By Lena Vasquez, Community Features & Culture Editor

The quiet change is not a new type of therapy but a new invoice.

This spring, the Department of Health and Human Services launched a plan to curb psychiatric overprescribing and sent clinicians a letter with billing codes they can use for deprescribing psychotropic medications. The codes created a pathway for providers to bill for care that is not a pill. Psychotherapy, family support, nutrition, and physical activity are among the therapies the new guidance tells clinicians they can charge for. The same day, Medicare spelled out how doctors get paid for supervised tapering. Pharmacists can contribute that time when they work with a physician. Private plans often follow the federal codes. The point is larger than one payer: a clinic can now bill insurance for taking a patient off drugs.

That is an odd kind of progress. For years the same billing system rewarded starting a prescription and keeping the refill visits coming. A walk, a full night’s sleep, and a conversation did not generate the same claim. Now the codes can pay for the off-ramp. The incentives are still about money. The opening for patients is still real.

The numbers around that opening should give anyone pause. Recent survey work puts current antidepressant use among U.S. adults near one in six. National spending on mental-health and substance-use treatment rose from about $41 billion in 2000 to nearly $140 billion in 2021. In 2024, SAMHSA estimated 23.4 percent of adults, or 61.5 million people, had any mental illness in the past year. More prescriptions. More spending. No clean drop in suffering.

Every few years the court record says the same thing in a different font. Pfizer paid $2.3 billion in 2009 over illegal marketing. GlaxoSmithKline paid $3 billion in 2012, including charges tied to Paxil and Wellbutrin. Purdue Pharma and the Sackler family have spent years in opioid litigation, with a settlement framework around $7.4 billion. As those rulings piled up, critics pointed to them as evidence that the system prioritizes profit over the least harmful treatment for the patient.

The side effects of psychiatric drugs are not theoretical. They are well established. These treatments can flatten emotion, disrupt sleep and sex, change weight and metabolism, and make coming off them miserable. That is why a paid, supervised stop is better than an abrupt one.

Now providers have an incentive to offer that off-ramp the same way they have long been incentivized to offer medication.

It is not new that life comes with challenges. The good news is that less harmful mental-health treatment is not only the domain of hippies and the New Age movement. Study after study finds regular exercise reduces symptoms of depression and anxiety as effectively as medication or talk therapy for many people. Sleep is consistently tied to better mental health. Cutting back on ultra-processed food and eating a diet with vegetables, fruit, and legumes has moved mood scores in clinical trials.

Even reading, the cheapest tool in the stack, can give the mind somewhere better to go. Whether it is a self-help book or the Bible, plenty of people will tell you about a book that changed their life.

Hippocrates, the Greek physician whose name sits on the oath, taught generations of doctors that the first duty of medicine is “do no harm.” Non-drug treatments offer patients a path that does not come with the side effects of psychotropic drugs. For some, those quieter tools may turn out to be more powerful than they look.