What medical school doesn’t teach
Recent 2022 US Centers for Disease Control data show that at any one time, about 25% of the US adult population takes at least one prescribed psychotropic drug for psychiatric, pain, or sleep treatment.
Medical education has not prepared clinicians for this flood of drugs or their attendant risks. An intrinsic pharmacological property of psychotropics is that, when they are dosed regularly, the neurobiological adaptation known as dependence naturally occurs, even when the drugs are taken as prescribed. Subsequent withdrawal difficulties are a major barrier to minimizing dosage or discontinuing the drugs when they are no longer beneficial.
There are many good reasons to reduce dosage of prescribed psychotropics. Even so, patients are often directed to taper too rapidly, leading to withdrawal symptoms that can be distressing, debilitating, or even disabling. A treatment-related or iatrogenic condition that with proper care would be temporary, withdrawal syndrome is frequently misidentified as treatment resistance, relapse, or a new disorder, with patients kept cycling through unnecessary treatment for years.
“Getting people off drugs is unfamiliar terrain for modern health systems, which are mostly set up to put patients on them.”
The Economist, April 26, 2023Patients and clinicians become reluctant to discontinue due to fear of these adverse outcomes. Consequently, psychotropic prescriptions are continued far too long for too many people, at great cost in money, effort, and wellbeing for both patients and clinicians. If even a small fraction of those tens of millions taking psychotropics become hobbled by withdrawal syndrome, this is a serious hidden public health problem.
Effective deprescribing of psychotropics requires an understanding of tapering techniques, withdrawal symptoms, and how to foster clinician-patient communication. Distinguished psychiatrist Allen Frances, MD, professor and chairman emeritus, Duke University psychiatry,
and former head of the DSM-IV committee observed: “Training programs should give deprescribing psychiatric drugs even more attention than prescribing because deprescribing requires more skill.”
Unfortunately, medical professionals are offered little guidance about best practices in ceasing treatment. As The Economist noted in 2023, “Getting people off drugs is unfamiliar terrain for modern health systems, which are mostly set up to put patients on them.”
A history of overlooked warnings
Of the phenomenally vast population taking prescribed psychotropics worldwide, most are taking antidepressants, a drug class that illustrates the problems in psychotropic deprescribing.
Warning signs about antidepressant withdrawal syndrome were there from the start. In his introduction of imipramine, the first antidepressant, in 1957, Swiss psychiatrist Roland Kuhn also described a withdrawal syndrome, which he called Abstinenzerscheinungen – symptoms of abstinence. The unpleasant adverse effects of the earliest antidepressants discouraged widespread prescribing for decades, during which psychiatry itself remained a relatively small specialty.
From the 1990s, pharmaceutical development and marketing very effectively entwined to place new antidepressants at the forefront of a burgeoning market for mental health drugs. Following an established psychotropic drug marketing template, the new antidepressants were promoted as safe, almost harmless, and — erroneously — free of the disadvantages of dependence and withdrawal because they were not addictive.
But assessments of antidepressant safety are basically derived from clinical trials lasting only 6-12 weeks, which understate adverse effects and withdrawal risk. Though guidelines recommend antidepressant treatment generally for 6 months to 2 years, in practice, the median duration of antidepressant treatment in the US is 5 years. However, extended duration of drug treatment compounds risks of adverse effects and withdrawal difficulties.
In recent years, following the lead of the new antidepressants, antipsychotics, stimulants, sleep drugs, and GABA analogs became more widely prescribed, joining those long-established troublemakers, benzodiazepines and opioids in a flood of psychotropic drug prescriptions.
Recognizing a systematic problem
Prescribed psychotropics are now ubiquitous – and so are complaints about adverse effects and withdrawal symptoms, thousands of patient voices being amplified by social media.
Absent medical support, a digital grassroots movement arose to collaboratively provide mutual aid and collect and share data. Experiencing antidepressant withdrawal syndrome myself, I founded SurvivingAntidepressants.org in 2011 to provide peer support for tapering and withdrawal syndrome from all psychiatric drugs. For almost 15 years, the site provided peer support to more than 20,000 people, tapering information to additional millions, and patient narratives for study by academic researchers.
“There’s a hidden public health problem in people experiencing withdrawal symptoms because they and their doctors don’t know how to gradually reduce the dosage.…people don’t learn this stuff in medical school.”
ADELE FRAMER
FOUNDER OF THE PSYCHOTROPIC DEPRESCRIBING COUNCIL
Shots: Health News from NPR, July 10, 2025
Over and over, the same story appeared in thousands of narratives: Patients followed their doctors’ instructions to taper the drug over a few weeks and experienced withdrawal symptoms that were invariably misdiagnosed, with subsequent interventions often exacerbating an avoidable injury that upended their lives.
Patients reported going from specialist to specialist, finding no understanding of the problem. Given the widespread online population describing difficulties in going off antidepressants, benzodiazepines, opioids, and other prescribed psychotropics, it appeared this was not limited to an inconsequential number of exceptionally unlucky people. It was common but unrecognized.
As a citizen researcher and patient advocate, in 2021 I published a landmark paper, “What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications”, which has garnered more than 150,000 views and 80 citations. I also co-authored a well-received paper about protracted antidepressant withdrawal syndrome, the most comprehensive source on protracted withdrawal in the peer-reviewed psychiatric literature, cited 71 times. In attention ratings, both are among the top 0.3% of all research articles, demonstrating significant interest in the issue.
With 20 years of experience and research in psychiatric drug withdrawal syndromes, I concluded that this hazard of psychotropic treatment – crippling withdrawal syndromes – arises from avoidable medical error, and that this could be remedied by updating medical education to include effective deprescribing.
A new paradigm for better outcomes
In late 2023, I founded the Psychotropic Deprescribing Council (PDC) to help balance a system that knows how to begin treatment but not how to end it safely — completing a therapeutic cycle that has been unresolved for decades.
“Deprescribing refers to the thoughtful and systematic process of identifying problematic medications and either reducing the dose or stopping these medications in a manner that is safe, effective, and helps people maximize their wellness and goals of care.”
US Deprescribing Research Network (USDeN)We aim to close a critical gap in clinical knowledge with medical education about how to recognize when psychotropic drugs are no longer appropriate, how to taper them to minimize withdrawal discomfort, and how to support patients through discontinuation to prevent relapse.
Yet, given the contexts of psychotropic prescriptions, effective deprescribing guidance goes beyond better procedures. It introduces a new patient-centered therapeutic goal: that a course of psychotropic treatment should have an end date, a principle emphasized in the field of pain medicine but largely missing in the current paradigm of psychiatric care.
An end date affirms an expectation of recovery. This requires a renewed partnership between clinicians and patients, one that transforms treatment planning, informed consent, and the meaning of recovery itself.
We believe that the process of psychotropic deprescribing goes beyond minimizing drug burden. It averts relapse as well, with wrap-around care as needed to help each person address underlying psychological issues, make lifestyle changes, manage physical health conditions, and build coping skills for the next stage of life.
Our organization arises from a transformational collaboration among the concerned public and medical professionals across primary care, psychiatry, pain medicine, addiction medicine, pharmacy, medical education, psychotherapy, and other healthcare disciplines — all working together for safer, more effective psychotropic treatment outcomes.
We invite all who share this vision to join us in creating this new paradigm.
References
Ballreich, J. M., Jeyakumar, S., Garrison, K., Lopez, A., Cohen, B. G., Paffrath, A., Steel, P., & Rubin, J. L. (2025). Societal burden of the US opioid epidemic over the next 15 years and the potential impact of effective non-opioid treatments for pain. Journal of Medical Economics, 28(1), 2247–2257. https://doi.org/10.1080/13696998.2025.2602385
Brody, D. J., & Gu, Q. (2020). Antidepressant Use Among Adults: United States, 2015-2018 (No. 377; NCHS Data Briefs). https://www.cdc.gov/nchs/products/databriefs/db377.htm
Brookfield, R. (2025). A Comparison of the CDC Clinical Practice Guidelines on the Use of Opioids for Pain: Clinical Implications. Pain Management Nursing, 26(2), e236. https://doi.org/10.1016/j.pmn.2025.01.084
Corwin, E. (2025, July 10). After quitting antidepressants, some people suffer surprising, lingering symptoms. Shots: Health News from NPR. https://www.npr.org/sections/shots-health-news/2025/07/09/nx-s1-5460018/antidepressant-ssri-side-effects-withdrawal-symptoms
Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR. Recommendations and Reports, 71(3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1
Economist. (2023, April 26). Too many people take too many pills. The Economist. https://www.economist.com/science-and-technology/2023/04/26/too-many-people-take-too-many-pills
Frank, R. G., Conti, R. M., & Goldman, H. H. (2005). Mental health policy and psychotropic drugs. The Milbank Quarterly, 83(2), 271–298. https://doi.org/10.1111/j.1468-0009.2005.00347.x
Framer, A. (2021). What I have learnt from helping thousands of people to taper off antidepressants and other psychotropic medications. Therapeutic Advances in Psychopharmacology, 11. https://doi.org/10.1177/2045125321991274
Hengartner, M. P., Schulthess, L., Sorensen, A., & Framer, A. (2020). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large internet forum. Therapeutic Advances in Psychopharmacology, 10. https://doi.org/10.1177/2045125320980573
Humphreys, K., Hagedorn, H., Han, X., Kemp, L., Poitra, N., & Cucciare, M. A. (2026). Electronic Intervention for Patient-Managed Benzodiazepine Tapering: A Randomized Clinical Trial. JAMA Network Open, 9(1), e2551807. https://doi.org/10.1001/jamanetworkopen.2025.51807
Horowitz, M. A., Buckman, J. E. J., Saunders, R., Aguirre, E., Davies, J., & Moncrieff, J. (2025). Antidepressants withdrawal effects and duration of use: A survey of patients enrolled in primary care psychotherapy services. Psychiatry Research, 350, 116497. https://doi.org/10.1016/j.psychres.2025.116497
Kramer, P. D. (1997). Listening to Prozac. Penguin Books.
Kuhn, R. (1957). Über die Behandlung depressiver Zustände mit einem Iminodibenzylderivat (G 22355) [On the treatment of depressive states with an iminodibenzyl derivative (G 22355)]. Schweizerische Medizinische Wochenschrift, 87(43), 1135–1140. PMID: 13467194
Leeuwen, E. V., Anthierens, S., van Driel, M. L., De Sutter, A., De Beir, R., & Christiaens, T. (2022). Should I, can I, dare I? Patients’ view on stopping long-term antidepressant use, a qualitative study. Acta Clinica Belgica, 1–8. https://doi.org/10.1080/17843286.2021.2024384
Meißner, C., Meyrose, A.-K., & Nestoriuc, Y. (2024). What helps, what hinders antidepressant discontinuation? Qualitative analysis of patients’ experiences and expectations. British Journal of General Practice, BJGP.2023.0020. https://doi.org/10.3399/BJGP.2023.0020
National Center for Health Statistics. (2024). Household Pulse Survey, 2020–2022. Mental Health Care. (Household Pulse Survey). U.S. Census Bureau. https://www.cdc.gov/nchs/covid19/pulse/mental-health-care.htm
National Center for Health Statistics. (2021). Mental health treatment among adults: United States, 2020 (NCHS Data Brief No. 419). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db419.htm
National Center for Health Statistics. (2020). Antidepressant use among adults: United States, 2015–2018 (NCHS Data Brief No. 377). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db377.htm
O’Brien, C. (2011). Addiction and dependence in DSM-V. Addiction (Abingdon, England), 106(5). https://doi.org/10.1111/j.1360-0443.2010.03144.x
Podolsky, S. H., Herzberg, D., & Greene, J. A. (2019). Preying on Prescribers (and Their Patients)—Pharmaceutical Marketing, Iatrogenic Epidemics, and the Sackler Legacy. New England Journal of Medicine, 380(19), 1785–1787. https://doi.org/10.1056/NEJMp1902811
Rasmussen, N. (2008). America’s first amphetamine epidemic 1929–1971: A quantitative and qualitative retrospective with implications for the present. American Journal of Public Health, 98(6), 974–985. https://doi.org/10.2105/AJPH.2007.110593
Reidenberg, M. M. (2011). Drug Discontinuation Effects Are Part of the Pharmacology of a Drug. The Journal of Pharmacology and Experimental Therapeutics, 339(2), 324–328. https://doi.org/10.1124/jpet.111.183285
Sørensen, A., Jørgensen, K. J., & Munkholm, K. (2022). Description of antidepressant withdrawal symptoms in clinical practice guidelines on depression: A systematic review. Journal of Affective Disorders, 316, 177–186. https://doi.org/10.1016/j.jad.2022.08.011
Tan, V. T. Y., & Van Oeveren, M. (2026). Pharmacopsychology of Prescribing: An Introduction to the PoP Model. Mental Illness, 2026(1), 3939110. https://doi.org/10.1155/mij/3939110
Truveta Research. (2025, February 4). Understanding mental health prescribing trends. Truveta. https://www.truveta.com/blog/research/research-insights/mental-health-prescribing-trends
Wand, T. (2025). Examining the Long-Term Impacts of Psychotropic Drugs and Considerations for People Discontinuing Treatment. Issues in Mental Health Nursing, 46(5), 411–419. https://doi.org/10.1080/01612840.2025.2476156
Ward, W., Haslam, A., & Prasad, V. (2025). Antidepressant Trial Duration Versus Duration of Real-World Use: A Systematic Analysis. The American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2025.04.037
