The Trump Administration has made a big hullabaloo about the concept of doctors being newly paid to deprescribe medication — specifically, antidepressants. Robert F. Kennedy Jr. is making it sound like doctors have only been paid to prescribe medications before, but now — shock, gasp — they will be prescribed to deprescribe them too! If doctors only got paid per prescription, this would, indeed, be big news. However, like with most of the wretched effluence oozing from the White House right now, this is nothing but a lie. Doctors have always been paid to prescribe and deprescribe medications — it’s called treating patients.

Doctors Don’t Get Paid to Prescribe

Back in the bad old days of decades past, there were times when doctors could be economically incentivised to write specific prescriptions. This was usually done through generous perks like all-expense-paid trips and huge “consulting fees” (because direct payment was illegal, just like now). Some unethical doctors may have taken the opportunity to line their own pockets with the dollars of pharmaceutical companies in that way, in the 80s and 90s.

However, in this day and age, there are more rules and transparency. No drug company can bribe a doctor like that ever. Now, do drug companies still try to influence the prescribing habits of doctors? Yes, of course they do. They are a business like any other, but paying doctors per prescription is not a method available to them. (If you want to find out if industry money is being paid to your doctor in the way of speaking fees, etc., see here. Yes, some doctors will always be unethical.)

Not only do doctors not get paid to prescribe specific medications, they don’t get paid to prescribe medications at all. Whether you talk to your doctor about your depression and it results in a prescription or showing a picture of your cat, your doctor gets paid either way. What the doctor is being paid for is to treat you for depression. That doesn’t necessitate a prescription in all cases. (Showing a picture of your cat constitutes talk therapy, at least, for cat lovers.)

Doctors Deprescribe All the Time

I’ve been on many psychiatric medications, including antidepressants, and the vast majority of them I am no longer on. In other words, all those medications have been deprescribed. And trust me, the doctors who did the deprescribing have been paid all along — both in Canada and the US. “Deprescribing” is simply the act of withdrawing a medication, which is something doctors do every day.

Again, what a doctor is paid for is the treatment of an illness like depression, not to scribble illegibly on a prescription pad. I have left many doctors’ appointments without prescriptions for all manner of reasons. That is normal and nothing new.

Why Is RFK Jr. Making Deprescribing Sound Like a New Thing?

Just like the Trump Administration tried to make antidepressants sound dangerous and scary, they are also making it sound like doctors are being sinisterly bribed into forcing them down your throat. They are trying to make political hay out of the idea that they are the ones who can get the US off the evil antidepressants.

This, of course, is hogwash on its face.

Doctors are doing today exactly what they did a month ago, which is exactly what they did two years ago: they are treating people for medical conditions like mental illnesses. Sometimes, those conditions require the prescription of medications like antidepressants. And sometimes those conditions require the withdrawal of medications like antidepressants. It was ever so.

Doctors also get paid just to talk to you and find out how treatment is going, in case you forgot. Prescribing is only one of the things these highly-trained professionals do.

What Really Happens When Deprescribing Is Falsely Emphasized?

Unfortunately, what’s likely to happen is that, rather than antidepressants being appropriately deprescribed at the appropriate times, what this all is going to result in is more stigma around mental illness medication and treatment, not to mention people just stopping their medications willy-nilly (which you should never do). People will get it further ingrained in their brains that there is something wrong with antidepressants, something wrong with doctors prescribing antidepressants, and thus, something wrong with people who take antidepressants. This is the opposite of helpful. This is hurtful to the millions of people who have many illnesses that are helped by antidepressants and other psychiatric medications.

Is there a time to come off antidepressants? For many people, yes, of course, but for some, no, there isn’t. Some people will need those medications forever, and it is not them or their “wicked” doctor who make it so. Some people just have brains that need a little more help on a daily basis. That is okay. Some of us have pancreases or other organs that need help too. That’s okay, also.

But don’t think that deprescribing is right for everyone or that it’s a new thing just because a catcher’s mitt of a man said so. It’s not. It’s one arrow in a quiver that has always been a part of treating illness.