[Editorial] The right medicines for the right reasons

The right medicines for the right reasons
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Publication History:
Published July 18, 2026
DOI: 10.1016/S0140-6736(26)01419-4 External LinkAlso available on ScienceDirect External Link
Copyright: © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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US Secretary of Health and Human Services Robert F Kennedy Jr has suggested that antidepressants are more addictive than heroin and may contribute to school shootings—allegations repeatedly rejected as false. Given this history, the announcement in May, 2026 of a new Make America Healthy Again Action Plan to Curb Psychiatric Overprescribing was met with alarm in many health circles. HHS officials have stressed that they aim to address “overmedicalization”, not ban certain antidepressants altogether, with a focus on reducing long-term medication use when no longer beneficial in improving patient outcomes. But harmful rhetoric aside, the broader issue of deprescribing is an important problem in modern clinical practice that deserves more attention.
Starting treatments can be easy but plans to monitor and discontinue medications are often an afterthought. Some patients can remain on medications for years without medication review; in other cases, they might initiate medication without sufficient informed consent, or knowledge of and access to alternatives. Some are not well supported through the process of deprescribing and face relapses. The rising use of GLP-1 receptor agonists raises questions about long-term pharmacotherapy. Like antidepressants, they are associated with stigma about lifestyle, dependence, and overuse. Stopping chronic disease medication can have undesireable effects. This might reflect recurrence of illness, withdrawal, or inadequate support for tapering. Deprescribing represents a challenge particularly in the context of polypharmacy, which affects roughly one in two older adults and increases the risk of adverse drug events, functional decline, and hospitalisation. Continually weighing the benefits against potential harm can address overtreatment as well as undertreatment. For example, the benefits of antihypertensive treatments to reduce cardiovascular events need to be balanced with the potential harms, which include orthostatic hypotension, falls, and acute kidney injury.
Clinical trials focus on initiating medications, but fewer studies determine when and how to stop taking them safely. Stopping treatment could be viewed as negligence; therefore, trials often need strong evidence on safety and effectiveness in specific patient populations to overcome not just clinical but also legal barriers. Patient goals, quality of life, and cognitive and physical functioning are crucial to these decisions, particularly for older adults. Even when evidence is clear, guidelines for practitioners may omit the practical details for implementing deprescribing and tapering, leaving clinicians having to undertake difficult conversations with patients without the tools to assess benefits, harms, and alternative options. Many medications for psychiatric and chronic conditions are initiated or continued in primary care. Family doctors need the time, training, and referral pathways to deprescribe safely—through careful review of medication history, monitoring systems for adverse effects and relapse, and plans to restart if symptoms recur. Promising studies in the UK suggest an important role for pharmacists in medication review.
Payment systems for health-care providers tend to reimburse for starting prescriptions but might fail to provide incentives for health providers to spend the time to discontinue them safely. The US Medicare and Medicaid programmes allow clinicians to count medication review, symptom monitoring, and patient communication as billable time, recognising that financial incentives matter as much as clinical guidance.
Medicines can be continued unnecessarily with unclear benefits when medication monitoring and support are lacking. At the same time, medications, including those for psychiatric and chronic diseases, can be lifesaving and many people do not receive the treatment they need. For example, in the USA, almost half of people with mental health conditions lacked appropriate treatment in 2024. Some patients may need to take medications for the rest of their lives to effectively control conditions. This need should not be stigmatised or unduly discouraged. The solution to overprescribing is not underprescribing or abruptly stopping treatment. The guiding aim should be that individual patients receive the right treatment for the right reasons, and understand the benefits and risks, and that health practitioners have the capacities and support to create a safe plan for starting, continuing, stopping, or restarting treatment as needed. Better care—not simply less or more—is the measure of success in medicine.

* US Secretary of Health and Human Services Robert F Kennedy Jr suggested antidepressants are more addictive than heroin and may contribute to school shootings.
* An announcement in May 2026 regarding a new Make America Healthy Again Action Plan to Curb Psychiatric Overprescribing was met with alarm in many health circles.
* HHS officials aim to address “overmedicalization” by reducing long-term medication use when no longer beneficial for patient outcomes.
* Some patients remain on medications for years without medication review.
* Some patients may initiate medication without sufficient informed consent or knowledge of alternatives.
* The rising use of GLP-1 receptor agonists raises questions about long-term pharmacotherapy due to stigma related to lifestyle, dependence, and overuse.
* Stopping chronic disease medication can have undesirable effects like recurrence of illness or withdrawal if tapering is inadequate.
* Deprescribing is a challenge in polypharmacy among older adults, increasing the risk of adverse drug events, functional decline, and hospitalization.
* Benefits of antihypertensive treatments must be balanced against potential harms like orthostatic hypotension, falls, and acute kidney injury.
* Clinical trials focus on initiating medications rather than determining safe stopping protocols.
* Payment systems do not always incentivize health providers to spend time on safe discontinuation.

The discussion centers on the concept of deprescribing—the process of safely reducing or stopping medications—as a necessary component of modern clinical practice, especially given concerns about overprescribing and long-term pharmacotherapy. There is an acknowledgment that while starting treatments is often easy, monitoring discontinuation and ensuring informed consent regarding alternatives remain significant challenges. The article raises specific concerns about the rising use of GLP-1 receptor agonists, similar to antidepressants, regarding stigma, dependence, and overuse. Furthermore, polypharmacy among older adults increases the risk of adverse drug events and functional decline. A key tension exists between the proven benefits of treatments, such as for cardiovascular health, and potential harms, such as orthostatic hypotension or falls. The text suggests that addressing overtreatment requires balancing benefits against harms, necessitating a focus on patient goals and the capacity for practitioners to implement safe tapering plans.

The underlying pattern reveals a systemic gap between the initiation of medical treatments and the necessary management of their continuation and cessation, framed by incentives rather than holistic patient outcomes. The resistance to deprescribing appears rooted in structural inertia—the ease of starting versus the difficulty of stopping—which is exacerbated by existing payment systems that reward prescribing over de-prescribing. This creates a tension where clinical goals (improving outcomes) clash with economic realities (reimbursement structures). The narrative pivots from individual patient choices to systemic responsibilities: clinicians lack adequate time, training, and referral pathways, and the system fails to provide necessary incentives for safe discontinuation. The implication is that the focus on managing pharmaceutical excesses ignores the practical, logistical burden on primary care providers and the necessity of integrating long-term functional goals into treatment decisions. The concept that "better care—not simply less or more—is the measure of success" serves as a counterpoint to purely quantitative metrics, suggesting that true progress requires procedural and systemic change to support patient agency over their entire treatment trajectory. What systems currently prioritize the initiation of care over stewardship? What structural changes are required to make safety in cessation an inherent part of the financial incentive structure for healthcare providers?

[Editorial] The right medicines for the right reasons

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Sentinel — Human

[Editorial] The right medicines for the right reasons

Facts Only

Executive Summary

Full Take

Sentinel — Human