It is interesting to hear the internal debate of the APA here. I can see they are put in a difficult position. To agree that it is worthwhile for there to be official deprescribing guidelines (which is very hard to disagree with – disagreement involves the assumption that all psychiatric drugs should be given life-long, a claim even beyond the pale for even the most reductive biological psychiatrist) involves admitting guilt that this has not been done in 40 years of practice and that the government needed to step in. The opposite option is to decry this as a radical step from a secretary of HHS who is known to hold other controversial views. This is made difficult as attempts to paint this as ‘the government coming for your drugs’ has been shown to be caricature of what is a sensible process to update guidelines and foster an ignored by important practice. The canniest move on the chess board is the ‘fake fix’ – proffering a hastily put together deprescribing textbook by the pre-eminent architect of mass prescribing (Stephen Stahl) or a complex exercise in obfuscation by the ASCP in their deprescribing consensus statement, both of which minimise or ignore the major issues (minimise withdrawal, de-center tapering and re-iterate again and again that relapse is a major risk and people should not stop their drugs, ignoring all the obvious flaws with research that systematically mis-classified withdrawal as relapse) as evidence that they are already dealing with the problem. Never mind that these initiative both came out 40 years after these drugs came on the market, after these bodies have issued thousands of missives that have increased prescribing, and that Stahl’s book enshrines existing dogma (with very, very pretty but irrelevant diagrams) of reducing drugs in 4-8 weeks using existing tablets and readily diagnosing relapse or adding more drugs if unpleasant symptoms arise. I certainly hope the more enlightened voices willing to face the reality of the problem rather than seek to take refuge in denial, minimisation or vilification of the messenger will prevail, but it seems like this may not be the case…

It really shouldn't need to be said but here is @taperingtay in possession of a bleeding lefty heart but also a brain susceptible to the principle of homeostasis in response to exposure to psychotropic drugs re-iterating that this is not a partisan issue but a public health issue that needs to be addressed.