American Thought Leaders - Antidepressants Are Having Horrific Effects on Sexual Function: Dr. Josef Witt-Doerring

Episode Date: March 26, 2025

“Fifteen or 16 percent of the population [is] now taking antidepressants … When they’ve gone out and asked people who actually use these medications whether they’re experiencing sexual dysfunction, approximately 60 percent of people will [affirm] it.”Dr. Josef Witt-Doerring is a board certified psychiatrist, former FDA medical officer, and director of the Taper Clinic. He treats patients suffering from post-SSRI sexual dysfunction (PSSD), and protracted withdrawal—two conditions becoming more common, and in some cases permanent, in people who have stopped taking antidepressants.“SSRIs and antidepressants are really popular drugs. Some people just don’t want to believe that they could potentially cause something so catastrophic,” he says. “We should only be using these medications after we’ve done everything else.”In this episode, we discuss how patients can safely discontinue psychiatric medications and regain control of their mental health, and why there needs to be more awareness about conditions that arise after people stop taking their drugs.“What I saw going through all of that ... as a drug safety officer ... was essentially that we really were practicing outside of what the psychiatric clinical trials and the evidence showed,” says Witt-Doerring. “Doctors have been led astray about the drugs to the point where they overestimate the benefits and minimize the harm.”Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

15 or 16% of the population now taking antidepressants. When they've gone out and asked people who actually use these medications, whether they're experiencing sexual dysfunction, approximately 60% of people will endorse it. We should only be using these medications after we've done everything else. Dr. Josef Witt-During is a board-certified psychiatrist, former FDA medical officer, and now director of the Tabor Clinic.

He treats patients suffering from post-SSRI sexual dysfunction, PSSD, and protracted withdrawal, to conditions becoming more common, and in some cases permanent, in people who have stopped taking antidepressants. SSRIs and antidepressants are really popular drugs, and some people just don't want to believe that they could potentially cause something so catastrophic. How can patients who have decided to discontinue the use of psychiatric medications do so safely? And how can we as a society gain control of our mental health? What I saw going through all of that as a drug safety officer was essentially that we really were practicing outside of what the psychiatric clinical trials and the evidence

showed. Doctors have been led astray about the drugs to the point where they overestimate the benefits and minimize the harm. This is American Thought Leaders, and I'm Jan Jekielek. Dr. Josef Wit-During, such a pleasure to have you on American Thought Leaders. Thanks for having me, Jan. So a very common side effect of antidepressant drugs is actually sexual dysfunction, if I understand perhaps the most common. And a lot of people assume that after they come off these drugs, that this will actually go away. But that isn't always the case, and a surprising number of cases exist where it hasn't. So tell me about that. So what you're referring to is a condition called PSSD, or post SSRI sexual

dysfunction. And although this has been talked about since the 90s, you know, published in the medical literature, it's only gained wider spread recognition recently. I mean, we've had several drug regulators, the most notable of which is the EMA, the European Medicines Agency, actually update the labels of all the SSRIs and the SNRIs, these are classes of antidepressant medications, to warn about this risk.

And like you said, there are a growing number of people who when they come off these medications, they find that their sexual functioning never returns again. And despite this being what I think is an extremely important risk and something that everyone would want to know about before being exposed to this type of medications, it's hardly known amongst doctors. And because of that, many patients aren't told about it either. So maybe give me a sense of, first of all, how common it is for just people that are on antidepressants in the first place. When they've gone out and asked people who actually use these medications whether they're

experiencing sexual dysfunction, approximately 60% of people will endorse it. However, that may even be an underestimation because just with the sensitivity of talking about sexual functioning, some people may not want to talk about it. But it is, what I think, probably the most common effect of the medication. And what about just in general, like how common is it for people to take antidepressants in the first place? It's been increasing a lot, actually. And the most recent statistic that I've seen, I think it's from 2018, is that there's about 13.2% of the US population taking these medications. I think

it's about 8% for men and it's about 18% for women on these drugs. And so it's incredibly common these days. And in fact, that was from 2018 before COVID happened. And I know that they've been seeing increases in antidepressant prescriptions since then. So it's likely even higher now. How well do they work? It is a controversial point. And I want to preface it by saying

there's a lot of variety. So there are going to be some people where they're very beneficial and some people where it's not so. So Irving Kirsch, he's a researcher, he looked at this and he found that when they got all of the clinical trials together and they did a meta-analysis to see what the overall effect was, it was approximately a two-point difference on a 57-point scale. Now that seems very measly. Does that mean two points in helping someone become less depressed?

Yes. Out of 57. Out of 57. And so a two-point difference on scores out of 57, that's not a lot. But for a long time, we were told that they fixed a chemical imbalance. You know, that was in a lot of marketing and there were a lot of researchers a long time ago saying this. And that kind of entered the zeitgeist. You know, people thought if you were depressed or anxious, could possibly be this chemical imbalance.

But researchers in the UK, Joanna Moncrief and her group out of University College of London published this umbrella meta-analysis where they looked at all of the data into potential chemical aberrations in depression and they found nothing. This wasn't disputed by anyone, so they're not fixing a chemical imbalance. The most logical way to explain what these drugs are doing is depending on the drug, they're either having some combination of numbing or anxiety reduction, they can be slightly energizing for some people, and they can be sleep promoting.

Now depending on the person, that can be very therapeutic or not. If you're a very high strung person and you have a lot of jitteriness and anxiety, to be on an SSRI, you might experience that as being very therapeutic. But for others, that blunting is not going to help them. And then there's also a lot of questions about the longevity of that effect and developing tolerance to it. And there are some researchers out there who do worry, and I think it's credible, that being on long-term antidepressant medication might actually make a proportion of people more prone to depression and anxiety overall. So it's actually really complicated that there can be, many things can be true, there can be a proportion of people who get on these medications, experience

it as therapeutic and it works long time, for a long time. But then there's also another group of people who it's really not that helpful for them and in fact it could be making them worse. And the problem is we don't have research to predict who is going to have a good effect from this and a negative one. One of the things that I've learned over the last years is you really have to look at the cost-benefit analysis as a doctor when you're going to prescribe a drug. There's always some cost, some drugs that's very low. I guess I'm always asking, are doctors doing that analysis?

I don't think it's happening enough. I work at a clinic, which I founded with my wife, where we help people come off these medications. And so a lot of people will tell me that they go and see their family medicine doctor, and sometimes they get diagnosed with a short five-minute conversation. Sometimes they even fill out check marks on a questionnaire in the waiting room, and then the doctor will come in and prescribe a medication that potentially has serious effects. It's kind of like a roll of the dice. Sure, I think most people are not going to have the serious problems, but if you roll the dice enough, you are going

to get some people who will be seriously harmed. And the real shame that I think here is, you know, when I talk to the people who are injured from these medications and who are having a lot of problems, they look back on why they went in there originally and they talk about a lot of problems that could have been resolved in other ways. If it was grief, maybe they just needed to meet with a doctor or a therapist or just wait. Maybe they didn't need any interventions. They just needed to be told that their sadness was justified and that it would go away and that someone would be there for them. Some people were

just drinking too much coffee, living sedentary lifestyles with poor diet, and they needed someone to help them with their sleep and their diet and maybe some of the substances they were using. Some people were having problems with work and relationships. And they look back on this and they think, wow, there could have been so many things that I wish someone would have supported me with, kind of held me and held me accountable to before the doctor prescribed the meds

that ultimately led me on this path. I also wanna be sympathetic to the doctors because I have sat in their shoes and I have worked in these county settings. Our healthcare system is not set up to support people in that way. It's very transactional visits and so I sympathize for a lot of doctors as well who are being tasked with helping people with problems as complicated as anxiety depression. I mean, it's one of the most complicated things. So many different things can cause that, medical and life

problems. And they're not really being given appropriate tools or time to help these people. And so there's these systemic problems that lead to these extremely transactional visits where people aren't getting the kind of care that you would want for a loved one. It's a big problem. That's why we have 13%, probably higher, it's probably around 15% or 16% of the population now taking antidepressants. What I hear you're saying is that although it can definitely help some people,

it's probably being used too much because of the nature of the medical system today. Yes. Yeah. When you said that earlier, that there's no chemical imbalance that's being fixed here, I have to tell you, I still believed until that moment that it was. I think that's what we've been conditioned to believe. Yeah. I mean, drug companies and there's this famous Zoloft commercial from back in the day where there's this bouncing blob, and it says, you may be suffering from a chemical

imbalance. Go and talk to your doctor about Zoloft, you know a popular SSRI medication as if we understood that there was this well-defined Biochemical process that that was disrupted and this drug could come in and fix it and you know And and all of the downstream problems would go away from there You know the sad feelings and such and you would like a magic bullet hit it at its root bad feelings and such, and you would, like a magic bullet, hit it at its root. Now I'm not trying to say there's no genetic factors that influence someone to become anxious or depressed. We know there's a whole range of different personalities which do have genetic influences. It's more neurotic people. They tend to become depressed more. You know, variations in human personality and such, and maybe there's some genetic problems we haven't identified that tilt people that way, but it is certainly not a well understood

biochemical process that these drugs insert themselves into and fix. The way that these drugs work, it can be numbing, it can be energizing, and it's essentially a papering over of symptoms. It's not root cause medicine. It's a papering over of symptoms. And so there is a place for the drug. I'm certainly not an anti-drug person, but it should only be after lifestyle interventions, social interventions, looking for medical reasons that can cause depression.

You have things like sleep apnea. You can have vitamin deficiencies. And more recently, and this is incredible, there's been some very promising research on dietary interventions like the ketogenic diet, which have been able to, and I'm not saying this lightly, they've been able to reverse symptoms of schizophrenia and bipolar to the point where people who have been on medications for decades have been able to reverse symptoms of schizophrenia and bipolar to the point where people who have been on medications for decades have been able to come off. And one really popular person is Lauren Kennedy West, who has a YouTube channel.

It's called Living with Schizophrenia. She had built a following of like 300,000 people talking about acceptance of the diagnosis, you know, rationalizing, you know, the role of medications in the treatment. And then she did this treatment and she's been able to come off and it's just been very interesting to watch her journey and there's hundreds of people just like her. And so we should only be using these medications after we've done everything else. At that point, paper over them

with drugs that have risks, but not before doing that. I would say in 95% of interactions with doctors, that's not happening. One, because the doctors aren't resourced and it's very transactional. I want to go back to PSSD. You mentioned numbing. Yeah. Okay. And so I understand that for some number of people, there's very significant numbing that ends up being permanent. And also tell me, what's the known prevalence of this, where it actually becomes something that's permanent? So from the epidemiologic studies that I've seen to date, there's one figure out there and it's that the incidence of this could be around 1 in 216 people. I mean, you could

debate the terminology, but it's not very common. But it's common enough that when you have 13, potentially 15, 16 percent of the population on this, we're talking about hundreds of thousands of people. Yeah. I mean, something to the tune of 200,000, maybe more, would be the back of napkin calculation. Yes, in the United States. And so it's common enough that I think people could expect to see it. So the most classic story of this is that you have a young person and they start taking this medication and they'll experience some degree of sexual dysfunction, you know, decreased libido, maybe some difficulty sustaining an erection,

decreased, you know, muted orgasms, things like that. Now, they'll take it for several years, and then when they come off the medication, it starts to intensify. Most people are told, yes, this is an effect of the drug. This is actually a common effect. That's not a secret. Most doctors will tell people about sexual dysfunction while on the drug. But people expect to actually get better on the way off. And that's not what happens in this smaller group, this 1 in 216.

It actually intensifies. And so they become more numb. And the way people describe that, the numbness, is they actually develop something called genital anesthesia, which is completely different from any other type of common sexual dysfunction. The main differential for that is usually like a performance anxiety, so like a psychological stress manifesting an inability to perform, or it can be cardiovascular problems that lead to impotence and difficulty maintaining an erection. Those things don't cause genital anesthesia.

And there are case reports in the literature of people putting things like Tiger Balm, which has a very strong sensory effect, like if you were to put it on a sensitive area, people feel nothing. There was one woman who, she even like pressed a hard bristled brush against the area down there to see if she could have any sensation, and there was nothing.

And so it is a genital anesthesia that occurs with these people. You cannot explain that away by performance anxiety or anything else. This is neurological problems happening there. So it's as if all erogenous sensation from that, you know, that pleasurable feelings that you would expect

to have down there have gone away. It's like touching the back of your hand, this disruption. So there's that part of it. Now, obviously there's erectile dysfunction and all of that. But the other thing that is not talked about a lot, but is actually even more troubling to the people is the emotional blunting that comes along with it and sometimes even cognitive dysfunction. So a part of the story that's often missed is people think it's just a sexual problem,

it's not. And the people who suffer from this, they describe feeling like just the volume on their feelings has been turned down. And they'll say things like, you know, I'll hug my parents or my child and there's no warmth there. I'm listening to a song from my youth which I loved and you just fill me with nostalgia and I get this prickling on the back of my neck

and it's gone. And so they feel like they're watching their life as if it's through like a TV with a volume turned down. They're not really in it. And all of those sensations that actually make us feel alive, which you and me, we sit in them every day to the point that we don't notice, but you do notice them when you have one of these neurological injuries

that knock out these sensations. Again, for some people, it can also cause some cognitive dysfunction as well, memory problems, there's a lot of sleep issues, and they actually struggle to work. For many people, this isn't going away. This is a potentially permanent problem. There are some people where maybe after three years, something like that, there's some gradual improvement.

But there are case reports of people out there who have had this happen decades ago, and they're still walking around with sexual dysfunction and this blunting that's had a catastrophic effect on their lives. You said something earlier, and you said basically, Jan, and this isn't something like performance anxiety. This is something quite different. And what I heard in that is that it's likely that a lot often doctors aren't able to understand what they're seeing because it's just not something that's generally known. I mean, some people would call it like medical gaslighting is what happens. They go and they say, I'm having this problem and the doctor will like write them off. But for it to truly be medical

gaslighting, doctors need to have been informed about this. The truth is they've never actually seen it before. They have no way of understanding what's happened. Something that I think is an absolute failing of our regulators and our doctors that we haven't gotten the word out about this. But the experience of someone when they get this is horrible. On

the better side, it's being dismissed by several doctors, not being taken seriously, kind of being written off, maybe. But then on the worse side, I've had some people say that they've been accused of being psychotic, that you've developed a delusion around this happening. It couldn't possibly be related to the drug, because our conception is that we only understand drug-induced side effects to occur when someone is on a medication, and the fact that it is enduring afterwards

doesn't make sense. And so they'll say that the person is almost delusional. There's been instances where they've turned family members against them. They say, you know, your loved one, they're spending too much time on the Reddit forums where they're talking about this. Even though this is acknowledged by several regulators

around the world, they write it off, and they say, couldn't possibly happen. Some people have even been hospitalized over this for a delusional disorder. I mean, it's the level of, I'd say, just like isolation and horror that some of these people find themselves in when, now you've had a severe neurological injury and no one believes you.

It's awful. The one thing that I want to add here for anyone clinical who may be watching this and just being like, this doesn't make sense that something like this could happen, a really good example that's very similar to this is actually the anti-psychotic medications, which do almost the exact same thing with a different side effect. Now, there's a side effect that you can have from antipsychotics called Tardive dyskinesia, which is most people may not know the word, but they've seen it in the Batman movies with

the Joker. He's always depicted with his tongue kind of moving, and he's making lip-smacking movements. There's a common side effect of long-term antipsychotic use in voluntary movements. And now what happens in these patients when they've been on the drug for several years is they start to develop these movements and then when they remove it, they intensify. And just like in PSSD, for some people it will go away over the course of several years, but there's also a lot of people who have it permanently afterwards. So this kind of pattern isn't really an exception. It's kind of a norm that we see with other psychiatric medications as well. I think it's

just less recognized for a couple of reasons. One, movement disorders. It's hard to blame a movement disorder on your psyche. You're clearly One, movement disorders. It's hard to blame a movement disorder on your psyche. You're clearly having a movement disorder, but you can blame cognitive problems, feeling dissociated, sexual performance. You can say, well, it's probably your depression or your anxiety. And also I think SSRIs and antidepressants are really popular drugs, and some people just don't want to believe that they could potentially cause something so catastrophic. You have a broad range of interests. I just wanted to talk about your background because you're a psychiatrist, but you also worked for the FDA, so you understand the drug side

of it. Just tell me a little bit about your background and how you came to be doing what you do now? Sure, yeah. So I did my medical school at University of Queensland in Brisbane, Australia, and then I came over to the United States for residency. And I'm gonna be very forthright here. As soon as I started my psychiatric training, I actually could sense that there was something that didn't sit quite right with me with how we were practicing. I grew up very interested in psychology and

self-help and I assumed that we were going to be using all of these tools and maybe leaning on medications occasionally. That was not what I saw in my training. I saw this very transactional approach to care where we weren't really trying to understand the root causes of what was going on with people. We were diagnosing them off checklists and treating them. And I asked a lot of questions about it. And I was kind of ostracized by my peers and even by staff in the program as kind of being a person who was asking uncomfortable questions.

I felt like, you know, who was I? You know, I'm probably like 25, 26 at this time. I don't know psychiatric research. I just have a hunch in my gut that how could you expect to help someone when you don't understand the root cause? And I decided I wanted to be a drug safety researcher. I said, I need to understand how this is happening. And so I became a board certified psychiatrist.

I then went and did a fellowship in psychiatric clinical trial design at Johnson & Johnson in the pharmaceutical branch, Janssen. They make the most novel psychiatric compounds. After that, I went and worked at the FDA in the division of psychiatry products, reviewing multiple different chemicals on the market and also in development across the U.S. in emergent safety issues. And then I returned to the pharmaceutical industry as a drug safety officer. And what I saw going through all of that was essentially that we really were practicing outside of what the psychiatric clinical trials and the evidence showed.

And so I'm noticing all of these problems. And I'm working clinically on the side, which is very common for people at the FDA or also the industry, that they'll have a clinical practice. And I'm also seeing people who are having these problems. When they try to come off the drugs, they were getting seriously hurt or their tapers were failing. Then it opened up this whole new vista for me where I realized that there's actually serious problems in

getting people off these medications as well. What do you mean by the tapers were failing, by the way? Common ways is that someone will come down off a medication and then they will step off and usually within a couple of months they'll have very severe symptoms and the doctors will tell them, well, it's your underlying condition coming back. You know, you need to be on these drugs long term. But there was this whole area of research that's really been spearheaded now by a doctor called Mark Horowitz and Joanna Moncrief. These are both researchers in the UK, showing that you need to be tapering people much slower for them to be

able to come off safely. And if you do it too quickly, they develop withdrawal symptoms, which are oftentimes mistaken for the underlying condition going on. And so you have people on unwanted psychiatric medications experiencing side effects, and they want to come off. But the doctors who are helping them are kind of dooming them to fail because they taper them too quickly and then when symptoms emerge they just say well you have to be on it for the rest of your life. It's your underlying condition.

And that's when my wife and I, we started to focus our clinical practice on doing slow tapers to help people come off and we now do, you know, we have a that does that, but we also do a lot of volunteer clinician education as well, helping people taper people off medications. You mentioned just in a lot of cases, the doctors probably are somewhat well intentioned. They probably truly believe that these are the symptoms that have come back because they don't understand. There are big problems with the psychiatric literature on this because for a long time, it was believed that, let's talk about antidepressant withdrawal, that this was a, they would say

it's a mild and self-limiting problem, meaning that withdrawal symptoms would go away within two to three weeks of coming off the medications. And so that was the sound bite that made antidepressant withdrawal seem like it wasn't a big deal. And people who had a vested interest in wanting doctors to see the drugs in the best possible light, they took that sound bite, you know, they took that piece from the literature and then they circulated it to medical schools, to doctors, at conferences, essentially saying, if you put people on these drugs for several years, if they want to come off, the withdrawal is gone in two to three weeks, not a big deal.

Now what doctors and the public weren't aware of was that that experience of this being mild and self-limited was from the randomized controlled trials when people were coming off These short randomized controlled trials which only lasted three months Now the withdrawal is going to be mild and self-limiting for the vast majority of people if you've if your brains only become dependent on it over three months time, that's not a lot of time to develop a physiologic dependence on it. But half of Americans using these medications have been taking them for five years or longer now. And so that's very different. I mean, five years of kind of neuro adaptations to

accommodate that drug in your brain, that's a lot more than three months. And the time it takes to undo those in a safe way that doesn't destabilize someone, it's much longer and it can be a lot more complicated. So surely there's studies being done to try to understand what this looks like. Well, you would hope so, but not really. Most of the literature in this space is more survey work now, where they're at least reaching out to people who have tried to come off these medications and they're trying to quantify how many of you went into withdrawal, what percentage of it was severe. There has not been a clinical trial on how to safely get people off the medications, but there

is a lot of anecdotal evidence about how it's done to the point where I actually don't think we need a clinical trial on this. We now know how to get people safely off these medications just from the hundreds of thousands of people out there who have been sharing their experience, not just online, but actually with researchers at institutions who have taken this information and they've turned it into guidelines. There's very good authoritative guidelines now, like the Maud's Lee Deprescribing Guidelines.

Royal College of Psychiatrists in the UK also have these slow, tapering guidelines. But despite these tools existing, especially here in the US, there hasn't been a push in that way. We don't have any of our psychiatric institutions or the College of Family Physicians or OB-GYNs. They don't have any of these guidelines that combat that old idea of the withdrawal being mild and self-limiting, and you can taper people off over a couple of months.

And so it's really not recognized in the United States yet, but there is growing recognition of the need for these slow tapers to get people off safely. And just with PSSD, you mentioned that in certain jurisdictions, it is actually on the label, right? But in others, like I think in the US, it isn't. Yeah. So the European Medicines Agency has a strong warning, Australia does, Hong Kong does, Ireland has a strong warning. In fact, they did what I think is actually the best out of all of them. Not only did they update their labels, they sent out Dear Health Care provider letters.

I consider this to be a very serious risk. If a risk is updated in a drug label, a lot of the times doctors won't even see it because they're not sitting there on the FDA website looking, oh, you know, FDA just updated the label. You have to get the information to people. And sometimes you do it with this Dear Health Care Provider letter that goes out to the colleges and the colleges then mail it or they email it to all of their members to update them.

And Ireland did that, I believe. They updated the labels and then they also messaged the doctors who prescribe a lot of these drugs. There is something that is awful in the United States and that is that we haven't updated the labels to warn our citizens about about this risk and the P you were talking about PSSD now yeah PSSD, yep. And we've been, a group of people have been asking for the labels to be updated for, you know, it's been over six or seven years now and really not a lot has happened.

And I think that's a failing of them. At your clinic, you probably encounter all sorts of injuries related to psychiatric drugs. So how common overall is it for doctors to understand that there is a risk and disclose that risk? Well, doctors can only disclose the risks that they've been informed about. And so we're in a situation right now where some of the most important risks that you would want a loved one to know about these medications are not being disclosed. And I think if we're talking about antidepressants, there's two main ones. There's PSSD, incredibly important for people to know.

And the other thing is a condition called protracted withdrawal. So protracted withdrawal, it's something that I see a lot in my practice. Essentially, it's, and I'm being purposeful with my words, it's a brain injury. So there is a proportion of people that when they come off these medications too quickly, a neurotoxicity takes place. You have someone, they're on the drug for several decades, they go and see the doctor, the doctor says, just halve the dose, wait two weeks, halve the dose again, wait two weeks and then stop. Some of those people will be in quite bad withdrawal and they'll call up the doctor

and they'll say, this feels pretty bad. What should I do? And then the doctor will say, well, it's a self-limiting problem, because that's what they've been told to do. And then so the person says, well, I don't want to lose this progress. I just want to white-knuckle it through this. And they do that. And then maybe a month or two months later, the withdrawal

hasn't gone away and they start to develop global neurological problems. They start to get ringing in their ears. They get light sensitivity. Some people will have gastrointestinal problems like constipation and diarrhea. Some people will even have a neuropathy where they get tingling in their hands and feet. But the symptoms that people complain about the most and which are the most devastating and troubling to them and their families is a severe form of anxiety, catastrophic anxiety that almost never leaves them. It completely hijacks them and they also have cognitive dysfunction. By the time this sets in, the person is ready to quit. They say, whatever, I can't come off this medication,

I don't want to anymore. They will go and they'll reinstate the drug, thinking that it's going to curb the withdrawal, but the symptoms don't go away, or only some of them partially improve. And after this has happened to them, they will endure sometimes for years. From what I see, people just walking into my office,

most people are pretty sick for the first 18 months to two years before they start to improve. But there are some people where this goes on for years. It's as if they've had a severe concussion or a brain injury. It's in that realm. And I want to be really clear about something. This is not a common thing. There are a lot of people who can come off these medications

even quite quickly, and their brains are just elastic. They're able to kind of bounce back despite the severe withdrawal and get on with their lives. They don't think twice about it. There's a small group of people where this happens, and there's now hundreds of thousands of them. They're on websites like Surviving Antidepressants, like Benzo Buddies for the benzodiazepine ones,

and there's Facebook groups. I mean, for Cymbalta, one of the common SNRIs and antidepressants, there's 40,000 people in a Facebook group called Symbolter-Hertz-Wurst talking about protracted injuries from these medications. And so the most important thing, I think, that doctors really should be telling people

about these medications is not just that you need to come off them gradually, because otherwise the taper will fail, and you might end up on them forever when you didn't need to and you just needed to go slower. It's that if you come off too quickly, you can cause a form of brain damage that may take years to recover. And I understand that it's a rare thing and it's not going to happen to everyone, but we can't predict who this happens to. And for something that's substantial, it is much safer to just taper everyone gradually in a way,

in a very gradual way, just to avoid that. Right now, the only group that really informs people about the severity of protracted withdrawal injury is the Royal College of Psychiatrists in the UK, and so in their NICE guidelines. That's another interesting story because it goes into Luke Montague, who was the son of the late Earl of Sandwich, and this happened to him. And so there's actually a lot of political pressure over there to get this type of withdrawal

injury recognized. But again, just like with PSSD, it's not a common thing. But when you have potentially 15-16% of the population on these medications, it's enough people for it to be a serious problem nationally. Right. Well, and then of course, that goes back to our initial discussion around root causes and the question of how much do you really need to be prescribing these things at the outset? There's other methods that can be tried and can be, as it sounds, quite effective that don't involve a drug even in some cases. It's a serious problem where the people who are prescribing these medications, especially

in the United States, have not been informed about the potential for these serious problems, like the difficulty getting off, the withdrawal injuries, PSSD. Because if they knew it, we wouldn't be in a situation where, you know, probably like 20% of women are on these medications now. And there's some differences in the guidelines out there. For instance, in the UK, antidepressants aren't recommended for the treatment of mild depression. And it's often encouraged that you should try lifestyle interventions first

before going to these medications and things like therapy. But in the United States, the APA says that antidepressants are a first line therapy. And if we were to learn from some of these other places, we wouldn't be doing what the American Psychiatric Association guidelines say where we should use these as first line treatments. We would only be using antidepressants after all of the non drug approaches

have failed. So how do you view this new executive order on making America healthy again, establishing of a commission over a short period of time to look at root causes of disease, chronic disease, and children? Yeah, I think it's long overdue. I mean, I really think that, and I'll focus on mental health, I think we need to look at the prevalence at which we're using these medications. And we need to start asking a lot of questions, like why are

we so quick to prescribe medications that have serious harms? How can we help our doctors who are in these family medicine offices all over the place who genuinely want to help people? How do we get them better access to people who can support them in helping the patients with things like therapy, lifestyle interventions, dietary interventions, which we all know can help

with things like depression and anxiety. These are serious problems that need to be addressed. And so I'm really excited that we're actually going to be looking into these things because I'm not afraid to say this and I don't think I'm alone here, Jan, is that what we're doing in mental health is not working for people. We have more mental health problems than we've ever had before and we have more prescriptions than we've ever

had before. I think as a community of doctors and psychiatrists and mental health specialists, the time is now for people to start putting up their hands and just saying, we can do so much better than this. We can do so much better than just using medications. We should be able to help people in more ways. And I think the tide needs to change. And I think it's happening now. So I'm really excited about it. So there's something called the revolving door. And you mentioned earlier

that you had worked in Big Pharma, and then you went to the FDA, and then you went back to Pharma. And that made me think of the revolving door. What do you think about that whole structure? I can just speak from my own experience. I did that. I think it's actually useful to talk about figures so people can understand. I was probably making around $160,000 working at the FDA. That was a salary. But when I went to industry, I mean my total compensation package, when I looked at like health insurance and time off, all of that, stock options, stocks, it was about $700,000. And so there's a big pull to leave government and go and work for industry just financially. And industry, they really want people from the government as well.

And it's for a couple of reasons. Some of them are really clear and some of them are soft but important. The really clear ways are if you're a drug company and you want to get something on the market, you want a guy on your team where you can say, hey, how do they really think about these things? How do they really think about these things? You know, how do they approach this? What's going to be the best way that we position this problem so we can be successful in getting the drug on the market? They need to know what's going on on the inside.

But there's also this soft side to it where if I'm working for the drug company and my name is on an application and I'm running a clinical trial and then I submit it to the agency and there's people there who know me, drug company and my name is on an application and I'm running a clinical trial. And then I submit it to the agency and there's people there who know me. I've been at their parties. I've been there when their spouse got sick with something to comfort them.

They look at it and they say, I know Joseph. Joseph's a great guy. I don't need to look as closely at this because I know that know that person and so there's a lot of problems with that when you when you really when the agency should not be biased in that way, I mean they need to be solely focused on the health of the American public and not Conflicted I know I did it, you know, it's hypocritical here But I do think that needs to end. I mean, there's serious problems with that.

I mean, it's just, it's a very kind of obvious perverse incentive structure that exists here, I think. Yeah. And I mean, the other one that I do think is really important to talk about, I actually think this is the most important one to talk about when it comes to how doctors have been led astray about the drugs to the point where they overestimate the benefits and minimize the harm is actually the capture of academia. And in a similar way to what's happening in government,

if you have ambitions to be a professor at Yale, Harvard, one of these big institutions, the way you do that is mostly by getting funding for research. It's by getting a lot of publishing a lot, flying around the world to talk about something. You need all of these things to bolster your reputation as an international expert in this area. Now the best way to do that, at least in psychiatry, but I suspect in other areas in medicine, is actually to collaborate with pharmaceutical companies to run clinical trials.

They write the publications for you, most of it. They do a lot of the grunt work. They give you the protocols, and then they essentially they fund you and fly you around the place. And I used to remember as a junior doctor looking up to the professors and they would say, you know, these drugs, they're safe and effective, there's not a lot of problems there. And I don't know that they're doing this. I don't know that their careers and their career success has been tied to running these trials and that they could be biased

in a way where they're going to want to put, they're going to want to talk about the drugs in a more favorable light because if they started being, saying negative things about them, they would compromise their ability to run more of this research and kind of be picked to do this thing. And so I would be looking at these professors saying they must be clinical experts, they must, they must know more about the totality of psychiatry and how to help patients. But what I've seen more and more is that they've been compromised and that they have incentives tied to the money and to career advancement that means that they can't be

as forthright as they ought to be about these things. And it's gotten to a problem where these are the professors who are training the doctors who are setting the tone for what is acceptable care out there. And it's, I think that's one of the biggest problems out there. Because that's why I got ostracized at the start, because it was like, why is Joseph saying these things things that all of these esteemed professors around the place, if what he was saying had any weight, surely other people would be saying this, but you're going against the grain. And it's because there's perverse career and

financial incentives there. Right. If you're financially incentivized to believe something, it's a lot harder to change your mind, not because you're doing it deliberately even, but just because there's so much benefit caught up in maintaining the belief. And you also see it with news organizations. If you're getting a lot of advertising revenue from pharmaceutical companies, are you really going to run that story? If you're a medical journal and you make a lot of money from reprints about like clinical trials that are kind of skewed to tell a more favorable story, are you going to maybe lean in to some of your suspicions that it hasn't really been represented right?

Or are you just going to go with it because financially it works for you. And so you just kind of see how this billion-dollar industry has, you know, money has sort of subtly corrupted all of these things to a point where people are getting hurt and doctors think they're helping people but they haven't been given accurate information. Many people that are being placed in high positions in HHS, whether it's FDA or NIH, which come to mind immediately, are change agents. In this area of yours, where you're looking at these rare injuries related to using antidepressants or coming off of antidepressants, what would you say to these change agents about what they might want to look into

right off the bat. Well, let me start with something softer. I think the culture, there needs to be a change in the culture where people are looking a lot more closely at the incentives of the pharmaceutical industry and how that has swayed kind of public opinion and research. But directly in psychiatry, we need studies on the long-term benefits and risks

of these medications right now. Without getting too in the weeds, the rationale for using psychiatric medications long-term is based off something called a relapse prevention study where essentially you get 100 people on the drug and then you split them into two groups. One group continues the drug, the other group gets tapered off the drug, usually on an average of five days. Some of these people have been on the drugs for quite some time.

And then they look at relapse. These studies are completely confounded by the fact that pulling people off the drugs quickly can look like relapse. They're completely compromised. This is the evidence base right now that we use to justify putting people on medications for several years, and so we need people there who could be brave enough to say, we've been doing this wrong

at the FDA. We have not been designing these studies in a way that is sufficiently solid and scientific, and we need to do things differently. We need to ask these drug companies to do longer studies that match the duration of use, you know, I think two years, three years. Let's look at how these drugs perform compared to things like, you know, lifestyle interventions, diet, exercise. And so we need this long-term data.

NIMH at the moment, it's meant to be public, you know, the people generating research to help the public. It's meant to be independent of the pharmaceutical industry, the government protecting the people through research. We need that organization to be doing this research. Right now they're doing something called RDoC, which is esoteric brain-based research. But there are a lot of problems affecting Americans right now. Right at the center of it is how effective are these drugs long-term.

It needs a fresh look, and that's really where, personally, I would start. On top of that, I think we need education campaigns out there. We need the NIMH or another government group to endorse a slow tapering guideline to get people safely off the drugs, and then also to inform family medicine doctors and psychiatrists and different practitioners to say, the evidence for long-term use, it's kind of shaky. There are these new risks that you should be aware of. Share this with your patients. There's a lot of things that I think these change agents could do, but that would be a start. And so, you've highlighted how important it is for people that might want to be coming

off these drugs to do it well under medical supervision. And that's indeed what you do. And I'm not asking you to be overly self-promotional or anything, but I don't think there's a lot of people that do this. So how can people learn to get, or where can people get the support they need if they want to explore this? Sure. So there's several places and I'm going to give you the names of different directories out there for physicians who do this type of work, who have this leaning, and you can put them in your show notes. I mean my website is taperclinic.com and I'm very active on social media. Essentially what my social media does, particularly the YouTube channel, it's Dr. Yosef, we have a lot of

guides there on how to get people safely off medications. And so there's a whole range of resources there. We also train clinicians. And so if you're a psychologist, nurse practitioner, doctor, and you're looking to learn about safe tapering practices, we share them. We share all of our internal trainings with people. We have a free mentorship group where clinicians can ask us questions. So I go to our YouTube channel and I'd also look at the directories for the doctors that lean this way.

And what about for people that might be suffering from PSSD? Where could they go? So for people suffering from PSSD, I wish I had good news and I could say that there is a clinic that you could go to where they could offer you an intervention. The only things that I've seen really help this condition is time, and so I don't want to create the impression that you could go to a doctor and there would be some fix for this other than time and chance. Don't get me wrong, some people are using things like Viagra and you know, the different medications, but these are symptomatic treatments that really aren't that effective for the global thing. The best place to go if you're having PSSD is PSSD Network. It's a community of people. You'll feel less isolated if you connect with them, and they also share research that's coming out about it. So PSSD Network is really the place to go.

Any final thoughts as we finish today? It would just be the recap that if you're hearing this right now and you are worried about a medication that you are taking, please do not stop at cold turkey. Please do not rush off it. Make sure you are informed that you need to go slowly because it could really make things worse. Well, Dr. Josef Witt-During, it's such a pleasure to have had you on. Thanks for having me on. Thank you all for joining Dr. Josef Witt-uring, it's such a pleasure to have had you on. Thanks for having me, Jan. Thank you all for joining Dr. Josef Wit-During and me on this episode of American Thought Leaders.

I'm your host, Jan Jekielek.