Title: How America Became Overmedicated—And What We Can Do About It
Author: KevinMD Podcast featuring Dr. Muhamad Aly Rifai
Published: April 2025
In a recent segment of The Podcast by KevinMD, internist and psychiatrist Dr. Muhamad Aly Rifai provided valuable insights into the increasing issue of overmedication in the U.S., particularly concerning psychotropic drugs. Expanding on his KevinMD article, “How America Became Overmedicated—And What We Can Do About It,” Dr. Rifai identified systemic challenges within American psychiatry and proposed actionable measures to tackle this escalating problem.
The Extent of Overmedication in Psychiatry
Data from the Centers for Disease Control and Prevention (CDC) reveals that almost 1 in 4 American adults—25%—are utilizing some form of psychotropic medication. This category encompasses antidepressants, antipsychotics, mood stabilizers, and drugs for anxiety, ADHD, and various mental health issues. Although these medications can be essential and life-saving, prolonged use without proper discontinuation strategies can result in side effects, dependency, and unnecessary healthcare expenses.
When compared to other nations, particularly the UK, there are significant differences in psychotropic prescribing trends in the U.S. For example, while only 1–2% of individuals in numerous developed countries take psychotropic medications, the percentage in the U.S. reaches 25%, a concerning statistic that calls for scrutiny and reform.
What Is Driving This Trend?
Dr. Rifai points out several factors contributing to the overprescribing of psychotropic medications:
1. Brief psychiatric appointments: Patient interactions, typically lasting only 15 or 16 minutes, do not permit thorough discussions regarding treatment progress or medication alternatives.
2. Insufficient institutional backing: Many physicians lack adequate training on deprescribing methods and distinguishing between actual relapses and withdrawal symptoms. Additionally, the pharmaceutical sector has little motivation to explore protocols for discontinuation.
3. Inefficient healthcare systems: Insurance reimbursement models prioritize quick medication assessments over comprehensive, therapeutic dialogues or long-term treatment strategies.
4. Patient-initiated discontinuation: Frustrated with side effects and a lack of proper guidance, some patients try to reduce their medication dosage independently or through online support groups—sometimes leading to harmful consequences.
Adverse Effects of Psychotropic Medications
Antipsychotic medications are particularly known for their side effects, which include:
– Metabolic syndrome: increased weight, high blood sugar levels, and the onset of diabetes.
– Movement disorders: such as tardive dyskinesia.
– Cognitive impairment, emotional detachment, or sexual dysfunction.
These adverse effects frequently remain unaddressed, causing patients to discontinue their medications without medical supervision—often leading to relapse or hospitalization.
U.S. vs. U.K.: The NICE Recommendations
In contrast, the United Kingdom’s National Institute for Health and Care Excellence (NICE) provides structured guidelines for managing depression and tapering medications. These recommendations encourage clinicians to discuss the duration of antidepressant treatment with patients, especially if:
– More than six months have elapsed since starting the medication
– It’s the patient’s first episode of depression
– Symptoms are currently in remission
This structured approach enables safer discontinuation and encourages patient empowerment while reducing risks.
What Can Primary Care Providers Do?
A majority of psychotropic medications in the U.S. are prescribed by primary care physicians. Dr. Rifai urges these providers to initiate proactive deprescribing discussions, particularly in cases of:
– Initial depressive episodes that have been in remission for 6 to 12 months
– Using serotonergic medications with longer half-lives, such as fluoxetine, which taper naturally from the body
He also highlights the importance of validated assessment tools like the PHQ-9 to track progress, monitor remission, and guide tapering strategies.
The Lack of Research
A significant gap exists in research focused on the safe cessation of psychotropic medications. Pharmaceutical companies, motivated by market interests, heavily fund studies that promote new drugs or their use as supplementary therapies but seldom support research on discontinuation. Without such evidence, U.S. physicians must depend on anecdotal experiences or international guidelines.
The Danger of Inaction: Growth of Unregulated Deprescribing
As the medical community fails to offer consistent guidance, online peer networks, coaches, and non-professional “tapering communities” are emerging to fill the gap. Although these support systems can be beneficial, they often lack medical expertise, potentially putting patients at risk for physical, emotional, and psychological harm.
A Call to Action: Creating a Recovery-Focused System
Dr. Rifai advocates for a comprehensive, national transformation in mental health care that extends beyond mere pharmacological solutions. Recommended steps include:
1. Formulating and disseminating formal deprescribing guidelines modeled after the UK’s NICE framework.
2. Improving physician training on medication tapering, monitoring side effects, and exploring alternative therapies.
3. Encouraging an integrated behavioral health care approach that incorporates therapy, case management, and social support.