John J. Miller, MD, Responds to Statement on Psychotropic Medication Concerns

Following the release of a joint statement¹ from leading psychiatric organizations voicing concern over Executive Order 14212, Psychiatric Times spoke with its Editor-in-Chief, John J. Miller, MD, to discuss the implications of this federal directive and the response from the psychiatric community.

The executive order, issued on February 13, 2025,² called for an assessment of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, and stimulants, raising concerns among psychiatrists that it could fuel misinformation and limit access to essential treatments. Miller emphasized the lack of respect for the overwhelming scientific evidence supporting these medications when they are appropriate.

“The executive order came as quite a surprise and is quite concerning to myself and many of my colleagues, if not all psychiatric providers in the United States, because we take our jobs seriously,” Miller told Psychiatric Times. “We're proud of our work. What we do is built on the foundation of literally decades of excellent basic science, research and development, reviews by the FDA, and clinical trials.”

On March 21, 2025, the American Psychiatric Association (APA) and other major psychiatric organizations released a statement noting the importance of evidence-based medicine and the patient-clinician relationship in leveraging evidence-based medicine to make treatment decisions.¹ Miller echoed these sentiments.

“Ultimately, we want safe and effective treatments, and once we correctly diagnose a patient, we offer them a range of treatments, including medications, to maximize their quality of life, function, and minimize their symptoms,” Miller said. “It is concerning to me as a psychiatrist to have individuals with no training in the field make statements that are inflammatory and, in my view, likely to have a chilling effect.”

In response to the order’s question of appropriate use of psychotropic medications, Miller explained that plays a role in all patient encounters. He pointed to similar issues in general medicine. “We can draw a simple analogy from medical practice. Not everyone with a cough and sore throat has a bacterial infection, so we don’t overuse antibiotics. Likewise, in psychiatry, accurate diagnosis is essential, and treatment should be used appropriately to maximize recovery and quality of life,” he told Psychiatric Times.

“We should always assess risks and benefits, particularly as new medications become available,” Miller added. “This is not a black-and-white issue, and any good clinician in any specialty continuously evaluates and refines the treatment plan in collaboration with the patient.”

Critics of psychiatry and psychotropics is not a new phenomenon, Miller said in the interview. “Psychiatry has been stigmatized since its inception, and that will likely continue. In my view, people criticize what they don’t understand. The brain is the most complex organ in the universe, and even as an expert in psychiatry, I know very little about it—but I continue to learn. Psychiatry is a young field, and while we are doing the best we can with the evidence available, it remains a work in progress.”

In terms of advice to colleagues, Miller reminded clinicians to be steadfast. “Ultimately, we must take refuge in our specialty and recognize that, no matter what we do, there will always be critics,” he said. “As long as we maintain our knowledge of the field and practice evidence-based medicine, we are doing the best we can. That has always been the history of medicine, and it will likely be its future.”

Dr Miller is Medical Director, Brain Health, Exeter, New Hampshire; Editor in Chief, Psychiatric Times; Voluntary Consulting Psychiatrist at Seacoast Mental Health Center, Exeter/Portsmouth, NH; Consulting Psychiatrist, Insight Meditation Society, Barre, Massachusetts.

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References

1. Joint Statement on Federal Concerns About Psychotropic Medication Safety. Press statement. American Psychiatric Association. March 21, 2025. Accessed March 21, 2025. https://www.psychiatry.org/News-room/News-Releases/Joint-Statement-on-Federal-Concerns-About-Psychotr

2. Trump DJ. Executive Order 14212—Establishing the President's Make America Healthy Again Commission. February 13, 2025. Accessed March 21, 2025. https://www.presidency.ucsb.edu/documents/executive-order-14212-establishing-the-presidents-make-america-healthy-again-commission