Psychiatric Pills Are Not the Problem—The System Is
My take on Trump’s Executive Order re: antidepressants & ADHD meds 💊
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On February 13, 2025, President Trump’s executive order covering mental health medications sent shockwaves through the medical and psychiatric communities. Its sweeping suggestion—that medications such as SSRIs and stimulants for attention deficit disorders might soon face heightened scrutiny and potential withdrawal from patients in need—has sparked a firestorm of debate. As a primary care physician, I worry that focusing solely on pills misses the true crisis: a broken healthcare system that has lost sight of patients themselves.
The challenges of the U.S. medical system will not be resolved by simply reducing access to medications. Instead, they require us to reimagine healthcare. We need a revamped system that integrates medical evidence with the patient’s social-emotional and behavioral health. Medications are not the enemy; an impersonal, fragmented system is.
A Case of Depression
I recently saw a patient in her sixties who has struggled with depression for twenty years. Despite taking fluoxetine (i.e., Prozac), her suffering persisted. When she came to me, it was clear that her struggle was not going to be remedied by more medication.
During our visit, I learned that she had long endured a toxic work environment where she was being undermined. At home, her partner’s substance abuse left her emotionally isolated and unable to advocate for herself. Her family history of depression compounded her vulnerability. The solution to her situation was not to escalate the dose of fluoxetine or to substitute it with another pill; rather, she needed regular CBT (cognitive behavioral therapy) to process difficult emotions and help her set boundaries at work and at home.
While fluoxetine had played an important role in managing her symptoms, arguably giving her the emotional reserves she needed to cope, it was not a substitute for the nuanced care that she needed.
The Dangers of a Fragmented Approach
Then there is the middle-aged professional woman who came to me underweight and suffering from gastrointestinal complaints. By the time she reached my office, she had already sought advice from a nutritionist, a gastroenterologist, and numerous online “gut experts,” many of whom preached the virtues of restrictive diets. Convinced that cutting out carbohydrates and gluten would remedy her issues, she adhered to an increasingly severe dietary regimen that led to her dangerously undernourished state.
In order to help break a vicious cycle of anxiety and gastrointestinal distress, she needed more than simply to be told “eat more food” and “gain weight.” At the root of her problem was obsessive-compulsive disorder (OCD), a condition that ran in her family for generations.
After three months of taking fluoxetine, a first-line medication for OCD, in addition to her work with a board-certified dietician, my patient’s rigid behaviors around food abated and her weight improved. Unsurprisingly, with less anxiety and a renewed desire for nourishment, her gut started working again.
Medication alone wouldn’t have been sufficient in this case, but it was a necessary part of her treatment.
The Medication Debate: Misplaced Focus
Proponents of the new presidential order argue that overprescription is a problem that must be curbed. Indeed, there is no doubt that our system readily falls into the trap of treating symptoms rather than addressing root causes. However, targeting the medications themselves is akin to treating the visible tip of an iceberg while ignoring the massive, submerged structure beneath the sea.
The simplistic notion that the remedy to mental health issues is binary: either restrict or liberally dispense medications like fluoxetine, ignores the complexity of the human experience. Neither of my patients needed more pills in isolation—they needed comprehensive, integrative care.
A Broken System
What underpins these challenges is a healthcare system that is increasingly impersonal and fragmented. In the United States, the economic incentives that drive our medical institutions often prioritize quick fixes and high-volume prescriptions over the slow, deliberate work of building a genuine doctor-patient relationship. The result is a system where patients are frequently treated as a set of symptoms to be managed.
When patients are routinely treated in hurried, impersonal settings—where a doctor has mere minutes to glean their story—it is no wonder that overprescription becomes a default solution. Without the time to explore the underlying causes of distress, clinicians may feel compelled to rely on medications as a stopgap measure.
The Mission Prescription: Agency and Access
The solution to our current crisis is not to demonize medications like SSRIs or stimulants. Rather, it is to empower every patient with access to a primary care medical home—a place where they can receive care that is as nuanced and multifaceted as their lives demand. In such an environment, the physician is not merely a dispenser of pills, but a guide who helps patients navigate the complexities of their health, integrating evidence-based medicine with an appreciation for personal narrative.
Imagine a healthcare system where each patient’s primary care provider has the time and resources to understand the patient's story—where factors such as work stress, relationship dynamics, and family history are given their due weight alongside lab results and diagnostic tests.
Achieving this vision requires a fundamental realignment of priorities. First, we must incentivize medical students and early-career physicians to pursue careers in primary care rather than specialty fields that often pay more but disconnect them from the holistic practice of medicine. Second, we need to restructure our healthcare financing to reward quality time with patients rather than high turnover and prescription volume. Finally, we must arm patients with the information and support necessary to become active participants in their care, instead of further detaching them from the facts, genuine guidance, and access to someone they can trust.
A Call for Systemic Change
Trump's executive order may be well-intentioned in its aim to address the overprescription of medications, but it is, at its core, a superficial fix to a deep-rooted problem. The ultimate goal is not to eliminate medications from our armamentarium, but to ensure they are used as part of a balanced, holistic approach to health.
Real health is not found in a pill bottle or a trending wellness meme. I hope we can move beyond the simplistic debates over medications and focus on what truly matters: creating a healthcare system that empowers patients to live longer, and better, lives.
What do you think? I’m all ears!
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Thank you for using your voice and platform to give the public solid information. Trump’s executive order regarding medications is outlandish. Yes, the system is broken. Our medical system has become financially centered rather than patient centered. The hospitals are run by administrators who are only interested in the bottom line, the almighty dollar.
Politicians need to stay out of medical decisions. We don’t need to rid the system of mental health medications, we need to improve the mental health branch of medicine.
Doctors and nurses are over-worked and underpaid. Salaries for doctors, who are owned by hospital systems are based on the rapid fire of patients in and out of offices in record time.
My husband is a retired family physician who had a practice for 40 years. When the group joined the hospital they were the number 1 family practice group, with the highest patient reviews. Over the next few years the administration stepped in and pretty much destroyed a well established and well loved practice. My husband and his colleagues left the practice because they couldn’t work under such duress, incompetence, and disregard for patient care.
Doctors are slowly, but surely, leaving the profession. I am on my third family doctor within 2 years. They’re exhausted and disillusioned. Patients can’t get an appointment for months.
Most definitely the system has to be reorganized and changed. Doctors are the backbone of hospital systems. Maybe it’s time for them to be one loud voice. There’s power in numbers.
Thank you, once again, Dr. McBride for your dedication and wisdom.
Would also add that the cost of medical school is part of what drives medical students into high paying specialties instead of primary care.