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[RUSH TRANSCRIPT BELOW] More than 11 percent of Americans take antidepressants, including rising numbers of kids and adolescents and even pregnant women.

The majority of Americans believe that depression is linked to a chemical imbalance in the brain, and that drugs can fix this imbalance—just as someone with Type 1 diabetes might take insulin. But that’s not true, according to board-certified psychiatrist Josef Witt-Doerring.

“There’s never been any evidence that there’s been a chemical imbalance,” Witt-Doerring says. “There is no way to differentiate patients who are depressed from those who are not depressed using any objective markers.”

Instead of fixing a chemical balance, what antidepressants really do is mask symptoms, he says.

A former FDA officer and now director of TaperClinic, Witt-Doerring helps people safely get off of psychiatric medications.

In this episode, we dive into the realities of antidepressant drug use, what most patients often aren’t told by their doctors, and how a patient can be weaned off of psychiatric drugs safely and avoid devastating withdrawal symptoms.

How do these drugs affect people long-term? Are they really safe for pregnant women? And what kinds of potential side effects do they have?

And we dig into perhaps the most taboo subject of all: Is there a link between antidepressants and mass shootings?

Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of NTD.

RUSH TRANSCRIPT
Jan Jekielek:

Dr. Josef Witt-Doerring, such a pleasure to have you back on American Thought Leaders.

Glad to be back.

So what’s the bottom line? We keep hearing about SSRIs [selective serotonin reuptake inhibitors]. We keep hearing about antidepressants, that they’re maybe not effective, not working. But then there are lots of studies that show that they do have a positive effect. What’s the bottom line?

It really comes down to the definition. What does it really mean to say that this medication works? And I think to answer that question, you really have to look at the chemical imbalance theory, because a lot of people have this idea that antidepressants are fixing something, you know, kind of like a type one diabetic takes insulin. So if it’s okay, I’d like to talk a little bit about that.

Yes, please.

So back in the 1950s, antidepressants emerged onto the market for the first time. And the way they were discovered was in tuberculosis patients. There was a new drug called iproniazid, and they noticed that when they gave it to those TB patients, they looked less depressed. They started to appear more energized. And so someone noticed this and said, well, let’s try this with patients who have depression. And they noticed that that effect translated. These depressed patients became more lively.

Now, as they discovered more about this drug and other antidepressants that were emerging at the time, they found that they were actually increasing monoamines, which is a name that we give to serotonin, norepinephrine, and dopamine. And so what the original researchers reasoned was that maybe depression is actually caused by deficits of those chemicals, and the reason these drugs are working is that they’re correcting that.

Now, I don’t really buy that because I think the alternative explanation is that you’re giving someone a drug that’s having a drug effect, and it’s masking it. You don’t have to postulate that the person is depressed because they were lacking those chemicals, but that ended up being a very commercially important narrative for drug companies. And so they kind of ran with this idea that the antidepressants were fixing an underlying thing because it’s better PR to say that they’re fixing a medical condition that you have than to actually confront the other side, which is that you are taking a drug that has a drug effect that is masking your symptoms.

Most people feel uncomfortable about that because they start to think, well, I don’t want to mask symptoms. I don’t want to sweep real problems under the rug. And so that’s where this idea of the chemical imbalance comes from. Now coming back to your original question about whether they work: a lot of people think that they work in that they are fixing this imbalance; they are restoring them to a normal state. That’s not true. There’s never been any evidence that there’s been a chemical imbalance. We’ve looked at the CSF [cerebrospinal fluid]. We’ve looked at metabolites for serotonin. We’ve done postmortem autopsies on the brains to look at receptors for serotonin. We’ve also done brain scans. We’ve never found a chemical imbalance.

And so we’ve never found depression connected with a chemical imbalance in the brain. That’s the bottom line.

That is the bottom line, yes. There is no way to differentiate patients who are depressed from those who are not depressed using any objective markers. And that’s why when you go and see a psychiatrist or a family medicine doctor, they’re not doing blood tests, they’re not scanning your brain; they’re essentially just doing a checklist. These are not biologically grounded conditions. And so the idea that you’re taking a drug that is going to fix that chemical imbalance has no legs underneath it because we haven’t even found it; there’s nothing there.

But what the drugs are doing, and what they are doing fairly consistently for people, is inducing a drug effect. And if we’re going to go with the most common class of antidepressants, which is the SSRIs, what that effect typically is, is one of emotional numbing, or emotional constriction, we say. And that can be experienced as very therapeutic for some people. If you are in a state where you’re having a lot of anxiety, and you take a drug and it kind of constricts that in, it sort of numbs that out, you’re going to feel better. And if you’re highly suicidal, you might even say that that drug saved your life.

And so I think that, yes, these drugs do work. They consistently produce this effect, and that can be experienced as therapeutic for some people. But for others, and this is why oftentimes you’ll never hear psychiatrists or the media kind of talk about them as having a drug effect, for some issues numbing someone out and masking those problems is actually going to make them worse because they need to actually focus on why they’re unhappy instead.

So the bottom line is basically it’s complicated.

Yes, it’s a lot easier of a narrative to kind of sell. You have a chemical imbalance, you have a problem, take this drug, it’s going to kind of pick it up to a place that’s normal, nothing to see here. But the truth is that depression is so much more complicated than that. You can have problems with your relationships and with work. Your physical health can sometimes result in depression. And if you’re not addressing those things, and you’re just kind of masking the symptoms with a drug, sure, you’re going to feel better; you could say that it’s working. You could say that it’s helping, but it’s not actually getting to the underlying reasons.

And this is really important because over time these drugs actually wear off. People become tolerant to them, and then you can get into a situation where you’re sort of maxed out on the dose of the drug; it’s wearing off, you’re not experiencing that therapeutic effect anymore, and you still have all of those problems that led you to getting on the drug in the first place.

And this is what drives polypharmacy. The tolerance leads them to start another drug; it wears off and they start another one. And this is why you hear that some people are on four, five, six medications. Then, they’re going for things like ECT [electroconvulsive therapy] and TMS [transcranial magnetic stimulation]. It’s not really a sustainable long-term strategy for many people.

So polypharmacy, that’s taking multiple drugs to deal with a condition, and you’re saying too often that’s because of the tolerance that’s developed. What about ECT and the other acronym you mentioned?

Yes, so ECT, electroconvulsive therapy, is shock therapy. TMS is transcranial magnetic stimulation. These are psychiatric interventions that are end-of-the-line treatments. After you’ve used the medications, they’re this advanced therapy. ECT has a lot more side effects. There’s cognitive damage that can emerge from it. But ultimately, people will end up there after they’ve been on five different medications and they have worn off.

One of the really sad things about what I’m seeing in my field right now is that there’s some dishonesty when it comes to explaining to patients why all of these medications aren’t working. Because I think an honest response would be, yes, this is the understandable and predictable outcome of masking symptoms with the drug effect that your body is adapting to, and here we are. But many patients are told that, well, you have treatment-resistant depression; your mental illness is evolving; you’ve developed a new condition. They don’t really tell the patients honestly what has happened. They just keep on stacking on treatments, when the solution might actually be to come off of them and find another approach.

Just a little bit about electroconvulsive therapy and TMS. From what I understand, there are campaigns to get rid of electroconvulsive therapy itself. Is it something that actually helps people? This is basically the same question as with SSRIs. And I guess, is it for depression? Is it for other conditions?

There are two main areas where people use ECT. The first one is depression, and the second one is catatonia. Catatonia is a state of, it’s a very severe psychiatric state where people can sometimes stop moving; they stop eating, and they enter a kind of a frozen state. Now for catatonia, ECT can be very effective in breaking people out of that, so I want to put that aside. I do think there is a use for ECT for patients with catatonia that don’t respond to other things.

But where it’s used mostly is in depression, in treatment-resistant depression, and the reason that it’s so controversial is that it can cause a lot of memory impairment. After you get ECT, you can forget large portions of your life; they call it retrograde amnesia. And that can be very devastating for some people. Some people even report that they have difficulty remembering things going forward.

The issue, and why this has become so controversial, is that it’s often downplayed. The psychiatric establishment has said, you know, ECT, it’s well tolerated; there are not a lot of side effects, but there’s actually a very large group of people out there who are saying, no, I actually have enduring problems with my memory after this. Coming back to the question of does it work, it does work for some people. and it will kind of break them out of the depressive cycle.

The issue is that it’s being used on a lot of patients whose problems aren’t actually, you know, this depression or this treatment-resistant depression. Their issues are really drug-induced, you know, they’re on a cocktail of five different medications that have worn off, causing side effects. And instead of the doctors looking at that and seeing it in that context, they’re very quick to say, no, you just have severe depression. They don’t look at the medications and start taking them off to see if the person gets better. And so that’s what I think is going on with ECT.

And before I ask you about TMS, because I’m also, that’s one that I’m not familiar with. Actually, a very influential book in my childhood, or I guess early young adult years was a book called Zen and the Art of Motorcycle Maintenance, which is a book where a guy is with his son, and he’s had ECT done, and he has retrograde amnesia, and he’s trying to figure out who he was on this trip. So I’m very familiar with this. But this was actually quite an influential book in a lot of ways for me. But what about this TMS?

TMS is like baby ECT. It’s actually a lot less harmful on average, and there’s less controversy about it. It’s essentially a large magnet that sends pulses into the brain that disrupt the magnetic fields.

As opposed to electric shocks, right?

As opposed to sending a direct current through the brain and inducing a seizure, because that’s what happens in ECT. Patients are awake when they get TMS. It’s less effective than ECT, but it also causes fewer side effects. And I’d say there’s much less controversy around that treatment.

I want to come back to your work. So your work is focused a lot on helping people come off of these psychiatric drug cocktails. And I think as we’re starting to talk about that, I want to mention that it’s incredibly important for people to do it properly with help. It needs to be done slowly. It needs to be done with support because sometimes cutting them off very quickly, which some people might be tempted to do if they realize that those drugs might actually now be the problem, can cause its own suite of problems. If you could just speak to that a little bit.

Yes, it’s an area where some nuance is needed. Now, I work in a specialty practice. People come and find me after they’ve had difficulty coming off their medications. Now, I want you to imagine that, let’s say you’ve been on an antidepressant or something like Xanax or Klonopin for several years. You know, that’s a lot of Americans. Quite a large group of them can actually stop these drugs pretty quickly.

Within a couple of months, they have really nasty withdrawal, but then they kind of pull through it, and things normalize for them. They move on with their life, and withdrawal is never really a big issue for them. I would say that they have very healthy, elastic brains. There’s something just about them that allowed them to adapt coming off that drug really quickly and readapt.

Now, what I focus on in my work is a smaller piece of that pie. There is a group of people that when you bring them off that medication over two months, that’s what I would say is a fast taper. And that’s really common for a lot of family doctors and psychiatrists. They will actually develop very severe withdrawal symptoms that do not get better. Well, they’ll develop very serious withdrawal symptoms that don’t get better in that timeframe.

Now, there are two really important things that most people need to be aware of here. The first thing is that if that happens to you and you don’t have one of these very elastic brains that can readapt quickly and you get through it, your doctor will tell you sometimes that, well, this is unexpected. I’ve been taught that you can taper people in two months, that the withdrawal is mild, and that it’s going to go away. And because that hasn’t happened with you, this is proof that your underlying condition is coming back. And this means that you need the drug. And so they’ll put the patient back on the drug, and this person essentially ends up on an unwanted medication, potentially indefinitely, afraid that they’re unable to come off. And so that’s happening with a lot of people.

Now, the other area, which is even less common but very important, is that some patients, when you pull them off the medications too quickly, particularly antidepressants and benzodiazepines, develop a condition called protracted withdrawal. And probably the best way to describe this is just to tell you what it’s like for a patient. So you go in and see your doctor, and you’re coming off Xanax or Klonopin. These are really common sedatives. Your doctor pulls you off pretty quickly, or maybe you do it yourself, and you end up with a lot of withdrawal.

You’re anxious, you can’t sleep, your ears are ringing—all pretty normal stuff. One month goes by, two months go by, and you’re still feeling unwell, and you’re white-knuckling it. You say, you know, if I just hang on long enough, I’m going to get through this, and I don’t want to give up. Three months go by, it’s still there.

Then you say, you know what, this is too much. I want to get back on the drug. I can’t deal with this. I’m going to figure out another way off. They get back on the drug, but the symptoms don’t go away, and so then you have a person who, you know, is essentially experiencing severe anxiety, brain fog, ear ringing—a whole host of neurological problems. That person has actually experienced a form of brain damage, and that’s really what I focus on in my practice: this small group of people whose nervous systems become incredibly sensitized, and for them, it usually takes about 18 months to two years to recover.

Sometimes it’s even years after. It’s like you’ve had a concussion, and that has been really important for me because it’s actually changed the way I practice. I now recommend to anyone that I talk to that you have to come off these medications in a controlled way. You need to do it gradually because severe withdrawal for some people—and we cannot predict who they are—can actually cause this type of injury, which is very disruptive to their lives.

What percentage of people are not the sort of neuroplastic type that can come off these common sedatives in a couple of months?

No one has ever studied that, but I will say I think it is a small fraction of people. I think it’s probably five to ten percent who have protracted withdrawal. Maybe it’s like, I think forty percent of people will have a lot of difficulty and may not be able to come off that quickly without severe symptoms. But the people who actually get hurt—that’s really small.

Now, I don’t want to diminish the problem because even if I say it’s a small fraction of them, there are millions of people dealing with this problem. When we have 15 percent of the American population taking antidepressants worldwide, that’s an enormous amount. And when you go online, you can go online to places like Surviving Antidepressants, other different online forums, and Facebook groups—that’s where these folks are. There are hundreds of thousands of people in these forums supporting each other as they’re going through this. So it’s not common, but it is a big public health issue.

The other dimension that we haven’t talked about yet is the side effects, which I understand often people coming into using these drugs are not aware of. And I’m not talking about the sedatives, but I’m talking about the SSRIs.

Sure, the antidepressants. So the side effect issue, if I were to list the ones that I’m most concerned about—and there are a lot—so I’m going to move fairly quickly on this. The first one is something that everyone should be aware of, and that is the risk of actually not dealing with the real problem because if you go and see a doctor, and they’re just like, hey, Jan, you have major depressive disorder, take this medication.

But actually, maybe there was some issue with your relationships or your work or something like that. You’re distracted. You now think, I’m going to understand these problems; it’s coming from my brain, and you miss the opportunity of actually addressing real issues in your life. And so they fester. That’s the main thing that I really worry about.

Now, there are some other issues which are less common but important. And so one of them is behavioral changes. And so the ways these have turned up in the media is really the issue of drug-induced suicide and drug-induced homicide. And so that is, you know, I’m not going to say that that’s a common issue, but it’s something that people need to be aware of, and they kind of have similar mechanisms, which I want to go into.

As I mentioned before, these drugs, the SSRIs, generally have a blunting and constricting effect, but all drugs, you know, recreational and otherwise, there can be a group of people who will have a paradoxical effect. The example I like to use is you could have ten people sitting around smoking some cannabis, nine people are giggling and having a good time, and you get one person who becomes paranoid. There’s just something unique about that person’s brain and their genetics that they have that bad reaction.

Now, if we’re talking about suicide, if you get someone who is already depressed, and then you expose them to a medication and they have one of these paradoxical reactions, you can actually make them worse. You can kind of tip them into actually acting on those behaviors. So not only are they depressed and suicidal in the first place, now they become more depressed, more agitated, more impulsive, very blunted and disconnected. They’re not having a therapeutic experience on it. And so they may impulsively end up taking their life because of the medication.

And this actually happened recently in a case I read about, a young man called Bryson Burks. He was 20-years-old and had a football injury. Now, he was never depressed before, but his doctor put him on three antidepressants for pain. He took them for several months while he was recovering, and when he healed, he came off of them. During that withdrawal process, he became unstable, and he actually took his life. His mom has been now speaking out about the risks of coming off these medications, because it was a completely avoidable death.

So in this case, if he had come off them slower or he had supervision, what I’m getting at is, it’s avoidable. How?

So the symptoms have to do with coming off the medication too quickly. If you do a staggered approach off these meds, you know, you drop 10 or 15 percent, and then you wait a short period of time, then you do it again, you’ll be much more in control. And so some withdrawal is inevitable when you’re coming off these medications, but you want to keep it in that mild to moderate range of symptoms where you’re still functioning well. You need to avoid severe withdrawal symptoms where you can become unstable.

Now, what I read about this case, and I don’t have all the details, is that he came off three medications in three weeks. And that is a lot, even if you’ve only been on the medications for several months. And so it was likely he was pulled off rapidly and  essentially went into severe withdrawal, and it did something he never would have done if he wasn’t in that state.

And then what about homicide? Now, this is a very controversial area that does not get a lot of coverage. And this has turned up in a lot of discussions about school shootings, actually, that they noticed that school shooters are taking SSRIs. And so I want to unpack that.

I want to start by saying this. I’m not trying to say that every single school shooter or mass shooting gun is a more deadly weapon and it can cause more harm. That said, the role that these antidepressants play has to be considered. And I want to talk a little bit about the drug labels quickly before I go on to this, because I know some people, they hear this and they go, this is quackery. There can’t be a link here.

If you just look at the drug labels for Adderall and Ritalin, in the warnings and precautions, it already lists aggression and hostility. This is where they put the most important risks. If you look at SSRIs, it already lists there in the label that they increase the risk of suicidal behavior. It lists hostility, agitation, and violence. If you look at Abilify, which is an antipsychotic, homicidal ideation is already in there.

And so what I want people to be aware of who are listening to this is this: these risks are actually already in the drug labels from the manufacturers. Now the question is, okay, sure, maybe there’s some violence, maybe you can have homicidal ideation. But can this have been linked to actual homicides? Time and time again, we’ve seen this go through the court system, and judges and juries have found that this has been involved.

Perhaps the most well-known case of this was a case in Wyoming, and it involved a gentleman named Don Schell. He was an older man and he had been exposed to Prozac in the past, an SSRI, and he had an agitated response to it and they stopped it quickly. His next doctor, who did not know that he had that history in the past, gave him a drug called Paxil, which is an SSRI.

Now, this shouldn’t have happened given he already had a bad experience with the same drug class. And so Don’s new doctor put him on Paxil, and within a week, he killed his wife, he killed his daughter, and he killed his granddaughter, and then he shot himself. I mean, an unspeakable tragedy for the family.

Now, the surviving son-in-law, his daughter’s husband, and the father of the grandchild that he lost, brought suit against SmithKline Beecham. This was before GSK [GlaxoSmithKline] had formed, and this was heard before a jury in Wyoming. They ruled in favor of Tobin, that was the name of the son-in-law who survived. He was given a million-dollar verdict; it was for failure to warn. SmithKline appealed it, but it did not change the verdict.

So we already have court cases where judges and juries have heard the information and said, you know, if not for the drug, this wouldn’t have happened. The same thing happened in Australia. A man strangled and killed his wife during a bad reaction to Paxil again. The judge ruled there as well; if not for the drug, this wouldn’t have happened.

There have been many other cases that have been described in a paper by David Healy, who really is the big expert on this, called Antidepressants and Violence; Problems at the Interface of Medicine and Law. So this is already happening. I know we don’t like to talk about it in the media. It’s something that’s very suppressed. But the courts are already dealing with this, and they are finding that these drugs are playing a role.

I often hear about possible SSRI involvement in shootings, but typically we hear about this with respect to mass shootings. Is there any relationship that’s been drawn there?

So perhaps the most well-known case when it comes to mass shootings was a case that was in Louisville, Kentucky, that involved a gentleman named Joseph Wesbecker. He went into his place of work, I think it was a paper printing factory, and he killed several people with a firearm. This case is a little bit complicated, though. There were multiple lawsuits about Prozac and violence at the time, and this was the first one that went forward. But before it got to a verdict, it was settled out of court, so we never really had a jury rule on it, but many people thought that the drug was involved.

What we know is that many of the mass shooters are exposed to antidepressants. In the case of some who are trans, there are also hormone medications as well, which can have a mood destabilizing effect. And so there is potential there that you get someone who is already unhappy and you put them on a medication that’s known in rare instances to cause these issues that can lead to or precipitate violence. Now, the problem is that we’re really not looking at it. And it’s very rare to evaluate someone who does something like this because they usually take their life.

The only case that I’ve really heard of recently where we were able to interview someone where it looked like there was a relationship was the Aurora shooting. I think it may have been 12 people who were killed in Colorado. It was the Batman shooting where James Holmes dressed up as the Joker, I believe, and he murdered a lot of people there. There were multiple forensic experts that ended up interviewing him.

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What Doctors Often Don’t Tell You About Antidepressants | Dr. Josef Witt-Doerring