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    What Kennedy Gets Right, And Wrong, About Antidepressants

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    Like every psychiatrist, I have patients for whom antidepressants are transformative, even lifesaving. But I also see a messier, less advertised side of these medications. There are patients with sexual side effects that they hadn’t known could be caused by their antidepressants because previous doctors never warned them. I’ve had patients experience manic episodes or suicidal thoughts with specific antidepressants, and patients who no longer need to take the drugs, but suffer severe withdrawal symptoms when they try to taper off.The medical community has reacted with alarm to Health Secretary Robert F. Kennedy’s claim that his family members have had a harder time getting off antidepressants than heroin. The American Psychiatric Association and five other psychiatric organizations recently declared that likening antidepressants to Schedule I drugs like heroin was “misleading” and emphasized that antidepressants are “safe and effective.”But some patients heard Mr. Kennedy’s comments and felt that someone in a position of power was finally speaking for them. On online forums dedicated to helping people withdraw from antidepressants, such as Surviving Antidepressants, patients describe coming “undone” and going through “pure hell” in efforts to get off their medication.They see in Mr. Kennedy someone who is alert to the seriousness of their problems, after years of neglect by the medical community, and it doesn’t matter to them that their experiences may be relatively rare or that Mr. Kennedy’s health movement, which disregards science and embraces anti-vaccine ideology, is unlikely to serve patients’ best interests.Selective serotonin reuptake inhibitors, or S.S.R.I.s (the most commonly prescribed form of antidepressant) were originally studied for short-term use and were approved based on trials that lasted only a few months. But people quickly began taking the drugs for extended periods. Now patients are likely to stay on antidepressants for years, even decades. Of those who try to quit, conservative estimates suggest about one in six experiences antidepressant withdrawal, with around one in 35 having more severe symptoms. Protracted and disabling withdrawal is estimated to be far less common than that. Still, in a country where more than 30 million people take antidepressants, even relatively rare complications can affect thousands of people.This is why it’s a travesty that nearly four decades after the approval of Prozac, there’s not a single high-quality randomized controlled trial that can guide clinicians in safely tapering patients off antidepressants. The lack of research also means that official U.S. guidelines for it are sparse. It’s no surprise that patients have flocked to online communities to figure out strategies on their own, sometimes cutting pills into increasingly smaller fractions to gradually lower their dose over months and years.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Jeremy Renner and the Science of Extraordinary Near-Death Experiences

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      A little over two years ago, the actor was run over by a snowplow. Like thousands of others, he then felt an “exhilarating peace.” Why?A little over two years ago, the actor Jeremy Renner was run over by a seven-ton snowplow. In a new memoir, he wrote that as he lay near death, he experienced something extraordinary.He could see his entire life at once, and felt an “exhilarating peace” and a connection to the world. He also saw family and friends arrayed before him, telling him not to let go.“What I felt was energy, a constantly connected, beautiful and fantastic energy,” Mr. Renner wrote. “There was no time, place or space, and nothing to see, except a kind of electric, two-way vision made from strands of that inconceivable energy, like the whipping lines of cars’ taillights photographed by a time-lapse camera.”What Mr. Renner described is “classic for near-death experiences,” the term researchers use for such events, said Dr. Jeffrey Long, the founder of the Near-Death Experience Research Foundation.Dr. Long’s foundation has collected more than 4,000 accounts similar to Mr. Renner’s. Some people who have come close to death have recounted a sense of energy, peace and absence of time, as Mr. Renner did. Some have also described watching their body from above, moving through a tunnel toward a light and even meeting God.The general public may be familiar with these events through a genre of memoirs that present near-death experiences as proof of a Christian afterlife. But they have been reported across countries, demographics and religions, as well as by atheists, and have been a subject of scientific research for decades.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      The Fear Factor and America’s Future

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      More from our inbox:Depression and AgingPaul Revere’s Legacy Robert Gumpert/ReduxTo the Editor:“I Have Never Been More Afraid for My Country’s Future,” by Thomas L. Friedman (column, April 17), is an alarm we all need to hear. His main point couldn’t be clearer: The things that have made America strong — our rule of law, our global partnerships and our ability to lead in innovation — are being systematically undermined by a leader more focused on revenge than building a future.While other countries, like China, are investing in clean energy, advanced technology and long-term strategy, we’re clinging to the past and isolating ourselves in the process. If we don’t start paying attention, demanding accountability and thinking beyond the next news cycle, we will wake up in a country that’s poorer, more divided and left behind.We ignore Mr. Friedman’s warning at our own peril.Robert StewartChantilly, Va.To the Editor:Like Thomas L. Friedman, I have never been more afraid for my country’s future. But not because of the mistaken economic policies he focuses upon, dangerous as those may be. By far the most dangerous and repugnant reality of President Trump’s second term is his ongoing violation of constitutional guardrails and democratic norms so that he can assume a level of power never intended for any president.This threat is not simply an undesirable context for potentially fatal economic actions, as Mr. Friedman indicates. Rather, those guardrails are more fundamental to a strong economic future than any particular policy action. Even more important, they are absolutely essential to the decent society that economic activity and government are supposed to promote.Robert WardAlbany, N.Y.To the Editor:Thomas L. Friedman’s column captures, with characteristic urgency and clarity, the Trump administration’s surrealism and strategic incoherence.His critique of President Trump’s nostalgia-driven economic nationalism — especially the fetishization of coal at the expense of clean technology innovation — is timely and damning. Few writers can as effectively tie in the everyday absurdities of this administration to their long-term global implications.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Is Paying Kids to Read a Wise Strategy?

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      More from our inbox:Trump and the Psychiatrists: Is He Unfit to Serve?The Folly of a Second DebateA Heartwarming Story of Immigrants in the Heartland Tara BoothTo the Editor:Re “To Persuade a Reluctant Tween to Read, Try Cash,” by Mireille Silcoff (Opinion guest essay, Sept. 8):While I appreciate Ms. Silcoff’s desire to have her daughter experience the joys of reading, I seriously doubt that paying her daughter to read “worked.” While the monetary reward persuaded her daughter to read the book in the short term, it was unlikely to facilitate the motivation to read, which must feel like a choice and unpressured.Decades of research have shown that paying people to do things they love undermines their subsequent motivation, and paying them to complete tasks they do not enjoy keeps the motivation tied to rewards so that they are less likely to value the activity and choose to engage in it on their own.The belief in rewards as an effective motivator is a myth; other strategies are more likely to facilitate long-term motivation. Rewards are a simple fix that is likely to backfire.Wendy S. GrolnickLongmeadow, Mass.The writer is professor emeritus of psychology at Clark University and co-author of “Motivation Myth Busters: Science-Based Strategies to Boost Motivation in Yourself and Others.”To the Editor:I loved this guest essay because that’s precisely what I did 20 years ago when my husband and I traveled for our yearly two-week vacation to the beach with my daughter, two nephews and three other children who often vacationed with us.I offered each child a new book of their choice and $20 if they finished it before the trip was over. All of the kids got the $20 to use during two hours on their own at souvenir shops, and this reading challenge became a standard of our summer vacations.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Held Involuntarily in a Psychiatric Hospital

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      More from our inbox:The Debate Over Taxing TipsNonpartisan ElectionsSitting Still in SchoolAcadia Healthcare’s Park Royal hospital in Fort Myers, Fla., and Florida is among those that wrongly held some patients against their will.Michael Adno for The New York TimesTo the Editor:Re “Patients Held Against Will by Hospitals” (front page, Sept. 2):Thank you for your hard-hitting exposé of Acadia Healthcare, a chain of psychiatric hospitals, which revealed Acadia’s corrupt financial practices. The authors report on the toxic effects — including but not limited to driving people away from treatment — of these unscrupulous procedures.But even when hospitals have pure motives, inpatient psychiatric care — especially when it is involuntary — can be traumatizing, and may lead to an increased risk of suicide: In one meta-analysis, “the postdischarge suicide rate was approximately 100 times the global suicide rate during the first 3 months after discharge.”The key to helping people is funding community-based, evidence-based programs. For example, “Peer-run respites provide a voluntary alternative to an emergency department visit or inpatient hospitalization for people experiencing a psychiatric crisis,” as was noted in a recent article in Psychiatry Online.With so much evidence to support the benefits of community-based mental health care, I believe that a paradigm shift in the mental health system — away from hospitalization and toward community-based treatment, including peer support — is long overdue.Susan RogersCherry Hill, N.J.The writer is the director of the National Mental Health Consumers’ Self-Help Clearinghouse.To the Editor:The motivation for this atrocious behavior is cited in the first paragraph of the article, where it is noted that Acadia Healthcare’s stock price has more than doubled. This is an example of the perverse results of the use of private equity to finance health care. There are other such examples.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Medicaid Funding Would Expand Psychiatric Beds Under New Bill

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      A Democrat and a Republican from New York will introduce the “Michelle Go Act,” named after a woman who was killed when a mentally ill homeless man pushed her in front of a subway train.As the nation faces a growing mental health crisis among people who are homeless, a bipartisan bill being introduced in Congress on Thursday may substantially increase the number of psychiatric beds covered by Medicaid.Proponents of the bill say that it will help address a severe shortage of psychiatric hospital beds and spur the construction of new beds and new facilities.The bill is sponsored by the unlikely-seeming New York City congressional duo of Dan Goldman, a liberal Democrat, and Nicole Malliotakis, a Republican Trump loyalist, along with Representatives Tony Cárdenas, Democrat of California, and Gus Bilirakis, a Florida Republican. Mr. Goldman is the lead author of the bill, the Michelle Go Act, named after the woman who was fatally pushed in front of a subway train in New York in 2022 by a man with schizophrenia, who had spent decades rotating from hospital to jail to street.Under current law, for people age 21 to 64, Medicaid covers stays in dedicated psychiatric hospitals only if they have 16 or fewer beds. The Michelle Go Act would raise the threshold to 36 beds.Mr. Goldman said in an interview that the legislation would “not only provide for significantly more beds for long-term mental health care but has the potential to increase the ability for those who cannot afford mental health care to get the treatment they need.”Mr. Goldman has said that he would have liked to remove the cap on hospital size altogether — one estimate put the cost at $33 billion over 10 years. But he said that the more modest measure was necessary to win support on both sides of the aisle.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Why Adult ADHD Is Hard to Diagnose

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      It’s one of the most common psychiatric disorders in adults. Yet there are no U.S. guidelines for diagnosing and treating patients beyond childhood.Just before Katie Marsh dropped out of college, she began to worry that she might have attention deficit hyperactivity disorder.“Boredom was like a burning sensation inside of me,” said Ms. Marsh, who is now 30 and lives in Portland, Ore. “I barely went to class. And when I did, I felt like I had a lot of pent-up energy. Like I had to just move around all the time.”So she asked for an A.D.H.D. evaluation — but the results, she was surprised to learn, were inconclusive. She never did return to school. And only after seeking help again four years later was she diagnosed by an A.D.H.D. specialist.“It was pretty frustrating,” she said.A.D.H.D. is one of the most common psychiatric disorders in adults. Yet many health care providers have uneven training on how to evaluate it, and there are no U.S. clinical practice guidelines for diagnosing and treating patients beyond childhood.Without clear rules, some providers, while well-intentioned, are just “making it up as they go along,” said Dr. David W. Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.This lack of clarity leaves providers and adult patients in a bind.“We desperately need something to help guide the field,” said Dr. Wendi Waits, a psychiatrist with Talkiatry, an online mental health company. “When everyone’s practicing somewhat differently, it makes it hard to know how best to approach it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Canada Delays Plan to Offer Medically Assisted Death to the Mentally Ill

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      A parliamentary panel concluded that there are not enough doctors, particularly psychiatrists, in the country to properly assess patients.Canada is postponing a plan to offer people suffering from mental illnesses the option of a medically assisted death, two cabinet ministers said on Monday.The announcement by Mark Holland, the health minister, and Arif Virani, the justice minister, came after a special parliamentary committee looking into the plan concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.“The system needs to be ready, and we need to get it right,” Mr. Holland told reporters. “It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”Neither minister offered any timeline for the latest extension. Following an earlier delay, the expansion had been scheduled to come into effect on March 17.Canada already offers medically assisted death to terminally and chronically ill people, but the plan to extend the program to people with mental illnesses has divided Canadians.Some critics say the plan is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber?  More

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      The Republican Alternatives to Trump

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      More from our inbox:Whatever Happened to Civil Presidential Debates?Questions for HamasQuestions for IsraelAdvice for These Fraught TimesAntipsychotic Drugs and Weight GainThe presidential hopefuls seemed content to aim for second place behind former President Donald J. Trump and deliver digs at President Biden.Maansi Srivastava/The New York TimesTo the Editor:Re “If You’re Going to Win the Nomination, Here’s Step 1,” by Kristen Soltis Anderson (Opinion guest essay, Nov. 8):Ms. Anderson says that many Republicans are open to opponents of Donald Trump who can articulate a new direction for the party, but that those candidates are running out of time to make their case.Ms. Anderson mentions the former South Carolina governor Nikki Haley as a viable alternative to Mr. Trump. But in terms of good fiscal governance and foreign policy, I believe that Ms. Haley is even more misguided than Mr. Trump.For example, she has recommended ending the federal gas tax, enacting a new middle-class tax cut and extending the 2017 Trump administration tax cut. While such policies might attract some voters to Ms. Haley, they would greatly diminish the revenue needed to pay for essential services, not to mention blowing up the national debt.As for international affairs, she has recommended sending special forces to “take out the cartels” in Mexico. Imagine how Mexico and other countries might react to such an invasion.Serious Republicans don’t need to look far to find a better presidential candidate than Ms. Haley.Eric MurchisonVienna, Va.To the Editor:Ron DeSantis, Nikki Haley and the other G.O.P. candidates must know that the most likely path to a nomination for them is if Donald Trump is convicted or forced to drop out of the race. In that scenario, many Republican voters are likely to be very angry, and they will rally behind the candidate who can most compellingly channel their indignation. Anyone who has been seen as significantly anti-Trump will be out of the running.It is strategically savvy of them not to level any direct harsh criticism at Mr. Trump. If the time comes that Mr. Trump is forced out of the race, the last thing his competitors will do in that situation is suggest that the charges against him are anything other than politically motivated.William ShermanHuntington, N.Y.To the Editor:This guest essay suggested that the candidates explain why they are running against Donald Trump, which in fact was one of the questions asked during Wednesday’s debate. Perhaps the reason they have not yet done so convincingly is that they are not running “against” Mr. Trump.Several of them are likely running for vice president, and that would preclude discussing their differences.Carolyn BrossBloomingdale, N.J.Whatever Happened to Civil Presidential Debates? To the Editor:Re “From Substance to Shouting: The Demise of Political Debate in America” (Opinion video, nytimes.com, Nov. 7):Our view of politics has shifted dramatically from the days when presidential debates were respectful discussions of platforms and ideologies. I am a high school junior, and my classmates and I are worried about the future of the American presidency.Presidential debates, once characterized by thoughtful discussions, have transformed into heated contests where candidates pick one another apart in hopes of winning a few more percentage points. Genuine discourse is rare, and recap videos showcase the biggest insults or the funniest moments.How does it affect our country’s future when presidential candidates can’t engage in respectful discussion? What does it mean for American society when our ideology divides us completely? A president’s priority should be to represent the people and work toward the betterment of our nation. We cannot afford to lower this standard.As the future generation of voters and leaders, it falls on us young people to advocate a return to civil and meaningful discussion in our political debates. The strength of our democracy depends on it, and young voices need to be part of the solution.Maia DietzSan Jose, Calif.Questions for Hamas Ronen Bergman/The New York TimesTo the Editor:Re “Hamas’s Goal for Oct. 7: A Permanent State of War; Group’s Leaders Say Carnage Was Needed to Restore Focus on Palestinians” (front page, Nov. 9):After reading your interviews with Hamas leaders, one wonders:1. Are the Palestinian citizens of Gaza OK with a permanent state of war?2. Where is that permanent state of war supposed to lead?3. What cause was “slipping away”? Certainly not peace or a two-state solution; so what is left?4. If the cause and the policy of permanent war mean the destruction of Israel, are all those chanting “Free Palestine” or “From the river to the sea” supportive of that?Scott BenardeWest Palm Beach, Fla.Questions for IsraelTo the Editor:Israel’s stated war objective, repeated often by Prime Minister Benjamin Netanyahu, is to “destroy Hamas.” Hamas is a movement, a political-military organization with the backing of Iran and other entities.Might one ask what exactly does “destroy Hamas” look like? Is it every member of Hamas surrendering, or is it the death of the leadership, much of which does not even live in Gaza? How does one measure success when the stated aim is impossible to measure, let alone manage?I think that if we are paying for the arming of Israel — and make no mistake, we are — we are entitled to a straight answer.Geoffrey D. BatrouneyRye Brook, N.Y.Advice for These Fraught Times Photo illustration by The New York TimesTo the Editor:Re “How to Stay Sane in Brutalizing Times,” by David Brooks (column, Nov. 5):What amazing advice from Mr. Brooks on how people can stay sane in these perilous times. His emphasis on humility, prudence and caution is inspiring. I would add just one thing: self-compassion. Today public leaders need to be kind to themselves for the nearly impossible jobs they are often called on to do.Jerome T. MurphyCambridge, Mass.The writer is a retired Harvard professor and dean who taught courses on leadership.To the Editor:David Brooks reaches back thousands of years, integrating diverse cultures and quoting appropriate phrases from several authors, to emphasize the vast depth of his subject matter. Yet after all that, he does not cite the one that summarizes the entire concept: “Love one another. As I have loved you, so you must love one another.”Mary Ann McGinleyWilmette, Ill.Antipsychotic Drugs and Weight Gain Derek AbellaTo the Editor:Re “Psychiatric Drugs Add Pounds. Some See Solution in Ozempic” (front page, Nov. 6):Like other clinical psychiatrists, I use a simple, low-tech solution for my patients who gain weight on their antipsychotic drugs. In consultation with our patients, we find another antipsychotic, one that doesn’t cause weight gain. There are many to choose from.Together with our patients, we look for the most effective drug with the least side effects, at the lowest possible dose. To be on the safe side, we weigh our patients at each visit to guard against weight gain.Of course, this requires continuing follow-up visits with our patients, to form a trusting relationship and a common goal of healing. But with a new patient it’s essential to provide such close attention.Some might object that such frequent office visits for follow-up care are too expensive. But compared with the monthly cost of Ozempic, good care is a bargain.Alice FellerBerkeley, Calif. More