Day Lila

Mind & Body · Sunday, 27 September 2026

01 Briefing what happened

A review of 76 trials found that stopping an antidepressant slowly, with talking therapy alongside, kept depression away about as well as staying on it

Mind & Body 52 sources

The US health secretary, Robert F. Kennedy Jr., has started a push to get Americans off antidepressants. How a person stops matters, because a fast drop can bring withdrawal symptoms or the illness back.

76 trials

compared ways of stopping an antidepressant, with 17,379 people in them

slow stopping with talking therapy did about as well as staying on the drug [4]

15 in 100

people who stop an antidepressant and get symptoms caused by stopping

about 3 in 100 get severe symptoms, one analysis found [1]

98 of 153

people in a Dutch study who tried to stop their antidepressant and managed it

those who felt their doctor understood them found stopping less of a struggle [10]

0.2 mg

cut every two months by one patient coming off escitalopram

faster cuts brought on strong anxiety and panic, a psychiatrist said on a New York Times podcast [11]

The lead story — what happened

  • The US health secretary, Robert F. Kennedy Jr., has started a push to get Americans to use fewer psychiatric drugs, especially children, and to help them stop antidepressants. [1][2]
  • About one in six American adults takes an SSRI, the family of antidepressants that includes sertraline and fluoxetine. [1][3]
  • A review of 76 trials with 17,379 people, published in the journal Lancet Psychiatry, compared ways of stopping. [4]
  • Cutting down slowly, over more than four weeks, together with talking therapy kept depression away about as well as staying on the drug. [4]
  • Stopping at once, or cutting down in four weeks or less, did much worse. Cutting down slowly without the therapy did not clearly beat stopping at once. [4][1]
  • One Lancet Psychiatry analysis found about 15 in 100 people get symptoms caused by stopping, and about 3 in 100 get severe ones. [1]
  • Kennedy has said SSRIs are harder to quit than heroin. Keith Humphreys, who studies addiction at Stanford University, said the two are in different universes. A standard psychiatric manual says stopping an antidepressant brings no craving. [1]
  • Guidance for doctors called the Maudsley Deprescribing Guidelines says withdrawal happens more often, is more severe and lasts longer than was thought. [5]
  • It recommends cutting in smaller and smaller steps as the dose falls. At low doses, each small cut takes away a large share of a drug's effect on its target. [5][6]
  • A computer model of five antidepressants looked at taking a pill every other day, a common way to cut down. It found the drug's level swings more, which probably raises the risk of withdrawal. [7]
  • No randomised trial has yet settled the best way down. A trial of 150 adults will compare fixed cuts with cuts of 20% to 25% of the current dose every two weeks. [8]
  • Scotland's prescribing guide says a person with bad withdrawal can go back to the last dose that felt fine, then cut more slowly. [9]

3 of 20

3 in 20 get symptoms caused by stopping

Out of every 20 people who stop an antidepressant, about 3 get symptoms caused by the stopping itself, in one Lancet Psychiatry analysis.

Who is involved

  • Robert F. Kennedy Jr.

    the US health secretary; he is leading a push to get Americans, especially children, off psychiatric drugs

  • Jonathan Slater

    a psychiatry professor at Columbia University in New York; he wrote in STAT, a US health news site, that the push mixes a real need with claims the evidence does not support

  • The American Society of Clinical Psychopharmacology

    a US group of psychiatrists and drug researchers; 45 experts it gathered in 2025 agreed 44 of 50 statements on stopping antidepressants

  • The Maudsley Deprescribing Guidelines

    guidance for doctors on stopping psychiatric drugs; it says withdrawal is more common than was thought and backs smaller and smaller cuts

How it unfolded

  1. 2025 45 experts gathered by a US psychiatry society agree 44 of 50 statements on stopping antidepressants [1]
  2. Dec 2025 a review of 76 trials finds slow stopping with therapy works about as well as staying on [4]
  3. May 2026 a Columbia psychiatrist writes in STAT that Kennedy's push goes beyond the evidence [1]
  4. Sep 2026 the debate reaches a New York Times Opinion podcast [2]
  5. Next a trial of 150 adults compares two ways of cutting the dose [8]

Where this points

Watch whether the US drug regulator asks makers to test how their antidepressants should be stopped, which it has never required, and what the 150-person trial comparing two ways of cutting finds. [1][8]

What is pushing on the whole day

The bar and the word are our reading of how hard each one is pushing today. The arrow is where it is heading. The evidence is in the stories below.

Stopping long-term drugs Building↑

A 2025 paper on opioid painkillers proposes cutting 1% to 10% of the latest dose every one to two weeks. [6] A review of antipsychotics proposes cuts of 5% to 10% a month. [12] Stopping the bone drug denosumab with nothing after it can bring fast bone loss and broken bones in the spine. [13]

Wildfire smoke High↑

Across 20 US states, wildfire smoke raised hospital stays for heart and lung disease more than the same amount of other air pollution. [14] A US model put deaths from long-term smoke at about 24,100 a year. [15] Children aged 5 to 9 in seven countries were among the hardest hit. [16]

Working through the night Steady→

People in the UK who always worked nights had 50% higher odds of bad sleep. [17] People who usually worked nights had 29% higher risk of thin bones. [18] Workers over 50 who left night shifts had longer telomeres, the caps on their chromosomes, for each year since. [19]

Hormone therapy after menopause Building↑

Use among US women fell from 4.4% in 2007 to 1.7% in 2023. [20] In Denmark, women who used it had a slightly lower risk of dying. [21] In South Korea, users had more breast cancer. [22]

Too much body fat High→

In 290,000 UK adults, extra fat that was already causing illness carried the highest risk of death. [23] Every 5 extra BMI points raised the odds of a skin infection by about a third. [24] Obesity was the physical factor most tied to new depression. [25]

The rest of the day

36 more stories on this beat.

Each with its own sources. None of these is a link to the story above.

  1. 02

    Antipsychotics change the brain they are stopped from

    Antipsychotics are drugs for psychosis, when a person loses touch with what is real. A 2025 review says years on them change the brain: one study found about 30% more receptors for dopamine, a chemical messenger, in people who had taken them. [12] Stopping fast can bring agitation, anxiety and poor sleep, which can be mistaken for the illness coming back. [12] The authors propose cutting 5% to 10% of the latest dose each month. [12]

    Why it matters — The authors say some of the relapse seen after stopping may be caused by the stopping itself. If so, the drugs' protection may have been overstated in trials where they were stopped. [12]

  2. 03

    Opioids: smaller cuts as the dose falls

    Opioids are strong painkillers, and guidelines say to stop them when the harm outweighs the help. [6] A 2025 paper, with authors at King's College London, says the guidelines disagree on how. Some cut a fixed amount each time, and others cut smaller amounts as the dose falls. [6] From the chemistry of how opioids attach to their target, it recommends cutting 1% to 10% of the most recent dose every one to two weeks. [6] For some long-term users that takes months or years. [6]

    Why it matters — It is the same rule the new antidepressant guidance uses, worked out for a different drug. The authors say it still has to be tested in randomised trials. [6]

  3. 04

    Stopping denosumab needs a plan

    Denosumab is an injection given every six months to slow bone loss in osteoporosis, the thinning of bone that makes it break easily. [26][13] Unlike some other bone drugs, it is not simply stopped when the course ends. [27] Without a follow-up drug, stopping it can lead to rapid bone loss and new broken bones in the spine. [13] A 2026 review says a different bone drug, a bisphosphonate, should be given as a way out. [13]

    Why it matters — The bone loss the drug was holding back comes back quickly once it is gone. Mayo Clinic tells patients to keep taking it on schedule for that reason. [27]

  4. 05

    One bone drip, protection years later

    Zoledronic acid is a bone drug of the bisphosphonate family, given as a drip into a vein. [27] In a trial of 1,054 women aged 50 to 60, a single dose did not reduce spine fractures in the first five years. It cut them by 57% in years five to ten. [28] A separate Auckland trial gave 2,000 women over 65 the drug every 18 months. Fractures outside the spine fell by 60% in years four to six, against a 17% fall in years one to three that could be chance. [29]

    Why it matters — Bisphosphonates stay in the bone after years of use, so their effect goes on after the last dose. [27] Most bone drug trials last three years or less, so they may miss the later benefit. [29]

  5. 06

    Three months of romosozumab was enough

    Romosozumab is a monthly bone-building injection whose use is limited by its cost, monthly clinic visits and concern about heart risk. [26] In a US trial, 50 women at high risk of fracture got either three months of it followed by nine months of denosumab, or twelve months of romosozumab. Both built about as much hip bone. [26] Hip bone density rose 5.7% against 6.0%, inside the margin the researchers set in advance. [26]

    Rise in hip bone density after a year, in 50 women at high risk of fracture.

    Why it matters — A shorter course costs less and needs fewer clinic visits, and in the US more than half of patients stop the full course early anyway. [26] The trial was small and measured bone density, not fractures. [26]

  6. 07

    Bone drug trials hang on a few patients

    Researchers took 27 large trials that showed a bone drug prevented fractures and asked how many patients' results would have to change to lose that finding. [30] The median answer was 9 patients, about half of one percent of a trial. [30] For bisphosphonates it was 8.5 on average. Romosozumab's evidence was the strongest, with a median of 19.5. [30]

    Why it matters — The drugs may still work. The finding is that many of the trials were only just big enough to show that they do. [30]

  7. 08

    Fewer US women use hormone therapy

    Mayo Clinic, a large US hospital group, found that hormone therapy use among US women over 40 fell from 4.4% in 2007 to 1.7% in 2023. [20] Even among women aged 50 to 59, who are most likely to benefit, only about 3.5% used it. [20] Up to 75% of women get hot flushes or night sweats at menopause, and they can last years. [20] Use is at its lowest since the early 2000s, when a large trial raised fears about safety. [20]

    Share of US women over 40 using hormone therapy for menopause.

    Why it matters — Stephanie Faubion, who led the study, blames misinformation and too little menopause training for doctors. [20] Use was lower among Black, Hispanic and Asian American women than among white women. [20]

  8. 09

    In Denmark, users lived slightly longer

    Denmark's national registers followed 876,805 women born between 1950 and 1977 from the age of 45, for a median of 14 years. [21] The 11.9% who took hormone therapy for menopause had a 4% lower risk of dying, once health, income and other differences were accounted for. [21] The lower risk showed after one to ten years of use, not under a year or over ten. [21]

    Why it matters — Before that adjustment the users' death rate was higher, 54.9 against 35.5 per 10,000 years lived, which shows how much the answer depends on the adjustment. [21] Among 703 women whose ovaries were removed at 45 to 54, users had a 27% to 34% lower risk. [21]

  9. 10

    Hormone therapy and the age of menopause

    A 2026 study used TriNetX, a network of health records covering about 111 million patients. It matched 83,670 women who started hormone therapy within a year of menopause with similar women who did not. [31] Where menopause came at 60 or younger, users had lower rates of diabetes, heart disease, spine fractures and breast cancer. [31] Where it came after 60, breast cancer was 15% more likely in users. [31]

    Why it matters — It fits the idea that timing matters. It is a records study, and the authors say women who chose the treatment may differ in ways the matching could not see. [31]

  10. 11

    In Korea, more cancer with hormone therapy

    A study of South Korea's national health records matched 138,445 women who took hormone therapy for menopause with the same number who did not. It followed them for about eight years. [22] Users had about 10% more cancer overall and 57% more breast cancer. [22] Their risk of cancer of the womb was about 13% lower. [22] Tibolone, a different menopause drug, did not raise overall cancer risk. [22]

    Why it matters — The authors suggest a milder form of progestogen, the second hormone in most combined treatments, might lower the breast cancer risk. [22]

  11. 12

    Hormone therapy alongside a weight-loss drug

    Mayo Clinic researchers looked at 120 women past menopause who took tirzepatide, a weight-loss drug approved by the US regulator, for at least a year. [32] Women also taking hormone therapy lost about 35% more weight than women on tirzepatide alone. [32][33] The study was not a randomised trial, so it cannot show that the hormone therapy caused the extra loss. [32]

    Why it matters — Maria Daniela Hurtado Andrade, the senior author, said women on hormone therapy may already have had healthier habits, or slept better once their symptoms eased. [32]

  12. 13

    Cancer survivors' hot flushes go untreated

    Many women treated for breast cancer take hormone-blocking drugs that bring on menopause symptoms such as hot flushes. [34] Records from the US, UK and Germany showed a treatment for those symptoms in 32.7%, 20.4% and 8.3% of such women. [34] Antidepressants were the most common first choice. [34] After six months, only 42% in the US, 12% in the UK and 7% in Germany were still taking them. [34]

    Share still taking an antidepressant for menopause symptoms six months after starting, among women on breast cancer drugs.

    Why it matters — Most of these women are offered drugs made for something else, and most stop within months. [34]

  13. 14

    Wildfire smoke hits harder than other smog

    A 2026 study compared two kinds of fine dust in the air, from wildfires and from everything else, across 20 US states from 2006 to 2019. [14] For each small rise in wildfire smoke over two years, hospital stays rose by 10% for heart failure and 16% for asthma. [14] The same rise in other air pollution raised them by 4.7% to 8.5%. [14]

    Rise in hospital stays for each small rise in fine dust, by where the dust came from, across 20 US states.

    Why it matters — The links were stronger in poorer communities, among people with less schooling and among ethnic minorities, so the same smoke lands harder on them. [14]

  14. 15

    About 24,100 US deaths a year from smoke

    A 2026 study estimated how long-term smoke from wildfires affected death rates across the continental US from 2006 to 2020. [15] It put the toll at about 24,100 deaths a year and found no safe level: deaths rose steadily with exposure. [15] Deaths from brain and nerve diseases rose most. [15] As a check, deaths from falls and road accidents showed no link, as expected. [15]

    Why it matters — This is a model of whole areas, not a count of death certificates, and it covers years of breathing smoke rather than the smoky days that make the news. [15]

  15. 16

    Canada's smoke toll swings with the season

    A 2026 study modelled smoke from wildfires across Canada for 2019 to 2023. [35] Long-term exposure caused between 660 and 5,400 early deaths a year, depending on how bad the fire season was. [35] The yearly cost of that harm ranged from $6.4 billion to $52 billion. [35] More than 80% of people in Canada breathed at least one microgram of smoke per cubic metre, on average, in a typical fire season. [35]

    Why it matters — The deadliest year in the study had about eight times the early deaths of the mildest, so the toll rises and falls with each fire season. [35]

  16. 17

    Fire smoke sends children to hospital

    A study linked daily hospital admissions in 1,012 communities across seven countries and territories to smoke from landscape fires, such as forest fires. [16] Each rise in smoke raised children's admissions for lung problems by 1.9%, heart problems by 2.9% and diabetes by 3.7%. [16] Children aged 5 to 9 and those in poorer areas were hit hardest. [16]

    Why it matters — Admissions for lung problems, infections and brain-related illness rose even at low levels of smoke. [16]

  17. 18

    Asthma worse in the smoky summer

    In summer 2023, smoke from distant wildfires reached Vermont and upstate New York, a region that rarely saw it. [36] Records from 1,217 visits by young people with asthma showed poorer asthma control that summer than in 2022, on two of three measures. [36] Control was no different from 2024, and local smoke levels within 2023 did not track it. [36]

    Why it matters — The signal is real but patchy, and the authors say it needs more watching as fire seasons get longer. [36]

  18. 19

    In Wyoming, the smoke's toll comes a week late

    Researchers counted breathing-related claims to Medicaid, the US health cover for people on low incomes, in 23 Wyoming counties during wildfire seasons from 2012 to 2024. [37] Claims averaged about 1.6 a day during smoke episodes and 7.9 a day in the week after, a five-fold rise. [37] The authors say distance and cost delay care until the smoke has passed. [37]

    Why it matters — Counting only the smoky days would miss most of the harm in rural places far from a doctor. [37]

  19. 20

    Night shifts and bad sleep

    UK Biobank is a study of half a million people aged 40 to 69 who joined between 2006 and 2010. [17] Among 285,175 of them who were working, those who always worked nights had 50% higher odds of both trouble sleeping and daytime sleepiness than people who never did shifts. [17] Those who sometimes worked nights had 37% higher odds, and day-shift workers 21%. [17]

    Higher odds of both poor sleep and daytime sleepiness, compared with people who never work shifts, in UK Biobank.

    Why it matters — The odds rose with every step towards permanent nights, and the link differed by age, ethnicity and smoking. [17]

  20. 21

    Night work and thinner bones

    Another UK Biobank analysis followed 276,774 working people for osteoporosis. [18] Every group that did night shifts had more of it than day workers, and those who usually worked nights had 29% higher risk. [18] Among 75,120 people with full job histories, more than ten years of nights carried an estimated 21% higher risk, though that estimate was not statistically certain. [18]

    Why it matters — It adds bone to the body systems linked to night work, alongside sleep. [18][17]

  21. 22

    Night shifts and breast cancer: not settled

    A 2026 review pooled 12 studies of night work and breast cancer among health workers, covering 12,132 cases. [38] Women who had ever worked nights showed no clear rise in risk. [38] Twenty years or more carried 25% higher risk, but that result stopped being statistically clear under checks for bias. [38] Six in ten studies were judged at high risk of error in how they measured night work. [38]

    Why it matters — If the link is real, night work would cause a substantial number of breast cancers in health workers, the authors say. [38]

  22. 23

    After night work ends, telomeres grow back

    Telomeres are protective caps on the ends of chromosomes that tend to shorten with age. In 262 workers over 50, mostly men, those still on night shifts had shorter telomeres than the rest. [19] Among former night workers, more years of nights meant shorter telomeres. [19] But for each year since they stopped, telomeres were longer and a DNA-based measure of body age was lower. [19]

    Why it matters — The study measured people once rather than following them. It suggests some of what night work does to the body reverses after it stops. [19]

  23. 24

    A study built to watch night workers

    EPHOR-NIGHT follows 937 workers aged 20 to 65, nearly all in health care, in Spain, Sweden, Denmark and the Netherlands. [39] They wore sensors for light, movement and heart rate, and gave saliva at five times of day. [39] Permanent night workers slept least and worst. [39] Many already reported anxiety (27%) or depression (18%), and a two-year follow-up was finished in June 2025. [39]

    Why it matters — Most night-work studies rely on people remembering their shifts, which is where a 2026 review found them weakest. [38]

  24. 25

    Three more countries free of malaria

    The WHO, the UN's health agency, certified Suriname, Timor-Leste and Georgia free of malaria in 2025, after Cabo Verde and Egypt in 2024. [40] That makes 47 countries and one territory. [40] A 2026 review found the three shared steady political backing, strong tracking of cases, community involvement and steady funding. [41] Suriname worked with indigenous communities and across its borders; Timor-Leste did it after a conflict. [41]

    Why it matters — Malaria still killed an estimated 610,000 people in 2024, most of them young children in Africa, and resistance to the main drug is growing. [40]

  25. 26

    Malaria by plane in Libya

    In November 2024 a 63-year-old man in Benghazi, Libya, who had not travelled, died of malaria, and three of his children were infected. [42] Libya was certified malaria-free in 1973. [42] Investigators, writing in February 2026, ruled out local spread and blamed infected mosquitoes arriving at Benina airport, about 450 metres away. [42] Sri Lanka, free for ten years, warns that imported cases can restart the disease. [43]

    Why it matters — Staying free of malaria means watching airports and travellers for decades. Sri Lanka has had no local case since 2012. [43]

  26. 27

    Five habits and 13 cancers

    A 2026 study followed 287,745 UK Biobank members for a median of 11.5 years, and 12,947 developed cancer. [44] It scored five habits: smoking, alcohol, diet, exercise and body weight. [44] People with four or five healthy habits had lower risk of 13 of 27 cancer types, including lung, bowel, liver and kidney, than people with none or one. [44] Smoking and excess weight were linked to the most types. [44]

    Why it matters — The list includes less common cancers, such as liver and mouth cancer, whose rates have been rising in the UK. [44]

  27. 28

    Obesity judged by illness, not only weight

    BMI, weight measured against height, cannot tell fat from muscle or say whether a person is ill. [23] A Lancet commission proposed judging obesity by body measurements and by whether the extra fat is already causing illness. [23] The WHO's cancer agency tested it on more than 290,000 UK Biobank adults over nearly 14 years. [23] Extra fat with illness carried the highest risk of death, and extra fat without illness was already riskier. [23]

    Why it matters — It could change who is counted as obese, and so who is offered treatment first. [23]

  28. 29

    Higher weight causes skin infections

    Researchers used a method that compares people by the genes they were born with, which works like a natural experiment, in UK Biobank and a Finnish study of 500,348 people. [24] Every 5 extra BMI points raised the odds of a bacterial skin infection seen by a family doctor by 37%. [24] The odds of going to hospital with one nearly doubled. [24]

    Why it matters — The same method was less certain about chest infections, which shows it can separate a cause from a coincidence. [24]

  29. 30

    Frailty and heart disease

    Frailty means a body that has become weak, slow and easily tired. In 408,163 UK Biobank members without heart disease, followed for 15 years, 30.5% of the frail developed it, against 13.1% of the robust. [45] After adjustment, frailty carried 85% higher risk, and early frailty 24%. [45] The link held at every stage of a scale of heart, kidney and blood-sugar health used by the American Heart Association. [45]

    Why it matters — The authors say frailty picks up risk that the usual heart, kidney and blood-sugar measures miss. [45]

  30. 31

    Lung disease and lung cancer

    A UK Biobank analysis compared 107,007 people with a long-term lung disease with 351,876 people without one. [46] Over nearly 4.8 million years of follow-up, 1,322 lung cancers appeared in the first group and 867 in the second. [46] After adjustment, lung disease went with about three times the risk of lung cancer. [46] The raised risk showed in both main types of the cancer. [46]

    Why it matters — It marks out a large group of people at about three times the usual risk of lung cancer. [46]

  31. 32

    What goes with new depression, in women and men

    A 2026 study followed 87,648 UK Biobank members for a median of 13.7 years. [25] In that time 5.65% of women and 4.21% of men developed depression, and 6.02% and 3.60% developed anxiety. [25] A lasting tendency to worry and feel low had the largest share: about half of new depression in women and 60% in men was statistically tied to it. [25] Among physical factors, obesity counted most. [25]

    Why it matters — Long-lasting inflammation in the body was linked to both depression and anxiety, in both sexes. [25]

  32. 33

    Sweet foods and chronic pancreatitis

    The pancreas makes digestive juices and insulin. A UK Biobank study followed 136,367 people aged 40 to 69 for about 11.6 years. [47] Those who ate the most sweet foods had 87% higher risk of chronic pancreatitis, a lasting inflammation of the pancreas, than those who ate the least. [47] Sweet foods showed no link with pancreatic cancer or with the sudden form of the illness. [47]

    Why it matters — Diet was reported on a questionnaire, so the link is a lead to test rather than a proven cause. [47]

  33. 34

    Back pain: doing beat receiving

    Physiotherapy is active when the patient moves and exercises, and passive when treatment is done to them, such as heat, taping or hands-on therapy. [48] A 2025 analysis pooled randomised trials with 2,768 people with long-term low back pain. [48] Active physiotherapy gave the lowest pain and disability scores, better than passive care or a mix of both. [48] The ranges around the estimates were wide. [48]

    Why it matters — Long-term low back pain is one of the main causes of disability worldwide. [49]

  34. 35

    Acupuncture for back pain, on weak evidence

    A 2025 review pooled eight randomised trials with 1,123 adults comparing acupuncture with usual care for long-term low back pain. [49] Acupuncture reduced pain and disability both within two weeks and up to six months later. [49] But the certainty of the evidence was rated low to very low, because of bias, mixed results and signs that small negative trials went unpublished. [49]

    Why it matters — The trials compared acupuncture with usual care, such as physiotherapy, advice or medicines, not with fake needles. [49]

  35. 36

    A waiting list as the comparison

    A Dutch rehabilitation clinic tested its team treatment for long-term low back pain without a full trial, by comparing 123 treated patients with 88 still on its waiting list. [50] Pain scores fell from about 54 to 35 out of 100, and fear of moving also dropped. [50] When 51 of the waiting patients were treated later, they improved by a similar amount. [50]

    Why it matters — Randomised trials are too costly for most small clinics, and a waiting list gives them a fairer comparison than none. [50]

  36. 37

    Therapy by phone app for young people

    Cognitive behavioural therapy teaches people to notice and change unhelpful thoughts and habits. A review found nine randomised trials of it delivered by mobile phone app, with 2,479 people aged 5 to 25. [51] Seven of eight trials that measured depression found it fell more than in comparison groups. [51] Only two of six that measured anxiety found a clear effect. [51]

    Why it matters — Apps can reach young people where therapists are scarce, and the evidence so far is stronger for low mood than for worry. [51]

02 Lesson why it matters

Stopping a medicine is a change the body must adjust to

Months or years on a drug change the body's own settings, so a fast stop can bring symptoms that were never there before.

The twist

The body keeps the changes it made for a drug after the drug is gone. That is why stopping fast can cause symptoms a person never had before they started.

The picture

A made-up starting dose of 100, cut by a quarter of what is left each time. Each step is smaller than the one before.

How it works

  1. A person takes a drug every day for months or years
  2. The body adjusts its own settings to the drug being there
  3. The drug stops fast, and the adjusted settings are still in place
  4. With nothing pushing back, the body swings the other way
  5. Smaller and smaller cuts give the body time to change back

The same force, elsewhere today

Where this chain is also running, in today's other stories.

  • Antipsychotics change the brain they are stopped from

    Years on the drug leave about 30% more dopamine receptors, so a fast stop brings agitation and poor sleep that look like relapse.

  • Opioids: smaller cuts as the dose falls

    At low doses each cut removes a big share of the drug's effect, so the guidance cuts only 1% to 10% of the latest dose at a time.

  • Stopping denosumab needs a plan

    The drug holds back bone loss, and when it stops with nothing after it, the loss comes back fast enough to break bones in the spine.

  • After night work ends, telomeres grow back

    Here the thing being stopped is night work, and the body moves back towards normal a little more with each year since.

Where you've seen this

Astronauts coming home

months in weightlessness reset their blood pressure control, so standing up on Earth can make them faint at first

Walking out of a dark cinema

eyes set for darkness are dazzled by daylight until they adjust back

Coming down from high mountains

a body that made extra red blood cells for thin air keeps them for weeks after returning

The catch

Not every drug leaves a swing behind: a bisphosphonate keeps protecting bone for years after the last dose, and some symptoms after stopping are the old illness returning, which looks almost the same.

And the whole of it

Anyone who takes a daily pill for years is inside this, along with the doctor who prescribed it and the people who wrote the guidance. None of them can see what the body changed until the pill stops.

03 Truth what's really going on

What is really going on

The US health secretary, Robert F. Kennedy Jr., wants fewer Americans on antidepressants, and the evidence he is arguing over says that slow stopping with therapy works about as well as staying on. [1][4] The same evidence shows that almost no drug company has ever paid for a trial of how to stop its own drug. [1]

Why it works on us — Comparing SSRIs to heroin sticks because it names a fear people already have, while the measured numbers, about 15 in 100 with symptoms and 3 in 100 severe, are harder to hold in mind. [1]

Who gains

  • Doctors who spend time helping patients stop — The part of Kennedy's plan the Columbia psychiatrist calls best supported by evidence is paying doctors for the time they spend helping patients stop. [1]
  • Younger, wealthier, insured Americans in cities — Recent gains in talking therapy went almost entirely to them, so they are the ones who can get the therapy that makes slow stopping work. [1]
  • Patients and insurers paying for romosozumab — Three months of the drug followed by denosumab built about as much hip bone as twelve, cutting romosozumab injections from twelve to three. [26]
  • Small rehabilitation clinics — Comparing treated patients with those still on a waiting list lets them show results without paying for a full randomised trial. [50]
  • Countries free of malaria — Suriname, Timor-Leste and Georgia joined the list in 2025 after years of case tracking and steady funding. [41][40]

Who pays

  • Older, rural and uninsured Americans on antidepressants — They saw no real rise in therapy use, so a push away from pills can leave them with neither. [1]
  • Family doctors — They write most US antidepressant prescriptions in short visits with little psychiatric training, and slow stopping takes months of follow-up. [1]
  • Breast cancer survivors with hot flushes — Their treatments are mostly drugs made for something else, and by six months only 7% to 42% are still taking them. [34]
  • Children and poorer communities under wildfire smoke — Children aged 5 to 9 and those in poorer areas had the largest rises in hospital admissions. [16] Poorer US communities showed stronger links to hospital stays. [14]
  • Women with menopause symptoms in the US — Only 1.7% used hormone therapy in 2023, which the Mayo Clinic researchers put down partly to misinformation and poor training for doctors. [20]

What nobody knows yet

Open questions from across today’s stories — ours included.

  • 01

    How many people get withdrawal symptoms when they stop an antidepressant.

    One Lancet Psychiatry analysis put it at about 15 in 100, with 3 in 100 severe. [1] A review of children's withdrawal cites up to 56 in 100 adults, and the Maudsley guidance says it is more common than was thought. [52][5] The figures come from different kinds of studies, counted in different ways.

  • 02

    Whether cutting in smaller and smaller steps beats cutting by fixed amounts.

    It follows from the chemistry, but no randomised trial has settled it. A trial of 150 adults comparing the two has not reported. [8][6]

  • 03

    Whether a person who feels bad after stopping is in withdrawal or relapsing.

    The symptoms overlap, and a Cochrane review found many trials did not separate the two. [1] A doctor on a New York Times podcast said it is often hard to tell. [11]

  • 04

    Whether hormone therapy at menopause raises or lowers breast cancer risk.

    In South Korea's records, users had 57% more breast cancer. [22] In TriNetX records, women with menopause at 60 or younger who used it had about 21% less, and those with menopause after 60 had 15% more. [31] Both are observational.

  • 05

    Whether night work causes breast cancer.

    Twenty years or more of nights carried 25% higher risk in health workers, but the result stopped being clear after checks for bias, and most studies measured night work poorly. [38]

  • 06

    How many people wildfire smoke kills.

    The US figure of about 24,100 a year comes from a model of whole areas. [15] Canada's estimate ranges from 660 to 5,400 a year depending on the season, with wide error margins. [35]

  • 07

    Whether acupuncture itself helps back pain.

    Trials against usual care found less pain, but the certainty was low to very low and none of the pooled trials used fake needles. [49]

  • 08

    How solid the proof is that bone drugs prevent fractures.

    In 27 large trials, the median result would have been lost if 9 patients' outcomes had gone the other way. [30]

04 Hope carry this

In 2025 the WHO certified Suriname, Timor-Leste and Georgia free of malaria, bringing the total to 47 countries and one territory.

Also true today

  • In workers over 50 who had left night shifts, the caps on the ends of their chromosomes were longer for each year since they stopped.
  • One drip of the bone drug zoledronic acid, given to women aged 50 to 60, cut spine fractures by 57% five to ten years later.
  • Sri Lanka has had no locally caught case of malaria since 2012, and in 2026 it marked ten years of being certified malaria-free.
  • In the Netherlands, 98 of 153 people who tried to stop their antidepressant managed it.

Across the beats