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The Clay Travis and Buck Sexton Show
Wellness Unmasked: Rethinking Mental Health: Dr. Josef Witt-Doerring on the Overmedication Crisis and the Truth About SSRIs
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- [02:17]
Dr. Nicole Safire
Welcome to wellness unmass. I'm Dr. Nicole Safire, and thanks so much for joining. Just like many other episodes, we're talking about a topic today that maybe isn't.
- [02:27]
Dr. Nicole Safire (Interviewer)
So popular to talk about in mainstream.
- [02:29]
Dr. Nicole Safire
Media, but it's certainly one that everyone is familiar about and are talking about in private circles, but they don't like.
- [02:36]
Dr. Nicole Safire (Interviewer)
To talk about it in public. So what is it?
- [02:38]
Dr. Nicole Safire
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 before COVID but also certainly during COVID we saw exponential rise in kids presenting 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.
- [03:11]
Dr. Nicole Safire (Interviewer)
And what are we doing about it?
- [03:13]
Dr. Nicole Safire
Well, in parallel with the rise in diagnoses, we're seeing more kids being prescribed medications to treat their mental illness. And while we're seeing the alarming rise in anxiety and depression, we're also seeing a rise in 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 untangle that question. Psychiatrist, but also former FDA medical officer, Dr. Yosef 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, and, but also the potential behavioral side effects of psychiatric medications, particularly SSRIs. So 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.
- [04:17]
Dr. Nicole Safire (Interviewer)
But first of all, Dr. Youssef, I know your background, but can you just give our listeners a little bit of information on why I have you here today?
- [04:25]
Dr. Yosef Witt Doring
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 overmedicate the American population. And it's something that I spend most of my time advocating against, you know, the use of the, the medications, the way we're using them. So, 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 for psychiatric medications. And 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, had really soured me on psychiatric medications. I ended up seeing that we are completely practicing outside of what the evidence base supports. And that has really inspired me to do what I do now, which is essentially take people off psychiatric medications.
- [05:25]
Dr. Nicole Safire (Interviewer)
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?
- [05:44]
Dr. Yosef Witt Doring
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 we'd put on these medications, and honestly, they. They wouldn't get better, or they would get better for a shorter period of time. And then, you know, they would kind of adapt to the drugs, and you need higher and higher doses. People would max out. You'd have to start stacking medications. And so intuitively I was like, hmm, you know, something doesn't feel quite right about this. And then when I went fda, I learned that we don't actually study any of these drugs longer than a year. And with, you know, 70% of the U.S. population who take antidepressants with them being on them for two years or more, it's kind of crazy that. 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. 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, that's a pattern. 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 tardive 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 where people start to develop brain fog and severe fatigue. I would, you know, and I 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, it's, 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 way to help people. We need to be going back to supporting people with non drug approaches rather than just kind of masking symptoms with drugs that wear off over time and then they also make some people worse.
- [08:18]
Dr. Nicole Safire (Interviewer)
So here's the question I have for you. Can, well let 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.
- [08:36]
Dr. Yosef Witt Doring
Sure. 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, 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 drug effect which is people will say numbing euphoria.
- [09:01]
Dr. Nicole Safire (Interviewer)
We talk about it here a lot like one of those hormones that are supposed to give you that happy euphoric feeling, right?
- [09:07]
Dr. Yosef Witt Doring
Yeah, yeah. Well, you know, people do think like, you know, oh, you know, serotonin, you know, it's just like the feel good chemical. 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. 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 revert the person back to normal, just like a type 1 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.
- [10:13]
Dr. Nicole Safire (Interviewer)
Sorry to interrupt you. So. Oh, you're just going to say evidence like type 1 diabetes. We can actually check C peptide. 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. How did that term, abnormal serotonin state even become.
- [10:35]
Dr. Yosef Witt Doring
Yeah, great question, Nicole. So the very brief history on this was back in the 1950s is we were treating tuberculosis patients, and we used a drug called Iproniazid, and we noticed that it energized the patients. And so doctors said, well, maybe this will help with depression. And so they took iproniazid 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 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. You know, that was one way. 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, they're. You know, they listen to their grandma's advice, which is it's not a good Idea to just sweep things under the rug. You know, you 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 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 cerebral. We've been collecting cerebral spinal fluid, we've been doing 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 we've been looking at depressed people. 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 is being fixed by an ss Gosh.
- [12:41]
Dr. Nicole Safire (Interviewer)
I mean, I haven't obviously studied that or read up on that, but that seems, I mean, that seems crazy to me that the narrative continues to be that you are fixing a chemical imbalance, yet 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 fox warning came out on the SSRIs about the suicidal risk. It was obviously clear. I think it was a 4% suicide risk in younger people taking SSRIs compared to 2% 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.
- [13:26]
Dr. Yosef Witt Doring
You know, you're talking about. 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 ago I 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 to use to. To explain a paradoxical side effect is imagine you have 10 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 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. They don't have the typical effect. They go a different way. 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, 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 rarer cases, but still importantly, it can actually make them violent. And that's the link to the whole SSRIs and the mass shooting issue. It's that some people, when they get on these medications, it puts them into a state where they do things that they would not normally do.
- [15:03]
Dr. Nicole Safire
You're listening to Wellness En Masse.
- [15:05]
Dr. Nicole Safire (Interviewer)
We'll be right back with more.
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Ed Helms
Hey, everyone.
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Kal Penn
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Ed Helms
This week on the podcast, I am sitting down with Jenny Garth, host of the iHeart podcast. I choose me to discuss the new Audible adaptation of the timeless Jane Austen classic Pride and Prejudice. This is not a trick question. There's no wrong answer. What role would I play?
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Dr. Nicole Safire (Interviewer)
You know what?
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I can see you as Mr. Darcy.
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Dr. Nicole Safire (Interviewer)
You got a little Colin Firth.
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Ed Helms
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- [18:53]
Dr. Nicole Safire (Interviewer)
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 think that the homicidal or the aggressive side effects are? I mean, honestly, 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 of try and push away from that. What are your thoughts on that?
- [19:35]
Dr. Yosef Witt Doring
What we're seeing, Nicole, is the, the interface of science and politics when it comes to the mass shooting issue. Because, listen, we, 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, and so we already know 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, they just, they want it to be about the guns. If you bring up something else, they just say, yeah, no, that's, you know, they're trying to distract away. 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. I, I, I just believe that. And, 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. 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 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.
- [21:28]
Dr. Nicole Safire (Interviewer)
So I guess if it is proven to be so, would that make these people then legally, retrospectively less liable for these mass shootings?
- [21:36]
Dr. Yosef Witt Doring
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 in the world. 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, 10 other kids at the same time, at a certain point, you want some justice for that. When you know, yes, the drugs can play a role in that. That's a very hard thing to tease out, how much liability is for the patient and how much for the person. But these are incredibly sensitive issues, and that's going to be a really hard call to make.
- [22:14]
Dr. Nicole Safire (Interviewer)
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 65% or something crazy like that. You know, how do you think we come back from this? Because the question is, you know, you have the chicken and 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 do we get out of the cycle of a rise in mental illness, a rise in prescriptions, and then the paradoxical effects of these prescriptions and so and so forth?
- [23:03]
Dr. Yosef Witt Doring
Yeah, what a question. I mean, so, yeah, it's a loaded one.
- [23:06]
Dr. Nicole Safire (Interviewer)
I apologize.
- [23:07]
Dr. Yosef Witt Doring
Yeah, no, no, I mean, I think, you know, if we. 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 whenever you're helping kids be less depressed, you start with the parents, to be honest. I mean, that's where you go. And so, putting that issue aside, we need to look at larger societal things going on right now. 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. Now if you 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, you know, they're looking at celebrities and other influences 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. I mean, I mean we've changed a lot. I MEAN in the 70s, you know, 50 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 30% 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 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 in service of others, you know, wisdom, you know, all of these, all of 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. I think we've lost that. I think we need to return to that place and it would be much, you know, 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. It's going to actually make many kids worse.
- [25:51]
Dr. Nicole Safire (Interviewer)
Well, you made, you mentioned one of my favorite terms is instant gratification. I wrote a book in 2020, 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 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 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.
- [26:58]
Dr. Yosef Witt Doring
Yeah. 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 OB GYNs 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. I mean, we're all here to help people. We. 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. 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 of trying to motivate them to make lifestyle and dietary changes and, you know, fix, you know, 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. 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 do it. Guys, we are the system. I mean, we. We are the doctors. We're the ones that work here. And there are different ways of working.
- [28:13]
Dr. Nicole Safire (Interviewer)
And so unfortunately, 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 by advocating at the federal level is really the way to get through, in my opinion, when it comes to the healthcare system.
- [28:41]
Dr. Yosef Witt Doring
You're right. And, you know, it is challenging. Nicole, 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 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 people out on Medicare, on Medicaid? It's not. You know, it's a really complicated issue. But I think we. 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 talk 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.
- [29:47]
Dr. Nicole Safire (Interviewer)
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 become so politicized that it's labeled a conservative talking point to criticize SSRIs or, you know, any form of medications for treating, you know, mental health. And so I imagine 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 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. We have to take this away from the political aspect of it.
- [30:57]
Dr. Yosef Witt Doring
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 conservative party 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, it's a bad thing that, you know, 17% of like adolescent boys have ADHD now. You know, you know, maybe we should question things more. They're so quick to say, you know, these redneck conservatives or whatever you want, 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 want the medications to be safe. Guys, that stuff came out of the medical affairs department of pharmaceutical companies. Do 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, you know, an anti drug puritan agenda. Like there's some kind of Luddite or someone that doesn't appreciate the horror of mental illness. Like, I know 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 your kids. Medicine shouldn't be like that. We just want honesty. We're all parents. We love our children and our family and 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 more.
- [32:57]
Dr. Nicole Safire (Interviewer)
Coming up on Wellness unmasked with Dr. Nicole Safire.
- [33:04]
Ed Helms
Hey everyone. Ed Helms here.
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Kal Penn
And hi, I'm Kal Penn and we're the hosts of Irsay The Audible and iHeart Audiobook Club.
- [33:14]
Ed Helms
This week on the podcast, I am sitting down with Jenny Garth, host of the iHeart podcast. I choose me to discuss the new Audible adaptation of the timeless Jane Austen classic Pride and Prejudice. This is not a trick question. There's no wrong answer. What role would I play?
- [33:35]
Dr. Nicole Safire (Interviewer)
You know what?
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Dr. Nicole Safire (Interviewer)
You got a little Colin Firth.
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Ed Helms
Okay, that's really sweet. I appreciate that. But are you sure I'm not the dad? I'm not Mr. Bennett.
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Dr. Nicole Safire (Interviewer)
Here.
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Ed Helms
Listen to Earsay the Audible and iHeart Audiobook Club on the iHeartradio app or wherever you get your podcasts.
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Dr. Nicole Safire (Interviewer)
One thing I want to ask is you were at the fda if you could change one policy today moving forward from the FDA standpoint or the HHS just to make antidepressant use safer for people, what would you change? What would be your ask if you had RFK Juniors ear?
- [37:06]
Dr. Yosef Witt Doring
I, you know, I'm gonna, I'm gonna take two, I'm gonna take two things. So the, the first thing that I would do is, 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 risks of these drugs accurately, I think, you know, 80% 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 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. You know, it's like double blind randomized controlled trials like, like two to five years for, for some of these Statins. I mean, we, we do it for nine, for, for 12 weeks with antidepressants. This is madness. When we have 15% of our population on antidepressants and in one in three, you know, like, sorry, one in one in four women over age 30 on them. This is a serious issue we need to look at. So I, I think we just, we need to study these drugs a lot longer.
- [38:16]
Dr. Nicole Safire (Interviewer)
You know, it's interesting you just mentioned women, women who are approaching that perimenopause menopausal age. You know, one thing that has come out of Dr. Marty Makary 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 rise in SSRI use in mental illness?
- [38:41]
Dr. Yosef Witt Doring
Us. Yeah, so I think, you know, the, the, the menopausal period is, is definitely a factor. I mean, we, we've kind of swung in two ways. I mean, we, we, we used to say, yeah, let's use, you know, hormone replacement therapies. And then all of a sudden it was like, no, we're never going to use hormone replacement therapies. They're terrible. We're going to just put everyone in SSRIs, because that's what they're doing now. You know, if you have insomnia or, you know, hot flushes or anything like that, you get put on an antidepressant, which is just crazy.
- [39:10]
Dr. Nicole Safire (Interviewer)
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 1 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 makes no sense that the answer to that would be the ssi. 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.
- [39:43]
Dr. Yosef Witt Doring
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, well, they seem to help with hot flushes, like, let's go after the menopause market. And, 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, 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, what is missing? And I know that's a more complicated issue. You know, it's for, 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.
- [40:44]
Dr. Nicole Safire (Interviewer)
So your, 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 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?
- [41:22]
Dr. Yosef Witt Doring
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, 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 career and you're now working in a job and 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 aren't just, oh, 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 this four main things that really make people unhappy. So the first is relational issues. Whether. And that can be dealing with social isolation or relationship problems. 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, 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 a tremendous place to go to find meaning in your life. I also think about health issues. You know, we, we forget that our 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. 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 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. Cannabis is nowhere near as safe as people say it is. They say it's like this healthy. You know, this, this, this met this medicine. Right now, guys, this is not the ditch weed from the 70s. That was 3%, the average THC concentration that you're getting from the dispensary. It's like 35% some of the concentrates and 90%. 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, I've never met someone who was anxious or depressed who had those four things in line. And so you want to start there. Now the next thing, 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 Tapir Clinic. The first one is if you've been on these drugs for several years, just start with a 5 to 10% reduction. That's a good reduction that most people can tolerate. Do that every two to four weeks. The next thing is that you want 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 that it can take time and especially at the end. So most people will fail a taper when they get to the lowest dose. And the way that I explain this is that at the higher doses, the drug is essentially flooding your brain and you could remove half of it, and there's still enough excess drug left over 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, 5%, even though you. You did that easily before, that 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 a 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.
- [45:46]
Dr. Nicole Safire (Interviewer)
I have never heard that before. That's really interesting. I'm just going to add one more caveat 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 am 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 have another set of eyes on you. That's just the responsible thing to do. Dr. Youssef, 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 health is actually just as diagnosable as diabetes or other physical ailments. And so it's. 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 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.
- [46:56]
Dr. Yosef Witt Doring
Well said. Dr. Safai, it was an absolute pleasure to be here with you today.
- [47:00]
Dr. Nicole Safire (Interviewer)
What a great conversation.
- [47:01]
Dr. Nicole Safire
What I hope everyone takes away from the conversation I had with Dr. Youssef 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.
- [47:23]
Dr. Nicole Safire (Interviewer)
It's part of life.
- [47:25]
Dr. Nicole Safire
Antidepressants, they may be life changing for some, but they're not a cure all.
- [47:29]
Dr. Nicole Safire (Interviewer)
And maybe in young people we should.
- [47:31]
Dr. Nicole Safire
Demand more vigilant monitoring and safety research, but definitely open dialogue. And as Dr. Youssef reminded us, there are some things that we can focus on rather than just the medication to treat those symptoms. We need to look 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.
- [47:55]
Dr. Nicole Safire (Interviewer)
And as he pointed out, he's not.
- [47:57]
Dr. Nicole Safire
Just talking about illicit drugs like cocaine or other things. He's talking about everything.
- [48:03]
Dr. Nicole Safire (Interviewer)
Caffeine, nicotine.
- [48:04]
Dr. Nicole Safire
If your body is addicted to something.
- [48:06]
Dr. Nicole Safire (Interviewer)
And you have that high, you're going.
- [48:08]
Dr. Nicole Safire
To feel a crash at some point. He also talked about exercising more, getting outside. You know, I love talking about getting outside.
- [48:16]
Dr. Nicole Safire (Interviewer)
Being in nature and being in the.
- [48:18]
Dr. Nicole Safire
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 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 medicine with awareness, education and compassion.
- [48:45]
Dr. Nicole Safire (Interviewer)
I'm Dr. Nicole Sarah.
- [48:47]
Dr. Nicole Safire
Thank you so much for listening to Wellness on Mass. Let's keep asking questions and staying curious. It's okay to ask questions. Be sure to listen to Wellness on Mass with Dr. Nicole Safire on iheartradio wherever you get your podcasts and we'll.
- [49:01]
Dr. Nicole Safire (Interviewer)
See you next time.
- [49:05]
Kal Penn
Hey, audiobook lovers, I'm Kalpen. I'm Ed Helms Ed and I are inviting you to join the best sounding book club you've ever heard with our new podcast, Hearsay. The Audible and iHeart Audiobook Club.
- [49:18]
Ed Helms
Each week we sit down with your favorite iHeart podcast hosts and some very special guests to discuss the latest and greatest audiobooks from Audible.
- [49:26]
Kal Penn
Listen to hearsay on America's number one podcast network, iHeart. Follow earsay and start listening on the free iHeartradio app today.
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