Docs may want to prepare for a blackout on SSRIs—because 'severely restricting access would be a public health disaster'
Key Takeaways
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“Sudden discontinuation can lead to withdrawal symptoms and an increased risk of relapse, so gradual dose reductions under medical supervision are critical.” — Laura Hack, MD, PhD, Director of Novel & Precision Neurotherapeutics at the Stanford Center for Precision Mental Health and Wellness
“I think that the motivations of the current people asking that question may not be aligned with best practices and recommendations for medicine—the field of medicine or the field of psychiatry.” — Steven Siegel, MD, PhD, Chief Mental Health and Wellness Officer and Chair of the Department of Psychiatry at Keck Medicine of USC
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The White House has announced the establishment of a “Make Our Children Healthy Again” assessment, which will include an evaluation of prescribing serotonin reuptake inhibitors (SSRIs) to children.[]
The executive order noted that a commission will assess the “threat posed by the prescription of [SSRIs]” for children.
So what should physicians do to prepare?
“While extreme restrictions are unlikely, physicians can be proactive by educating patients about tapering strategies and discussing alternative treatments. Sudden discontinuation can lead to withdrawal symptoms and an increased risk of relapse, so gradual dose reductions under medical supervision are critical,” Laura Hack, MD, PhD, Assistant Professor in the Department of Psychiatry and Behavioral Sciences and Director of Novel & Precision Neurotherapeutics at the Stanford Center for Precision Mental Health and Wellness, tells MDLinx.
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Evidence-based alternatives to SSRIs for children and adolescents depend on the specific condition and its severity, Dr. Hack says. She notes organizations like the American Academy of Child and Adolescent Psychiatry and the Canadian Network for Mood and Anxiety Treatments provide structured treatment guidelines that emphasize safety and efficacy, offering a roadmap for managing potential SSRI shortages or restrictions.
Is an assessment needed?
The executive order states that a commission will “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors” and other drugs.
Steven Siegel, MD, PhD, Chief Mental Health and Wellness Officer at Keck Medicine of USC and Chair of the Department of Psychiatry and the Behavioral Sciences at the Keck School of Medicine of USC, has some concerns about the assessment.
“I think that the motivations of the current people asking that question may not be aligned with best practices and recommendations for medicine—the field of medicine or the field of psychiatry. However, with that caveat, it is always appropriate to [assess] the safety and efficacy of medical treatments as new data is available,” Dr. Siegel tells MDLinx.
While the executive order doesn’t state whether SSRIs will be restricted, Drs. Hack and Siegel tell MDLinx that significant or blanket restrictions would be problematic.
What could happen?
"Severely restricting access to SSRIs would be a public health disaster."
— Laura Hack, MD, PhD
“Untreated depression and anxiety lead to increased suicide risk, disability, and reduced quality of life. Many people rely on SSRIs to maintain daily functioning, and sudden discontinuation can cause withdrawal symptoms and relapses in mental illness. Indeed, studies show [that] stopping antidepressants cold turkey doubles the risk of recurrence in MDD patients. Restricting access would disproportionately harm those who cannot afford alternative treatments like psychotherapy, ketamine, or [transcranial magnetic stimulation]," Dr. Hack says.
"There is no medical or scientific justification for limiting access to SSRIs on a broad scale."
— Laura Hack, MD, PhD
Overall, Dr. Hack says, SSRIs have significantly improved depression treatment since the 1980s. They are safer than older medications, backed by decades of data, and can be life-changing or even life-saving when used appropriately. While concerns about side effects, over-prescription, and withdrawal exist, the risks of restricting access outweigh these drawbacks.
“Severe mental illness doesn’t wait for policy debates; people need options. Access shouldn’t be tighter; prescribing should be smarter—reserved for clear diagnoses in appropriately selected patients, monitored closely, and deprescribed thoughtfully after sustained remission. Blanket restrictions would punish the sick for systemic failures. SSRIs save lives when used right,” Dr. Hack says.