Culture Apothecary with Alex Clark Episode Summary: Step-by-Step Guide to Getting Off Antidepressants 💊 | Dr. Josef Witt-Doerring, MD Release Date: April 11, 2025
Introduction
In this compelling episode of Culture Apothecary with Alex Clark, host Alex Clark engages in a deep and insightful conversation with Dr. Joseph Whit Doring, a board-certified psychiatrist, drug safety expert, and co-founder of Taper Clinic—the largest psychiatric deprescribing practice in the United States. Dr. Doring brings a wealth of experience from his tenure as an FDA medical officer and consultant to the pharmaceutical industry, offering a critical examination of the current practices surrounding antidepressant prescriptions and their long-term implications.
I. The Problem with Overprescription of SSRIs
Dr. Joseph Whit Doring opens the discussion by addressing the prevalent issue of SSRIs (Selective Serotonin Reuptake Inhibitors) being widely prescribed, often by primary care physicians rather than specialists. He starkly labels this practice as "malpractice," highlighting a fundamental flaw in the mental health care system.
Dr. Doring [02:29]: "I think it's malpractice."
He critiques the transactional approach in psychiatry, where brief consultations lead to immediate diagnoses based on symptom checklists and subsequent prescription of medications without exploring non-drug therapies or underlying causes of mental health issues.
II. Side Effects and Risks of SSRIs
A significant portion of the discussion delves into the lesser-known and severe side effects associated with long-term SSRI use. Dr. Doring introduces listeners to Post SSRI Sexual Dysfunction (PSSD), a condition not listed on U.S. drug labels, where individuals experience enduring sexual dysfunction even after discontinuing the medication.
Dr. Doring [23:18]: "PSSD is not in the drug labels."
He elaborates on the emotional and cognitive blunting caused by SSRIs, describing it as a state where individuals feel disconnected and emotionally numb, thereby masking the very symptoms the drugs are intended to alleviate without addressing the root causes.
Dr. Doring [20:28]: "The main ones that everyone should know and that unfortunately aren't mentioned is... post SSRI sexual dysfunction."
III. The Tapering Process for Discontinuing SSRIs
Transitioning from the risks, Dr. Doring provides a detailed guide on safely tapering off antidepressants. Emphasizing a gradual reduction in dosage—typically 5 to 10% per month for those on SSRIs for over a year—he underscores the importance of personalized tapering schedules to mitigate withdrawal symptoms and prevent protracted withdrawal syndromes.
Dr. Doring [39:33]: "I typically recommend people knock the dose down by 5 to 10% per month, and then they just adjust it as they go."
He advises the use of liquid formulations and precise dosing tools like syringes to achieve finer control over dosage reductions as patients reach lower dose ranges, ensuring a safer and more manageable transition off the medication.
IV. SSRIs and Use in Children
Addressing the controversial topic of prescribing SSRIs to children, Dr. Doring expresses significant concerns. He points out the increased risk of suicidal behavior in individuals under 25 taking these medications, a factor that often goes unheeded in clinical settings.
Dr. Doring [49:38]: "When you look at it in that way, you're more likely to have a suicide attempt on the drug than if you were just given placebo."
He argues that the developing nervous systems of children make them more susceptible to adverse reactions, questioning the appropriateness of SSRI prescriptions in pediatric populations unless all other interventions have been exhausted.
V. Alternatives to Antidepressants
Dr. Doring advocates for a holistic approach to treating depression, emphasizing lifestyle modifications and functional medicine over pharmacological interventions. He highlights the effectiveness of exercise, anti-inflammatory diets, and psychotherapy, supported by substantial evidence demonstrating better long-term outcomes compared to antidepressant use.
Dr. Doring [67:16]: "They [lifestyle changes] help improve your health. You want to do the things that are much safer before you go and lean on a drug that can... [be] really hard to come off."
He underscores the importance of addressing underlying issues such as relationships, meaningful work, and physical health as foundational elements in overcoming depression.
VI. The Taper Clinic: A Solution
Introducing the Taper Clinic, Dr. Doring explains its mission to assist individuals in safely discontinuing psychiatric medications. The clinic employs a structured, long-term approach to tapering, staffed by clinicians who have personally experienced the challenges of psychiatric medication withdrawal.
Dr. Doring [71:05]: "The Taper Clinic is a business my wife and I started... we take people off psychiatric meds, we help them find non-drug approaches to deal with their mental health problems."
The clinic operates across the ten most populous states in the U.S., providing personalized support to ensure patients can transition off medications without enduring severe withdrawal symptoms.
VII. Links Between Antidepressants and Broader Societal Issues
A thought-provoking segment explores the potential connections between antidepressant use and societal phenomena such as the transgender movement. Dr. Doring speculates that emotional and sexual dysfunction caused by prolonged antidepressant use could contribute to identity confusion and gender dysphoria among users.
Dr. Doring [54:37]: "You rob someone of that, the emotional development... You rob them of the opportunity to really work through their emotions."
While acknowledging that this is a speculative association, he stresses the profound and far-reaching impacts that psychiatric medications can have on personal identity and societal trends.
VIII. ADHD Medications: Parallels and Concerns
While the primary focus is on antidepressants, Dr. Doring also touches upon ADHD medications, expressing concerns about their addictive potential and the cultural pressures that drive their widespread use. He draws parallels between ADHD medications and substances like methamphetamine, highlighting the thin line between therapeutic use and abuse.
Dr. Doring [60:09]: "I think it's just completely fair to get distinction. I mean, there's a drug called Desoxin that, that is methamphetamine... but no, they're all stimulants."
He warns of the cascading effects of ADHD medications, which can lead to a dependence on multiple drugs to manage subsequent side effects and lifestyle disruptions.
IX. Conclusion
In wrapping up, Dr. Doring emphasizes the critical need for individuals to trust their intuition regarding antidepressant use and to prioritize comprehensive lifestyle changes alongside any pharmacological treatments. He calls for greater awareness of the long-term risks associated with SSRIs and advocates for a healthcare system that addresses the root causes of mental health issues rather than merely masking symptoms with medication.
Dr. Doring [72:20]: "You need to trust your intuition... do these other things that are really well known to help improve your health."
Alex Clark concludes the episode by reiterating the importance of informed decision-making in mental health treatment and encourages listeners to seek out resources like the Taper Clinic for support in their journey towards mental well-being.
Key Takeaways:
- Overprescription of SSRIs, especially by primary care physicians, is deemed malpractice by Dr. Doring.
- SSRIs carry significant long-term risks, including PSSD, emotional blunting, and cognitive impairments.
- Safe discontinuation of antidepressants requires a gradual, personalized tapering process.
- Prescribing SSRIs to children is fraught with increased risks of suicidal behavior and emotional development issues.
- Holistic approaches, including lifestyle changes and functional medicine, are advocated as more effective and safer alternatives to antidepressants.
- The Taper Clinic offers specialized support for individuals seeking to discontinue psychiatric medications safely.
Notable Quotes:
- Dr. Doring [02:29]: "I think it's malpractice."
- Dr. Doring [23:18]: "PSSD is not in the drug labels."
- Dr. Doring [39:33]: "I typically recommend people knock the dose down by 5 to 10% per month, and then they just adjust it as they go."
- Dr. Doring [49:38]: "When you look at it in that way, you're more likely to have a suicide attempt on the drug than if you were just given placebo."
- Dr. Doring [67:16]: "They help improve your health. You want to do the things that are much safer before you go and lean on a drug that can... [be] really hard to come off."
- Dr. Doring [71:05]: "We take people off psychiatric meds, we help them find non-drug approaches to deal with their mental health problems."
- Dr. Doring [72:20]: "You need to trust your intuition... do these other things that are really well known to help improve your health."
Resources Mentioned:
- Taper Clinic: www.taperclinic.com
- Surviving Antidepressants: survivingantidepressants.com
This episode serves as an eye-opener to the often-overlooked complexities and dangers associated with long-term antidepressant use. Dr. Joseph Whit Doring's expertise provides listeners with valuable insights into making informed decisions about their mental health treatments.