Addressing America's reliance on psychotropic medication

Practicing internist and psychiatrist Muhamad Aly Rifai discusses his article, "How America became overmedicated—and what we can do about it." He raises concerns about the high rate of psychotropic medication use in the U.S., citing CDC data suggesting nearly 1 in 4 adults may be taking these drugs, often without clear long-term plans or exit strategies. Muhamad contrasts this with U.K. NICE guidelines that emphasize structured deprescribing protocols, highlighting a significant gap in U.S. clinical guidance. He points to systemic issues like short medication management visits, lack of industry incentives for deprescribing, and the need for better physician training in distinguishing withdrawal symptoms from relapse. Dr. Rifai advocates for a national shift towards wellness, emphasizing medication optimization, integrated behavioral health (including therapy and trauma-informed care), addressing social determinants of health, and fostering recovery-oriented conversations that explore non-pharmacologic approaches like peer support, nutrition, and exercise. Actionable takeaways include the need for robust deprescribing guidelines, investment in holistic and integrated care models, and a conscious effort by clinicians to discuss not just starting medications, but also safely stopping them when appropriate.

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