He can be reached on LinkedIn, Facebook, X @muhamadalyrifai, YouTube, and his website. You can also read his Wikipedia entry and publications.
