ANTIDEPRESSANTS, DEPRESCRIBING, AND THE BÉQUILLE OF EXHAUSTED SOCIETIES

THE MENTAL FORECAST

Liviu Poenaru, May 2026

The debate over deprescribing antidepressants is not simply a fight between “medicine” and “anti-medicine.” It is a fight over trust, review, and the right to decide when a medication is still needed. In May 2026, the U.S. Department of Health and Human Services announced a plan to reduce psychiatric overprescribing, promote informed consent, and support tapering or discontinuation when clinically indicated (U.S. Department of Health and Human Services 2026). The American Psychiatric Association responded that better prescribing and deprescribing are important, but warned that describing the mental-health crisis mainly as “overprescribing” risks oversimplifying the issue and stigmatizing people who depend on medication (American Psychiatric Association 2026). The key tension is therefore not whether antidepressants should exist, but whether they are being used with enough care, review, and exit strategies.

The case for deprescribing is strongest when antidepressants have been continued for years without review, when they were started for mild or situational distress, or when the person is experiencing side effects. In 2023, 11.4 percent of U.S. adults reported taking prescription medication for depression, which shows how ordinary these medicines have become in everyday life (Elgaddal, Weeks, and Mykyta 2025). NICE guidance says antidepressants should not routinely be offered as first-line treatment for less severe depression unless this is the person’s informed preference (National Institute for Health and Care Excellence 2022). The old “chemical imbalance” explanation also deserves criticism: a major umbrella review found no consistent evidence that depression is caused by low serotonin (Moncrieff et al. 2023). This does not prove that antidepressants never help; it means patients deserve a more honest explanation than “your brain lacks serotonin.”

The case against broad anti-antidepressant policy is equally important. A large network meta-analysis of 522 trials found that all 21 antidepressants studied were more effective than placebo for acute major depressive disorder in adults, although benefits and tolerability differed between drugs (Cipriani et al. 2018). In the ANTLER trial, relapse by 52 weeks occurred in 39 percent of people who continued antidepressants, compared with 56 percent of those who discontinued them (Lewis et al. 2021). These numbers matter because they show why sudden cultural or political pressure to stop medication can be dangerous. For people with recurrent depression, severe symptoms, suicidality, or fragile support systems, antidepressants may not be a luxury or a habit; they may be part of staying functional.

There is also a broader social criticism here: people in exhausted societies often need a trigger, a béquille — a psychological crutch — to keep going. In cultures shaped by consumption, self-consumption, constant optimization, and the on-off rhythm of high performance and collapse, medication can become more than treatment: it can become reassurance. The pill says, “something is being done,” and that message itself can have power. This does not mean the effect is fake. Placebo responses involve expectation, meaning, ritual, trust, and the therapeutic relationship, and they can produce real changes in symptoms (Colloca 2018). Some antidepressant research also suggests that the drug-placebo difference is smaller in less severe depression and becomes clearer as severity increases, which supports the idea that part of the antidepressant effect is psychological, contextual, and expectational, especially in milder cases (Kirsch et al. 2008; Fournier et al. 2010). The uncomfortable question is whether modern societies are treating only depression, or whether they are also medicating exhaustion, loneliness, insecurity, and the pressure to remain productive.

The Mental Forecast is that the debate will move away from “Do antidepressants work?” and toward “How do we use them more honestly?” Withdrawal is central: NICE warns that stopping abruptly or reducing too fast can cause dizziness, electric-shock sensations, anxiety, irritability, sleep problems, nausea, palpitations, headaches, and other symptoms, sometimes lasting weeks or months (National Institute for Health and Care Excellence 2022). A 2024 meta-analysis estimated that discontinuation symptoms directly attributable to stopping antidepressants affect about 15 percent of people who discontinue, with severe symptoms in about 3 percent (Henssler et al. 2024). The REDUCE trial found that active family-practitioner review helped more than 40 percent of selected long-term users who were well and willing to stop discontinue safely, with or without added internet and telephone support (Kendrick et al. 2024). The best position is therefore neither “keep everyone on antidepressants” nor “get everyone off them.” It is regular review, informed consent, social and psychological support, careful tapering, and respect for the fact that stability is sometimes medical, sometimes social, and often both.

REFERENCE

American Psychiatric Association. 2026. “APA Welcomes National Focus on Mental Health, Urges Evidence-Based Approach and Continued Focus on Access to Care.” May 4, 2026. https://www.psychiatry.org/news-room/news-releases/apa-welcomes-national-focus-on-mental-health-urges

Cipriani, Andrea, Toshi A. Furukawa, Georgia Salanti, Anna Chaimani, Lauren Z. Atkinson, Yusuke Ogawa, Stefan Leucht, et al. 2018. “Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults with Major Depressive Disorder: A Systematic Review and Network Meta-Analysis.” The Lancet 391 (10128): 1357–66. DOI: 10.1016/S0140–6736(17)32802–7

Colloca, Luana. 2018. “Preface: The Fascinating Mechanisms and Implications of the Placebo Effect.” International Review of Neurobiology 138: xv–xx. DOI: 10.1016/S0074–7742(18)30027–8

Elgaddal, Nazik, Julie D. Weeks, and Laryssa Mykyta. 2025. “Characteristics of Adults Age 18 and Older Who Took Prescription Medication for Depression: United States, 2023.” NCHS Data Brief, no. 528: 1–9. DOI: 10.15620/cdc/174589

Fournier, Jay C., Robert J. DeRubeis, Steven D. Hollon, Sona Dimidjian, Jay D. Amsterdam, Richard C. Shelton, and Jan Fawcett. 2010. “Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis.” JAMA 303 (1): 47–53. DOI: 10.1001/jama.2009.1943

Henssler, Jonathan, Yannick Schmidt, Urszula Schmidt, Guido Schwarzer, Tom Bschor, and Christopher Baethge. 2024. “Incidence of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta-Analysis.” The Lancet Psychiatry 11 (7): 526–35. DOI: 10.1016/S2215–0366(24)00133–0

Kendrick, Tony, Beth Stuart, Hannah Bowers, Mahboobeh Haji Sadeghi, Helen Page, Christopher Dowrick, Michael Moore, et al. 2024. “Internet and Telephone Support for Discontinuing Long-Term Antidepressants: The REDUCE Cluster Randomized Trial.” JAMA Network Open 7 (6): e2418383. DOI: 10.1001/jamanetworkopen.2024.18383

Kirsch, Irving, Brett J. Deacon, Tania B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, and Blair T. Johnson. 2008. “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration.” PLoS Medicine 5 (2): e45. DOI: 10.1371/journal.pmed.0050045

Lewis, Gemma, Louise Marston, Larisa Duffy, Nick Freemantle, Simon Gilbody, Rachael Hunter, Tony Kendrick, et al. 2021. “Maintenance or Discontinuation of Antidepressants in Primary Care.” New England Journal of Medicine 385 (14): 1257–67. DOI: 10.1056/NEJMoa2106356

Moncrieff, Joanna, Ruth E. Cooper, Tom Stockmann, Simone Amendola, Michael P. Hengartner, and Mark A. Horowitz. 2023. “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence.” Molecular Psychiatry 28: 3243–56. DOI: 10.1038/s41380–022–01661–0

National Institute for Health and Care Excellence. 2022. Depression in Adults: Treatment and Management. NICE Guideline NG222. https://www.nice.org.uk/guidance/ng222

U.S. Department of Health and Human Services. 2026. “HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing.” May 4, 2026. https://www.hhs.gov/press-room/hhs-launches-maha-action-plan-curb-psychiatric-overprescribing.html

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