Trump Administration Review of Psych Meds Raises Concerns

The Trump administration’s plans to study the “threat” posed by psychiatric medications in children have medical societies and mental health professionals concerned that the administration may be considering restrictions on the use of psychotropic drugs in pediatric patients.

An executive order signed last week created the “Make American Healthy Again Commission” to investigate the nation’s “escalating health crisis,” particularly in child health. Recently confirmed Secretary of the Department of Health and Human Services Robert F. Kennedy Jr. will chair the effort.

As part of its investigation, the executive order directed the commission to assess “the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

A report on the commission’s findings is due in a little less than 100 days. Eighty days later, the commission must submit recommendations for federal action.

Although who the commission members are and the scope of its work is unclear, the language in the executive order — namely the implication that the Trump administration views psychotropic medication as a “threat” to children — was enough to prompt psychiatrists from across the country to contact the American Psychiatric Association (APA) about possible limitations on the use of psychotropic medications in pediatric patients.

“It’s concerning and surprising that some of our nation’s most vulnerable children who need these treatments to participate fully in life would be under scrutiny in this way,” Marketa Wills, MD, MBA, chief executive officer and medical director for the APA, told Medscape Medical News. 

“If these medications are under threat and children decompensate that would not be good from a public health perspective, for the health care system or for the families we serve,” Wills said. 

Past Comments Fuel Distress

Past comments by the commission chair have only fueled distress over the commission’s goals. Kennedy has long expressed skepticism about antidepressants, especially (SSRIs), questioning their safety and suggesting they are as addictive as heroin. 

“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than they have getting off of heroin,” Kennedy said during his Senate confirmation hearing in late January.

But there is no evidence to suggest SSRIs or other antidepressants are addictive, Leslie A. Hulvershorn, MD, chair and associate professor of psychiatry at Indiana University School of Medicine, told Medscape Medical News. 

“They don’t work in the systems of the brain that drive addiction. A large amount of research suggests that they are safe to take for a long time,” she said. “I suspect the confusion comes from the difference between it not being wise to come off of the medication, because of a concern for relapse of a psychiatric illness, and some transient discomfort from abruptly stopping SSRIs without tapering them off versus being addicted to it, like heroin.”

During the hearing, Kennedy was also asked to respond to comments he made during a 2023 livestream on X in which he claimed that the use of antidepressants have contributed to the increase in school shootings in the US. 

“I am also going to look very closely at the role of psychiatric drugs in these events and there are no good studies right now that should have been done years ago on this issue because there is a tremendous circumstantial evidence that SSRIs and benzos and other drugs are doing this,” he said in the livestream. 

Research has shown that there is no link between school shootings and antidepressant use. 

In a 2024 interview on the Latino Capitalist podcast, Kennedy said that he wanted create “wellness farms” for adults addicted to illicit drugs and children who take antidepressants or stimulants for ADHD could be “reparented.”

“The views on those wellness farms are concerning for us here at the American Psychiatric Association. It remains to be seen if he brings that back up in his new role at HHS. There is currently no evidence of their efficacy,” Wills said.

Fear Is a ‘Real Concern’

These controversial comments, combined with the commission’s charge to investigate the potential “threat” psychotropic medications pose to children, worry clinicians and families fear that access to medication could be restricted. 

“Psychiatrists and patients are very concerned about the risk these statements may pose,” Hulvershorn said. 

“Certainly, there is evidence that psychotropic medications are overprescribed, particularly in children who are in state care – like wards of the state – and who are part of Medicaid programs, but there is tremendous overall benefit associated with psychotropic medications in youth and adults. They are lifesaving and game changing in many instances,” she added.

Psychiatrists who’ve contacted the APA since last week’s announcement echo Hulvershorn’s comments. 

“The fear is the real concern,” Wills said. “No parent takes the decision lightly to put their child on medication. With all interventions, particularly with children, there are risks and benefits that must be carefully weighed. The best person to weigh those risks and benefits is the child and adolescent psychiatrist, in conjunction with the child’s parents.”

The focus on medication also overlooks the fact that psychosocial interventions — not medication — are first-line treatment for children with mental health issues and that guidelines recommend medication be used alongside nonpharmacological therapy. 

“Extensive research, including large national multi-site studies, have examined the most effective ways to reduce psychological symptoms among youth, including anxiety, depression, and ADHD. Results consistently reveal that both psychotropic medications and psychological interventions can offer significant improvements, often in combination,” Mitch Prinstein, PhD, chief of psychology strategy and integration at the American Psychological Association, told Medscape Medical News. 

“Given the substantial challenges for many in gaining access to psychotherapy and a national shortage of licensed psychologists, reducing access to medications would undoubtedly have a debilitating effect of the already concerning youth mental health crisis,” Prinstein said. 

A Seat at The Table

While the launch of the commission has left some feeling uneasy, experts agree that a national focus on children’s mental health is needed. 

The APA would “welcome an opportunity to be part of this national conversation following the evidence base, following settled science that shows when and how these medications are effective and helpful for children and families,” said Wills. “We also think it’s very important that child and adolescent psychiatrists be at the table for this national conversation on behalf of the families they serve.” 

In a joint letter with the APA, officials with the American Academy of Child and Adolescent Psychiatry also expressed interest in playing a role in the commission’s work. 

“We are in the middle of a mental health crisis, with a record number of Americans struggling with mental health and substance use disorders. We strongly urge you to prioritize strengthening the ability to respond to an increasing demand for psychiatric services, especially for children,” the letter stated.

Indeed, looking beyond just the use of psychotropic medications is vital to the success of any strategy to address the youth mental health crisis, Hulvershorn noted. 

“There are already many programs underway to examine the overprescribing. In my view, the lack of supports by payors for behavioral interventions, such as evidence-based family interventions, psychotherapies, etc., is the major driver for overuse of medications,” she said.

“Every pediatrician and child psychiatrist I know would rather try a behavioral intervention with a family first, but those are services that our systems do not financially support well and are, thus, underdeveloped, and very difficult to access,” Hulvershorn added.

More funding for evidence-based interventions — both behavioral and pharmacological — is desperately needed, she said. Support for workforce development should also be a part of any proposed solution. 

“Adequate and responsible funding in all of those areas is needed, but we have some low hanging fruit in terms of figuring out how to just deliver the interventions that science has shown us do work,” Hulvershorn said. “Many of those interventions don’t involve medication and I think every expert in the field would be glad to see more effort put into system reform to better deliver interventions that work to youth and their families.”

Kelli Whitlock Burton is an assistant managing editor covering psychiatry and neurology for Medscape Medical News.