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00:00:38.920I think this is one of those topics that if people understood the scale of the problem and the severity that we would be talking about this every day, along with, you know, immigration and foreign policy, this is, in my view, one of the most important things going on right now.
00:00:56.060So, give us a sense of how widespread the use of, let's just start with SSRIs, antidepressants.
00:01:02.720How widespread is their use in the United States?
00:01:59.500It's likely, you know, last statistics I looked at, I think it's about a 500% increase from where things were in the 90s, in the early 90s.
00:02:09.060Has America's collective mental health improved?
00:02:21.160So, if there's been a 500% thereabouts increase in the use of these drugs, but more people are killing themselves and the drugs are prescribed in order to make you not kill yourself, then that suggests that, like, we're getting the opposite of the intended effect?
00:02:42.020Where, you know, there's more psychiatric prescribers now, there's more drug, you know, drug prescribing, and the outcomes are actually getting worse.
00:02:49.920It's what we're doing is not working on a national level.
00:02:52.960Well, I'm just going to skip ahead to my opinion, then I'm going to pull back, but that suggests that we should ban the drugs and imprison the people selling them.
00:05:12.580But when you craft a narrative about these drugs, fixing a chemical imbalance, like, say, like a type 1 diabetic who doesn't have enough insulin, you give them insulin, and it kind of sort of like a magic bullet kind of injects itself like right into that, you know, pathological process and fixes it.
00:05:33.500And that's kind of a different message.
00:05:35.500The message to the person is that your brain is defective, there's something wrong with it, and we're going to give you this chemical to bring things up to normal.
00:05:53.220The idea that these drugs, you know, fixed a chemical imbalance simply came from observations that when you give people serotonergic drugs, they can become calmer, they can look less depressed.
00:06:07.100And so rather than the obvious explanation being, okay, this is a drug effect that we're seeing, you know, they are drugged, and that's what we're looking at, people said, well, maybe they just had low serotonin, and now they're looking better because we've fixed this chemical imbalance.
00:06:21.240And so that message has just been grabbed by pharmaceutical industry and, you know, psychiatrists to essentially lull people into this state where they feel more comfortable taking them.
00:06:35.980It changed, among other things, the practice of psychiatry completely.
00:06:40.760And I remember this just because I grew up in an affluent area where people use psychiatrists, not in my family, but everyone else's family.
00:06:47.600And the idea, it was Freudian psychiatry, and the idea was we are going to treat the root causes.
00:06:54.680Now, whatever you think of Freudian psychiatry or Freud or whatever, but, you know, you'd sit on a couch and talk about your childhood.
00:07:00.480Like that would, by addressing the root cause of your problems, you would make it better.
00:07:06.540That was the promise of it, whether it worked or not.
00:07:08.480And then it felt like in one day, right around the time Prozac came out, Freud was being denounced everywhere as a sexist.
00:07:17.400And Freudian psychiatry became not just sort of passe, but like affirmatively unpopular.
00:07:24.440And the role of psychiatrists was to dispense these drugs.
00:07:28.860From an outsider's perspective, that's what I noticed at the time.
00:07:33.580And I think what was going on was all of a sudden you had a billion-dollar war chest of marketing spend that was trying to seize control of the narrative about medications.
00:07:46.220And so, I mean, Prozac was like a blockbuster.
00:07:50.460Some people may not remember this, but that was the drug that made Eli Lilly a billion-dollar company.
00:07:55.900I mean, it was a small company before then.
00:07:57.980And so, at every single level, there was an incentive to change how people thought about distress.
00:08:05.640You know, no longer was depression and anxiety a complex thing where, you know, there could be relationship issues and problems at work and, you know, problems in your childhood.
00:08:16.080All of that stuff was, now it was almost bigoted in a way to talk about depression and anxiety as if it had these intuitive social and societal like causes.
00:08:32.580And if you were going to say that it wasn't a medical condition, you weren't taking it seriously and you were stigmatizing people.
00:08:38.280So, drug companies, they would platform, I guess, through their influence with the universities and the media, they were able to push out this narrative.
00:08:50.080And so, they could shoot down Freudian analysis and therapy.
00:08:54.180And so, the message essentially came out that was, this is a chemical imbalance.
00:09:10.240But it doesn't really make internal sense.
00:09:13.100Like, you could say, you know, I think you're depressed because all your relationships are dysfunctional or your parents are horrible or whatever.
00:09:39.320I mean, I think to logical people that makes sense.
00:09:42.140But the way that played out in public spaces and in medical schools was that that was actually a very backwards and kind of, you know, dismissive thing to, you know, people would say things like, you know, depression just isn't normal.
00:09:57.680You know, it's a serious biological problem.
00:10:00.860And so to suggest that, you know, this is just some, you know, life issues going on, relationship issues, you were kind of branded as someone who really, you just didn't get it.
00:10:10.640You didn't understand, you know, the medical underpinnings of this new disease that was gripping the country and kind of evolving and making people suffer.
00:32:20.520And so after residency, I go and I work for Janssen, which is the pharmaceutical arm of Johnson & Johnson.
00:32:27.980And I get involved in clinical development there doing a fellowship so I could see how the pharmaceutical companies develop the drugs.
00:32:34.480I stay there for a year and then eventually I go to the FDA and I become a medical officer in the division of psychiatry where I'm overseeing the safety of the drugs on the U.S. market.
00:32:45.400And it was by going through that experience and actually seeing how these drugs were developed over time that I realized that we are practicing so far outside of what the evidence shows, like in an insane way.
00:33:24.620Millions and millions of people, yeah.
00:33:26.240So, you know, I said before, you know, about probably between, I mean, let's just call it 20%, you know, 15 to 20% of people are on these medications.
00:33:34.140Half of the people that use antidepressants are on them for over five years.
00:33:38.180And so, you know, maybe seven, you know, seven to 10% of Americans are essentially on an experiment where there's no clinical trial evidence that says that these drugs are safe.
00:33:51.140You know, the scary thing is, you know, when my doctors used to say to me, these medications are safe and effective.
00:33:59.560The thing that they would leave out was for the 12 weeks that they were studied in the clinical trial.
00:34:06.440That's like, and then when you look at the research, there has never been a randomized control trial that has gone, that has looked at this over 12 months.
00:34:19.32012 months, but you said there are millions, tens of millions of people on this for years.
00:35:48.060What it does is it tilts the agency towards certain activities.
00:35:51.500So, when pharma hands over money to the agency, they say, we're going to give you this money, but every time we give you an application for a drug, you need to review it within nine months because, you know, our patents are going to expire.
00:36:06.180And so, you need to get it done in nine months.
00:36:08.640Every time there's a protocol that comes in, you need to look at it within 30 days.
00:36:12.820There's nothing, I think, on face, you know, that bad about it.
00:36:17.640There's commercial interest here and they want to get something.
00:36:20.460But what it actually does at the reviewer level is that all of our resources go towards drug development activities.
00:36:27.860And so, we're reviewing protocols for the drug companies rather than following up on safety issues.
00:36:33.440So, there could be something like, you know, PSSD, which I'd like to talk about later on.
00:36:38.500It's a serious sexual dysfunction problem.
00:36:40.540All these different side effects going on that need reports and that need attention from medical reviewers.
00:36:47.380Those were all just put on the back burner.
00:36:49.780They were neglected because the way success in our division was measured was that we were just getting these things, you know, these activities done on time.
00:37:00.540And so, there was much more of an emphasis on drug development activities.
00:37:06.200Now, the other thing that was really disturbing about being at the FDA, it's not so much the agency, but it kind of speaks to academic psychiatry as a whole.
00:37:20.280Now, you know, as I mentioned before, I think we're almost brainwashed when we go through our training to internalize these beliefs, you know, that these psychiatric conditions, they kind of morph and they evolve and they can get worse.
00:37:37.380You know, to criticize the medications is to be morally bad and to be stigmatizing the mentally ill and scaring people away from medications.
00:37:45.800Lots of academics, they end up working at the FDA.
00:37:49.720That's just a natural progression for them.
00:37:52.460And many of the people there had those beliefs.
00:37:54.560And so, I didn't actually, when I looked at a lot of the colleagues that I was working with there, they were so hesitant to call out problems with medications.
00:38:05.640I think the really cynical side of me says, maybe there was like a laziness component because if you identify a problem, you kind of have to deal with it and you have to do a report.
00:38:17.980But I actually think it was more that they had been so kind of sucked into this narrative that they almost, they needed to protect the drugs and they needed to be kind of advocates for them.
00:38:30.880So, rather than actually doing good science and really having a critical look at all of the problems that were happening with them, like the withdrawal problems, like PSSD, really clear issues, they were so hesitant to call people that, call it out.
00:38:47.440So, I feel like it had been captured by industry just through all of that messaging.
00:38:54.340We did an interview with a woman called Casey Means.
00:38:58.460She's a Stanford-educated surgeon and really one of the most remarkable people I have ever met.
00:39:04.860In the interview, she explained how the food that we eat produced by huge food companies, big food, in conjunction with pharma, is destroying our health, making this a weak and sick country.
00:39:18.220The levels of chronic disease are beyond belief.
00:39:21.160What Casey Means, who we've not stopped thinking about ever since, is the co-founder of a healthcare technology company called Levels.
00:39:30.100And we are proud to announce today that we are partnering with Levels.
00:39:36.540Levels is a really interesting company and a great product.
00:39:39.620It gives you insight into what's going on inside your body, your metabolic health.
00:39:44.280It helps you understand how the food that you're eating, the things that you're doing every single day, are affecting your body in real time.
00:50:56.860I mean, I think we're ideologues in there.
00:50:59.220We've been pushed into thinking about mental illness essentially in a way that benefits drug companies.
00:51:07.420And a profession because psychiatry as a profession is also really into pushing this narrative because it gives us a primacy amongst the healthcare professionals.
00:52:22.820It stands for post-SSRI sexual dysfunction.
00:52:25.660And from my perspective, this is the biggest scandal in psychiatry going on at the moment that has been not discussed.
00:52:34.280Now, there are people who get put on these medications that, well, firstly, when you, one of the big side effects of these medications is sexual dysfunction.
00:52:44.640It happens in, I think it's like 70% of people.
00:52:56.720So, so, so it would be like loss of interest in sex, you know, loss of arousal, difficulty to, to, to reach climax and erectile dysfunction.
00:53:13.400And, but the issue is we tell people that this goes away when they come off the medications.
00:53:19.080And this is just a temporary trade-off, you know, to feel less depressed, you're going to deal with the sexual dysfunction.
00:53:25.980But what we've been seeing is that these drugs are causing permanent sexual dysfunction in people, even when they come off of them, they develop, you know, on top of all of those things I mentioned, they will develop genital anesthesia.
00:53:40.820And so this is a real like neurological issue, like those areas down there, they, they, they lose erogenous sensation.
00:53:48.400People will say that when they touch down there, it feels like the back of their hand or the back of their arm.
00:54:05.120And so the prognosis is actually really, it's not good for that.
00:54:09.540I, I, you know, some people will recover and, you know, three years or so, but there are case reports out there where this has gone on for decades.
00:54:21.280You bet you're essentially castrating people, but it's worse than that because-
00:54:25.060How could anything be worse than that?
00:54:26.560Because along with the sexual dysfunction, and this is where the condition is, is misunderstood.
00:54:31.940People think it's just a sexual problem, which is already horrific as is.
00:54:36.060It causes, it causes cognitive damage as well.
00:54:42.040People will, will, along with that, they'll have difficulty, severe difficulty concentrating, focusing, paying attention.
00:54:49.280And there's also severe emotional blunting.
00:54:52.340And so people will talk about being completely dissociated as well from their emotions.
00:54:58.060Like if you were to hug a child, you know, your child or your wife, you just don't feel anything warm.
00:55:03.660If you were to hear a favorite song from your childhood that, you know, used to make like the back of your neck kind of a prickle from nostalgia, all of that gets like nuked and taken out.
00:55:16.080And so you have people who are essentially lobotomized with cognitive impairment who actually, who also have severe sexual dysfunction.
00:56:30.940The New York Times has run pieces on this.
00:56:33.780It's, it's, this is being reviewed by the FDA right now.
00:56:37.520This, this is like, this is not a fringe issue.
00:56:41.520This is something that several regulatory agencies, like the biggest ones in the world, like the European Union, second biggest regulatory agency in the world.
00:56:49.040They have acknowledged this and they put this in the drug labels to warn doctors so they can talk to their patients about this.
00:57:35.920Like, why don't, why don't people talk about this?
00:57:38.700Again, it's, it's this issue where I think media doesn't want to touch it because to do so would be to scare people away from life-saving drugs.
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00:59:26.040I mean, it's just a slogan because they're not life-saving at all.
00:59:29.120Because when you look at, actually, the clinical trial data, it's clear evidence that people who are under age 25, it actually makes them, they engage in more suicidal activity than the people on placebo.
00:59:55.880They can be experienced as life-saving for some people.
01:00:00.580Like, if you have a lot of anxiety and you get put on this medication and it blunts it, you will experience that at life-saving, as feeling life-saving in that moment.
01:00:09.400But in general, on a population level, they're actually contributing to more suicide attempts.
01:03:14.940Like, it's like they wake up in a horror movie.
01:03:18.820I, you know, I think about a woman and I interviewed her and from my recollection, I mean, so she got on one of these medications, beautiful young woman, and she ended up developing PSSD.
01:03:31.880She told the doctor that it had happened to her and she became incredibly distressed.
01:03:39.680Sex drive gone, cognitive damage, emotional blunting, completely disassociated from her
01:03:44.560family, from her emotions and disconnected from her life.
01:03:49.400The doctor involuntarily hospitalized her, saying that she was delusional and that she had health
01:03:56.300anxiety and tried to pressure her onto anti-psychotic medication because they just, they simply did not, they could not accept that this had happened.
01:04:05.040They managed to briefly turn her family against her and just say, you know, she's wrong.
01:20:41.220And this is, these are the patients that I actually treat in my practice.
01:20:43.920I'd say probably 70% of the people I work with now have neurological damage from coming off benzodiazepines and SSRI medications too quickly.
01:20:55.940Um, thankfully it actually has, I mean, it's awful.
01:43:50.320How does being on SSRIs affect people's relationships?
01:43:57.000So the question, yeah, I mean, it's, it's a question really about how does emotional blunting affect your ability to connect with one another?
01:45:26.720Well, she felt like I didn't really care about her anymore.
01:45:32.580Like she would, you know, we would be having like, you know, she'd be upset about something.
01:45:37.900I don't know, the kitchen was dirty and I'd left a mess and she'd be talking to me.
01:45:41.420And I'd just be like so zoned out, not caring about her emotions, emotionless, not aware, not being able to intuit things.
01:45:49.420Because in the past, like if I walked into the house and I could pick up that she was upset and walk over to her and say, hey, you know, what's going on?
01:48:14.380Because I would be sitting there trying to concentrate on my reports and I'd be getting obsessive thoughts about embarrassing things that had happened in the past.
01:48:24.680I mean, it was like torturous, like just like they would just spring into my mind.
01:48:29.240And thankfully I had the foresight to realize that the drug was actually making me more anxious.
01:48:42.580But that experience really taught me about how easy it is for these drugs to make you worse.
01:48:51.880And I mean, if I didn't know what I was doing and I wasn't interested in drug side effects, I could have gone in to see a doctor and they would have said,
01:48:58.600Oh, you've developed an anxiety disorder.
01:49:02.440And then you get on this prescribing cascade where you got started on one drug, you had a side effect, and then you get started on another one.
01:49:10.060And before you know it, you're taking multiple meds.
01:49:13.840So you say you would go into a doctor and tell them this, but now post-COVID, there's something called telehealth.
01:49:22.960And my impression is the bar has dropped maybe.
01:51:13.820It's drug dispensing and just milking insurance because you can just...
01:51:18.140The person pays you 150 bucks a month or whatever it is.
01:51:23.560And you just keep on sending them SSRIs without really trying to help them at all.
01:51:31.660And remember, these are the drugs that cause PSSD and can cause homicide, homicidal behavior and can cause brain injury when people try and come off of them.
01:51:40.800And no one is even sitting with them to say, hey, I really need to make sure that you understand what you're getting into.
01:51:46.340I really need to make sure that you understand that there are alternatives for this that are safer.
01:51:51.020However, these companies have just like, you know, there's like a PDF that you could read on the way to like the checkout page.
01:51:58.500And they're just like, okay, our job is done here.
01:52:01.060But what's wild is after, you know, an hour and a half of telling me, and I think making an airtight case that these drugs are really dangerous and are grossly overprescribed, you're describing changes to the system that make it easier.
01:52:17.540That guarantee their use is more widespread and less regulated and less oversight and less actual care.
01:52:26.460I mean, it's kind of weird that the evidence is in, it sounds like.
01:52:41.400What did, something just happened, I don't fully understand it, in the state of Illinois, Governor J.B. Pritzker, who wants to run for president, Democrat, signed a bill that brings some of this into the schools.
01:53:12.840And so their response was, well, we need to get into the classroom and we need to make these kids fill out mental health screeners to see if they have anxiety or to see if they have depression with the goal that that is going to improve mental health outcomes.
01:53:30.680Because if you detect it, you can treat it.
01:53:33.100Now, why I think this is the dumbest law ever, and it's going to lead to more problems, is our mental health care system is so dysfunctional.
01:53:54.720But what is going to happen with a law like this is it's going to end up just scaring parents.
01:53:59.020They're going to be saying, oh, you know, your kid has anxiety and depression.
01:54:01.420You should get that taken care of before they start becoming suicidal.
01:54:05.220They will go into a mental health care system, which is already broken, highly transactional, where doctors will have limited face time and will lean on prescribing medications.
01:54:18.800I'm all for screening, but not when the mental health care system is dysfunctional.
01:54:24.120It's just funneling people into a broken system.
01:54:26.160But why, so they're targeting kids for this.
01:55:11.060It is, you know, talking about mental health and being an advocate for mental health is one of the, you know, it's this, you know, this, you know, this morally righteous thing to do.
01:55:23.280And people want to jump on that bandwagon.
01:55:25.540And this seems like, oh, this is like, you know, this is a good thing for me to be doing.
01:55:28.700I'm such a good person, not understanding that the downstream effects can be really harmful.
01:55:44.960And I think unusually for a psychiatrist, you seem to really care about the outcome and whether people are thriving or not, which is supposed to be the goal of the business is to help people thrive.
01:55:56.420So, what advice would you give to people who are anxious or depressed or sad or struggling with what we call mental health?
01:56:05.320Like, what are the ways to restore happiness and vigor to a human life?
01:56:13.640I would say, I think a lot of mental health comes down to three things.
01:56:20.260I think it comes down to your relationships.
01:56:22.180I think it comes down to your purpose and what you do.
01:56:24.560And I think it comes down to your physical health.
01:56:27.120And so, I would want the person to audit their life.
01:56:33.580And to treat the root causes, you know, don't let someone tell you you have a chemical imbalance.
01:56:38.980If you look at your life and, you know, you're using drugs that can, you know, mess with your chemistry, address that.
01:56:46.580If you're eating foods that, you know, if you have like pre-diabetes or, and because your diet is off, you know, fix your diet, get moving, get in the sun, do the things that our bodies are naturally designed to do.
01:57:00.000So, so work on your health and then just think about the next thing that needs to be addressed.
01:57:05.180You know, are you having problems with loneliness and relationships?
01:57:08.960You can find people that can help you with that problem.
01:57:12.000It's not like a bullshit therapist, but someone that actually has a track record of helping with your relationships or helping with connections.
01:57:19.140If you're having difficulty at work, you can find coaches that actually have a track record of helping you find more meaning in your work as well.
01:57:28.020And so, what I tell people is that there's no, don't believe the story that there is this magic pill that is going to fix pretty much the most complicated issues in your life.
01:58:06.460That is so disturbing because I feel like AI therapy is like the most, like, it just, it doesn't give you like, it just affirms what you put into it as well.
01:58:20.520It's just like, oh yeah, that's so hard.