In this episode, Dr. Josef Witt-Doerring exposes the growing problem of psychiatric overmedication in America and questions the long-held belief in “chemical imbalances” as the root of mental illness. He breaks down the risks of widespread SSRI use, explains why long-term studies are urgently needed, and explores how societal pressures and lifestyle changes are fueling today’s mental health crisis—especially among young people. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to Wellness on MASS. I'm doctor Nicole Safire and
thanks so much for joining. Just like many other episodes,
we're talking about a topic today that maybe isn't so
popular to talk about in mainstream media, but it's certainly
one that everyone is familiar about and are talking about
in private circles, but they don't like to talk about
it in public.
Speaker 2 (00:24):
So what is it?
Speaker 1 (00:25):
Well, over the last two decades, antidepressant prescriptions for kids, teenagers,
and even young adults have skyrocketed. In some cases, these
numbers have doubled. And why is that. Well, We've seen
more mental health being diagnosed in before COVID, but also
certainly during COVID, we saw exponential rise in kids presenting
(00:47):
to the emergency department with mental illness. I mean, that's obvious.
They were on their devices, they were socially isolated. Mental
health is a crisis here in the United States, and
what are we doing about it? Well, in parallel with
the rise and diagnoses, we're seeing more kids being prescribed
medications to treat their mental illness. And while we're seeing
(01:09):
the alarming rise and anxiety and depression, we're also seeing
a rise and self harm and even violent outbursts among
these kids. So are we finally addressing the hidden mental
health crisis or have we swung too far in relying
on medications to manage their distress. Today I'm joined by
someone who is uniquely qualified to help us mentangle that question. Psychiatrists,
(01:33):
but also former FDA Medical Officer, doctor Joseph Witt Doring.
He is the CEO, and he's the medical director of
the Tabor Clinic, and he's one of the country's most
outspoken voices on drug safety, informed consent, but also the
potential behavioral side effects of psychiatric medications, particularly SSRIs. So
(01:54):
we're going to talk about the science, the controversy, and
most importantly, how to protect our kids from untreated depression
but also from unintended harm. But first of all, doctor Josef,
I know your background, but can you just give our
listeners a little bit of information on why I have
you here today.
Speaker 3 (02:11):
Nicole, I'm so happy to be here with you today.
Thank you for having me. So my background is that
I'm a psychiatrist, and I'm not really a normal psychiatrist
because I have taken quite a strong stance against medications.
I think we completely over medicate the American population, and
it's something that I spend most of my time advocating
against the use of the medications the way we're using them.
(02:34):
So I'm a medical doctor. What else is unique about
me is I worked in the pharmaceutical industry for a
couple of years doing drug development of for psychiatric medications,
and then I also worked at the FDA as a
medical officer in the Division of Psychiatry, doing drug review
there and essentially that experience, along with working in academic medicine,
(02:55):
really soured me on psychiatric medications. I ended up seeing
that we are completely practicing outside of what the evidence
based supports, and that has really inspired me to do
what I do now, which is essentially take people off
psychiatric medications.
Speaker 1 (03:11):
I imagine that's challenging, but I find that really interesting
that you were in the FDA, because obviously that's a
very small niche amount of people who are intricately involved
in that. So going from a practicing clinician then being
involved in the FDA, what was it really that kind
of made you do an about face and say this
isn't right.
Speaker 3 (03:30):
I think the major thing is how long we study
the drugs for, so you know when I was a
junior physician, I would you know, I would be copying
what my professors were saying, and they're like, you know,
these drugs, they're safe and effective, they're proofed by the FDA,
you know, don't worry about it. And what I would
see clinically was that there actually was a lot to
worry about. You know, many people would put on these
(03:51):
medications and honestly, they wouldn't get better, or they would
get better for a short period of time, and then
you know, they would kind of adapt to the drugs
and you need higher and high Adosas people would max out,
you'd have to start stacking medications. And so intuitively, I
was like, h you know, something doesn't feel quite right
about this. And then when I went to the FDA,
I learned that we don't actually study any of these
(04:11):
drugs longer than a year, and with you know, seventy
percent of the US population who take any depressants with
them being on them for two years or more, it's
kind of crazy that we don't really know whether they're
effective past a year. And really what I was seeing
in my clinical experience was that they weren't, and that
they were wearing off and so that was the first thing.
(04:33):
It's that we were saying, hey, these drugs are safe
and effective, but we were leaving off the most important part,
which was, yeah, for the year that these drugs are
studied for and I think intuitively for the audience listening,
they that's a really important question how long these drugs
work for? Because I mean, they're drugs, right, and everyone
understands tolerance. They understand that they wear off over time,
that we adapt to them, you know, It's a pattern
(04:55):
we see with all chemicals that we take. And so
I mean that was the first thing that I saw.
On top of that, I saw a whole range of
I learned about a whole range of side effects that
we were not telling our patients about, specifically with the SSRIs.
You know, the issue of tardiv dysphoria, which is a
very complicated term, but really what it means is that
there's a toxicity that occurs with long term SSRI use,
(05:18):
where people start to develop brain fog and severe fatigue,
you know. And I've never known about this, but when
I look back at my clinical practice, and this is
what I see now as well. There's so many people
on chronic SSRIs who are being told that they have
treatment resistant depression or that their brain illness is somehow
like transforming and it's making them worse, and it isn't.
(05:39):
It's the drugs. Our brains are not designed to be
on SSRIs for like decades at a time, and when
you do that, there are some people who get worse.
And so it was those things together that I was like,
you know, this really isn't a sustainable.
Speaker 2 (05:52):
Way to help people.
Speaker 3 (05:54):
We need to be going back to supporting people with
non drug approaches rather than just kind of masking some
with drugs that wear off over time, and then they
also make some people worse.
Speaker 1 (06:05):
So here's the question I have for you. Well, let's
actually let's go simple for a second. Can you just
explain how SSRIs and some of the others actually work
on specifically like a developing brain, which is we're seeing
more and more youth, kids, adolescents, even young adults who
are taking these medications.
Speaker 2 (06:22):
Sure.
Speaker 3 (06:23):
Yeah, So, an SSRI is a selective serotonin reuptake inhibitor,
and basically what it does is it binds to the
receptors in the brain that pull serotonin out of the
space where it sort of acts on the nerves, and
when you do that, it'll temporarily increase the amount of
serotonin that's in the brain. And that's associated with a
(06:43):
drug effect, which is people will say numbing.
Speaker 2 (06:46):
Like erectoria.
Speaker 1 (06:47):
We talk about it here a lot, like one of
those hormones that are supposed to give you that happy,
euphoric feeling, right yeah.
Speaker 3 (06:54):
Yeah, Well, you know, people do think like, you know, oh,
you know, serotonin, you know, it's just like the feel
good chemical or but from my experience, it's like when
you take the SSRIs, it's actually like a blunting experience.
And so many people who have like severe anxiety, they'll
experience this as being really therapeutic, because if your mind
is all over the place and you take something that
kind of numbs you out, you'll say, well, that's helpful,
(07:17):
and you may even say it's life saving sometimes. But
what I want to be really clear about, Nicole, is
that these drugs, they're not fixing a chemical imbalance. And
there was this myth for a long time that you know,
there was like a normal serotonin state and there was
an abnormal serotonin state, and if you took the SSRI
you would fix that abnormal serotonin state. And you would
(07:40):
revert the person back to normal, just like a type
one diabetic who couldn't make insulin out of their pancreas.
You just bring the insulin back in and now they're
back into a normal a normal state. Now, that was
the narrative that has been pushed on the American public
for really the last three decades, and there has never
been any evidence.
Speaker 1 (08:00):
Sorry to interrupt you, so, oh, you're just going to
say evidence like type one diabetes, we can actually check seepepti,
they don't make insulin. When we're talking about the abnormal
serotonin state, and we hear people talking about that and
therefore they recommend the SSRI. You know, is there a
way to actually prove or how did that term abnormal
serotonin state even become?
Speaker 2 (08:21):
Yeah, great question, Nicole.
Speaker 3 (08:23):
So the very brief history on this was back in
the nineteenth is we were treating tuberculosis patients and we
used a drug called ipronize it, and we noticed that
it energized the patients, and so doctors said, well, maybe
this will help with depression, and so they took ipronize
it and they made some drugs just like it and
they gave them to depressed patients and the depressed patients
they looked more lively afterwards. Now, what we knew about
(08:45):
that class of drugs at the time was that they
increased chemicals like serotonin, and so there were two ways
that you could have looked at this problem at the time.
One is, you know, these are drugs just like any
other drugs, and it has an energizing effect that's masking
the depressive symptoms.
Speaker 2 (08:59):
That was one way.
Speaker 3 (09:01):
But then there was a much more commercially viable message,
which was these people have chemical imbalances and that's why
this is helping them. And so that was the narrative
that took off. And the reason that that was chosen
is because I think intuitively, a lot of Americans out
there are you know that you know, they listened to
their grandma's advice, which is it's not a good idea
to just sweep things under the rug. You know, you
(09:22):
need to address your problems when you take and so
if you can tell someone that you know, you're not
really masking something with drugs, you're actually fixing a biological
problem in the brain, all of a sudden, that stigma
goes away and that okay, well, you know this is
just me being responsible, This is me being healthy, this
is me using you know, you know, modern science, and
(09:43):
it's it's a very good thing. But that is not
true because what we have been doing for the last
several decades is we've been sticking needles into the cerebral
We've been collecting cerebel spinal fluid. We've been in lumbar punctures,
that's the fluid that goes around the brain. And we've
been looking at the metabolites of serotonin. And we've been
looking at normal people and been looking at depressed people,
(10:04):
no difference. We've been doing autopsies, we've been taking slices
of the brain for depressed people and non depressed people
and comparing them. There's no changes in receptors there. And
so every time we've tried to look at this, like
is there a normal serotonin state and an abnormal serotonin state,
We've never found it. And so there is no evidence
of a you know, a quote unquote chemical imbalance that
(10:25):
is being fixed by an SSM.
Speaker 1 (10:27):
Gosh, I mean, I haven't obviously studied that or read
upon that, but that seems I mean, that seems crazy
to me that the narrative continues to be that you
are fixing a chemical imbalance that you don't actually have
objective evidence of that chemical imbalance. I mean, that's mind blowing,
you know, especially when I think it was a couple
decades ago the black box warning came out on the
SSRIs about the suicidal risk. It was obviously clear. I
(10:51):
think it was a four percent suicide risk in younger
people taking SSRIs compared to two percent in the placebo,
which is a substantial risk. But I'm curious on your
thought of the lesser talked about risk of the increased agitation, irritability,
or even aggression during early use of SSI.
Speaker 2 (11:12):
You know, you're talking about this.
Speaker 3 (11:14):
This issue is really about paradoxical reactions, and so what
is that? So that is when you have an atypical
response to the drug. So, you know, a moment a
guy mentioned that the normal drug effect that we affect
from the expect from these medications is one of blunting.
But everyone responds to drugs a little bit differently, and
so that's like the norm. And the analogy I like
(11:35):
to use to explain a paradoxical side effect is imagine
you have ten people, you know, they're sitting around and
they're smoking a joint. You have nine people who are giggling,
you know, they're having a good time, and you have
one person that becomes paranoid. This can happen with every
single drug. You know, there are genetic reasons that we
don't understand that when some people get exposed to a drug,
they don't have the typical effect, they go a different way.
(11:59):
And with SS what researchers have found, and this happened
like immediately when Prozac came out onto the market, is
that for some people, if you put them on this drug,
they can become acutely suicidal. And so you could imagine
how horrible that could be. You already have a depressed
and anxious kid. They get on a drug, they have
a paradoxical reaction and it starts to give them obsessive, dark,
(12:23):
morbid thoughts. They start to feel really agitated, they start
to feel incredibly uncomfortable, and in those states they can
actually it can actually push them into suicidal behavior or
in even rareer cases, but still importantly, you can actually
make them violent. And that's the link to the whole
SSRIs and the mass shooting issue. It's that some people
(12:44):
when they get on these medications, it puts them into
a state where they do things that they would not
normally do.
Speaker 1 (12:50):
You're listening to Wellness and Mass. We'll be right back
with more. Is there a way to identify which people
who are more likely to be on these medications who
result with the suicidal or the homicidal ideation? And I
think it's important to note though the suicidal ideations well
documented black box warning by the FDA, Why do you
(13:12):
think that the homicidal or the aggressive side effects are
I mean, honestly, if you talk to people about them,
you know, when a mass shooting happens, you say, well,
they're on an SSRI and there is an association with
aggression and violence behavior. And then they quickly come back
and say, well, the data is conflicted, and they kind
(13:33):
of try and push away from that. What are your
thoughts on that?
Speaker 3 (13:38):
What we're seeing, Nicole, is the interface of science and
politics when it comes to the mass shooting issue. Because listen,
we've had numerous court cases that have gone before impartial
judges and juries where they have found that if not
for the SSRI, this person would not have committed these,
you know, multiple murders sometimes and so we already know
(14:01):
that when people have looked at these cases, they've found
them to be at fault. Now, the reason we hear
something very different in the media is because school shootings
is a very political topic and for a lot of
the media, the answer is already clear. It's the guns.
And so I mean, that's all they want to hear.
They want it to be about the guns. If you
bring up something else, they just say, yeah, no, that's
(14:22):
you know, they're trying to distract a way. Now, I'm
not trying to say that every single school shooting that
has taken place is because of an SSRI. Obviously there
are evil people out there. I think people can do
this completely sober off any drugs.
Speaker 2 (14:36):
I just believe that.
Speaker 3 (14:38):
And yes, sure having access to firearms does make it easier,
but without a doubt, some people are being pushed into violence, homicide,
and murder because of these medications. And we owe it
to the public to actually look at these things. And
that's what Bobby Kennedy is doing now. He is trying
to put together a group of people to investigate mass shootings.
(14:58):
And the only way that you can do that is
that when one of these events happens, you need to
go out there and you need to interview the person
if they survive, and their family and their doctors, and
put together a narrative, a case narrative around it where
you look for alternative explanations, and if there's nothing else
that exists, and you see a clear history where the
person got on the drug and then they acutely became
(15:20):
different in their personality, more irritable, more agitated, then you
have to call it what it is, which is a
case where it looks like a drug may have pushed
someone into an act of violence.
Speaker 1 (15:31):
So I guess if it has proven to be so,
would that make these people then legally retrospectively less liable
for these mass shootings.
Speaker 3 (15:40):
It's a really delicate issue. I think it has to
weigh into it. But that's a really hard call to make.
I mean, we're talking about some of the most horrific incidents.
Speaker 2 (15:50):
In the world.
Speaker 3 (15:51):
I mean, if you were a parent and someone got
on an SSRI and they killed your child and they
may have taken out, i don't know, like ten other
kids at the same time, at a certain point you
want some justice for that way. And you know, yes,
the drugs can play a role in that that's a
very hard thing to tase out. You know how much
liability is for the patient and how much for the person.
But these are incredibly sensitive issues and that's going to
(16:14):
be a really hard call to make.
Speaker 1 (16:17):
Yeah, I mean, if you look at the stats, I mean,
I'm sure you know them significantly better than I do.
But the use of these SSRIs over the last couple
of decades have skyrocketed, especially in the youth during COVID.
I think prescriptions were up like sixty five percent or
something crazy like that. You know, how do you think
we come back from this? Because the question is, you know,
(16:37):
you have the chicken in the egg scenario. You have
a rise in mental health issues. Obviously we're seeing anxiety
and depression, mood disorders more frequently from you have video games,
you know, social media, the isolation of COVID, the societal pressures,
all of these things. You know, how do we how
(16:57):
do we get out of the cycle of a rise
in mental illness, arise in prescriptions, and then the paradoxical
effects of these prescriptions and so and so forth.
Speaker 2 (17:06):
Yeah, what a question? I mean, so, yeah, it's.
Speaker 1 (17:09):
A loaded what I apologize?
Speaker 3 (17:11):
Yeah, No, No, I mean I think, you know, if
we look at in general, every time I'm seeing serious
mental health problems going on, I think the biggest mistake
is to blame the child. You have to look at
the family unit as a whole. What's going on with
the parents, you know, how are they around, you know,
what is the interaction like with the kids, And so
(17:31):
whenever you're helping kids be less depressed, you start with
the parents, to be honest, I mean, that's that's where
you go. And so putting that issue aside, we need
to look at larger societal things going on.
Speaker 2 (17:42):
Right now.
Speaker 3 (17:43):
For me, I think that social media use is massive.
I think everyone kind of knows in the back of
their mind, Hey, this is kind of bad. You know,
this is kind of different. I think it's a lot
worse than than people think. Some of the stats I've
seen lately show that children are spending an average of
three and a half hours on social media, and some
of them are spending like five hours a day on it.
Speaker 2 (18:05):
Now, if you.
Speaker 3 (18:06):
Think about it, this is several hours that in the
past they used to be spending face to face with
their friends, developing social skills, hanging out. They would be sleeping,
maybe they would be exercising instead of that, you have
young girls on Instagram posting selfies of themselves for strangers
to comment on and friends to comment on, and like,
(18:28):
you know, they're looking at celebrities and other influencers out
there who you know, seemingly have vastly better bodies and
lives than them, even though everyone knows. You don't post
the bad photos on there, and you don't post the
bad things that happen to you, and it poisons your mind.
Speaker 2 (18:44):
I mean, I mean we've.
Speaker 3 (18:46):
Changed a lot. I mean, in the seventies, you know,
fifty percent of Americans were going to church. There was
a lot more moral teachings going on there. It was
much more of a values based society. And that's decreased.
It's thirty percent now, and we're spending and the kids
are spending like, you know, three hours on social media
ingesting consumeristic values that that kind of espouse, Like if
(19:09):
you get lots of likes on social media, if you
earn a lot of money, if you look a certain way,
like it's this kind of this instant gratification kind of
buzz that you get that that that gives you values.
I think it's poisoning their minds, and I think we
need to go back to a much more value based
society where you know, living a life and service of others,
you know, wisdom, you know, all of these, all of
(19:32):
these values that used to come from the home and
from the community and the church that would actually lead
to longer term happiness over time.
Speaker 2 (19:39):
I think we've lost that.
Speaker 3 (19:40):
I think we need to return to that place and
then it would be much you know, and and and
that's the way, and that's the way to go, not
not have all of these issues going on and then
just saying oh, yeah, you know this, this pill is
going to fix it. The pill is it's not going
to fix it's going to actually make many kids worse.
Speaker 1 (19:55):
Well, you made. You mentioned One of my favorite terms
is instant gratification. I wrote a book in twenty two
where I think if there was one repeated term, it
was that because especially here in the United States, we
want things, we want things fast, we want things cheap,
and we want things right now. And you know, the society,
the culture we live in continues to perpetuate this. And
I think the Internet, social media has just made this
(20:19):
almost to a pathological place. And you know, we have psychiatrists, pediatricians,
family practitioners who are all overburdened the Affordable Care Act.
That's an entirely different conversation, but has certainly put more
pressure on a lot of people to see more patients,
to spend less time with patients, and unfortunately it has
resulted in rise in prescriptions because they don't have time
(20:43):
to talk about the underlying drivers of poor sleep, nutrition, trauma,
social media exposure, and the fact that a lot of
our youth are coming from broken homes. I think if
we really paused and focused on us where we are
as a society, we could actually tackle the mental health crisis.
Speaker 2 (21:01):
Yeah.
Speaker 3 (21:02):
And you know, the one of the big things that
I would the message that I have for doctors, family
medicine doctors and psychiatrists and obg y ns and all
of them is, guys, we need to grab the steering wheel.
We need to wrestle it away from corporate interests right now.
You know, private equity who are running our hospitals. We
know it's bullshit. And and because here's here's the thing.
(21:23):
I mean, we're all here to help people. We want
to help our patients, and if we're being pushed into
a system where Oh, in order to sort of make
ends meet, we need to see four patients in an
hour who are having mental health problems. And you know,
because of that, you're diagnosing depression based off a checklist
without even understanding the person's life. Because of this, instead
(21:46):
of trying to motivate them to make lifestyle and dietary
changes and you know, fix relationship issues, you know, find meaning,
do all of the stuff we know that matters. If
we don't have the time to do that and we
have to default to giving a pill, guys, I have
to tell it as it is. We're not actually helping
our patients. In fact, we're making them worse. And our
justification for this is, oh, the system is making me
(22:08):
do it.
Speaker 2 (22:09):
Guys.
Speaker 3 (22:09):
We are the system. I mean, we are the doctors.
We're the ones that work here, and there are different
ways of working and so undortually.
Speaker 1 (22:18):
Though we don't have a lot of control. We are
mandated on federal, state, local levels. And you're right, unless
everyone wants to go to concierge, but there's some things
that are out of people's control. I think it's tough.
I think it has to happen from the individual position,
but also Elections have consequences and votes matter, and I
(22:38):
advocating at the federal level is really the way to
get through in my opinion, when it comes to the
healthcare system.
Speaker 3 (22:44):
You're right, and you know it is challenging, Nicole. Do
don't get me wrong. I understand that. But we need
to be speaking up. We need to be I mean,
we have to be talking to the media. We need
to be being honest to our patients. I mean, if
it even starts at a place where it's just like, listen,
we actually don't have time to help you in the
way that I would like to. All I really have
to offer you is this medication. And really there's a
(23:07):
whole lot more to do than this, and I wish
we had more to offer you, but this is not
the answer. So I think just starting by being honest
with the patients is really important. And you know, there
are some doctors out there who are doing things like
direct primary care. I think they're getting better results by
leaving the insurance system. Is that a solution for the
(23:27):
people out on Medicaid?
Speaker 2 (23:30):
It's not.
Speaker 3 (23:30):
You know, it's a really complicated issue, but I think
we have to be louder about this problem. We know
that we can be doing a better job. I mean,
my colleagues, we feel it. I talked to psychiatrists about there.
They feel like they're doing their job with one leg
and one arm tied behind their back, and we need
serious systemic change in the way we deliver medical care.
Speaker 1 (23:50):
Yeah, well, I agree with that. You know, one of
the things that you touched on earlier is like this
is now you know, violence, mass shootings, even adolescent mental
health has been so politicized that it's labeled a conservative
talking point to criticize SSRIs or you know, any form
of medications for treating mental health. And so I imagine
(24:14):
that there are a lot of doctors out there who
would like to say something, but because of political reasons,
they don't want to be criticized. They don't want to
put their job in jeopardy. We already know that social
media and other forms of media have algorithms that suppress
conservative voices, and conservatives who speak out tend to be ridiculed.
(24:34):
More So, I think there's a lot of people who
are concerned that if they criticize SSRIs that they are
that people are going to say that they're conservative because
it's now turned into a conservative talking point. But at
the end of the day, it's not a conservative talking point.
This is a healthcare talking point. This is talking about,
you know, the mental health and the wellness of our nation.
(24:56):
We have to take this away from the political aspect
of it.
Speaker 3 (25:00):
Yeah, I think you're absolutely right, and you touched on
something which I think is actually quite sinister that that's
going on, and that is the whole idea that you know,
these drugs are always safe, and you know that the
mentally you know, people who have mental health diagnoses, they're
they're sort of stigmatized and being you know, unfairly treated
by I don't know, like rednecks from the Conservative party
(25:20):
who are just saying, just pull yourself up by your bootstraps.
These are manufactured by the pharmaceutical industry. Anytime someone criticizes
SSRIs or they say, hey, you know, maybe it's a
bad thing that you know, seventeen percent of like adolescent
boys have ADHD.
Speaker 2 (25:38):
Now, you know, you know, maybe we should question things more.
Speaker 3 (25:40):
They're so quick to say, you know, these redneck conservatives
or whatever you want, in these bootstrap type people, they're
trying to stigmatize the mentally ill. They want to take
away the drugs, and we don't do that here on
the left. You know, here on the left, we you know,
we stand for mental health issues. We you know, we
want the medications to be safe. Guys, that stuff came
out of the Medical Affairs Department of pharmaceutical companies. Do
(26:03):
you realize that these billion dollar companies have groups where
they can control the narrative, and that's essentially what they're
trying to do. Anytime you criticize these things, they want
to characterize the person as having an anti drug puritan agenda,
like there's some kind of blood eyed or someone that
doesn't appreciate the horror of mental illness. Like I know
(26:26):
these problems are hard, but I think a more nuanced
discussion about like the drugs and how they're not studied
long term and how people get worse. I mean, that's
not a partisan issue. This is something that if you're
on the left, you'd want that for your kids. If
you're on the right, you'd want that for you kids.
Medicine shouldn't be like that. We just want honesty. We're
all parents, We love our children and our family, and
(26:46):
we just want the right information. And so it really
is the left and the pharmaceutical industry who just seem
to be kind of whipping this up into a storm,
and I think they're harming people by doing that.
Speaker 1 (27:00):
More coming up on Wellness and Masked with doctor Nicole Sapphire.
One thing I want to ask is you were at
the FDA, if you could change one policy to day,
moving forward from the FDA standpoint or the AHHS, just
to make antidepressant use safer for people, what would you change?
(27:21):
What would be your ask if you had RFK Junior's year.
Speaker 3 (27:25):
You know, I'm going to take two. I'm going to
take two things. So the first thing that I would
do is we need to update the labels. It needs
to be really clear that these drugs aren't studied long term.
We also need to talk about the fact that they
are making some people worse in the long run. We
need to talk about the fact that there is a
proportion of people who have severe problems when they come
off these medications. I think if people just knew the
(27:48):
risks of these drugs accurately, I think, you know, eighty
percent of people would say yeah, no thanks. And the
next thing that we need to do is, guys, we
need to study these drugs in a way that's in
life line with how the population uses them. I mean,
we need a trial that goes for at least two years.
This is not impossible. I mean we do this for statins,
(28:08):
you know, it's like double blind, randomized controlled trials, like
like two to five years for some of these statins.
I mean we do it for nine for twelve weeks
with antidepressants. This is madness. When we have fifteen percent
of our population on antidepressants and one in three you know,
like sorry, one in one in four women over age
thirty on them, this is a serious issue we need
(28:30):
to look at. So I think we just we need
to study these drugs a lot longer.
Speaker 1 (28:35):
You know, it's interesting you just mentioned women women who
are approaching that perimenopause menopausal. Ah. You know, one thing
that has come out of doctor Marty McCay being at
the FDA is there's finally conversations about menopausal perimenopausal health
again trying to destigmatize against that. What do you think
the link is with women of this age and the
(28:58):
rise in SSRI use in mental illness?
Speaker 3 (29:02):
Yeah, so I think, you know, the menopausal period is
definitely a factor. I mean, we've kind of swung in
two ways. I mean, we used to say, yeah, let's
use you know, homone replacement therapies, and then all of
a sudden it was like, no, we're never going to
use homemone replacement therapies.
Speaker 2 (29:17):
They're terrible.
Speaker 3 (29:17):
We're going to just put everyone an SSRIs because that's
what they're doing now. You know, if you have insomni area,
you know, hot flushes or anything like that, you get
put on an antidepressant, which is just crazy.
Speaker 1 (29:28):
Isn't that interesting because unlike what we were talking about
with the serotonin deficit or change or whatever, that they
can't prove, you know, type one diabetes, you can show
that the body's not making insulin when they talk about
serotonin dysfunction and giving an SSRI they can't prove that.
But in perimenopause menopause, we're not making estrogen and progesterone
and testosterone, and that's something you can prove. So it
(29:51):
makes no sense that the answer to that would be
the ssis you actually know what their deficient is. You
have to be able to provide what their deficient is.
That's what's going to help them.
Speaker 3 (30:02):
And a lot of people are going that way now
and I would say that's a much safer way than
getting on a drug that simply wears off over time.
I mean, the reason we use these drugs in perimenopause
is because, I mean these were billion dollar drugs that
had some of the smartest marketing minds behind them, and
they all sat around in a room and they were like,
how can we expand our market share? And then someone said,
(30:23):
well they seem to help with hot flushes, like let's
go after the menopause market. And then doctors were just
flooded with that for you know, for a couple of decades,
and now every other woman who's perimenopausal is kind of
being pressured into taking an SSRI when, like you said,
you know, how does that make sense just you know,
replace what is missing? And I know that's a more
(30:45):
complicated issue. You know, it's for people that really specialize
in that space. But clinically, what I see is a
lot of women do really well with some hormone supplementation,
and to me, it just seems a lot safer than
putting someone on effexor or one of these other antidepressants
for hot flushes.
Speaker 1 (31:02):
So your recommendations to HHS are essentially we need longer
term study of these medications, and probably that we're overusing
these medications, and a lot of people may choose not
to take these medications if they actually knew the risks
with these medication. But so for the people who are
either on the medication and you, like you said, in
(31:24):
your practice, you're trying to take them off, or people
who are struggling with depression or anxiety who are considering
an SSRI. But what are what's your recommendations for non
drug therapies that have the best evidence of course for
like mild to moderate depression.
Speaker 3 (31:41):
Yeah, so it's these are really complicated issues what I
want to say. I mean, I mean, if you think
about the reasons why people are unhappy, let's talk about
some of them. You know what if you're in a
terrible relationship, What if you have kids, that's a really
complicated issue. What if you've spent a lot of time
in a and you're now working in a job and
(32:03):
you don't find any meaning in it and you're kind
of you're stuck there. That's really complicated. You know what
if you're having some problems with addiction or some serious
health issues, and maybe the way you've learned to deal
with emotional pain is through food. These are all challenging things,
and so I want to start off my response by
saying that because I don't want to belittle just how
hard some of these problems are. Anxiety and depression. These
(32:25):
aren't just feeling a little bit sad. I mean, these
can be completely oppressive issues that can be really hard
to treat. I mean that said, when I look at
my patients, I think there's the four main things that
really make people unhappy. So the first is relational issues,
whether that can be dealing with social isolation or relationship problems.
(32:46):
Working with interpersonal therapists is a great place to go.
The next things are issues of meaning in your life.
You can deal with that with a career coach if
it's about the work that you're doing, or you can
go to or you can double down on your faith
and your spirituality. That can be in a tremendous place
to go to find meaning in your life. I also
think about health issues. You know, we forget that our
(33:07):
heads are connected to our bodies through this thing called
the neck over here. And if you're obese and you're
having problems and you're putting like bad food into your
body and you're not exercising, you're going to see that
poor health reflected in your body, but it's also going
to be reflected in your mind. And so you know,
nourishing your body, moving your body, getting in the sun
is really important. And then the final thing is is sobriety.
(33:32):
And you know, I talk about a lot of controversial things,
but when I say this, people really don't like it.
And that's sobriety from also legal legal things. And so
you know, having a cup of coffee in the morning
is fine. But if you're having a cup of coffee
in the morning, then you're throwing down three diet cokes
and you have chewing tobacco in your mouth all day.
You know you're going to crash from stimulants. It's going
(33:52):
to mess with your sleep. That's something that that that's
a lot for the body to go through, so you
want to make sure you're using them in moderation. Is
nowhere near as safe as people say it is. They
say it's like this healthy. You know this this medicine
right now, guys, this is not the ditch weed from
the seventies that was three percent the average THHG concentration
that you're getting from the dispensary, it's like thirty five
(34:15):
percent of the some of the concentrates in ninety percent.
This stuff is making people suicidal, it's making people become psychotic,
and so you want to get the drugs out. And
so I would focus on those four areas. You're going
to know the ones that are the most important for you.
And the thing is like, I've never met someone who
was anxious or depressed who had those four things in line,
(34:37):
and so you want to start there.
Speaker 2 (34:39):
Now.
Speaker 3 (34:39):
The next thing, you know, what do you need to
know about coming off these medications? I break it into
three things, and this is what we do at the
Taper Clinic. The first one is, if you've been on
these drugs for several years, just start with a five
to ten percent reduction. You know that's that's a good
reduction that most people can tolerate. Do that every two
to four weeks. The next thing is that you want
(35:00):
to listen to your body. If you tolerated that reduction, well,
you can increase the amount you remove. If you didn't
tolerate it, well you can decrease the amount you remove.
And then the last thing is is that it can
take time, and especially at the end. So most people
will fail a taper when they get to the lowest dose.
(35:21):
And the way that I explain this is that at
the higher doses, you know, the drug is essentially flooding
your brain, and you could remove half of it and
there's still enough excess drug leftover to jump onto those receptors.
But when you get to the very low dose of
that drug, there's not enough like reserve floating around in
the brain. And if you remove like even you know,
five percent, even though you did that easily before, that
(35:44):
could actually be a huge amount. And so what I
often have my patients do is when they get to
the lowest dose is we actually liquefy the medication. We
put it in a syringe that has one hundred little
lines on the side, and it allows you to lower
it down with such great precision that you you have
a lot of control, and people usually find that much
easier and much more tolerable.
Speaker 1 (36:05):
I have never heard that before. That's really interesting. I'm
just going to add one more conveiat that people if
you've been on these medications for a long time and
you're going you want to come off. I mean, I'm
all about always trying to get off medications. Make sure
you talk to your doctor about it, because there can
be some there can be some side effects. Some people
don't do well coming off medication. It's always good to
(36:25):
have another set of eyes on you. That's just a
responsible thing to do. Doctor Yoziv, thank you so much.
I think you have given some incredible advice for people,
and you've also made it clear that mental health this
is not something that should be stigmatized. I mean, this
is not just you know, people being lazy or not
trying to put in the effort to feel better. Mental
(36:46):
health is actually just as diagnosable as diabetes or other
physical ailments, and so it has to be taken seriously.
But the way over the last couple of decades, with
the increased use of medications, the over diagnosis, we have
to pause to make sure that we are doing more
benefit than harm. And just like you're saying, you know,
some of my concern is that we're doing some harm
(37:08):
and looking at the long term effects of this is
crucial and I agree with you entirely. Thank you so
much for coming on. I really appreciate it.
Speaker 3 (37:14):
Well said doctor Safi. Was an absolute pleasure to be
here with you today.
Speaker 1 (37:19):
What a great conversation. What I hope everyone takes away
from the conversation I had with doctor Yosef is that
mental health and mental health treatment it's not one size
fits all, and there's no shame with being diagnosed or
being treated for any mental illness. The reality is none
of us get through our lives without dealing with some
level of mental health challenges throughout it. It's part of life.
(37:43):
Antidepressants they may be life changing for some, but they're
not a cure all and maybe in young people we
should demand more vigilant monitoring and safety research, but definitely
open dialogue. And as doctor Yosef reminded us, there are
some things that we can focus on rather than just
the medication to treat those symptoms. We need to look
(38:05):
inward in our life. What are some modifiable risk factors
that may be contributing to how we're feeling, Looking at
our relationships, looking at if we're addicted to something, And
as he pointed out, he's not just talking about illicit
drugs like cocaine or other things. He's talking about everything caffeine, nicotine.
If your body is addicted to something and you have
(38:25):
that high you're going to feel a crash at some point.
He also talked about exercising more, getting outside. You know,
I love talking about getting outside, being in nature and
being in the sunlight and vitamin D. It's all good
for you. There are some things you can do to
take control of your life. If you find you still
need help. There's absolutely no shame in considering some of
(38:47):
these medications. But maybe, as we talked about, short term
use of these medications should be the goal and not
necessarily medication for life. Healing the next generation means combining
the best of modern metay listen with awareness, education and compassion.
Speaker 2 (39:04):
I'm doctor Nicole Sapphire.
Speaker 1 (39:06):
Thank you so much for listening to Wellness on MASS.
Speaker 2 (39:08):
Let's keep asking questions and staying curious. It's okay to
ask questions.
Speaker 1 (39:13):
Be sure to listen to Wellness on Mass with doctor
Nicole Sapphire on iHeartRadio or wherever you get your podcasts,
and we'll see you next time.
Welcome to Wellness on MASS. I'm doctor Nicole Safire and
thanks so much for joining. Just like many other episodes,
we're talking about a topic today that maybe isn't so
popular to talk about in mainstream media, but it's certainly
one that everyone is familiar about and are talking about
in private circles, but they don't like to talk about
it in public.
Speaker 2 (00:24):
So what is it?
Speaker 1 (00:25):
Well, over the last two decades, antidepressant prescriptions for kids, teenagers,
and even young adults have skyrocketed. In some cases, these
numbers have doubled. And why is that. Well, We've seen
more mental health being diagnosed in before COVID, but also
certainly during COVID, we saw exponential rise in kids presenting
(00:47):
to the emergency department with mental illness. I mean, that's obvious.
They were on their devices, they were socially isolated. Mental
health is a crisis here in the United States, and
what are we doing about it? Well, in parallel with
the rise and diagnoses, we're seeing more kids being prescribed
medications to treat their mental illness. And while we're seeing
(01:09):
the alarming rise and anxiety and depression, we're also seeing
a rise and self harm and even violent outbursts among
these kids. So are we finally addressing the hidden mental
health crisis or have we swung too far in relying
on medications to manage their distress. Today I'm joined by
someone who is uniquely qualified to help us mentangle that question. Psychiatrists,
(01:33):
but also former FDA Medical Officer, doctor Joseph Witt Doring.
He is the CEO, and he's the medical director of
the Tabor Clinic, and he's one of the country's most
outspoken voices on drug safety, informed consent, but also the
potential behavioral side effects of psychiatric medications, particularly SSRIs. So
(01:54):
we're going to talk about the science, the controversy, and
most importantly, how to protect our kids from untreated depression
but also from unintended harm. But first of all, doctor Josef,
I know your background, but can you just give our
listeners a little bit of information on why I have
you here today.
Speaker 3 (02:11):
Nicole, I'm so happy to be here with you today.
Thank you for having me. So my background is that
I'm a psychiatrist, and I'm not really a normal psychiatrist
because I have taken quite a strong stance against medications.
I think we completely over medicate the American population, and
it's something that I spend most of my time advocating
against the use of the medications the way we're using them.
(02:34):
So I'm a medical doctor. What else is unique about
me is I worked in the pharmaceutical industry for a
couple of years doing drug development of for psychiatric medications,
and then I also worked at the FDA as a
medical officer in the Division of Psychiatry, doing drug review
there and essentially that experience, along with working in academic medicine,
(02:55):
really soured me on psychiatric medications. I ended up seeing
that we are completely practicing outside of what the evidence
based supports, and that has really inspired me to do
what I do now, which is essentially take people off
psychiatric medications.
Speaker 1 (03:11):
I imagine that's challenging, but I find that really interesting
that you were in the FDA, because obviously that's a
very small niche amount of people who are intricately involved
in that. So going from a practicing clinician then being
involved in the FDA, what was it really that kind
of made you do an about face and say this
isn't right.
Speaker 3 (03:30):
I think the major thing is how long we study
the drugs for, so you know when I was a
junior physician, I would you know, I would be copying
what my professors were saying, and they're like, you know,
these drugs, they're safe and effective, they're proofed by the FDA,
you know, don't worry about it. And what I would
see clinically was that there actually was a lot to
worry about. You know, many people would put on these
(03:51):
medications and honestly, they wouldn't get better, or they would
get better for a short period of time, and then
you know, they would kind of adapt to the drugs
and you need higher and high Adosas people would max out,
you'd have to start stacking medications. And so intuitively, I
was like, h you know, something doesn't feel quite right
about this. And then when I went to the FDA,
I learned that we don't actually study any of these
(04:11):
drugs longer than a year, and with you know, seventy
percent of the US population who take any depressants with
them being on them for two years or more, it's
kind of crazy that we don't really know whether they're
effective past a year. And really what I was seeing
in my clinical experience was that they weren't, and that
they were wearing off and so that was the first thing.
(04:33):
It's that we were saying, hey, these drugs are safe
and effective, but we were leaving off the most important part,
which was, yeah, for the year that these drugs are
studied for and I think intuitively for the audience listening,
they that's a really important question how long these drugs
work for? Because I mean, they're drugs, right, and everyone
understands tolerance. They understand that they wear off over time,
that we adapt to them, you know, It's a pattern
(04:55):
we see with all chemicals that we take. And so
I mean that was the first thing that I saw.
On top of that, I saw a whole range of
I learned about a whole range of side effects that
we were not telling our patients about, specifically with the SSRIs.
You know, the issue of tardiv dysphoria, which is a
very complicated term, but really what it means is that
there's a toxicity that occurs with long term SSRI use,
(05:18):
where people start to develop brain fog and severe fatigue,
you know. And I've never known about this, but when
I look back at my clinical practice, and this is
what I see now as well. There's so many people
on chronic SSRIs who are being told that they have
treatment resistant depression or that their brain illness is somehow
like transforming and it's making them worse, and it isn't.
(05:39):
It's the drugs. Our brains are not designed to be
on SSRIs for like decades at a time, and when
you do that, there are some people who get worse.
And so it was those things together that I was like,
you know, this really isn't a sustainable.
Speaker 2 (05:52):
Way to help people.
Speaker 3 (05:54):
We need to be going back to supporting people with
non drug approaches rather than just kind of masking some
with drugs that wear off over time, and then they
also make some people worse.
Speaker 1 (06:05):
So here's the question I have for you. Well, let's
actually let's go simple for a second. Can you just
explain how SSRIs and some of the others actually work
on specifically like a developing brain, which is we're seeing
more and more youth, kids, adolescents, even young adults who
are taking these medications.
Speaker 2 (06:22):
Sure.
Speaker 3 (06:23):
Yeah, So, an SSRI is a selective serotonin reuptake inhibitor,
and basically what it does is it binds to the
receptors in the brain that pull serotonin out of the
space where it sort of acts on the nerves, and
when you do that, it'll temporarily increase the amount of
serotonin that's in the brain. And that's associated with a
(06:43):
drug effect, which is people will say numbing.
Speaker 2 (06:46):
Like erectoria.
Speaker 1 (06:47):
We talk about it here a lot, like one of
those hormones that are supposed to give you that happy,
euphoric feeling, right yeah.
Speaker 3 (06:54):
Yeah, Well, you know, people do think like, you know, oh,
you know, serotonin, you know, it's just like the feel
good chemical or but from my experience, it's like when
you take the SSRIs, it's actually like a blunting experience.
And so many people who have like severe anxiety, they'll
experience this as being really therapeutic, because if your mind
is all over the place and you take something that
kind of numbs you out, you'll say, well, that's helpful,
(07:17):
and you may even say it's life saving sometimes. But
what I want to be really clear about, Nicole, is
that these drugs, they're not fixing a chemical imbalance. And
there was this myth for a long time that you know,
there was like a normal serotonin state and there was
an abnormal serotonin state, and if you took the SSRI
you would fix that abnormal serotonin state. And you would
(07:40):
revert the person back to normal, just like a type
one diabetic who couldn't make insulin out of their pancreas.
You just bring the insulin back in and now they're
back into a normal a normal state. Now, that was
the narrative that has been pushed on the American public
for really the last three decades, and there has never
been any evidence.
Speaker 1 (08:00):
Sorry to interrupt you, so, oh, you're just going to
say evidence like type one diabetes, we can actually check seepepti,
they don't make insulin. When we're talking about the abnormal
serotonin state, and we hear people talking about that and
therefore they recommend the SSRI. You know, is there a
way to actually prove or how did that term abnormal
serotonin state even become?
Speaker 2 (08:21):
Yeah, great question, Nicole.
Speaker 3 (08:23):
So the very brief history on this was back in
the nineteenth is we were treating tuberculosis patients and we
used a drug called ipronize it, and we noticed that
it energized the patients, and so doctors said, well, maybe
this will help with depression, and so they took ipronize
it and they made some drugs just like it and
they gave them to depressed patients and the depressed patients
they looked more lively afterwards. Now, what we knew about
(08:45):
that class of drugs at the time was that they
increased chemicals like serotonin, and so there were two ways
that you could have looked at this problem at the time.
One is, you know, these are drugs just like any
other drugs, and it has an energizing effect that's masking
the depressive symptoms.
Speaker 2 (08:59):
That was one way.
Speaker 3 (09:01):
But then there was a much more commercially viable message,
which was these people have chemical imbalances and that's why
this is helping them. And so that was the narrative
that took off. And the reason that that was chosen
is because I think intuitively, a lot of Americans out
there are you know that you know, they listened to
their grandma's advice, which is it's not a good idea
to just sweep things under the rug. You know, you
(09:22):
need to address your problems when you take and so
if you can tell someone that you know, you're not
really masking something with drugs, you're actually fixing a biological
problem in the brain, all of a sudden, that stigma
goes away and that okay, well, you know this is
just me being responsible, This is me being healthy, this
is me using you know, you know, modern science, and
(09:43):
it's it's a very good thing. But that is not
true because what we have been doing for the last
several decades is we've been sticking needles into the cerebral
We've been collecting cerebel spinal fluid. We've been in lumbar punctures,
that's the fluid that goes around the brain. And we've
been looking at the metabolites of serotonin. And we've been
looking at normal people and been looking at depressed people,
(10:04):
no difference. We've been doing autopsies, we've been taking slices
of the brain for depressed people and non depressed people
and comparing them. There's no changes in receptors there. And
so every time we've tried to look at this, like
is there a normal serotonin state and an abnormal serotonin state,
We've never found it. And so there is no evidence
of a you know, a quote unquote chemical imbalance that
(10:25):
is being fixed by an SSM.
Speaker 1 (10:27):
Gosh, I mean, I haven't obviously studied that or read
upon that, but that seems I mean, that seems crazy
to me that the narrative continues to be that you
are fixing a chemical imbalance that you don't actually have
objective evidence of that chemical imbalance. I mean, that's mind blowing,
you know, especially when I think it was a couple
decades ago the black box warning came out on the
SSRIs about the suicidal risk. It was obviously clear. I
(10:51):
think it was a four percent suicide risk in younger
people taking SSRIs compared to two percent in the placebo,
which is a substantial risk. But I'm curious on your
thought of the lesser talked about risk of the increased agitation, irritability,
or even aggression during early use of SSI.
Speaker 2 (11:12):
You know, you're talking about this.
Speaker 3 (11:14):
This issue is really about paradoxical reactions, and so what
is that? So that is when you have an atypical
response to the drug. So, you know, a moment a
guy mentioned that the normal drug effect that we affect
from the expect from these medications is one of blunting.
But everyone responds to drugs a little bit differently, and
so that's like the norm. And the analogy I like
(11:35):
to use to explain a paradoxical side effect is imagine
you have ten people, you know, they're sitting around and
they're smoking a joint. You have nine people who are giggling,
you know, they're having a good time, and you have
one person that becomes paranoid. This can happen with every
single drug. You know, there are genetic reasons that we
don't understand that when some people get exposed to a drug,
they don't have the typical effect, they go a different way.
(11:59):
And with SS what researchers have found, and this happened
like immediately when Prozac came out onto the market, is
that for some people, if you put them on this drug,
they can become acutely suicidal. And so you could imagine
how horrible that could be. You already have a depressed
and anxious kid. They get on a drug, they have
a paradoxical reaction and it starts to give them obsessive, dark,
(12:23):
morbid thoughts. They start to feel really agitated, they start
to feel incredibly uncomfortable, and in those states they can
actually it can actually push them into suicidal behavior or
in even rareer cases, but still importantly, you can actually
make them violent. And that's the link to the whole
SSRIs and the mass shooting issue. It's that some people
(12:44):
when they get on these medications, it puts them into
a state where they do things that they would not
normally do.
Speaker 1 (12:50):
You're listening to Wellness and Mass. We'll be right back
with more. Is there a way to identify which people
who are more likely to be on these medications who
result with the suicidal or the homicidal ideation? And I
think it's important to note though the suicidal ideations well
documented black box warning by the FDA, Why do you
(13:12):
think that the homicidal or the aggressive side effects are
I mean, honestly, if you talk to people about them,
you know, when a mass shooting happens, you say, well,
they're on an SSRI and there is an association with
aggression and violence behavior. And then they quickly come back
and say, well, the data is conflicted, and they kind
(13:33):
of try and push away from that. What are your
thoughts on that?
Speaker 3 (13:38):
What we're seeing, Nicole, is the interface of science and
politics when it comes to the mass shooting issue. Because listen,
we've had numerous court cases that have gone before impartial
judges and juries where they have found that if not
for the SSRI, this person would not have committed these,
you know, multiple murders sometimes and so we already know
(14:01):
that when people have looked at these cases, they've found
them to be at fault. Now, the reason we hear
something very different in the media is because school shootings
is a very political topic and for a lot of
the media, the answer is already clear. It's the guns.
And so I mean, that's all they want to hear.
They want it to be about the guns. If you
bring up something else, they just say, yeah, no, that's
(14:22):
you know, they're trying to distract a way. Now, I'm
not trying to say that every single school shooting that
has taken place is because of an SSRI. Obviously there
are evil people out there. I think people can do
this completely sober off any drugs.
Speaker 2 (14:36):
I just believe that.
Speaker 3 (14:38):
And yes, sure having access to firearms does make it easier,
but without a doubt, some people are being pushed into violence, homicide,
and murder because of these medications. And we owe it
to the public to actually look at these things. And
that's what Bobby Kennedy is doing now. He is trying
to put together a group of people to investigate mass shootings.
(14:58):
And the only way that you can do that is
that when one of these events happens, you need to
go out there and you need to interview the person
if they survive, and their family and their doctors, and
put together a narrative, a case narrative around it where
you look for alternative explanations, and if there's nothing else
that exists, and you see a clear history where the
person got on the drug and then they acutely became
(15:20):
different in their personality, more irritable, more agitated, then you
have to call it what it is, which is a
case where it looks like a drug may have pushed
someone into an act of violence.
Speaker 1 (15:31):
So I guess if it has proven to be so,
would that make these people then legally retrospectively less liable
for these mass shootings.
Speaker 3 (15:40):
It's a really delicate issue. I think it has to
weigh into it. But that's a really hard call to make.
I mean, we're talking about some of the most horrific incidents.
Speaker 2 (15:50):
In the world.
Speaker 3 (15:51):
I mean, if you were a parent and someone got
on an SSRI and they killed your child and they
may have taken out, i don't know, like ten other
kids at the same time, at a certain point you
want some justice for that way. And you know, yes,
the drugs can play a role in that that's a
very hard thing to tase out. You know how much
liability is for the patient and how much for the person.
But these are incredibly sensitive issues and that's going to
(16:14):
be a really hard call to make.
Speaker 1 (16:17):
Yeah, I mean, if you look at the stats, I mean,
I'm sure you know them significantly better than I do.
But the use of these SSRIs over the last couple
of decades have skyrocketed, especially in the youth during COVID.
I think prescriptions were up like sixty five percent or
something crazy like that. You know, how do you think
we come back from this? Because the question is, you know,
(16:37):
you have the chicken in the egg scenario. You have
a rise in mental health issues. Obviously we're seeing anxiety
and depression, mood disorders more frequently from you have video games,
you know, social media, the isolation of COVID, the societal pressures,
all of these things. You know, how do we how
(16:57):
do we get out of the cycle of a rise
in mental illness, arise in prescriptions, and then the paradoxical
effects of these prescriptions and so and so forth.
Speaker 2 (17:06):
Yeah, what a question? I mean, so, yeah, it's.
Speaker 1 (17:09):
A loaded what I apologize?
Speaker 3 (17:11):
Yeah, No, No, I mean I think, you know, if
we look at in general, every time I'm seeing serious
mental health problems going on, I think the biggest mistake
is to blame the child. You have to look at
the family unit as a whole. What's going on with
the parents, you know, how are they around, you know,
what is the interaction like with the kids, And so
(17:31):
whenever you're helping kids be less depressed, you start with
the parents, to be honest, I mean, that's that's where
you go. And so putting that issue aside, we need
to look at larger societal things going on.
Speaker 2 (17:42):
Right now.
Speaker 3 (17:43):
For me, I think that social media use is massive.
I think everyone kind of knows in the back of
their mind, Hey, this is kind of bad. You know,
this is kind of different. I think it's a lot
worse than than people think. Some of the stats I've
seen lately show that children are spending an average of
three and a half hours on social media, and some
of them are spending like five hours a day on it.
Speaker 2 (18:05):
Now, if you.
Speaker 3 (18:06):
Think about it, this is several hours that in the
past they used to be spending face to face with
their friends, developing social skills, hanging out. They would be sleeping,
maybe they would be exercising instead of that, you have
young girls on Instagram posting selfies of themselves for strangers
to comment on and friends to comment on, and like,
(18:28):
you know, they're looking at celebrities and other influencers out
there who you know, seemingly have vastly better bodies and
lives than them, even though everyone knows. You don't post
the bad photos on there, and you don't post the
bad things that happen to you, and it poisons your mind.
Speaker 2 (18:44):
I mean, I mean we've.
Speaker 3 (18:46):
Changed a lot. I mean, in the seventies, you know,
fifty percent of Americans were going to church. There was
a lot more moral teachings going on there. It was
much more of a values based society. And that's decreased.
It's thirty percent now, and we're spending and the kids
are spending like, you know, three hours on social media
ingesting consumeristic values that that kind of espouse, Like if
(19:09):
you get lots of likes on social media, if you
earn a lot of money, if you look a certain way,
like it's this kind of this instant gratification kind of
buzz that you get that that that gives you values.
I think it's poisoning their minds, and I think we
need to go back to a much more value based
society where you know, living a life and service of others,
you know, wisdom, you know, all of these, all of
(19:32):
these values that used to come from the home and
from the community and the church that would actually lead
to longer term happiness over time.
Speaker 2 (19:39):
I think we've lost that.
Speaker 3 (19:40):
I think we need to return to that place and
then it would be much you know, and and and
that's the way, and that's the way to go, not
not have all of these issues going on and then
just saying oh, yeah, you know this, this pill is
going to fix it. The pill is it's not going
to fix it's going to actually make many kids worse.
Speaker 1 (19:55):
Well, you made. You mentioned One of my favorite terms
is instant gratification. I wrote a book in twenty two
where I think if there was one repeated term, it
was that because especially here in the United States, we
want things, we want things fast, we want things cheap,
and we want things right now. And you know, the society,
the culture we live in continues to perpetuate this. And
I think the Internet, social media has just made this
(20:19):
almost to a pathological place. And you know, we have psychiatrists, pediatricians,
family practitioners who are all overburdened the Affordable Care Act.
That's an entirely different conversation, but has certainly put more
pressure on a lot of people to see more patients,
to spend less time with patients, and unfortunately it has
resulted in rise in prescriptions because they don't have time
(20:43):
to talk about the underlying drivers of poor sleep, nutrition, trauma,
social media exposure, and the fact that a lot of
our youth are coming from broken homes. I think if
we really paused and focused on us where we are
as a society, we could actually tackle the mental health crisis.
Speaker 2 (21:01):
Yeah.
Speaker 3 (21:02):
And you know, the one of the big things that
I would the message that I have for doctors, family
medicine doctors and psychiatrists and obg y ns and all
of them is, guys, we need to grab the steering wheel.
We need to wrestle it away from corporate interests right now.
You know, private equity who are running our hospitals. We
know it's bullshit. And and because here's here's the thing.
(21:23):
I mean, we're all here to help people. We want
to help our patients, and if we're being pushed into
a system where Oh, in order to sort of make
ends meet, we need to see four patients in an
hour who are having mental health problems. And you know,
because of that, you're diagnosing depression based off a checklist
without even understanding the person's life. Because of this, instead
(21:46):
of trying to motivate them to make lifestyle and dietary
changes and you know, fix relationship issues, you know, find meaning,
do all of the stuff we know that matters. If
we don't have the time to do that and we
have to default to giving a pill, guys, I have
to tell it as it is. We're not actually helping
our patients. In fact, we're making them worse. And our
justification for this is, oh, the system is making me
(22:08):
do it.
Speaker 2 (22:09):
Guys.
Speaker 3 (22:09):
We are the system. I mean, we are the doctors.
We're the ones that work here, and there are different
ways of working and so undortually.
Speaker 1 (22:18):
Though we don't have a lot of control. We are
mandated on federal, state, local levels. And you're right, unless
everyone wants to go to concierge, but there's some things
that are out of people's control. I think it's tough.
I think it has to happen from the individual position,
but also Elections have consequences and votes matter, and I
(22:38):
advocating at the federal level is really the way to
get through in my opinion, when it comes to the
healthcare system.
Speaker 3 (22:44):
You're right, and you know it is challenging, Nicole. Do
don't get me wrong. I understand that. But we need
to be speaking up. We need to be I mean,
we have to be talking to the media. We need
to be being honest to our patients. I mean, if
it even starts at a place where it's just like, listen,
we actually don't have time to help you in the
way that I would like to. All I really have
to offer you is this medication. And really there's a
(23:07):
whole lot more to do than this, and I wish
we had more to offer you, but this is not
the answer. So I think just starting by being honest
with the patients is really important. And you know, there
are some doctors out there who are doing things like
direct primary care. I think they're getting better results by
leaving the insurance system. Is that a solution for the
(23:27):
people out on Medicaid?
Speaker 2 (23:30):
It's not.
Speaker 3 (23:30):
You know, it's a really complicated issue, but I think
we have to be louder about this problem. We know
that we can be doing a better job. I mean,
my colleagues, we feel it. I talked to psychiatrists about there.
They feel like they're doing their job with one leg
and one arm tied behind their back, and we need
serious systemic change in the way we deliver medical care.
Speaker 1 (23:50):
Yeah, well, I agree with that. You know, one of
the things that you touched on earlier is like this
is now you know, violence, mass shootings, even adolescent mental
health has been so politicized that it's labeled a conservative
talking point to criticize SSRIs or you know, any form
of medications for treating mental health. And so I imagine
(24:14):
that there are a lot of doctors out there who
would like to say something, but because of political reasons,
they don't want to be criticized. They don't want to
put their job in jeopardy. We already know that social
media and other forms of media have algorithms that suppress
conservative voices, and conservatives who speak out tend to be ridiculed.
(24:34):
More So, I think there's a lot of people who
are concerned that if they criticize SSRIs that they are
that people are going to say that they're conservative because
it's now turned into a conservative talking point. But at
the end of the day, it's not a conservative talking point.
This is a healthcare talking point. This is talking about,
you know, the mental health and the wellness of our nation.
(24:56):
We have to take this away from the political aspect
of it.
Speaker 3 (25:00):
Yeah, I think you're absolutely right, and you touched on
something which I think is actually quite sinister that that's
going on, and that is the whole idea that you know,
these drugs are always safe, and you know that the
mentally you know, people who have mental health diagnoses, they're
they're sort of stigmatized and being you know, unfairly treated
by I don't know, like rednecks from the Conservative party
(25:20):
who are just saying, just pull yourself up by your bootstraps.
These are manufactured by the pharmaceutical industry. Anytime someone criticizes
SSRIs or they say, hey, you know, maybe it's a
bad thing that you know, seventeen percent of like adolescent
boys have ADHD.
Speaker 2 (25:38):
Now, you know, you know, maybe we should question things more.
Speaker 3 (25:40):
They're so quick to say, you know, these redneck conservatives
or whatever you want, in these bootstrap type people, they're
trying to stigmatize the mentally ill. They want to take
away the drugs, and we don't do that here on
the left. You know, here on the left, we you know,
we stand for mental health issues. We you know, we
want the medications to be safe. Guys, that stuff came
out of the Medical Affairs Department of pharmaceutical companies. Do
(26:03):
you realize that these billion dollar companies have groups where
they can control the narrative, and that's essentially what they're
trying to do. Anytime you criticize these things, they want
to characterize the person as having an anti drug puritan agenda,
like there's some kind of blood eyed or someone that
doesn't appreciate the horror of mental illness. Like I know
(26:26):
these problems are hard, but I think a more nuanced
discussion about like the drugs and how they're not studied
long term and how people get worse. I mean, that's
not a partisan issue. This is something that if you're
on the left, you'd want that for your kids. If
you're on the right, you'd want that for you kids.
Medicine shouldn't be like that. We just want honesty. We're
all parents, We love our children and our family, and
(26:46):
we just want the right information. And so it really
is the left and the pharmaceutical industry who just seem
to be kind of whipping this up into a storm,
and I think they're harming people by doing that.
Speaker 1 (27:00):
More coming up on Wellness and Masked with doctor Nicole Sapphire.
One thing I want to ask is you were at
the FDA, if you could change one policy to day,
moving forward from the FDA standpoint or the AHHS, just
to make antidepressant use safer for people, what would you change?
(27:21):
What would be your ask if you had RFK Junior's year.
Speaker 3 (27:25):
You know, I'm going to take two. I'm going to
take two things. So the first thing that I would
do is we need to update the labels. It needs
to be really clear that these drugs aren't studied long term.
We also need to talk about the fact that they
are making some people worse in the long run. We
need to talk about the fact that there is a
proportion of people who have severe problems when they come
off these medications. I think if people just knew the
(27:48):
risks of these drugs accurately, I think, you know, eighty
percent of people would say yeah, no thanks. And the
next thing that we need to do is, guys, we
need to study these drugs in a way that's in
life line with how the population uses them. I mean,
we need a trial that goes for at least two years.
This is not impossible. I mean we do this for statins,
(28:08):
you know, it's like double blind, randomized controlled trials, like
like two to five years for some of these statins.
I mean we do it for nine for twelve weeks
with antidepressants. This is madness. When we have fifteen percent
of our population on antidepressants and one in three you know,
like sorry, one in one in four women over age
thirty on them, this is a serious issue we need
(28:30):
to look at. So I think we just we need
to study these drugs a lot longer.
Speaker 1 (28:35):
You know, it's interesting you just mentioned women women who
are approaching that perimenopause menopausal. Ah. You know, one thing
that has come out of doctor Marty McCay being at
the FDA is there's finally conversations about menopausal perimenopausal health
again trying to destigmatize against that. What do you think
the link is with women of this age and the
(28:58):
rise in SSRI use in mental illness?
Speaker 3 (29:02):
Yeah, so I think, you know, the menopausal period is
definitely a factor. I mean, we've kind of swung in
two ways. I mean, we used to say, yeah, let's
use you know, homone replacement therapies, and then all of
a sudden it was like, no, we're never going to
use homemone replacement therapies.
Speaker 2 (29:17):
They're terrible.
Speaker 3 (29:17):
We're going to just put everyone an SSRIs because that's
what they're doing now. You know, if you have insomni area,
you know, hot flushes or anything like that, you get
put on an antidepressant, which is just crazy.
Speaker 1 (29:28):
Isn't that interesting because unlike what we were talking about
with the serotonin deficit or change or whatever, that they
can't prove, you know, type one diabetes, you can show
that the body's not making insulin when they talk about
serotonin dysfunction and giving an SSRI they can't prove that.
But in perimenopause menopause, we're not making estrogen and progesterone
and testosterone, and that's something you can prove. So it
(29:51):
makes no sense that the answer to that would be
the ssis you actually know what their deficient is. You
have to be able to provide what their deficient is.
That's what's going to help them.
Speaker 3 (30:02):
And a lot of people are going that way now
and I would say that's a much safer way than
getting on a drug that simply wears off over time.
I mean, the reason we use these drugs in perimenopause
is because, I mean these were billion dollar drugs that
had some of the smartest marketing minds behind them, and
they all sat around in a room and they were like,
how can we expand our market share? And then someone said,
(30:23):
well they seem to help with hot flushes, like let's
go after the menopause market. And then doctors were just
flooded with that for you know, for a couple of decades,
and now every other woman who's perimenopausal is kind of
being pressured into taking an SSRI when, like you said,
you know, how does that make sense just you know,
replace what is missing? And I know that's a more
(30:45):
complicated issue. You know, it's for people that really specialize
in that space. But clinically, what I see is a
lot of women do really well with some hormone supplementation,
and to me, it just seems a lot safer than
putting someone on effexor or one of these other antidepressants
for hot flushes.
Speaker 1 (31:02):
So your recommendations to HHS are essentially we need longer
term study of these medications, and probably that we're overusing
these medications, and a lot of people may choose not
to take these medications if they actually knew the risks
with these medication. But so for the people who are
either on the medication and you, like you said, in
(31:24):
your practice, you're trying to take them off, or people
who are struggling with depression or anxiety who are considering
an SSRI. But what are what's your recommendations for non
drug therapies that have the best evidence of course for
like mild to moderate depression.
Speaker 3 (31:41):
Yeah, so it's these are really complicated issues what I
want to say. I mean, I mean, if you think
about the reasons why people are unhappy, let's talk about
some of them. You know what if you're in a
terrible relationship, What if you have kids, that's a really
complicated issue. What if you've spent a lot of time
in a and you're now working in a job and
(32:03):
you don't find any meaning in it and you're kind
of you're stuck there. That's really complicated. You know what
if you're having some problems with addiction or some serious
health issues, and maybe the way you've learned to deal
with emotional pain is through food. These are all challenging things,
and so I want to start off my response by
saying that because I don't want to belittle just how
hard some of these problems are. Anxiety and depression. These
(32:25):
aren't just feeling a little bit sad. I mean, these
can be completely oppressive issues that can be really hard
to treat. I mean that said, when I look at
my patients, I think there's the four main things that
really make people unhappy. So the first is relational issues,
whether that can be dealing with social isolation or relationship problems.
(32:46):
Working with interpersonal therapists is a great place to go.
The next things are issues of meaning in your life.
You can deal with that with a career coach if
it's about the work that you're doing, or you can
go to or you can double down on your faith
and your spirituality. That can be in a tremendous place
to go to find meaning in your life. I also
think about health issues. You know, we forget that our
(33:07):
heads are connected to our bodies through this thing called
the neck over here. And if you're obese and you're
having problems and you're putting like bad food into your
body and you're not exercising, you're going to see that
poor health reflected in your body, but it's also going
to be reflected in your mind. And so you know,
nourishing your body, moving your body, getting in the sun
is really important. And then the final thing is is sobriety.
(33:32):
And you know, I talk about a lot of controversial things,
but when I say this, people really don't like it.
And that's sobriety from also legal legal things. And so
you know, having a cup of coffee in the morning
is fine. But if you're having a cup of coffee
in the morning, then you're throwing down three diet cokes
and you have chewing tobacco in your mouth all day.
You know you're going to crash from stimulants. It's going
(33:52):
to mess with your sleep. That's something that that that's
a lot for the body to go through, so you
want to make sure you're using them in moderation. Is
nowhere near as safe as people say it is. They
say it's like this healthy. You know this this medicine
right now, guys, this is not the ditch weed from
the seventies that was three percent the average THHG concentration
that you're getting from the dispensary, it's like thirty five
(34:15):
percent of the some of the concentrates in ninety percent.
This stuff is making people suicidal, it's making people become psychotic,
and so you want to get the drugs out. And
so I would focus on those four areas. You're going
to know the ones that are the most important for you.
And the thing is like, I've never met someone who
was anxious or depressed who had those four things in line,
(34:37):
and so you want to start there.
Speaker 2 (34:39):
Now.
Speaker 3 (34:39):
The next thing, you know, what do you need to
know about coming off these medications? I break it into
three things, and this is what we do at the
Taper Clinic. The first one is, if you've been on
these drugs for several years, just start with a five
to ten percent reduction. You know that's that's a good
reduction that most people can tolerate. Do that every two
to four weeks. The next thing is that you want
(35:00):
to listen to your body. If you tolerated that reduction, well,
you can increase the amount you remove. If you didn't
tolerate it, well you can decrease the amount you remove.
And then the last thing is is that it can
take time, and especially at the end. So most people
will fail a taper when they get to the lowest dose.
(35:21):
And the way that I explain this is that at
the higher doses, you know, the drug is essentially flooding
your brain, and you could remove half of it and
there's still enough excess drug leftover to jump onto those receptors.
But when you get to the very low dose of
that drug, there's not enough like reserve floating around in
the brain. And if you remove like even you know,
five percent, even though you did that easily before, that
(35:44):
could actually be a huge amount. And so what I
often have my patients do is when they get to
the lowest dose is we actually liquefy the medication. We
put it in a syringe that has one hundred little
lines on the side, and it allows you to lower
it down with such great precision that you you have
a lot of control, and people usually find that much
easier and much more tolerable.
Speaker 1 (36:05):
I have never heard that before. That's really interesting. I'm
just going to add one more conveiat that people if
you've been on these medications for a long time and
you're going you want to come off. I mean, I'm
all about always trying to get off medications. Make sure
you talk to your doctor about it, because there can
be some there can be some side effects. Some people
don't do well coming off medication. It's always good to
(36:25):
have another set of eyes on you. That's just a
responsible thing to do. Doctor Yoziv, thank you so much.
I think you have given some incredible advice for people,
and you've also made it clear that mental health this
is not something that should be stigmatized. I mean, this
is not just you know, people being lazy or not
trying to put in the effort to feel better. Mental
(36:46):
health is actually just as diagnosable as diabetes or other
physical ailments, and so it has to be taken seriously.
But the way over the last couple of decades, with
the increased use of medications, the over diagnosis, we have
to pause to make sure that we are doing more
benefit than harm. And just like you're saying, you know,
some of my concern is that we're doing some harm
(37:08):
and looking at the long term effects of this is
crucial and I agree with you entirely. Thank you so
much for coming on. I really appreciate it.
Speaker 3 (37:14):
Well said doctor Safi. Was an absolute pleasure to be
here with you today.
Speaker 1 (37:19):
What a great conversation. What I hope everyone takes away
from the conversation I had with doctor Yosef is that
mental health and mental health treatment it's not one size
fits all, and there's no shame with being diagnosed or
being treated for any mental illness. The reality is none
of us get through our lives without dealing with some
level of mental health challenges throughout it. It's part of life.
(37:43):
Antidepressants they may be life changing for some, but they're
not a cure all and maybe in young people we
should demand more vigilant monitoring and safety research, but definitely
open dialogue. And as doctor Yosef reminded us, there are
some things that we can focus on rather than just
the medication to treat those symptoms. We need to look
(38:05):
inward in our life. What are some modifiable risk factors
that may be contributing to how we're feeling, Looking at
our relationships, looking at if we're addicted to something, And
as he pointed out, he's not just talking about illicit
drugs like cocaine or other things. He's talking about everything caffeine, nicotine.
If your body is addicted to something and you have
(38:25):
that high you're going to feel a crash at some point.
He also talked about exercising more, getting outside. You know,
I love talking about getting outside, being in nature and
being in the sunlight and vitamin D. It's all good
for you. There are some things you can do to
take control of your life. If you find you still
need help. There's absolutely no shame in considering some of
(38:47):
these medications. But maybe, as we talked about, short term
use of these medications should be the goal and not
necessarily medication for life. Healing the next generation means combining
the best of modern metay listen with awareness, education and compassion.
Speaker 2 (39:04):
I'm doctor Nicole Sapphire.
Speaker 1 (39:06):
Thank you so much for listening to Wellness on MASS.
Speaker 2 (39:08):
Let's keep asking questions and staying curious. It's okay to
ask questions.
Speaker 1 (39:13):
Be sure to listen to Wellness on Mass with doctor
Nicole Sapphire on iHeartRadio or wherever you get your podcasts,
and we'll see you next time.
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Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.