HHS MAHA Psychiatric Overprescribing Action Plan: A Psychiatrist’s Read

On May 4, 2026, the U.S. Department of Health and Human Services announced the MAHA Action Plan to curb psychiatric overprescribing. The MAHA psychiatric overprescribing plan, as the agency framed it, has several moving parts: a letter to clinicians, a payment change at Medicare, and a timeline toward formal federal guidance. The headline read like a political shot at psychiatry. The documents underneath it read like something the field has needed for a decade.

I’m a board-certified psychiatrist with subspecialty certification in forensic psychiatry, running a cash-pay telehealth practice in North Carolina. Patients land in my practice every month asking how to come off an antidepressant they have taken for years, sometimes after a taper that failed. So I read the May 4 documents closely, not as politics, but as the clinical and payment scaffolding they actually describe.

Most of what the plan says is right. Some of it is overdue. One part, the framing around children, is where the caution belongs.

Among the alternatives to reflexive prescribing is attention to metabolic health, which I explore in metabolic psychiatry.

What the HHS MAHA Action Plan Actually Says

The plan came out of a MAHA Institute summit on mental health and overmedicalization, with HHS Secretary Robert F. Kennedy, Jr. as the closing speaker. The stated goal is to prevent the unnecessary initiation of psychiatric medications and to support tapering and discontinuation for patients who are not getting clinical benefit.

Kennedy framed it as autonomy and consent. The plan would, in his words, “support patient autonomy, require informed consent and shared decision-making, and shift the standard of care toward prevention, transparency” in mental health treatment.

Three concrete actions landed the same day. A Dear Colleague Letter from four HHS divisions on informed consent, shared decision-making, and nonmedication treatment. CMS guidance clarifying how clinicians get paid under Medicare for deprescribing. And a public timeline of SAMHSA reports, prescriber webinars, and a July Technical Expert Panel charged with writing formal HHS clinical guidance.

The Course Correction Was Overdue

This is where I largely agree with the plan. For two decades, long-term antidepressant use grew faster than the evidence supporting it. The chemical imbalance explanation for depression that drove much of that prescribing was never well supported, and patient-facing messaging kept repeating it long after the literature moved on.

Withdrawal got minimized the same way. The 2019 systematic review by Davies and Read put the incidence of antidepressant withdrawal around 56%, with roughly half of those affected describing it as severe (Davies and Read, 2019). Horowitz and Taylor then showed why standard tapers fail: serotonin transporter occupancy follows a hyperbolic curve, so the final few milligrams carry the largest physiologic change (Horowitz and Taylor, 2019). That is the mechanism behind why the standard two-week taper fails most long-term users.

Organized psychiatry is already moving in the same direction. The Dear Colleague Letter itself cites a 2026 consensus statement from the American Society of Clinical Psychopharmacology Task Force, which recommends that psychotropic medications be periodically reassessed and that deprescribing decisions involve active patient participation (Goldberg et al., 2026). The federal plan is catching policy up to where the clinical evidence already sits.

The SAMHSA Dear Colleague Letter: Informed Consent and Shared Decision Making

The Dear Colleague Letter, signed by SAMHSA, CMS, HRSA, and ACF, is the most clinically substantive of the three documents. On medication itself, the letter is unambiguous: psychiatric medications can play an important and, at times, essential role in treatment.

What it asks for is a real consent conversation. Before starting, continuing, or stopping a psychiatric medication, the letter says patients should hear the purpose, the expected benefit, the adverse effects, the monitoring plan, the potential discontinuation symptoms, the risk of abrupt cessation, and the availability of nonmedication options. The letter notes that shared decision-making in mental health care can improve a patient’s sense of involvement in their own treatment (Aoki et al., 2022).

That last category gets real space in the letter. It points to psychotherapy, social connection, sleep-focused treatment, physical activity, and nutrition as evidence-based options when clinically appropriate, citing meta-analyses on exercise (Noetel et al., 2024) and dietary improvement (Firth et al., 2019) for depressive symptoms. The caveat is built in: these are not interchangeable with medication in every case, and not sufficient for everyone.

For men in particular, the nonmedication review the letter calls for overlaps with something I write about often: the hormonal and metabolic contributors that get missed in a standard depression workup. When a workup is thorough, fewer patients end up on a medication they never needed in the first place.

CMS Deprescribing Guidance: How Physicians Get Paid to Help Patients Come Off Medications

This is the part with teeth. Consent letters change tone. Payment rules change behavior.

For years, supervised deprescribing was clinical work almost nobody could bill for cleanly. A careful taper takes visits, phone calls, symptom monitoring, and coordination, and none of it had a reliable payment path. So it often did not happen, or it got compressed into a two-week stop that set patients up to fail.

The CMS guidance issued May 4 clarifies that deprescribing work can be paid under Medicare. The activities involved, including medication review, care-plan revision, symptom monitoring, patient communication, and care-team coordination, can be counted under existing chronic care management and principal care management rules. CMS also directs clinicians to professional society guidelines, peer-reviewed deprescribing protocols, and FDA taper-schedule instructions.

That matters more than any rhetoric at the summit. A reimbursable supervised taper is one a clinic can actually offer.

What This Means for Adults on an Antidepressant in North Carolina

If you are an adult in North Carolina who has taken an antidepressant for years, two things are worth knowing.

First, nothing in the plan says your medication was a mistake, and nothing in it tells you to stop on your own. Stopping abruptly is exactly what produces the withdrawal the plan is trying to prevent. If a medication is still working, the same documents say to keep it.

Second, what changes is access. The plan pushes toward a model where a supervised taper is a billable, documented, shared decision rather than an afterthought. For patients who have cycled through medications without real benefit, or who tried to come off before and crashed, that is the difference between a slow, symptom-paced taper and the standard schedule that fails.

Some antidepressants are far harder to stop than others. Venlafaxine (Effexor) is the toughest of the common ones; our guide to venlafaxine withdrawal explains why it hits between doses and how to taper it without crashing.

Deprescribing, in the letter’s own framing, is a deliberate, individualized clinical process. It applies when a drug has stopped helping, is causing harm, or no longer fits the patient’s goals, and it calls for close monitoring through the taper. The decision runs both ways, and it belongs in a clinical conversation.

Among the SSRIs, paroxetine (Paxil) is the hardest to come off, for reasons of half-life and anticholinergic rebound. See our guide on how to taper off paroxetine.

The Children’s Question: Where the Plan Lands Hardest

The plan leads with children, and this is where I would flag the most caution.

The clinical concern is real. Foster youth in particular have been prescribed antipsychotics and polypharmacy at rates that are hard to defend, and the Dear Colleague Letter’s attention to that population, through ACF oversight and CMS pediatric quality measures, is warranted.

The risk sits on the other side of the same coin. Pediatric mental illness is also undertreated in many parts of the country, and a federal message built around overprescribing in children can be read by a frightened parent as a reason to stop a medication that is keeping a child stable. Untreated depression and ADHD in young people carry their own serious harms.

I treat adults, so I will defer the pediatric prescribing specifics to child and adolescent psychiatrists. The general principle holds at every age: the decision to start, continue, or stop is individual, and it belongs in a careful conversation between a family and a clinician who knows the patient.

What Comes Next: SAMHSA Reports, Webinars, and the Technical Expert Panel

The May 4 announcement was a starting line, and several things follow on a public timeline.

SAMHSA said it would release a report on prescribing trends and a fact sheet for prescribers and patients this month. Educational webinars for prescribers are scheduled across June and July. A joint SAMHSA and HRSA webinar for federally qualified health centers is set for the summer.

The most consequential item comes in July, when HHS will convene a Technical Expert Panel of clinicians, patients, families, agencies, and professional societies to write formal HHS clinical guidance on the appropriate use of psychiatric medications and on tapering and discontinuation. NIH and FDA also said they would expedite research into new treatments.

The guidance is what to watch. A press release sets direction. Clinical guidance sets standards. Whether this becomes durable practice or a single news cycle depends on what that panel produces, and on whether the payment changes outlast the politics that announced them.

Frequently Asked Questions

Does the MAHA plan mean I should stop my antidepressant?

No. Nothing in the plan tells patients to stop medication, and stopping suddenly is what causes the withdrawal the plan is trying to prevent. If you want to come off, the plan actually makes it easier to do that under supervision. Talk with your prescriber about a slow, monitored taper rather than stopping on your own. You can read more about how a supervised taper works.

Is this an anti-psychiatry policy?

The documents do not read that way. The Dear Colleague Letter states that psychiatric medications can play an essential role and cites a 2026 psychiatry-society deprescribing consensus. The thrust is appropriate prescribing, informed consent, and access to nonmedication options, rather than removing access to medication.

What actually changed on May 4, 2026?

The MAHA psychiatric overprescribing plan bundled three concrete actions: a Dear Colleague Letter on informed consent and nonmedication options, CMS guidance making supervised deprescribing billable under Medicare, and a published timeline toward formal HHS clinical guidance later in 2026.

I tried to come off an antidepressant before and felt awful. Was that withdrawal or relapse?

It can be either, and telling them apart is a clinical skill. Withdrawal usually starts within days of a dose drop and includes physical symptoms like dizziness and brain zaps. Relapse tends to come on later and looks like the original depression returning. A supervised taper is built to manage exactly this question.

Does any of this apply in North Carolina?

Yes. The CMS payment changes are federal, and the clinical principles apply anywhere. Baghel Psychiatry is a cash-pay telehealth practice serving adults across North Carolina, and supervised tapering is part of that work.

This article is for general educational purposes and does not constitute medical advice or create a physician-patient relationship. Do not start, stop, or change a psychiatric medication without consulting your prescriber. Stopping an antidepressant abruptly can cause withdrawal symptoms. If you are in crisis, call or text 988.

References

1. U.S. Department of Health and Human Services. HHS Launches MAHA Action Plan to Curb Psychiatric Overprescribing. May 4, 2026. hhs.gov
2. SAMHSA, CMS, HRSA, ACF. Dear Colleague Letter: psychiatric medication and non-pharmacological treatments. May 4, 2026. samhsa.gov (PDF)
3. Centers for Medicare & Medicaid Services. Billing Supervised Medication Deprescribing Services Under the Physician Fee Schedule. May 4, 2026. cms.gov (PDF)
4. Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects. Addict Behav. 2019. PMID 30292574
5. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019. PMID 30850328
6. Goldberg JF, et al. Recommendations for the deprescribing of psychotropic medications: a consensus statement from the American Society of Clinical Psychopharmacology Task Force. JAMA Netw Open. 2026;9(2):e260043. doi.org
7. Noetel M, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847. doi.org
8. Firth J, et al. The effects of dietary improvement on symptoms of depression and anxiety: a meta-analysis of randomized controlled trials. Psychosom Med. 2019;81(3):265-280. doi.org
9. Simon GE, Moise N, Mohr DC. Management of depression in adults: a review. JAMA. 2024;332(2):141-152. doi.org
10. Aoki Y, et al. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev. 2022;11(11):CD007297. doi.org