1 00:00:04,360 --> 00:00:07,000 Speaker 1: Welcome to Wellness on MASS. I'm doctor Nicole Safire and 2 00:00:07,040 --> 00:00:10,360 Speaker 1: thanks so much for joining. Just like many other episodes, 3 00:00:10,720 --> 00:00:13,560 Speaker 1: we're talking about a topic today that maybe isn't so 4 00:00:13,720 --> 00:00:16,959 Speaker 1: popular to talk about in mainstream media, but it's certainly 5 00:00:17,000 --> 00:00:20,319 Speaker 1: one that everyone is familiar about and are talking about 6 00:00:20,400 --> 00:00:23,079 Speaker 1: in private circles, but they don't like to talk about 7 00:00:23,120 --> 00:00:23,759 Speaker 1: it in public. 8 00:00:24,000 --> 00:00:24,720 Speaker 2: So what is it? 9 00:00:25,280 --> 00:00:30,480 Speaker 1: Well, over the last two decades, antidepressant prescriptions for kids, teenagers, 10 00:00:30,520 --> 00:00:33,959 Speaker 1: and even young adults have skyrocketed. In some cases, these 11 00:00:34,040 --> 00:00:37,480 Speaker 1: numbers have doubled. And why is that. Well, We've seen 12 00:00:37,560 --> 00:00:42,160 Speaker 1: more mental health being diagnosed in before COVID, but also 13 00:00:42,280 --> 00:00:47,479 Speaker 1: certainly during COVID, we saw exponential rise in kids presenting 14 00:00:47,520 --> 00:00:51,400 Speaker 1: to the emergency department with mental illness. I mean, that's obvious. 15 00:00:51,520 --> 00:00:55,840 Speaker 1: They were on their devices, they were socially isolated. Mental 16 00:00:55,880 --> 00:00:58,520 Speaker 1: health is a crisis here in the United States, and 17 00:00:58,560 --> 00:01:01,640 Speaker 1: what are we doing about it? Well, in parallel with 18 00:01:01,720 --> 00:01:04,759 Speaker 1: the rise and diagnoses, we're seeing more kids being prescribed 19 00:01:04,840 --> 00:01:09,000 Speaker 1: medications to treat their mental illness. And while we're seeing 20 00:01:09,120 --> 00:01:12,759 Speaker 1: the alarming rise and anxiety and depression, we're also seeing 21 00:01:12,800 --> 00:01:16,360 Speaker 1: a rise and self harm and even violent outbursts among 22 00:01:16,400 --> 00:01:20,040 Speaker 1: these kids. So are we finally addressing the hidden mental 23 00:01:20,040 --> 00:01:23,720 Speaker 1: health crisis or have we swung too far in relying 24 00:01:23,760 --> 00:01:27,720 Speaker 1: on medications to manage their distress. Today I'm joined by 25 00:01:27,720 --> 00:01:33,040 Speaker 1: someone who is uniquely qualified to help us mentangle that question. Psychiatrists, 26 00:01:33,080 --> 00:01:37,720 Speaker 1: but also former FDA Medical Officer, doctor Joseph Witt Doring. 27 00:01:38,040 --> 00:01:40,679 Speaker 1: He is the CEO, and he's the medical director of 28 00:01:40,720 --> 00:01:43,479 Speaker 1: the Tabor Clinic, and he's one of the country's most 29 00:01:43,520 --> 00:01:48,160 Speaker 1: outspoken voices on drug safety, informed consent, but also the 30 00:01:48,200 --> 00:01:54,920 Speaker 1: potential behavioral side effects of psychiatric medications, particularly SSRIs. So 31 00:01:54,960 --> 00:01:57,560 Speaker 1: we're going to talk about the science, the controversy, and 32 00:01:57,680 --> 00:02:01,840 Speaker 1: most importantly, how to protect our kids from untreated depression 33 00:02:02,240 --> 00:02:05,520 Speaker 1: but also from unintended harm. But first of all, doctor Josef, 34 00:02:05,640 --> 00:02:07,560 Speaker 1: I know your background, but can you just give our 35 00:02:07,600 --> 00:02:10,840 Speaker 1: listeners a little bit of information on why I have 36 00:02:10,919 --> 00:02:11,440 Speaker 1: you here today. 37 00:02:11,680 --> 00:02:14,400 Speaker 3: Nicole, I'm so happy to be here with you today. 38 00:02:14,440 --> 00:02:16,680 Speaker 3: Thank you for having me. So my background is that 39 00:02:16,720 --> 00:02:20,480 Speaker 3: I'm a psychiatrist, and I'm not really a normal psychiatrist 40 00:02:20,600 --> 00:02:24,359 Speaker 3: because I have taken quite a strong stance against medications. 41 00:02:24,400 --> 00:02:27,520 Speaker 3: I think we completely over medicate the American population, and 42 00:02:27,560 --> 00:02:30,800 Speaker 3: it's something that I spend most of my time advocating 43 00:02:30,919 --> 00:02:34,520 Speaker 3: against the use of the medications the way we're using them. 44 00:02:34,520 --> 00:02:37,800 Speaker 3: So I'm a medical doctor. What else is unique about 45 00:02:37,840 --> 00:02:39,840 Speaker 3: me is I worked in the pharmaceutical industry for a 46 00:02:39,880 --> 00:02:43,840 Speaker 3: couple of years doing drug development of for psychiatric medications, 47 00:02:43,880 --> 00:02:46,320 Speaker 3: and then I also worked at the FDA as a 48 00:02:46,360 --> 00:02:49,920 Speaker 3: medical officer in the Division of Psychiatry, doing drug review 49 00:02:49,919 --> 00:02:54,440 Speaker 3: there and essentially that experience, along with working in academic medicine, 50 00:02:55,639 --> 00:02:58,919 Speaker 3: really soured me on psychiatric medications. I ended up seeing 51 00:02:58,960 --> 00:03:03,359 Speaker 3: that we are completely practicing outside of what the evidence 52 00:03:03,360 --> 00:03:07,200 Speaker 3: based supports, and that has really inspired me to do 53 00:03:07,280 --> 00:03:09,240 Speaker 3: what I do now, which is essentially take people off 54 00:03:09,280 --> 00:03:10,880 Speaker 3: psychiatric medications. 55 00:03:11,639 --> 00:03:14,800 Speaker 1: I imagine that's challenging, but I find that really interesting 56 00:03:14,840 --> 00:03:17,520 Speaker 1: that you were in the FDA, because obviously that's a 57 00:03:17,600 --> 00:03:21,480 Speaker 1: very small niche amount of people who are intricately involved 58 00:03:21,520 --> 00:03:24,480 Speaker 1: in that. So going from a practicing clinician then being 59 00:03:24,520 --> 00:03:27,520 Speaker 1: involved in the FDA, what was it really that kind 60 00:03:27,520 --> 00:03:29,920 Speaker 1: of made you do an about face and say this 61 00:03:30,040 --> 00:03:30,480 Speaker 1: isn't right. 62 00:03:30,760 --> 00:03:32,840 Speaker 3: I think the major thing is how long we study 63 00:03:32,880 --> 00:03:34,520 Speaker 3: the drugs for, so you know when I was a 64 00:03:34,600 --> 00:03:38,960 Speaker 3: junior physician, I would you know, I would be copying 65 00:03:39,200 --> 00:03:40,960 Speaker 3: what my professors were saying, and they're like, you know, 66 00:03:41,000 --> 00:03:43,480 Speaker 3: these drugs, they're safe and effective, they're proofed by the FDA, 67 00:03:43,600 --> 00:03:46,320 Speaker 3: you know, don't worry about it. And what I would 68 00:03:46,360 --> 00:03:49,200 Speaker 3: see clinically was that there actually was a lot to 69 00:03:49,200 --> 00:03:51,040 Speaker 3: worry about. You know, many people would put on these 70 00:03:51,040 --> 00:03:54,480 Speaker 3: medications and honestly, they wouldn't get better, or they would 71 00:03:54,480 --> 00:03:56,920 Speaker 3: get better for a short period of time, and then 72 00:03:57,080 --> 00:03:59,080 Speaker 3: you know, they would kind of adapt to the drugs 73 00:03:59,080 --> 00:04:01,720 Speaker 3: and you need higher and high Adosas people would max out, 74 00:04:01,760 --> 00:04:05,160 Speaker 3: you'd have to start stacking medications. And so intuitively, I 75 00:04:05,200 --> 00:04:07,400 Speaker 3: was like, h you know, something doesn't feel quite right 76 00:04:07,440 --> 00:04:09,280 Speaker 3: about this. And then when I went to the FDA, 77 00:04:09,360 --> 00:04:11,880 Speaker 3: I learned that we don't actually study any of these 78 00:04:11,960 --> 00:04:15,000 Speaker 3: drugs longer than a year, and with you know, seventy 79 00:04:15,040 --> 00:04:18,440 Speaker 3: percent of the US population who take any depressants with 80 00:04:18,520 --> 00:04:21,520 Speaker 3: them being on them for two years or more, it's 81 00:04:21,920 --> 00:04:25,000 Speaker 3: kind of crazy that we don't really know whether they're 82 00:04:25,040 --> 00:04:28,520 Speaker 3: effective past a year. And really what I was seeing 83 00:04:28,520 --> 00:04:31,279 Speaker 3: in my clinical experience was that they weren't, and that 84 00:04:31,320 --> 00:04:33,320 Speaker 3: they were wearing off and so that was the first thing. 85 00:04:33,440 --> 00:04:35,800 Speaker 3: It's that we were saying, hey, these drugs are safe 86 00:04:35,800 --> 00:04:38,559 Speaker 3: and effective, but we were leaving off the most important part, 87 00:04:38,960 --> 00:04:41,000 Speaker 3: which was, yeah, for the year that these drugs are 88 00:04:41,000 --> 00:04:44,040 Speaker 3: studied for and I think intuitively for the audience listening, 89 00:04:44,080 --> 00:04:47,640 Speaker 3: they that's a really important question how long these drugs 90 00:04:47,800 --> 00:04:50,400 Speaker 3: work for? Because I mean, they're drugs, right, and everyone 91 00:04:50,480 --> 00:04:53,200 Speaker 3: understands tolerance. They understand that they wear off over time, 92 00:04:53,240 --> 00:04:55,200 Speaker 3: that we adapt to them, you know, It's a pattern 93 00:04:55,200 --> 00:04:57,680 Speaker 3: we see with all chemicals that we take. And so 94 00:04:57,960 --> 00:04:59,920 Speaker 3: I mean that was the first thing that I saw. 95 00:05:00,080 --> 00:05:01,960 Speaker 3: On top of that, I saw a whole range of 96 00:05:02,480 --> 00:05:04,400 Speaker 3: I learned about a whole range of side effects that 97 00:05:04,440 --> 00:05:08,279 Speaker 3: we were not telling our patients about, specifically with the SSRIs. 98 00:05:08,560 --> 00:05:10,840 Speaker 3: You know, the issue of tardiv dysphoria, which is a 99 00:05:10,920 --> 00:05:14,520 Speaker 3: very complicated term, but really what it means is that 100 00:05:14,720 --> 00:05:17,960 Speaker 3: there's a toxicity that occurs with long term SSRI use, 101 00:05:18,040 --> 00:05:21,440 Speaker 3: where people start to develop brain fog and severe fatigue, 102 00:05:22,040 --> 00:05:24,080 Speaker 3: you know. And I've never known about this, but when 103 00:05:24,080 --> 00:05:26,240 Speaker 3: I look back at my clinical practice, and this is 104 00:05:26,279 --> 00:05:28,720 Speaker 3: what I see now as well. There's so many people 105 00:05:28,800 --> 00:05:32,520 Speaker 3: on chronic SSRIs who are being told that they have 106 00:05:32,600 --> 00:05:35,960 Speaker 3: treatment resistant depression or that their brain illness is somehow 107 00:05:36,040 --> 00:05:38,960 Speaker 3: like transforming and it's making them worse, and it isn't. 108 00:05:39,040 --> 00:05:41,760 Speaker 3: It's the drugs. Our brains are not designed to be 109 00:05:42,480 --> 00:05:46,000 Speaker 3: on SSRIs for like decades at a time, and when 110 00:05:46,000 --> 00:05:47,960 Speaker 3: you do that, there are some people who get worse. 111 00:05:48,320 --> 00:05:50,960 Speaker 3: And so it was those things together that I was like, 112 00:05:51,000 --> 00:05:53,520 Speaker 3: you know, this really isn't a sustainable. 113 00:05:52,839 --> 00:05:53,920 Speaker 2: Way to help people. 114 00:05:54,279 --> 00:05:56,719 Speaker 3: We need to be going back to supporting people with 115 00:05:56,800 --> 00:05:59,760 Speaker 3: non drug approaches rather than just kind of masking some 116 00:06:00,240 --> 00:06:02,120 Speaker 3: with drugs that wear off over time, and then they 117 00:06:02,120 --> 00:06:03,719 Speaker 3: also make some people worse. 118 00:06:05,080 --> 00:06:07,839 Speaker 1: So here's the question I have for you. Well, let's 119 00:06:07,880 --> 00:06:10,279 Speaker 1: actually let's go simple for a second. Can you just 120 00:06:10,360 --> 00:06:13,560 Speaker 1: explain how SSRIs and some of the others actually work 121 00:06:13,720 --> 00:06:17,400 Speaker 1: on specifically like a developing brain, which is we're seeing 122 00:06:17,440 --> 00:06:21,000 Speaker 1: more and more youth, kids, adolescents, even young adults who 123 00:06:21,040 --> 00:06:22,200 Speaker 1: are taking these medications. 124 00:06:22,760 --> 00:06:23,000 Speaker 2: Sure. 125 00:06:23,080 --> 00:06:27,440 Speaker 3: Yeah, So, an SSRI is a selective serotonin reuptake inhibitor, 126 00:06:27,680 --> 00:06:29,640 Speaker 3: and basically what it does is it binds to the 127 00:06:29,680 --> 00:06:33,920 Speaker 3: receptors in the brain that pull serotonin out of the 128 00:06:33,960 --> 00:06:36,120 Speaker 3: space where it sort of acts on the nerves, and 129 00:06:36,440 --> 00:06:39,320 Speaker 3: when you do that, it'll temporarily increase the amount of 130 00:06:39,320 --> 00:06:43,760 Speaker 3: serotonin that's in the brain. And that's associated with a 131 00:06:43,839 --> 00:06:46,880 Speaker 3: drug effect, which is people will say numbing. 132 00:06:46,839 --> 00:06:47,600 Speaker 2: Like erectoria. 133 00:06:47,760 --> 00:06:49,599 Speaker 1: We talk about it here a lot, like one of 134 00:06:49,640 --> 00:06:52,080 Speaker 1: those hormones that are supposed to give you that happy, 135 00:06:52,160 --> 00:06:54,960 Speaker 1: euphoric feeling, right yeah. 136 00:06:54,800 --> 00:06:57,200 Speaker 3: Yeah, Well, you know, people do think like, you know, oh, 137 00:06:57,279 --> 00:06:59,039 Speaker 3: you know, serotonin, you know, it's just like the feel 138 00:06:59,040 --> 00:07:02,440 Speaker 3: good chemical or but from my experience, it's like when 139 00:07:02,480 --> 00:07:05,839 Speaker 3: you take the SSRIs, it's actually like a blunting experience. 140 00:07:06,360 --> 00:07:09,920 Speaker 3: And so many people who have like severe anxiety, they'll 141 00:07:10,000 --> 00:07:13,040 Speaker 3: experience this as being really therapeutic, because if your mind 142 00:07:13,080 --> 00:07:14,640 Speaker 3: is all over the place and you take something that 143 00:07:14,720 --> 00:07:17,240 Speaker 3: kind of numbs you out, you'll say, well, that's helpful, 144 00:07:17,280 --> 00:07:20,720 Speaker 3: and you may even say it's life saving sometimes. But 145 00:07:20,840 --> 00:07:22,840 Speaker 3: what I want to be really clear about, Nicole, is 146 00:07:22,880 --> 00:07:27,040 Speaker 3: that these drugs, they're not fixing a chemical imbalance. And 147 00:07:27,080 --> 00:07:29,760 Speaker 3: there was this myth for a long time that you know, 148 00:07:29,840 --> 00:07:32,760 Speaker 3: there was like a normal serotonin state and there was 149 00:07:32,800 --> 00:07:36,160 Speaker 3: an abnormal serotonin state, and if you took the SSRI 150 00:07:36,640 --> 00:07:40,120 Speaker 3: you would fix that abnormal serotonin state. And you would 151 00:07:40,160 --> 00:07:43,560 Speaker 3: revert the person back to normal, just like a type 152 00:07:43,560 --> 00:07:46,920 Speaker 3: one diabetic who couldn't make insulin out of their pancreas. 153 00:07:46,960 --> 00:07:49,520 Speaker 3: You just bring the insulin back in and now they're 154 00:07:49,560 --> 00:07:53,080 Speaker 3: back into a normal a normal state. Now, that was 155 00:07:53,120 --> 00:07:55,680 Speaker 3: the narrative that has been pushed on the American public 156 00:07:56,120 --> 00:07:59,000 Speaker 3: for really the last three decades, and there has never 157 00:07:59,040 --> 00:07:59,960 Speaker 3: been any evidence. 158 00:08:00,280 --> 00:08:02,560 Speaker 1: Sorry to interrupt you, so, oh, you're just going to 159 00:08:02,600 --> 00:08:06,040 Speaker 1: say evidence like type one diabetes, we can actually check seepepti, 160 00:08:06,160 --> 00:08:09,560 Speaker 1: they don't make insulin. When we're talking about the abnormal 161 00:08:09,600 --> 00:08:12,680 Speaker 1: serotonin state, and we hear people talking about that and 162 00:08:12,720 --> 00:08:16,000 Speaker 1: therefore they recommend the SSRI. You know, is there a 163 00:08:16,000 --> 00:08:19,400 Speaker 1: way to actually prove or how did that term abnormal 164 00:08:19,440 --> 00:08:21,320 Speaker 1: serotonin state even become? 165 00:08:21,960 --> 00:08:23,520 Speaker 2: Yeah, great question, Nicole. 166 00:08:23,640 --> 00:08:26,080 Speaker 3: So the very brief history on this was back in 167 00:08:26,080 --> 00:08:29,400 Speaker 3: the nineteenth is we were treating tuberculosis patients and we 168 00:08:29,480 --> 00:08:31,720 Speaker 3: used a drug called ipronize it, and we noticed that 169 00:08:31,800 --> 00:08:35,000 Speaker 3: it energized the patients, and so doctors said, well, maybe 170 00:08:35,000 --> 00:08:37,720 Speaker 3: this will help with depression, and so they took ipronize 171 00:08:37,760 --> 00:08:39,920 Speaker 3: it and they made some drugs just like it and 172 00:08:39,920 --> 00:08:42,560 Speaker 3: they gave them to depressed patients and the depressed patients 173 00:08:42,600 --> 00:08:45,640 Speaker 3: they looked more lively afterwards. Now, what we knew about 174 00:08:45,679 --> 00:08:47,959 Speaker 3: that class of drugs at the time was that they 175 00:08:48,080 --> 00:08:51,680 Speaker 3: increased chemicals like serotonin, and so there were two ways 176 00:08:51,679 --> 00:08:53,480 Speaker 3: that you could have looked at this problem at the time. 177 00:08:53,760 --> 00:08:55,960 Speaker 3: One is, you know, these are drugs just like any 178 00:08:55,960 --> 00:08:58,760 Speaker 3: other drugs, and it has an energizing effect that's masking 179 00:08:58,800 --> 00:09:00,000 Speaker 3: the depressive symptoms. 180 00:08:59,840 --> 00:09:00,680 Speaker 2: That was one way. 181 00:09:01,120 --> 00:09:03,920 Speaker 3: But then there was a much more commercially viable message, 182 00:09:03,960 --> 00:09:07,400 Speaker 3: which was these people have chemical imbalances and that's why 183 00:09:07,400 --> 00:09:09,720 Speaker 3: this is helping them. And so that was the narrative 184 00:09:09,760 --> 00:09:12,000 Speaker 3: that took off. And the reason that that was chosen 185 00:09:12,640 --> 00:09:15,679 Speaker 3: is because I think intuitively, a lot of Americans out 186 00:09:15,679 --> 00:09:17,920 Speaker 3: there are you know that you know, they listened to 187 00:09:17,920 --> 00:09:20,800 Speaker 3: their grandma's advice, which is it's not a good idea 188 00:09:20,840 --> 00:09:22,880 Speaker 3: to just sweep things under the rug. You know, you 189 00:09:22,960 --> 00:09:25,720 Speaker 3: need to address your problems when you take and so 190 00:09:25,760 --> 00:09:27,840 Speaker 3: if you can tell someone that you know, you're not 191 00:09:27,920 --> 00:09:31,880 Speaker 3: really masking something with drugs, you're actually fixing a biological 192 00:09:31,920 --> 00:09:34,640 Speaker 3: problem in the brain, all of a sudden, that stigma 193 00:09:35,040 --> 00:09:37,040 Speaker 3: goes away and that okay, well, you know this is 194 00:09:37,160 --> 00:09:39,719 Speaker 3: just me being responsible, This is me being healthy, this 195 00:09:39,760 --> 00:09:43,080 Speaker 3: is me using you know, you know, modern science, and 196 00:09:43,160 --> 00:09:46,079 Speaker 3: it's it's a very good thing. But that is not 197 00:09:46,160 --> 00:09:48,120 Speaker 3: true because what we have been doing for the last 198 00:09:48,120 --> 00:09:52,439 Speaker 3: several decades is we've been sticking needles into the cerebral 199 00:09:52,600 --> 00:09:55,600 Speaker 3: We've been collecting cerebel spinal fluid. We've been in lumbar punctures, 200 00:09:55,760 --> 00:09:57,800 Speaker 3: that's the fluid that goes around the brain. And we've 201 00:09:57,840 --> 00:10:01,280 Speaker 3: been looking at the metabolites of serotonin. And we've been 202 00:10:01,280 --> 00:10:03,760 Speaker 3: looking at normal people and been looking at depressed people, 203 00:10:04,240 --> 00:10:07,320 Speaker 3: no difference. We've been doing autopsies, we've been taking slices 204 00:10:07,320 --> 00:10:10,120 Speaker 3: of the brain for depressed people and non depressed people 205 00:10:10,120 --> 00:10:13,200 Speaker 3: and comparing them. There's no changes in receptors there. And 206 00:10:13,240 --> 00:10:15,880 Speaker 3: so every time we've tried to look at this, like 207 00:10:16,160 --> 00:10:19,640 Speaker 3: is there a normal serotonin state and an abnormal serotonin state, 208 00:10:19,920 --> 00:10:22,760 Speaker 3: We've never found it. And so there is no evidence 209 00:10:22,840 --> 00:10:25,520 Speaker 3: of a you know, a quote unquote chemical imbalance that 210 00:10:25,640 --> 00:10:27,360 Speaker 3: is being fixed by an SSM. 211 00:10:27,440 --> 00:10:30,760 Speaker 1: Gosh, I mean, I haven't obviously studied that or read 212 00:10:30,840 --> 00:10:33,520 Speaker 1: upon that, but that seems I mean, that seems crazy 213 00:10:33,559 --> 00:10:35,960 Speaker 1: to me that the narrative continues to be that you 214 00:10:36,000 --> 00:10:38,480 Speaker 1: are fixing a chemical imbalance that you don't actually have 215 00:10:38,559 --> 00:10:42,400 Speaker 1: objective evidence of that chemical imbalance. I mean, that's mind blowing, 216 00:10:42,760 --> 00:10:44,720 Speaker 1: you know, especially when I think it was a couple 217 00:10:44,840 --> 00:10:47,160 Speaker 1: decades ago the black box warning came out on the 218 00:10:47,240 --> 00:10:51,720 Speaker 1: SSRIs about the suicidal risk. It was obviously clear. I 219 00:10:51,720 --> 00:10:55,160 Speaker 1: think it was a four percent suicide risk in younger 220 00:10:55,200 --> 00:10:58,319 Speaker 1: people taking SSRIs compared to two percent in the placebo, 221 00:10:58,640 --> 00:11:01,920 Speaker 1: which is a substantial risk. But I'm curious on your 222 00:11:02,040 --> 00:11:09,200 Speaker 1: thought of the lesser talked about risk of the increased agitation, irritability, 223 00:11:09,280 --> 00:11:12,400 Speaker 1: or even aggression during early use of SSI. 224 00:11:12,679 --> 00:11:14,240 Speaker 2: You know, you're talking about this. 225 00:11:14,240 --> 00:11:18,160 Speaker 3: This issue is really about paradoxical reactions, and so what 226 00:11:18,320 --> 00:11:21,040 Speaker 3: is that? So that is when you have an atypical 227 00:11:21,080 --> 00:11:23,360 Speaker 3: response to the drug. So, you know, a moment a 228 00:11:23,360 --> 00:11:27,200 Speaker 3: guy mentioned that the normal drug effect that we affect 229 00:11:27,200 --> 00:11:29,680 Speaker 3: from the expect from these medications is one of blunting. 230 00:11:30,240 --> 00:11:33,240 Speaker 3: But everyone responds to drugs a little bit differently, and 231 00:11:33,280 --> 00:11:35,600 Speaker 3: so that's like the norm. And the analogy I like 232 00:11:35,640 --> 00:11:39,400 Speaker 3: to use to explain a paradoxical side effect is imagine 233 00:11:39,440 --> 00:11:41,720 Speaker 3: you have ten people, you know, they're sitting around and 234 00:11:41,720 --> 00:11:44,559 Speaker 3: they're smoking a joint. You have nine people who are giggling, 235 00:11:44,800 --> 00:11:46,480 Speaker 3: you know, they're having a good time, and you have 236 00:11:46,520 --> 00:11:50,000 Speaker 3: one person that becomes paranoid. This can happen with every 237 00:11:50,000 --> 00:11:52,280 Speaker 3: single drug. You know, there are genetic reasons that we 238 00:11:52,320 --> 00:11:55,520 Speaker 3: don't understand that when some people get exposed to a drug, 239 00:11:55,559 --> 00:11:58,720 Speaker 3: they don't have the typical effect, they go a different way. 240 00:11:59,280 --> 00:12:03,240 Speaker 3: And with SS what researchers have found, and this happened 241 00:12:03,280 --> 00:12:07,000 Speaker 3: like immediately when Prozac came out onto the market, is 242 00:12:07,000 --> 00:12:09,640 Speaker 3: that for some people, if you put them on this drug, 243 00:12:09,640 --> 00:12:13,240 Speaker 3: they can become acutely suicidal. And so you could imagine 244 00:12:13,240 --> 00:12:15,520 Speaker 3: how horrible that could be. You already have a depressed 245 00:12:15,520 --> 00:12:18,520 Speaker 3: and anxious kid. They get on a drug, they have 246 00:12:18,559 --> 00:12:23,000 Speaker 3: a paradoxical reaction and it starts to give them obsessive, dark, 247 00:12:23,200 --> 00:12:26,760 Speaker 3: morbid thoughts. They start to feel really agitated, they start 248 00:12:26,760 --> 00:12:30,280 Speaker 3: to feel incredibly uncomfortable, and in those states they can 249 00:12:30,320 --> 00:12:33,880 Speaker 3: actually it can actually push them into suicidal behavior or 250 00:12:34,160 --> 00:12:36,720 Speaker 3: in even rareer cases, but still importantly, you can actually 251 00:12:36,720 --> 00:12:40,240 Speaker 3: make them violent. And that's the link to the whole 252 00:12:40,800 --> 00:12:44,640 Speaker 3: SSRIs and the mass shooting issue. It's that some people 253 00:12:44,640 --> 00:12:47,240 Speaker 3: when they get on these medications, it puts them into 254 00:12:47,280 --> 00:12:49,120 Speaker 3: a state where they do things that they would not 255 00:12:49,440 --> 00:12:50,000 Speaker 3: normally do. 256 00:12:50,480 --> 00:12:53,040 Speaker 1: You're listening to Wellness and Mass. We'll be right back 257 00:12:53,080 --> 00:12:59,320 Speaker 1: with more. Is there a way to identify which people 258 00:12:59,400 --> 00:13:01,960 Speaker 1: who are more likely to be on these medications who 259 00:13:02,200 --> 00:13:05,520 Speaker 1: result with the suicidal or the homicidal ideation? And I 260 00:13:05,520 --> 00:13:08,600 Speaker 1: think it's important to note though the suicidal ideations well 261 00:13:08,640 --> 00:13:12,440 Speaker 1: documented black box warning by the FDA, Why do you 262 00:13:12,520 --> 00:13:18,200 Speaker 1: think that the homicidal or the aggressive side effects are 263 00:13:18,360 --> 00:13:21,280 Speaker 1: I mean, honestly, if you talk to people about them, 264 00:13:21,320 --> 00:13:24,320 Speaker 1: you know, when a mass shooting happens, you say, well, 265 00:13:24,400 --> 00:13:27,840 Speaker 1: they're on an SSRI and there is an association with 266 00:13:28,040 --> 00:13:30,840 Speaker 1: aggression and violence behavior. And then they quickly come back 267 00:13:30,880 --> 00:13:33,920 Speaker 1: and say, well, the data is conflicted, and they kind 268 00:13:33,920 --> 00:13:36,240 Speaker 1: of try and push away from that. What are your 269 00:13:36,280 --> 00:13:36,720 Speaker 1: thoughts on that? 270 00:13:38,520 --> 00:13:41,840 Speaker 3: What we're seeing, Nicole, is the interface of science and 271 00:13:41,920 --> 00:13:45,960 Speaker 3: politics when it comes to the mass shooting issue. Because listen, 272 00:13:46,000 --> 00:13:50,239 Speaker 3: we've had numerous court cases that have gone before impartial 273 00:13:50,320 --> 00:13:53,080 Speaker 3: judges and juries where they have found that if not 274 00:13:53,240 --> 00:13:56,600 Speaker 3: for the SSRI, this person would not have committed these, 275 00:13:56,800 --> 00:14:01,160 Speaker 3: you know, multiple murders sometimes and so we already know 276 00:14:01,280 --> 00:14:03,480 Speaker 3: that when people have looked at these cases, they've found 277 00:14:03,520 --> 00:14:05,800 Speaker 3: them to be at fault. Now, the reason we hear 278 00:14:05,880 --> 00:14:09,840 Speaker 3: something very different in the media is because school shootings 279 00:14:10,000 --> 00:14:12,880 Speaker 3: is a very political topic and for a lot of 280 00:14:12,880 --> 00:14:15,559 Speaker 3: the media, the answer is already clear. It's the guns. 281 00:14:16,040 --> 00:14:18,079 Speaker 3: And so I mean, that's all they want to hear. 282 00:14:18,160 --> 00:14:20,360 Speaker 3: They want it to be about the guns. If you 283 00:14:20,360 --> 00:14:22,640 Speaker 3: bring up something else, they just say, yeah, no, that's 284 00:14:22,720 --> 00:14:24,640 Speaker 3: you know, they're trying to distract a way. Now, I'm 285 00:14:24,640 --> 00:14:27,800 Speaker 3: not trying to say that every single school shooting that 286 00:14:27,840 --> 00:14:31,320 Speaker 3: has taken place is because of an SSRI. Obviously there 287 00:14:31,320 --> 00:14:33,400 Speaker 3: are evil people out there. I think people can do 288 00:14:33,440 --> 00:14:35,880 Speaker 3: this completely sober off any drugs. 289 00:14:36,040 --> 00:14:37,480 Speaker 2: I just believe that. 290 00:14:38,200 --> 00:14:41,520 Speaker 3: And yes, sure having access to firearms does make it easier, 291 00:14:41,880 --> 00:14:47,040 Speaker 3: but without a doubt, some people are being pushed into violence, homicide, 292 00:14:47,080 --> 00:14:49,840 Speaker 3: and murder because of these medications. And we owe it 293 00:14:49,880 --> 00:14:52,080 Speaker 3: to the public to actually look at these things. And 294 00:14:52,080 --> 00:14:55,040 Speaker 3: that's what Bobby Kennedy is doing now. He is trying 295 00:14:55,040 --> 00:14:58,280 Speaker 3: to put together a group of people to investigate mass shootings. 296 00:14:58,440 --> 00:15:00,560 Speaker 3: And the only way that you can do that is 297 00:15:00,560 --> 00:15:03,280 Speaker 3: that when one of these events happens, you need to 298 00:15:03,280 --> 00:15:05,000 Speaker 3: go out there and you need to interview the person 299 00:15:05,080 --> 00:15:08,520 Speaker 3: if they survive, and their family and their doctors, and 300 00:15:08,600 --> 00:15:11,800 Speaker 3: put together a narrative, a case narrative around it where 301 00:15:11,840 --> 00:15:15,000 Speaker 3: you look for alternative explanations, and if there's nothing else 302 00:15:15,040 --> 00:15:17,480 Speaker 3: that exists, and you see a clear history where the 303 00:15:17,520 --> 00:15:19,960 Speaker 3: person got on the drug and then they acutely became 304 00:15:20,200 --> 00:15:23,960 Speaker 3: different in their personality, more irritable, more agitated, then you 305 00:15:24,040 --> 00:15:26,360 Speaker 3: have to call it what it is, which is a 306 00:15:26,400 --> 00:15:28,200 Speaker 3: case where it looks like a drug may have pushed 307 00:15:28,240 --> 00:15:30,000 Speaker 3: someone into an act of violence. 308 00:15:31,240 --> 00:15:33,200 Speaker 1: So I guess if it has proven to be so, 309 00:15:33,320 --> 00:15:37,920 Speaker 1: would that make these people then legally retrospectively less liable 310 00:15:38,200 --> 00:15:39,560 Speaker 1: for these mass shootings. 311 00:15:40,320 --> 00:15:43,160 Speaker 3: It's a really delicate issue. I think it has to 312 00:15:43,200 --> 00:15:46,560 Speaker 3: weigh into it. But that's a really hard call to make. 313 00:15:46,600 --> 00:15:50,960 Speaker 3: I mean, we're talking about some of the most horrific incidents. 314 00:15:50,280 --> 00:15:50,840 Speaker 2: In the world. 315 00:15:51,440 --> 00:15:53,360 Speaker 3: I mean, if you were a parent and someone got 316 00:15:53,400 --> 00:15:55,960 Speaker 3: on an SSRI and they killed your child and they 317 00:15:55,960 --> 00:15:58,480 Speaker 3: may have taken out, i don't know, like ten other 318 00:15:58,600 --> 00:16:00,960 Speaker 3: kids at the same time, at a certain point you 319 00:16:01,000 --> 00:16:03,360 Speaker 3: want some justice for that way. And you know, yes, 320 00:16:03,400 --> 00:16:06,160 Speaker 3: the drugs can play a role in that that's a 321 00:16:06,280 --> 00:16:08,040 Speaker 3: very hard thing to tase out. You know how much 322 00:16:08,080 --> 00:16:11,040 Speaker 3: liability is for the patient and how much for the person. 323 00:16:11,240 --> 00:16:14,920 Speaker 3: But these are incredibly sensitive issues and that's going to 324 00:16:14,920 --> 00:16:16,120 Speaker 3: be a really hard call to make. 325 00:16:17,400 --> 00:16:19,400 Speaker 1: Yeah, I mean, if you look at the stats, I mean, 326 00:16:19,440 --> 00:16:22,040 Speaker 1: I'm sure you know them significantly better than I do. 327 00:16:22,160 --> 00:16:25,560 Speaker 1: But the use of these SSRIs over the last couple 328 00:16:25,560 --> 00:16:29,560 Speaker 1: of decades have skyrocketed, especially in the youth during COVID. 329 00:16:29,600 --> 00:16:32,000 Speaker 1: I think prescriptions were up like sixty five percent or 330 00:16:32,000 --> 00:16:34,800 Speaker 1: something crazy like that. You know, how do you think 331 00:16:34,840 --> 00:16:37,800 Speaker 1: we come back from this? Because the question is, you know, 332 00:16:37,840 --> 00:16:39,880 Speaker 1: you have the chicken in the egg scenario. You have 333 00:16:40,040 --> 00:16:43,480 Speaker 1: a rise in mental health issues. Obviously we're seeing anxiety 334 00:16:43,480 --> 00:16:49,760 Speaker 1: and depression, mood disorders more frequently from you have video games, 335 00:16:49,960 --> 00:16:54,160 Speaker 1: you know, social media, the isolation of COVID, the societal pressures, 336 00:16:54,320 --> 00:16:57,880 Speaker 1: all of these things. You know, how do we how 337 00:16:57,920 --> 00:16:59,680 Speaker 1: do we get out of the cycle of a rise 338 00:16:59,720 --> 00:17:03,360 Speaker 1: in mental illness, arise in prescriptions, and then the paradoxical 339 00:17:03,360 --> 00:17:05,680 Speaker 1: effects of these prescriptions and so and so forth. 340 00:17:06,840 --> 00:17:09,720 Speaker 2: Yeah, what a question? I mean, so, yeah, it's. 341 00:17:09,600 --> 00:17:11,000 Speaker 1: A loaded what I apologize? 342 00:17:11,320 --> 00:17:14,359 Speaker 3: Yeah, No, No, I mean I think, you know, if 343 00:17:14,400 --> 00:17:17,960 Speaker 3: we look at in general, every time I'm seeing serious 344 00:17:18,000 --> 00:17:20,960 Speaker 3: mental health problems going on, I think the biggest mistake 345 00:17:21,040 --> 00:17:23,000 Speaker 3: is to blame the child. You have to look at 346 00:17:23,000 --> 00:17:25,480 Speaker 3: the family unit as a whole. What's going on with 347 00:17:25,600 --> 00:17:28,959 Speaker 3: the parents, you know, how are they around, you know, 348 00:17:29,080 --> 00:17:31,520 Speaker 3: what is the interaction like with the kids, And so 349 00:17:31,800 --> 00:17:34,679 Speaker 3: whenever you're helping kids be less depressed, you start with 350 00:17:34,720 --> 00:17:37,440 Speaker 3: the parents, to be honest, I mean, that's that's where 351 00:17:37,440 --> 00:17:39,920 Speaker 3: you go. And so putting that issue aside, we need 352 00:17:39,960 --> 00:17:42,760 Speaker 3: to look at larger societal things going on. 353 00:17:42,840 --> 00:17:43,240 Speaker 2: Right now. 354 00:17:43,400 --> 00:17:47,480 Speaker 3: For me, I think that social media use is massive. 355 00:17:48,040 --> 00:17:49,879 Speaker 3: I think everyone kind of knows in the back of 356 00:17:49,920 --> 00:17:52,159 Speaker 3: their mind, Hey, this is kind of bad. You know, 357 00:17:52,200 --> 00:17:54,680 Speaker 3: this is kind of different. I think it's a lot 358 00:17:54,720 --> 00:17:57,640 Speaker 3: worse than than people think. Some of the stats I've 359 00:17:57,640 --> 00:18:00,600 Speaker 3: seen lately show that children are spending an average of 360 00:18:00,640 --> 00:18:03,040 Speaker 3: three and a half hours on social media, and some 361 00:18:03,080 --> 00:18:05,400 Speaker 3: of them are spending like five hours a day on it. 362 00:18:05,840 --> 00:18:06,480 Speaker 2: Now, if you. 363 00:18:06,440 --> 00:18:10,000 Speaker 3: Think about it, this is several hours that in the 364 00:18:10,040 --> 00:18:13,000 Speaker 3: past they used to be spending face to face with 365 00:18:13,040 --> 00:18:17,760 Speaker 3: their friends, developing social skills, hanging out. They would be sleeping, 366 00:18:17,880 --> 00:18:20,600 Speaker 3: maybe they would be exercising instead of that, you have 367 00:18:20,760 --> 00:18:24,760 Speaker 3: young girls on Instagram posting selfies of themselves for strangers 368 00:18:24,800 --> 00:18:27,240 Speaker 3: to comment on and friends to comment on, and like, 369 00:18:28,280 --> 00:18:31,520 Speaker 3: you know, they're looking at celebrities and other influencers out 370 00:18:31,560 --> 00:18:35,399 Speaker 3: there who you know, seemingly have vastly better bodies and 371 00:18:35,520 --> 00:18:38,399 Speaker 3: lives than them, even though everyone knows. You don't post 372 00:18:38,440 --> 00:18:40,439 Speaker 3: the bad photos on there, and you don't post the 373 00:18:40,480 --> 00:18:43,919 Speaker 3: bad things that happen to you, and it poisons your mind. 374 00:18:44,160 --> 00:18:47,199 Speaker 2: I mean, I mean we've. 375 00:18:46,720 --> 00:18:49,320 Speaker 3: Changed a lot. I mean, in the seventies, you know, 376 00:18:49,359 --> 00:18:51,720 Speaker 3: fifty percent of Americans were going to church. There was 377 00:18:51,760 --> 00:18:54,240 Speaker 3: a lot more moral teachings going on there. It was 378 00:18:54,359 --> 00:18:58,800 Speaker 3: much more of a values based society. And that's decreased. 379 00:18:58,800 --> 00:19:01,640 Speaker 3: It's thirty percent now, and we're spending and the kids 380 00:19:01,680 --> 00:19:04,439 Speaker 3: are spending like, you know, three hours on social media 381 00:19:05,040 --> 00:19:09,959 Speaker 3: ingesting consumeristic values that that kind of espouse, Like if 382 00:19:09,960 --> 00:19:12,320 Speaker 3: you get lots of likes on social media, if you 383 00:19:12,359 --> 00:19:14,320 Speaker 3: earn a lot of money, if you look a certain way, 384 00:19:14,800 --> 00:19:18,359 Speaker 3: like it's this kind of this instant gratification kind of 385 00:19:18,480 --> 00:19:21,639 Speaker 3: buzz that you get that that that gives you values. 386 00:19:21,680 --> 00:19:24,199 Speaker 3: I think it's poisoning their minds, and I think we 387 00:19:24,280 --> 00:19:26,520 Speaker 3: need to go back to a much more value based 388 00:19:26,640 --> 00:19:29,800 Speaker 3: society where you know, living a life and service of others, 389 00:19:29,800 --> 00:19:32,199 Speaker 3: you know, wisdom, you know, all of these, all of 390 00:19:32,240 --> 00:19:34,480 Speaker 3: these values that used to come from the home and 391 00:19:34,520 --> 00:19:36,880 Speaker 3: from the community and the church that would actually lead 392 00:19:36,880 --> 00:19:38,879 Speaker 3: to longer term happiness over time. 393 00:19:39,200 --> 00:19:40,200 Speaker 2: I think we've lost that. 394 00:19:40,240 --> 00:19:42,280 Speaker 3: I think we need to return to that place and 395 00:19:42,280 --> 00:19:44,359 Speaker 3: then it would be much you know, and and and 396 00:19:44,400 --> 00:19:46,560 Speaker 3: that's the way, and that's the way to go, not 397 00:19:46,560 --> 00:19:48,840 Speaker 3: not have all of these issues going on and then 398 00:19:48,880 --> 00:19:50,600 Speaker 3: just saying oh, yeah, you know this, this pill is 399 00:19:50,640 --> 00:19:52,159 Speaker 3: going to fix it. The pill is it's not going 400 00:19:52,240 --> 00:19:54,520 Speaker 3: to fix it's going to actually make many kids worse. 401 00:19:55,200 --> 00:19:57,520 Speaker 1: Well, you made. You mentioned One of my favorite terms 402 00:19:57,560 --> 00:19:59,919 Speaker 1: is instant gratification. I wrote a book in twenty two 403 00:20:00,280 --> 00:20:03,280 Speaker 1: where I think if there was one repeated term, it 404 00:20:03,320 --> 00:20:06,560 Speaker 1: was that because especially here in the United States, we 405 00:20:06,600 --> 00:20:08,760 Speaker 1: want things, we want things fast, we want things cheap, 406 00:20:08,800 --> 00:20:11,960 Speaker 1: and we want things right now. And you know, the society, 407 00:20:12,000 --> 00:20:14,840 Speaker 1: the culture we live in continues to perpetuate this. And 408 00:20:14,880 --> 00:20:18,800 Speaker 1: I think the Internet, social media has just made this 409 00:20:19,240 --> 00:20:24,920 Speaker 1: almost to a pathological place. And you know, we have psychiatrists, pediatricians, 410 00:20:24,960 --> 00:20:28,600 Speaker 1: family practitioners who are all overburdened the Affordable Care Act. 411 00:20:28,600 --> 00:20:32,080 Speaker 1: That's an entirely different conversation, but has certainly put more 412 00:20:32,119 --> 00:20:35,440 Speaker 1: pressure on a lot of people to see more patients, 413 00:20:35,480 --> 00:20:39,000 Speaker 1: to spend less time with patients, and unfortunately it has 414 00:20:39,240 --> 00:20:43,399 Speaker 1: resulted in rise in prescriptions because they don't have time 415 00:20:43,440 --> 00:20:47,560 Speaker 1: to talk about the underlying drivers of poor sleep, nutrition, trauma, 416 00:20:48,040 --> 00:20:50,520 Speaker 1: social media exposure, and the fact that a lot of 417 00:20:50,520 --> 00:20:53,679 Speaker 1: our youth are coming from broken homes. I think if 418 00:20:53,720 --> 00:20:57,160 Speaker 1: we really paused and focused on us where we are 419 00:20:57,200 --> 00:21:01,200 Speaker 1: as a society, we could actually tackle the mental health crisis. 420 00:21:01,359 --> 00:21:02,080 Speaker 2: Yeah. 421 00:21:02,119 --> 00:21:04,280 Speaker 3: And you know, the one of the big things that 422 00:21:04,320 --> 00:21:06,760 Speaker 3: I would the message that I have for doctors, family 423 00:21:06,800 --> 00:21:09,800 Speaker 3: medicine doctors and psychiatrists and obg y ns and all 424 00:21:09,840 --> 00:21:12,600 Speaker 3: of them is, guys, we need to grab the steering wheel. 425 00:21:12,600 --> 00:21:16,120 Speaker 3: We need to wrestle it away from corporate interests right now. 426 00:21:16,160 --> 00:21:19,040 Speaker 3: You know, private equity who are running our hospitals. We 427 00:21:19,119 --> 00:21:23,040 Speaker 3: know it's bullshit. And and because here's here's the thing. 428 00:21:23,440 --> 00:21:25,760 Speaker 3: I mean, we're all here to help people. We want 429 00:21:25,760 --> 00:21:28,280 Speaker 3: to help our patients, and if we're being pushed into 430 00:21:28,359 --> 00:21:31,320 Speaker 3: a system where Oh, in order to sort of make 431 00:21:31,480 --> 00:21:35,320 Speaker 3: ends meet, we need to see four patients in an 432 00:21:35,359 --> 00:21:38,719 Speaker 3: hour who are having mental health problems. And you know, 433 00:21:38,800 --> 00:21:42,320 Speaker 3: because of that, you're diagnosing depression based off a checklist 434 00:21:42,560 --> 00:21:46,479 Speaker 3: without even understanding the person's life. Because of this, instead 435 00:21:46,480 --> 00:21:49,440 Speaker 3: of trying to motivate them to make lifestyle and dietary 436 00:21:49,520 --> 00:21:53,160 Speaker 3: changes and you know, fix relationship issues, you know, find meaning, 437 00:21:53,200 --> 00:21:55,720 Speaker 3: do all of the stuff we know that matters. If 438 00:21:55,720 --> 00:21:57,119 Speaker 3: we don't have the time to do that and we 439 00:21:57,200 --> 00:22:00,679 Speaker 3: have to default to giving a pill, guys, I have 440 00:22:00,720 --> 00:22:03,200 Speaker 3: to tell it as it is. We're not actually helping 441 00:22:03,200 --> 00:22:06,000 Speaker 3: our patients. In fact, we're making them worse. And our 442 00:22:06,119 --> 00:22:08,560 Speaker 3: justification for this is, oh, the system is making me 443 00:22:08,680 --> 00:22:09,240 Speaker 3: do it. 444 00:22:09,400 --> 00:22:09,640 Speaker 2: Guys. 445 00:22:09,800 --> 00:22:12,240 Speaker 3: We are the system. I mean, we are the doctors. 446 00:22:12,240 --> 00:22:14,679 Speaker 3: We're the ones that work here, and there are different 447 00:22:14,720 --> 00:22:18,480 Speaker 3: ways of working and so undortually. 448 00:22:18,080 --> 00:22:20,200 Speaker 1: Though we don't have a lot of control. We are 449 00:22:20,400 --> 00:22:24,560 Speaker 1: mandated on federal, state, local levels. And you're right, unless 450 00:22:24,560 --> 00:22:27,880 Speaker 1: everyone wants to go to concierge, but there's some things 451 00:22:27,920 --> 00:22:30,880 Speaker 1: that are out of people's control. I think it's tough. 452 00:22:30,920 --> 00:22:33,520 Speaker 1: I think it has to happen from the individual position, 453 00:22:33,600 --> 00:22:37,760 Speaker 1: but also Elections have consequences and votes matter, and I 454 00:22:38,240 --> 00:22:41,000 Speaker 1: advocating at the federal level is really the way to 455 00:22:41,200 --> 00:22:43,359 Speaker 1: get through in my opinion, when it comes to the 456 00:22:43,359 --> 00:22:44,280 Speaker 1: healthcare system. 457 00:22:44,720 --> 00:22:47,920 Speaker 3: You're right, and you know it is challenging, Nicole. Do 458 00:22:48,080 --> 00:22:50,359 Speaker 3: don't get me wrong. I understand that. But we need 459 00:22:50,400 --> 00:22:52,520 Speaker 3: to be speaking up. We need to be I mean, 460 00:22:52,520 --> 00:22:54,200 Speaker 3: we have to be talking to the media. We need 461 00:22:54,240 --> 00:22:57,159 Speaker 3: to be being honest to our patients. I mean, if 462 00:22:57,200 --> 00:22:59,240 Speaker 3: it even starts at a place where it's just like, listen, 463 00:22:59,680 --> 00:23:02,520 Speaker 3: we actually don't have time to help you in the 464 00:23:02,520 --> 00:23:04,560 Speaker 3: way that I would like to. All I really have 465 00:23:04,640 --> 00:23:07,760 Speaker 3: to offer you is this medication. And really there's a 466 00:23:07,800 --> 00:23:10,680 Speaker 3: whole lot more to do than this, and I wish 467 00:23:10,840 --> 00:23:13,000 Speaker 3: we had more to offer you, but this is not 468 00:23:13,119 --> 00:23:16,240 Speaker 3: the answer. So I think just starting by being honest 469 00:23:16,280 --> 00:23:19,680 Speaker 3: with the patients is really important. And you know, there 470 00:23:19,720 --> 00:23:21,720 Speaker 3: are some doctors out there who are doing things like 471 00:23:21,760 --> 00:23:24,680 Speaker 3: direct primary care. I think they're getting better results by 472 00:23:24,800 --> 00:23:27,800 Speaker 3: leaving the insurance system. Is that a solution for the 473 00:23:27,840 --> 00:23:29,679 Speaker 3: people out on Medicaid? 474 00:23:30,160 --> 00:23:30,480 Speaker 2: It's not. 475 00:23:30,640 --> 00:23:34,080 Speaker 3: You know, it's a really complicated issue, but I think 476 00:23:34,200 --> 00:23:36,720 Speaker 3: we have to be louder about this problem. We know 477 00:23:36,880 --> 00:23:39,000 Speaker 3: that we can be doing a better job. I mean, 478 00:23:39,040 --> 00:23:42,040 Speaker 3: my colleagues, we feel it. I talked to psychiatrists about there. 479 00:23:42,160 --> 00:23:44,400 Speaker 3: They feel like they're doing their job with one leg 480 00:23:44,480 --> 00:23:47,440 Speaker 3: and one arm tied behind their back, and we need 481 00:23:47,520 --> 00:23:50,200 Speaker 3: serious systemic change in the way we deliver medical care. 482 00:23:50,960 --> 00:23:52,639 Speaker 1: Yeah, well, I agree with that. You know, one of 483 00:23:52,680 --> 00:23:54,600 Speaker 1: the things that you touched on earlier is like this 484 00:23:54,640 --> 00:23:58,760 Speaker 1: is now you know, violence, mass shootings, even adolescent mental 485 00:23:58,800 --> 00:24:04,520 Speaker 1: health has been so politicized that it's labeled a conservative 486 00:24:04,560 --> 00:24:09,280 Speaker 1: talking point to criticize SSRIs or you know, any form 487 00:24:09,359 --> 00:24:14,200 Speaker 1: of medications for treating mental health. And so I imagine 488 00:24:14,400 --> 00:24:16,280 Speaker 1: that there are a lot of doctors out there who 489 00:24:16,280 --> 00:24:19,480 Speaker 1: would like to say something, but because of political reasons, 490 00:24:19,920 --> 00:24:22,439 Speaker 1: they don't want to be criticized. They don't want to 491 00:24:22,440 --> 00:24:25,360 Speaker 1: put their job in jeopardy. We already know that social 492 00:24:25,400 --> 00:24:29,360 Speaker 1: media and other forms of media have algorithms that suppress 493 00:24:29,480 --> 00:24:34,119 Speaker 1: conservative voices, and conservatives who speak out tend to be ridiculed. 494 00:24:34,640 --> 00:24:36,520 Speaker 1: More So, I think there's a lot of people who 495 00:24:36,600 --> 00:24:41,480 Speaker 1: are concerned that if they criticize SSRIs that they are 496 00:24:41,920 --> 00:24:44,639 Speaker 1: that people are going to say that they're conservative because 497 00:24:44,680 --> 00:24:46,919 Speaker 1: it's now turned into a conservative talking point. But at 498 00:24:46,920 --> 00:24:49,680 Speaker 1: the end of the day, it's not a conservative talking point. 499 00:24:49,720 --> 00:24:53,320 Speaker 1: This is a healthcare talking point. This is talking about, 500 00:24:53,560 --> 00:24:55,840 Speaker 1: you know, the mental health and the wellness of our nation. 501 00:24:56,440 --> 00:24:59,200 Speaker 1: We have to take this away from the political aspect 502 00:24:59,280 --> 00:24:59,480 Speaker 1: of it. 503 00:25:00,400 --> 00:25:03,280 Speaker 3: Yeah, I think you're absolutely right, and you touched on 504 00:25:03,320 --> 00:25:06,240 Speaker 3: something which I think is actually quite sinister that that's 505 00:25:06,280 --> 00:25:09,080 Speaker 3: going on, and that is the whole idea that you know, 506 00:25:09,119 --> 00:25:11,280 Speaker 3: these drugs are always safe, and you know that the 507 00:25:11,320 --> 00:25:14,360 Speaker 3: mentally you know, people who have mental health diagnoses, they're 508 00:25:14,480 --> 00:25:17,600 Speaker 3: they're sort of stigmatized and being you know, unfairly treated 509 00:25:17,640 --> 00:25:20,439 Speaker 3: by I don't know, like rednecks from the Conservative party 510 00:25:20,440 --> 00:25:22,960 Speaker 3: who are just saying, just pull yourself up by your bootstraps. 511 00:25:23,640 --> 00:25:29,480 Speaker 3: These are manufactured by the pharmaceutical industry. Anytime someone criticizes 512 00:25:29,640 --> 00:25:33,000 Speaker 3: SSRIs or they say, hey, you know, maybe it's a 513 00:25:33,040 --> 00:25:36,320 Speaker 3: bad thing that you know, seventeen percent of like adolescent 514 00:25:36,680 --> 00:25:38,080 Speaker 3: boys have ADHD. 515 00:25:38,200 --> 00:25:40,560 Speaker 2: Now, you know, you know, maybe we should question things more. 516 00:25:40,920 --> 00:25:44,320 Speaker 3: They're so quick to say, you know, these redneck conservatives 517 00:25:44,440 --> 00:25:46,879 Speaker 3: or whatever you want, in these bootstrap type people, they're 518 00:25:46,920 --> 00:25:49,199 Speaker 3: trying to stigmatize the mentally ill. They want to take 519 00:25:49,240 --> 00:25:52,040 Speaker 3: away the drugs, and we don't do that here on 520 00:25:52,080 --> 00:25:54,199 Speaker 3: the left. You know, here on the left, we you know, 521 00:25:54,240 --> 00:25:56,639 Speaker 3: we stand for mental health issues. We you know, we 522 00:25:56,680 --> 00:26:00,120 Speaker 3: want the medications to be safe. Guys, that stuff came 523 00:26:00,200 --> 00:26:03,840 Speaker 3: out of the Medical Affairs Department of pharmaceutical companies. Do 524 00:26:03,880 --> 00:26:06,880 Speaker 3: you realize that these billion dollar companies have groups where 525 00:26:06,920 --> 00:26:09,560 Speaker 3: they can control the narrative, and that's essentially what they're 526 00:26:09,600 --> 00:26:13,080 Speaker 3: trying to do. Anytime you criticize these things, they want 527 00:26:13,119 --> 00:26:20,000 Speaker 3: to characterize the person as having an anti drug puritan agenda, 528 00:26:20,520 --> 00:26:22,800 Speaker 3: like there's some kind of blood eyed or someone that 529 00:26:22,880 --> 00:26:26,600 Speaker 3: doesn't appreciate the horror of mental illness. Like I know 530 00:26:26,680 --> 00:26:29,199 Speaker 3: these problems are hard, but I think a more nuanced 531 00:26:29,240 --> 00:26:32,080 Speaker 3: discussion about like the drugs and how they're not studied 532 00:26:32,119 --> 00:26:34,880 Speaker 3: long term and how people get worse. I mean, that's 533 00:26:34,880 --> 00:26:36,920 Speaker 3: not a partisan issue. This is something that if you're 534 00:26:36,960 --> 00:26:38,719 Speaker 3: on the left, you'd want that for your kids. If 535 00:26:38,720 --> 00:26:40,240 Speaker 3: you're on the right, you'd want that for you kids. 536 00:26:40,640 --> 00:26:43,760 Speaker 3: Medicine shouldn't be like that. We just want honesty. We're 537 00:26:43,800 --> 00:26:46,879 Speaker 3: all parents, We love our children and our family, and 538 00:26:46,920 --> 00:26:50,040 Speaker 3: we just want the right information. And so it really 539 00:26:50,160 --> 00:26:52,760 Speaker 3: is the left and the pharmaceutical industry who just seem 540 00:26:52,840 --> 00:26:56,399 Speaker 3: to be kind of whipping this up into a storm, 541 00:26:56,440 --> 00:26:59,560 Speaker 3: and I think they're harming people by doing that. 542 00:27:00,200 --> 00:27:03,400 Speaker 1: More coming up on Wellness and Masked with doctor Nicole Sapphire. 543 00:27:06,560 --> 00:27:08,560 Speaker 1: One thing I want to ask is you were at 544 00:27:08,560 --> 00:27:12,000 Speaker 1: the FDA, if you could change one policy to day, 545 00:27:12,240 --> 00:27:16,919 Speaker 1: moving forward from the FDA standpoint or the AHHS, just 546 00:27:16,960 --> 00:27:20,879 Speaker 1: to make antidepressant use safer for people, what would you change? 547 00:27:21,000 --> 00:27:23,560 Speaker 1: What would be your ask if you had RFK Junior's year. 548 00:27:25,680 --> 00:27:28,320 Speaker 3: You know, I'm going to take two. I'm going to 549 00:27:28,359 --> 00:27:30,840 Speaker 3: take two things. So the first thing that I would 550 00:27:30,880 --> 00:27:33,120 Speaker 3: do is we need to update the labels. It needs 551 00:27:33,119 --> 00:27:35,719 Speaker 3: to be really clear that these drugs aren't studied long term. 552 00:27:36,040 --> 00:27:37,880 Speaker 3: We also need to talk about the fact that they 553 00:27:37,880 --> 00:27:40,480 Speaker 3: are making some people worse in the long run. We 554 00:27:40,560 --> 00:27:42,080 Speaker 3: need to talk about the fact that there is a 555 00:27:42,119 --> 00:27:45,400 Speaker 3: proportion of people who have severe problems when they come 556 00:27:45,400 --> 00:27:48,040 Speaker 3: off these medications. I think if people just knew the 557 00:27:48,119 --> 00:27:52,320 Speaker 3: risks of these drugs accurately, I think, you know, eighty 558 00:27:52,359 --> 00:27:54,919 Speaker 3: percent of people would say yeah, no thanks. And the 559 00:27:54,960 --> 00:27:57,399 Speaker 3: next thing that we need to do is, guys, we 560 00:27:57,440 --> 00:27:59,800 Speaker 3: need to study these drugs in a way that's in 561 00:27:59,840 --> 00:28:02,120 Speaker 3: life line with how the population uses them. I mean, 562 00:28:02,119 --> 00:28:05,240 Speaker 3: we need a trial that goes for at least two years. 563 00:28:05,520 --> 00:28:08,200 Speaker 3: This is not impossible. I mean we do this for statins, 564 00:28:08,240 --> 00:28:11,520 Speaker 3: you know, it's like double blind, randomized controlled trials, like 565 00:28:11,520 --> 00:28:13,879 Speaker 3: like two to five years for some of these statins. 566 00:28:14,960 --> 00:28:17,560 Speaker 3: I mean we do it for nine for twelve weeks 567 00:28:17,560 --> 00:28:20,679 Speaker 3: with antidepressants. This is madness. When we have fifteen percent 568 00:28:20,760 --> 00:28:24,920 Speaker 3: of our population on antidepressants and one in three you know, 569 00:28:25,359 --> 00:28:28,080 Speaker 3: like sorry, one in one in four women over age 570 00:28:28,119 --> 00:28:30,840 Speaker 3: thirty on them, this is a serious issue we need 571 00:28:30,840 --> 00:28:32,720 Speaker 3: to look at. So I think we just we need 572 00:28:32,760 --> 00:28:34,760 Speaker 3: to study these drugs a lot longer. 573 00:28:35,040 --> 00:28:38,480 Speaker 1: You know, it's interesting you just mentioned women women who 574 00:28:38,560 --> 00:28:42,680 Speaker 1: are approaching that perimenopause menopausal. Ah. You know, one thing 575 00:28:42,720 --> 00:28:45,720 Speaker 1: that has come out of doctor Marty McCay being at 576 00:28:45,720 --> 00:28:50,680 Speaker 1: the FDA is there's finally conversations about menopausal perimenopausal health 577 00:28:50,680 --> 00:28:54,080 Speaker 1: again trying to destigmatize against that. What do you think 578 00:28:54,200 --> 00:28:58,120 Speaker 1: the link is with women of this age and the 579 00:28:58,240 --> 00:29:00,520 Speaker 1: rise in SSRI use in mental illness? 580 00:29:02,360 --> 00:29:05,680 Speaker 3: Yeah, so I think, you know, the menopausal period is 581 00:29:06,040 --> 00:29:09,040 Speaker 3: definitely a factor. I mean, we've kind of swung in 582 00:29:09,080 --> 00:29:11,560 Speaker 3: two ways. I mean, we used to say, yeah, let's 583 00:29:11,640 --> 00:29:14,080 Speaker 3: use you know, homone replacement therapies, and then all of 584 00:29:14,120 --> 00:29:15,720 Speaker 3: a sudden it was like, no, we're never going to 585 00:29:15,800 --> 00:29:17,120 Speaker 3: use homemone replacement therapies. 586 00:29:17,120 --> 00:29:17,640 Speaker 2: They're terrible. 587 00:29:17,680 --> 00:29:20,200 Speaker 3: We're going to just put everyone an SSRIs because that's 588 00:29:20,240 --> 00:29:22,880 Speaker 3: what they're doing now. You know, if you have insomni area, 589 00:29:23,160 --> 00:29:25,560 Speaker 3: you know, hot flushes or anything like that, you get 590 00:29:25,600 --> 00:29:28,040 Speaker 3: put on an antidepressant, which is just crazy. 591 00:29:28,640 --> 00:29:31,520 Speaker 1: Isn't that interesting because unlike what we were talking about 592 00:29:31,560 --> 00:29:34,720 Speaker 1: with the serotonin deficit or change or whatever, that they 593 00:29:34,720 --> 00:29:37,520 Speaker 1: can't prove, you know, type one diabetes, you can show 594 00:29:37,520 --> 00:29:40,280 Speaker 1: that the body's not making insulin when they talk about 595 00:29:40,360 --> 00:29:43,760 Speaker 1: serotonin dysfunction and giving an SSRI they can't prove that. 596 00:29:44,440 --> 00:29:48,400 Speaker 1: But in perimenopause menopause, we're not making estrogen and progesterone 597 00:29:48,400 --> 00:29:51,080 Speaker 1: and testosterone, and that's something you can prove. So it 598 00:29:51,160 --> 00:29:54,840 Speaker 1: makes no sense that the answer to that would be 599 00:29:54,920 --> 00:29:58,120 Speaker 1: the ssis you actually know what their deficient is. You 600 00:29:58,200 --> 00:30:00,000 Speaker 1: have to be able to provide what their deficient is. 601 00:30:00,120 --> 00:30:01,200 Speaker 1: That's what's going to help them. 602 00:30:02,520 --> 00:30:04,320 Speaker 3: And a lot of people are going that way now 603 00:30:04,360 --> 00:30:07,120 Speaker 3: and I would say that's a much safer way than 604 00:30:07,160 --> 00:30:09,640 Speaker 3: getting on a drug that simply wears off over time. 605 00:30:09,680 --> 00:30:13,440 Speaker 3: I mean, the reason we use these drugs in perimenopause 606 00:30:14,040 --> 00:30:16,240 Speaker 3: is because, I mean these were billion dollar drugs that 607 00:30:16,320 --> 00:30:19,120 Speaker 3: had some of the smartest marketing minds behind them, and 608 00:30:19,160 --> 00:30:20,720 Speaker 3: they all sat around in a room and they were like, 609 00:30:20,920 --> 00:30:23,720 Speaker 3: how can we expand our market share? And then someone said, 610 00:30:23,720 --> 00:30:26,240 Speaker 3: well they seem to help with hot flushes, like let's 611 00:30:26,240 --> 00:30:29,600 Speaker 3: go after the menopause market. And then doctors were just 612 00:30:29,680 --> 00:30:32,480 Speaker 3: flooded with that for you know, for a couple of decades, 613 00:30:32,520 --> 00:30:36,400 Speaker 3: and now every other woman who's perimenopausal is kind of 614 00:30:36,400 --> 00:30:39,520 Speaker 3: being pressured into taking an SSRI when, like you said, 615 00:30:39,560 --> 00:30:41,680 Speaker 3: you know, how does that make sense just you know, 616 00:30:42,200 --> 00:30:45,000 Speaker 3: replace what is missing? And I know that's a more 617 00:30:45,040 --> 00:30:48,040 Speaker 3: complicated issue. You know, it's for people that really specialize 618 00:30:48,080 --> 00:30:50,560 Speaker 3: in that space. But clinically, what I see is a 619 00:30:50,600 --> 00:30:54,000 Speaker 3: lot of women do really well with some hormone supplementation, 620 00:30:54,240 --> 00:30:56,280 Speaker 3: and to me, it just seems a lot safer than 621 00:30:56,480 --> 00:30:59,720 Speaker 3: putting someone on effexor or one of these other antidepressants 622 00:30:59,760 --> 00:31:01,440 Speaker 3: for hot flushes. 623 00:31:02,880 --> 00:31:07,200 Speaker 1: So your recommendations to HHS are essentially we need longer 624 00:31:07,280 --> 00:31:10,840 Speaker 1: term study of these medications, and probably that we're overusing 625 00:31:10,840 --> 00:31:14,360 Speaker 1: these medications, and a lot of people may choose not 626 00:31:14,480 --> 00:31:18,320 Speaker 1: to take these medications if they actually knew the risks 627 00:31:18,440 --> 00:31:21,720 Speaker 1: with these medication. But so for the people who are 628 00:31:21,760 --> 00:31:24,480 Speaker 1: either on the medication and you, like you said, in 629 00:31:24,520 --> 00:31:27,280 Speaker 1: your practice, you're trying to take them off, or people 630 00:31:27,320 --> 00:31:31,720 Speaker 1: who are struggling with depression or anxiety who are considering 631 00:31:31,800 --> 00:31:35,760 Speaker 1: an SSRI. But what are what's your recommendations for non 632 00:31:35,880 --> 00:31:39,040 Speaker 1: drug therapies that have the best evidence of course for 633 00:31:39,160 --> 00:31:40,760 Speaker 1: like mild to moderate depression. 634 00:31:41,600 --> 00:31:46,720 Speaker 3: Yeah, so it's these are really complicated issues what I 635 00:31:46,720 --> 00:31:48,880 Speaker 3: want to say. I mean, I mean, if you think 636 00:31:48,880 --> 00:31:51,840 Speaker 3: about the reasons why people are unhappy, let's talk about 637 00:31:51,840 --> 00:31:53,280 Speaker 3: some of them. You know what if you're in a 638 00:31:53,360 --> 00:31:56,560 Speaker 3: terrible relationship, What if you have kids, that's a really 639 00:31:56,560 --> 00:31:59,360 Speaker 3: complicated issue. What if you've spent a lot of time 640 00:31:59,640 --> 00:32:02,600 Speaker 3: in a and you're now working in a job and 641 00:32:03,000 --> 00:32:04,960 Speaker 3: you don't find any meaning in it and you're kind 642 00:32:04,960 --> 00:32:07,880 Speaker 3: of you're stuck there. That's really complicated. You know what 643 00:32:07,920 --> 00:32:10,200 Speaker 3: if you're having some problems with addiction or some serious 644 00:32:10,200 --> 00:32:13,360 Speaker 3: health issues, and maybe the way you've learned to deal 645 00:32:13,400 --> 00:32:17,200 Speaker 3: with emotional pain is through food. These are all challenging things, 646 00:32:17,280 --> 00:32:20,080 Speaker 3: and so I want to start off my response by 647 00:32:20,120 --> 00:32:22,840 Speaker 3: saying that because I don't want to belittle just how 648 00:32:22,920 --> 00:32:25,720 Speaker 3: hard some of these problems are. Anxiety and depression. These 649 00:32:25,720 --> 00:32:28,080 Speaker 3: aren't just feeling a little bit sad. I mean, these 650 00:32:28,120 --> 00:32:31,400 Speaker 3: can be completely oppressive issues that can be really hard 651 00:32:31,440 --> 00:32:34,880 Speaker 3: to treat. I mean that said, when I look at 652 00:32:34,880 --> 00:32:37,680 Speaker 3: my patients, I think there's the four main things that 653 00:32:38,240 --> 00:32:42,000 Speaker 3: really make people unhappy. So the first is relational issues, 654 00:32:42,040 --> 00:32:45,960 Speaker 3: whether that can be dealing with social isolation or relationship problems. 655 00:32:46,040 --> 00:32:48,840 Speaker 3: Working with interpersonal therapists is a great place to go. 656 00:32:49,280 --> 00:32:51,800 Speaker 3: The next things are issues of meaning in your life. 657 00:32:51,920 --> 00:32:54,479 Speaker 3: You can deal with that with a career coach if 658 00:32:54,520 --> 00:32:56,520 Speaker 3: it's about the work that you're doing, or you can 659 00:32:56,560 --> 00:32:58,840 Speaker 3: go to or you can double down on your faith 660 00:32:58,880 --> 00:33:01,160 Speaker 3: and your spirituality. That can be in a tremendous place 661 00:33:01,200 --> 00:33:04,040 Speaker 3: to go to find meaning in your life. I also 662 00:33:04,280 --> 00:33:07,360 Speaker 3: think about health issues. You know, we forget that our 663 00:33:07,400 --> 00:33:09,920 Speaker 3: heads are connected to our bodies through this thing called 664 00:33:09,920 --> 00:33:12,720 Speaker 3: the neck over here. And if you're obese and you're 665 00:33:12,760 --> 00:33:16,080 Speaker 3: having problems and you're putting like bad food into your 666 00:33:16,080 --> 00:33:19,560 Speaker 3: body and you're not exercising, you're going to see that 667 00:33:19,680 --> 00:33:21,800 Speaker 3: poor health reflected in your body, but it's also going 668 00:33:21,840 --> 00:33:24,200 Speaker 3: to be reflected in your mind. And so you know, 669 00:33:24,240 --> 00:33:26,840 Speaker 3: nourishing your body, moving your body, getting in the sun 670 00:33:27,040 --> 00:33:31,520 Speaker 3: is really important. And then the final thing is is sobriety. 671 00:33:32,040 --> 00:33:34,440 Speaker 3: And you know, I talk about a lot of controversial things, 672 00:33:34,480 --> 00:33:37,000 Speaker 3: but when I say this, people really don't like it. 673 00:33:37,080 --> 00:33:39,920 Speaker 3: And that's sobriety from also legal legal things. And so 674 00:33:40,360 --> 00:33:42,040 Speaker 3: you know, having a cup of coffee in the morning 675 00:33:42,120 --> 00:33:44,600 Speaker 3: is fine. But if you're having a cup of coffee 676 00:33:44,600 --> 00:33:47,080 Speaker 3: in the morning, then you're throwing down three diet cokes 677 00:33:47,120 --> 00:33:50,440 Speaker 3: and you have chewing tobacco in your mouth all day. 678 00:33:50,560 --> 00:33:52,560 Speaker 3: You know you're going to crash from stimulants. It's going 679 00:33:52,600 --> 00:33:55,480 Speaker 3: to mess with your sleep. That's something that that that's 680 00:33:55,480 --> 00:33:57,240 Speaker 3: a lot for the body to go through, so you 681 00:33:57,280 --> 00:34:00,520 Speaker 3: want to make sure you're using them in moderation. Is 682 00:34:00,560 --> 00:34:02,880 Speaker 3: nowhere near as safe as people say it is. They 683 00:34:02,880 --> 00:34:06,160 Speaker 3: say it's like this healthy. You know this this medicine 684 00:34:06,240 --> 00:34:08,640 Speaker 3: right now, guys, this is not the ditch weed from 685 00:34:08,640 --> 00:34:12,160 Speaker 3: the seventies that was three percent the average THHG concentration 686 00:34:12,239 --> 00:34:15,319 Speaker 3: that you're getting from the dispensary, it's like thirty five 687 00:34:15,360 --> 00:34:18,720 Speaker 3: percent of the some of the concentrates in ninety percent. 688 00:34:18,960 --> 00:34:22,960 Speaker 3: This stuff is making people suicidal, it's making people become psychotic, 689 00:34:23,520 --> 00:34:25,880 Speaker 3: and so you want to get the drugs out. And 690 00:34:25,960 --> 00:34:28,840 Speaker 3: so I would focus on those four areas. You're going 691 00:34:28,920 --> 00:34:31,120 Speaker 3: to know the ones that are the most important for you. 692 00:34:31,600 --> 00:34:34,719 Speaker 3: And the thing is like, I've never met someone who 693 00:34:34,800 --> 00:34:37,439 Speaker 3: was anxious or depressed who had those four things in line, 694 00:34:37,520 --> 00:34:39,239 Speaker 3: and so you want to start there. 695 00:34:39,360 --> 00:34:39,560 Speaker 2: Now. 696 00:34:39,680 --> 00:34:41,279 Speaker 3: The next thing, you know, what do you need to 697 00:34:41,320 --> 00:34:43,640 Speaker 3: know about coming off these medications? I break it into 698 00:34:43,640 --> 00:34:45,360 Speaker 3: three things, and this is what we do at the 699 00:34:45,400 --> 00:34:49,480 Speaker 3: Taper Clinic. The first one is, if you've been on 700 00:34:49,480 --> 00:34:51,560 Speaker 3: these drugs for several years, just start with a five 701 00:34:51,600 --> 00:34:54,640 Speaker 3: to ten percent reduction. You know that's that's a good 702 00:34:54,719 --> 00:34:57,520 Speaker 3: reduction that most people can tolerate. Do that every two 703 00:34:57,560 --> 00:35:00,359 Speaker 3: to four weeks. The next thing is that you want 704 00:35:00,400 --> 00:35:04,000 Speaker 3: to listen to your body. If you tolerated that reduction, well, 705 00:35:04,040 --> 00:35:06,359 Speaker 3: you can increase the amount you remove. If you didn't 706 00:35:06,400 --> 00:35:09,840 Speaker 3: tolerate it, well you can decrease the amount you remove. 707 00:35:10,719 --> 00:35:14,839 Speaker 3: And then the last thing is is that it can 708 00:35:14,880 --> 00:35:18,560 Speaker 3: take time, and especially at the end. So most people 709 00:35:18,560 --> 00:35:21,240 Speaker 3: will fail a taper when they get to the lowest dose. 710 00:35:21,680 --> 00:35:24,440 Speaker 3: And the way that I explain this is that at 711 00:35:24,480 --> 00:35:27,440 Speaker 3: the higher doses, you know, the drug is essentially flooding 712 00:35:27,480 --> 00:35:29,480 Speaker 3: your brain, and you could remove half of it and 713 00:35:29,480 --> 00:35:33,080 Speaker 3: there's still enough excess drug leftover to jump onto those receptors. 714 00:35:33,480 --> 00:35:35,440 Speaker 3: But when you get to the very low dose of 715 00:35:35,560 --> 00:35:39,040 Speaker 3: that drug, there's not enough like reserve floating around in 716 00:35:39,040 --> 00:35:40,960 Speaker 3: the brain. And if you remove like even you know, 717 00:35:41,040 --> 00:35:44,279 Speaker 3: five percent, even though you did that easily before, that 718 00:35:44,320 --> 00:35:46,520 Speaker 3: could actually be a huge amount. And so what I 719 00:35:46,600 --> 00:35:49,239 Speaker 3: often have my patients do is when they get to 720 00:35:49,280 --> 00:35:52,640 Speaker 3: the lowest dose is we actually liquefy the medication. We 721 00:35:52,719 --> 00:35:54,719 Speaker 3: put it in a syringe that has one hundred little 722 00:35:54,760 --> 00:35:57,160 Speaker 3: lines on the side, and it allows you to lower 723 00:35:57,200 --> 00:36:00,520 Speaker 3: it down with such great precision that you you have 724 00:36:00,560 --> 00:36:03,319 Speaker 3: a lot of control, and people usually find that much 725 00:36:03,400 --> 00:36:05,000 Speaker 3: easier and much more tolerable. 726 00:36:05,200 --> 00:36:07,560 Speaker 1: I have never heard that before. That's really interesting. I'm 727 00:36:07,560 --> 00:36:10,000 Speaker 1: just going to add one more conveiat that people if 728 00:36:10,000 --> 00:36:12,440 Speaker 1: you've been on these medications for a long time and 729 00:36:12,520 --> 00:36:14,919 Speaker 1: you're going you want to come off. I mean, I'm 730 00:36:14,960 --> 00:36:17,640 Speaker 1: all about always trying to get off medications. Make sure 731 00:36:17,680 --> 00:36:19,920 Speaker 1: you talk to your doctor about it, because there can 732 00:36:19,960 --> 00:36:22,479 Speaker 1: be some there can be some side effects. Some people 733 00:36:22,520 --> 00:36:24,759 Speaker 1: don't do well coming off medication. It's always good to 734 00:36:25,360 --> 00:36:27,920 Speaker 1: have another set of eyes on you. That's just a 735 00:36:28,000 --> 00:36:30,920 Speaker 1: responsible thing to do. Doctor Yoziv, thank you so much. 736 00:36:31,040 --> 00:36:33,760 Speaker 1: I think you have given some incredible advice for people, 737 00:36:33,880 --> 00:36:37,279 Speaker 1: and you've also made it clear that mental health this 738 00:36:37,400 --> 00:36:39,640 Speaker 1: is not something that should be stigmatized. I mean, this 739 00:36:39,760 --> 00:36:43,600 Speaker 1: is not just you know, people being lazy or not 740 00:36:43,680 --> 00:36:46,279 Speaker 1: trying to put in the effort to feel better. Mental 741 00:36:46,320 --> 00:36:50,160 Speaker 1: health is actually just as diagnosable as diabetes or other 742 00:36:50,320 --> 00:36:53,560 Speaker 1: physical ailments, and so it has to be taken seriously. 743 00:36:53,960 --> 00:36:56,400 Speaker 1: But the way over the last couple of decades, with 744 00:36:56,560 --> 00:37:00,279 Speaker 1: the increased use of medications, the over diagnosis, we have 745 00:37:00,320 --> 00:37:03,160 Speaker 1: to pause to make sure that we are doing more 746 00:37:03,160 --> 00:37:05,799 Speaker 1: benefit than harm. And just like you're saying, you know, 747 00:37:05,920 --> 00:37:08,520 Speaker 1: some of my concern is that we're doing some harm 748 00:37:08,760 --> 00:37:10,880 Speaker 1: and looking at the long term effects of this is 749 00:37:10,920 --> 00:37:13,239 Speaker 1: crucial and I agree with you entirely. Thank you so 750 00:37:13,320 --> 00:37:14,920 Speaker 1: much for coming on. I really appreciate it. 751 00:37:14,960 --> 00:37:17,960 Speaker 3: Well said doctor Safi. Was an absolute pleasure to be 752 00:37:18,040 --> 00:37:18,800 Speaker 3: here with you today. 753 00:37:19,000 --> 00:37:21,760 Speaker 1: What a great conversation. What I hope everyone takes away 754 00:37:21,920 --> 00:37:24,920 Speaker 1: from the conversation I had with doctor Yosef is that 755 00:37:25,040 --> 00:37:28,360 Speaker 1: mental health and mental health treatment it's not one size 756 00:37:28,400 --> 00:37:31,279 Speaker 1: fits all, and there's no shame with being diagnosed or 757 00:37:31,280 --> 00:37:35,200 Speaker 1: being treated for any mental illness. The reality is none 758 00:37:35,239 --> 00:37:38,080 Speaker 1: of us get through our lives without dealing with some 759 00:37:38,360 --> 00:37:43,600 Speaker 1: level of mental health challenges throughout it. It's part of life. 760 00:37:43,840 --> 00:37:47,080 Speaker 1: Antidepressants they may be life changing for some, but they're 761 00:37:47,120 --> 00:37:50,200 Speaker 1: not a cure all and maybe in young people we 762 00:37:50,200 --> 00:37:54,840 Speaker 1: should demand more vigilant monitoring and safety research, but definitely 763 00:37:54,920 --> 00:37:59,319 Speaker 1: open dialogue. And as doctor Yosef reminded us, there are 764 00:37:59,360 --> 00:38:02,120 Speaker 1: some things that we can focus on rather than just 765 00:38:02,160 --> 00:38:05,080 Speaker 1: the medication to treat those symptoms. We need to look 766 00:38:05,120 --> 00:38:08,360 Speaker 1: inward in our life. What are some modifiable risk factors 767 00:38:08,360 --> 00:38:11,359 Speaker 1: that may be contributing to how we're feeling, Looking at 768 00:38:11,400 --> 00:38:14,680 Speaker 1: our relationships, looking at if we're addicted to something, And 769 00:38:14,760 --> 00:38:17,240 Speaker 1: as he pointed out, he's not just talking about illicit 770 00:38:17,360 --> 00:38:23,120 Speaker 1: drugs like cocaine or other things. He's talking about everything caffeine, nicotine. 771 00:38:23,520 --> 00:38:25,600 Speaker 1: If your body is addicted to something and you have 772 00:38:25,760 --> 00:38:28,280 Speaker 1: that high you're going to feel a crash at some point. 773 00:38:28,719 --> 00:38:32,360 Speaker 1: He also talked about exercising more, getting outside. You know, 774 00:38:32,520 --> 00:38:35,879 Speaker 1: I love talking about getting outside, being in nature and 775 00:38:35,920 --> 00:38:39,080 Speaker 1: being in the sunlight and vitamin D. It's all good 776 00:38:39,120 --> 00:38:41,680 Speaker 1: for you. There are some things you can do to 777 00:38:41,680 --> 00:38:44,160 Speaker 1: take control of your life. If you find you still 778 00:38:44,200 --> 00:38:47,440 Speaker 1: need help. There's absolutely no shame in considering some of 779 00:38:47,440 --> 00:38:50,879 Speaker 1: these medications. But maybe, as we talked about, short term 780 00:38:50,960 --> 00:38:53,879 Speaker 1: use of these medications should be the goal and not 781 00:38:53,960 --> 00:38:58,800 Speaker 1: necessarily medication for life. Healing the next generation means combining 782 00:38:58,880 --> 00:39:03,839 Speaker 1: the best of modern metay listen with awareness, education and compassion. 783 00:39:04,480 --> 00:39:05,720 Speaker 2: I'm doctor Nicole Sapphire. 784 00:39:06,040 --> 00:39:08,360 Speaker 1: Thank you so much for listening to Wellness on MASS. 785 00:39:08,600 --> 00:39:11,880 Speaker 2: Let's keep asking questions and staying curious. It's okay to 786 00:39:11,920 --> 00:39:12,759 Speaker 2: ask questions. 787 00:39:13,400 --> 00:39:15,439 Speaker 1: Be sure to listen to Wellness on Mass with doctor 788 00:39:15,520 --> 00:39:19,239 Speaker 1: Nicole Sapphire on iHeartRadio or wherever you get your podcasts, 789 00:39:19,239 --> 00:39:20,319 Speaker 1: and we'll see you next time.