308. PSSD, Anti-Depressant Withdrawals & NOT Telling Your Doctor You’re Depressed
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Thank you for listening to the Boost Your Biology podcast. My name is Lucas Owen. I uncover the most cutting edge health information on the planet, ranging from hormones, nutrition, supplementation, fat loss, biohacking, longevity, wellness, and a whole lot more. Welcome to the Boost Your Biology podcast.

Hello, ladies and gentlemen, and welcome back to the Boost Your Biology podcast. Today, I'm very excited because we have a very special guest who I've been following his content for the past year or so, and have been extremely impressed with the quality of his information and the way that he's raising awareness for common issues with

drugs and medications. So joining me on the studio, we have Joseph Whitdoring. Joseph, welcome to the podcast. Lucas, thanks so much for having me. Awesome. So maybe Joseph, I guess we can sort of start out by

outlining the fact that you are a board-certified psychiatrist, but I would say you don't typically follow the exact same path as your standard typical psychiatrist. So maybe do you want to share a little bit about your journey, how you got into this? Sure. Yeah. Okay. So...

I went into psychiatry because I really loved self-help. I loved thinking about how you could live better and have more fulfilling relationships, find work that you love. And when I was in medical school, I thought becoming a psychiatrist would be a great way to merge those two interests. Unfortunately, when I entered the mental health field and I trained in the US, I noticed that it really was so far from that, that it shocked me. We

We would just spend, you know, 15 minutes with our patients, you know, no one really seemed to get to the root of what was bothering them, whether it was life stresses, dietary problems, or something else, you know, we kind of just diagnosed based off a checklist. And there was just an awful lot of pressure just to kind of see people in a short amount of time and not a lot of resources, resources, to be honest, like, you know, therapists at our disposals, different coaches, dietitians, things like that. And so everyone ended up getting put on drugs.

And I actually, you know, I do talk to some Australians and I know it's maybe not quite as bad as it is in the US, but I do know that psychiatrists and docs are pretty quick to prescribe psychiatric meds. And

intuitively that just felt wrong to me. Um, because I'm a, I think I'm a very pragmatic guy. And from my perspective, when there's a problem, I want to understand, you know, why is there a problem? You know, what's the root cause, but in modern psychiatry, it was very much like, if you just had these symptoms, you make criteria for this condition and as whether it's

Some people bought that. I didn't buy that. And I was just like, you know, there's a lot more to this than just assuming everyone's got these biological problems that we need to fix with drugs. But who was I? And so I had all these kind of questions about it. I'm just like, I'm sure we really shouldn't be putting people on this many medications so quickly. But I didn't really understand the researchers and I was quite insecure, rightly so, about sort of questioning everything.

And so after I left residency, I went straight to I went to the pharmaceutical industry. I did fellowship in psychiatric drug drug development. And then I worked at the FDA as a medical safety officer reviewing side effects and looking at applications coming onto the U.S. market. Then I went to the pharmaceutical industry again and was a drug safety officer.

And essentially what I noticed from studying the psychiatric clinical trials and being at the FDA was we were practicing like way outside of what the trials were showing, you know,

we'd be telling patients, Hey, these drugs are safe and effective, but we'd be leaving out like a key part, which was, you know, for the three months that we studied them, you know, and most people get put on these meds for years and truly we don't really know what's going on. And as I dug deeper into it,

I found a whole host of problems. There was issues like oppositional tolerance, tardive dysphoria, which are both essentially side effects when people get worse on antidepressants in the long run. We found there's problems with brain shrinkage, with antipsychotics, which we hand out so easily now for depression and insomnia. People who get put on benzodiazepines, many of them actually get worse in the long run. I'm looking at this stuff and I'm just like,

You know, and PSSD as well, you know, there was a group of people who got on antidepressant medications, and their sexual functioning just never returned. And so I'm looking at how we're practicing psychiatry. And I'm just saying, well, you know, we really only know how well these drugs work for three months. There seems to be all sorts of, you know, pretty bad problems that can happen in the long run.

Like, why aren't we talking about any of this stuff? And as I sort of marinated in that for a while, I learned and I've become quite cynical since then is that, you know, these problems have been known for a long time, but there's no incentive to get the information out there. You know, the pharmaceutical industry obviously doesn't

You know, they're not going to be paying for speakers to fly around the country and talk about it. They're not going to be bringing these articles about these side effects to doctors' offices and educating them. You know, they have an incentive for doctors to see this stuff in the best possible light. And then on top of that, doctors really didn't have that much time to talk to patients about it. And it was just easier to go with the flow and just say, hey, we're just going to write you this med.

And obviously, that's not good because there's no informed consent really going on about these things. We're kind of overhyping the benefits and not informing people about the harms. But then the real kicker to this was that these drugs were super hard to get off for some people. And a lot of doctors would say the withdrawal is mild and self-limited.

And I learned that there was this thing called protracted withdrawal, which most people have never heard of, even though it's in the FDA drug labels for benzos now, and it's in guidelines in the UK. And essentially what it's saying is if you suddenly come off these medications, you can develop a form of brain damage. It's as if when you withdraw from them, your brain goes into an excitatory state, and it's almost like you get a concussion, right?

And these people, and these people, like it can take them two years to recover from it. And it's completely avoidable if you taper them off the medication slowly. And that wasn't happening either. And so I was looking at all this stuff and I'm just like, you know, there's really some pretty bad things going on. And so,

I opened a practice. It's called the taper clinic. And my wife and I, originally my wife and I now mostly me help, we help people taper off these medications in a safe way. And I have a special interest in drug side effects. You know, I talked to people who have been injured by like lion's mane, you know, any, any presence and things like that. And so anything that has to do with

exposure to a substance and neurotoxicity, it's kind of right up my alley. Neurotoxic reactions that affect the brain. And so that's kind of my story. That was a lot there, but that's who I am and sort of where I fit into this. Yeah, it's extraordinary. I'm really...

I really respect a lot of what you've covered so far and I'm really excited to see you continue to grow on social media and have a stronger voice and reach more people. So thank you for doing what you do, man. I really do appreciate that. I would love to dive into the discussion around PSSD. This is an area that I've been, you know, I've created a little bit of content around it because PSSD

a number of guys within the natural health space have identified that there are certain herbal extracts things like lion's mane ashwagandha these compounds can mimic some of the effects seen in those that are afflicted with pssd so maybe you want to start out by just sort of covering you know a little bit about what pssd actually is sure so

So PSSD stands for post SSRI sexual dysfunction. And it's really a label, it's a name we give to a group of problems that happen with antidepressants, not just SSRIs, it can happen with SNRIs like Effexor and Cymbalta. And it can also happen with metazapine, I've seen it as well. But most people just refer to the whole thing as PSSD. And essentially, it's

when you get enduring sexual dysfunction that lasts even when you come off a medication. Clinically, what happens to some people is that they might have pretty mild sexual dysfunction, which is really normal. This is like 50% to 70% of people will have some mild sexual dysfunction, sometimes a bit more than mild. But when they come off the drug, it intensifies. And

a lot of people think that the symptoms of PSSD, you know, they're just confined to, um, I guess the common symptom would be like genital. It's called general anesthesia. People say that their, their genitals feel different, almost like touching the back of your elbow or your arm. It's, it's not erogenous sensation anymore. So it feels very kind of numbed out in that way. Um, they also, you know, they struggle with erection, the sustaining erections. They have very muted orgasms as well. Um,

And so many people will think that this problem is just sustained to the genitals. But when you speak with these patients, and I've spoken to a lot of them now, they're experiencing global sensory problems and some neurological problems as well. So a lot of them describe a feeling of very intense dissociation where they feel kind of disconnected from other people, almost like they're looking at the world in 2D mode.

or almost through a screen. When they go and they hug someone, they feel very disconnected from them. They're not having this welling up of sensations of joy inside them and connection.

um they also can have quite bad cognitive dysfunction as well as it can be very hard to concentrate and really interestingly and this is a unique a unique finding they don't respond to things like alcohol or drugs you can give some of these these patients a lot of alcohol or you can send them on like you know ibogaine trips and they have very muted experiences to um

to to these drugs it's it's it's really unusual and so pssd i think probably a good way to think about it is this this global sensory dysfunction that happens that really affects the genitals but can kind of hit like internal sensations like the welling up of joy emotions and um and all of that um

And the one thing that I want to say to people who are out there taking these medications is it is a, I'm going to say it's an uncommon side effect. Most people will come off the medications. They'll be just fine. It's not certain why some people have this happen to them. It's believed to be just an unknown genetic susceptibility, but it is an uncommon side effect that people have.

So my question, Joseph, is obviously it's a relatively newer area of research. Can you sort of expand upon maybe like where that research might be heading in the future with this particular area? Are there clinical trials underway now? Like what's the future direction looking like?

So it's really disappointing, actually, because, you know, when something like this, that's, you know, one, it's really frightening. But two, I feel like it's like 15% of the US population is taking an SSRI or an antidepressant medication. I imagine maybe it's kind of similar in Australia. So it's a big public health concern, even if it's like, you know,

it fairly rare. Um, but to my knowledge, there have been no, you know, federal grants studying this on the FDA or any other government organization looking into it. The only group that has done systematic research on this is a place, uh, in San Diego called San Diego sexual medicine. That's run by Dr. Irwin Goldstein. And what they did was, um,

And they're going to release this paper soon, I believe. But he did discuss the results with me when I interviewed him. What they did was they got a lot of men who had PSSD and they actually ultrasounded their penis. And then they compared it to controls, essentially, you know,

uh, people who weren't suspected to have neurological damage. They had some control samples of men who had penile fractures because they, you know, they jump on a bicycle wrong or something like that. And they, so they can look at the tissue, the tissue between, I guess the healthy fragment of the, of the man who jumped on the bike wrong. They can look at the healthy penile tissue there and they can compare it to the penile tissue, um, from the people with PSSD. Uh, and so they use a very, um,

high resolution ultrasound, a special ultrasound. And what they found when they looked in there was that there were actually some physical changes. And so there did seem to be changes in the tissue. And some people with PSSD, they talk about that there's been some shrinkage or maybe some change in the shape of their penis as well. And that would correlate. So

Right now, it's just, you know, they're putting this together, they're going to publish it, there does seem to be some anatomical changes there. But we really, that's about as much as we know, we don't know, kind of why exactly it happens. And I don't think we're anywhere near like, how could you reverse it? You know, is there some drug intervention that could reverse some of these changes? And unfortunately, from talking to a lot of people who have had this,

Quite a lot of people who develop this, it doesn't get better. There is a group of people who it'll happen to and then their body bounces back. But unfortunately, it does seem to be something that can be long lasting and potentially even permanent for quite a few of the people who experience this, which is obviously terrible.

And Joseph, in terms of the interventions and sort of like modalities that people are resorting to, including pharmaceutical compounds, you know, maybe like herbal extracts, things like that. Like over the years, what have you seen people experiment with to try and undo the side effects? Yeah, so I would...

I can only speak to what patients have told me. I do think there's probably some pretty good Reddit pages out there and maybe even some Facebook groups where you can, um, ask to see what's been helpful. Some people like it is, it's symptomatic management. So some people, uh, you know, they may use things like Viagra, you know, if they're wanting to be intimate and they're having difficulty sustaining an erection, some people will take a drug called Welbutrin, which is an antidepressant that, um,

that can also help with performance and it can also help with some of the blunting in PSSD, the emotional blunting. Some people use Adderall and they say it can help with just, again, you know, the symptoms of it as well. And

that that's really all that that that is jumping out to me there may be other things that people have tried uh but yeah it's really like a like you know trying to find a drug that helps with the symptoms in terms of the um you sort of mentioned the crossover effects in terms of they're noticing a blunting effect on not only their genital region but also like

emotional depth or like just feeling detached from their emotions. How are you seeing this impact patients when you're consulting them? So it's tremendously to the point where many people say that, you know, as horrid as the sexual side effects are, it's the emotional side effects which most people find worse because it makes you feel

um, really flat. You know, a lot of these people, they, they, they, they struggle with motivation because they just don't feel like that drive anymore. There's this, not this kind of enjoyment for life. Um, they don't feel connection to their family and their loved ones. It's almost like they feel like they're sort of locked in a box. Um, and, um,

It's almost like kind of living as if you had nothing to look forward to because you don't, it's just like you're so numbed out, but consciously aware that, you know, something terrible has happened to your nervous system because you're feeling so unusual. And so there's this, there's this like fear and this also strong lack of connection to other people, um,

And so it's awful. And when a tragedy like this happens, it can be all consuming. All of a sudden, you can't really relate to your friends and family anymore because everyone's going along living their life with their functioning nervous system and feeling joy and excitement for things. But you can't really be there with them because you're sort of just tormented by this sort of brain injury that's occurred where you feel almost like you're

I mean, I'll say just like a really bad never-ending sort of drug trip where it's just you feel really, really out of it. So it can also be just hard to even connect with people over like the day-to-day things happening in their life because it's like who gives a shit? It's just like I feel nothing. So it's awful. It's kind of like one of the worst sorts of states of mind to be in.

It almost, whenever I like reflect on it and sort of like observe it from the outside, it almost sounds like a broad spectrum oxytocin deficiency or some sort of like serotonin over dominance, you know, overpowering the dopamine release in like the VTA or some sort of like in terms of mechanisms, what have we uncovered so far and or what

Surely there's, I mean, we've got AI now. Surely we can rapidly accelerate learning and merge all of these different clinical trials together to come closer to an established mechanism. Sure. So from what I know, the mechanisms right now, it's all hypothetical. Probably the best person to follow if you're interested in a real deep dive on hypothetical mechanisms is a

um, Irish doctor called Dr. David Healy. Um, and he has, um, two blogs, one's, you know, davidhealy.org and the other one's, uh, rxisk.org risk, you know? Um, and so he talks a lot about what he thinks is, is wrong with it. Um, me, I have probably what I would say is a very

you know, just speculative. I would say that there is something about the serotonergic medications and that when you're coming off of them or when you're particularly sensitive to them, it just causes some global neurological damage, I think is what's happening. Like there's some damage to the receptors that really disrupts the serotonin system to the point where, you know, you have all these sensory problems and these blunting issues. As for like clinical trials and research, the sad thing is

Um, there, there has been no study where let's say for instance, you know, you'd have like NIH or, you know, a big research Institute in Australia where they're saying, Hey, if you have PSSD, I want you to turn up here. We're going to do an MRI of all of your brains. We're going to, um,

you know, we're going to compare it to normal brains and then we're going to run you through maybe a bunch of like different drug treatments and we're going to like image your brain and we're going to look for correlations and we're going to see if,

this gives us some better insight into what's going on. These patients, for the most part, have been completely abandoned by the scientific community. There's very little interest in studying them. I think one of the reasons is, you know, obviously the pharmaceutical industry won't do it because it's, you know, they want doctors to see their drugs in the best possible light, so they'll deny it as long as possible. But there's also this...

this thing that, that happens even among, I think psychiatrists and doctors where they feel the need to defend these medications. Um, and, and, and,

to the point where it's almost like kind of protecting the medical profession and the, you know, psychiatry because we, we, we rely on them. So we don't want people to, to, to, to think poorly of them. So it's, they, they really have been, um, that this group of patients have been kind of abandoned by the people that you would expect to, to give a shit. I mean, it's, it's, it's awful. So I don't think there's any research, uh, on the horizon right now. Hmm.

You mentioned earlier, Joseph, about Lion's Mane. What have you heard in terms of Lion's Mane usage? Because I've covered content on that as well in the past, talking about the dangers of Lion's Mane as a 5-alpha reductase inhibitor. But there's guys that are getting these similar side effects that they see with

So they're getting that anhedonia, they're getting the blunted sexual response. So what have you seen with some of the patients you've worked with? So to be fair, I've only spoken with one gentleman who had a lion's mane reaction, but I am familiar with their lion's mane recovery like Reddit. And so I do know that there's a lot of people out there and that group is growing.

You're right, it is similar to 5-alpha reductase, which is the inhibition, which is very similar to another drug called finasteride, which is something that men can be prescribed for benign prosthetic hypertrophy. That's when your prostate grows and it's difficult to urinate. And some men also take it for hair growth, sorry, to prevent male pattern balding.

And that drug can cause something called post finasteride syndrome, which is essentially the same as PSSD. And there's a lot of people who are suffering from that. And so it is likely that the lion's mane is actually causing problems via that same mechanism as finasteride, because they're both five alpha reductase inhibitors. And so, yeah,

Most of what I know is that essentially, mechanistically, it makes sense that there could be a susceptible group of people who when they take maybe a little bit of lion's mane or sometimes maybe if you're not that sensitive, a lot of lion's mane, you may cross a threshold where it becomes neurotoxic and you're left with one of these global sensory injuries that take a while to recover from. Yeah.

Yeah, that's exactly what I've been researching that and noticing that those groups are actually starting to evolve. And what I think actually happens is a lot of guys don't... It takes them quite a long time for some guys to even recognize that there's something changing from their typical norm. And they typically will just...

adjust and adapt to their new normal. But then when they reflect back on how they were maybe like a year ago, they're like, hang on a second, I never had these issues a year ago. And it's kind of making it hard for them to put two and two together. Like they're not able to link. There's no way a herbal supplement could do that to me. And then maybe like a year later, they're saying, hang on a second, that's when I started taking that. Yeah.

Well, I mean, one of the most insidious things about neurological drug injury, as opposed to say, like physical side effects where like maybe you take a drug and it causes acute abdominal pain. When you're taking a drug and it's slowly becoming toxic to your nervous system,

Most people don't realize it's the drug. In fact, they think it's things happening in their life because usually the first symptom that people have is they start to have anxiety and they start to just feel like something's off. Maybe they're more irritable. Maybe they're more tired. Maybe they start to have difficulty sleeping. And they'll actually start to look at themselves and they'll look at their life, not realizing that

Their whole perspective on the world has been clouded by the fact that their neurology is toxic at the moment. You're absolutely right. Because these side effects affect the mind, it's often really hard for people to perceive that because you're looking through the damaged organ. You're experiencing the world through the damaged organ and that can make it really challenging to make that connection. Switching gears a little bit, Joseph, in terms of

You made a video recently, which I really, really enjoyed about why people should not tell their doctor they're depressed. Like this was a really interesting video subject. Talk to us like what inspired you to make that video and maybe cover a little bit about what you were trying to elucidate. Sure. Yeah. So it's,

The video is essentially a rant on why I think the mental health care system is dysfunctional. And

If I look back on it now, I haven't thought about this. I actually think the reason I wrote this video was because I saw something on X or Twitter and it was talking about... No, no, no. What had happened was, I think at the time, my wife and I, we were at the doctor's office and she got a depression screening tool and...

I kind of looked at it and I was just like, and I was like angry at this thing. And I was just like, Oh, it's just trying to funnel people towards drugs, these bloody depression screening tools. And then I had to reflect on that. And I'm just like, well,

why is this such a bad thing? Like, here's a screening tool, it's meant to identify people who are unhappy, and then it's meant to try and help them. Why am I having such a strong reaction to, to at least this tool that's meant to be bringing up something that people can be really sensitive about, and maybe they should be talking about it. And then I thought about the mental health care system that I've been working in and how dysfunctional it is. And so I

it wasn't that it was a problem screening for depression. It was the fact that when people end up depressed and they go and tell their doctor, usually you, you know, some of the things that I was saying at the beginning tie in here, you get, you get someone who's,

who's got 15 minutes to see you. They're incentivized to see as many people as possible in an hour. They get paid more for it. They're heavily under-resourced. They don't have access to therapists that could help with relationship problems. They don't have access to maybe career coaches or work coaches that could help people find more fulfillment from work because relationships and work, I mean, these are the main things that get people unhappy.

And, you know, they don't have access to like a dietary consultant who could kind of work with them. And they don't have access to people who could help them exercise, which is another people. Another reason that a lot of people have a lot of anxiety because there's their sedentary. And so you've got this doctor there who really doesn't have time to to to

to even understand the problem that's going on with the patient. And they're heavily incentivized to see as many quickly. And because they don't have support, they just prescribe people medications and they don't help them with the root cause. And then all of these problems happen that I mentioned before. They start taking the drug, they get told it's safe and effective, but it slowly makes them worse. And then they get on more and more medications. And before you know it,

They're trapped on like several meds. Maybe they've had side effects from them. Maybe an antidepressant made them a little irritable and now they've gotten diagnosed with bipolar. It's completely changed how you see yourself. And the truth is you probably would have been a lot better off not going and seeing your doctor. And so that was what the whole video was about. It was really kind of a scathing critique at just how...

ill-equipped our current mental health care system is is true truly is to actually help people with with modifiable things that get to the root modifiable problems that we could fix that get to the root cause of why they're unhappy um and that and you know we just don't do that we just put people on drugs and and it makes people worse and so i was just ranting about that yeah yeah

Yeah, no, it's definitely a must watch. If anyone's tuning into this podcast, definitely check out Joseph's YouTube channel, which I'll leave linked in the podcast show notes so you guys can check that out. What about in terms of, I'd imagine over the years, Joseph, you had a number of patients that have also potentially come in and seen you in relation to

wanting to go down the route of psychedelics usage or they've used psychedelics and now they're suffering from consequences associated with these particular substances. So what is your stance on psychedelic usage as it pertains to mental health? So I guess I'll start by saying like any intervention has a risk, right? So

But generally, the way I see psychedelics is more favorable than daily SSRI use or something like that. And that's because of the way they package psychedelics. At least in mainstream medicine right now, they're not talking about microdoses or anything like that. They're talking about having a full-on trip

And in the lead up to that, you actually have to prepare for it. You need to go and meet with someone. You need to talk about struggles that you're having in your life. Maybe it's a past trauma or something that,

something that's made you unhappy, you then do the trip with a licensed therapist who helps you gain a new perspective on your problem. And they help you kind of come up with solutions or help you try and just change the way you're viewing things. And then you have multiple sessions afterwards where they help you try and integrate this new perspective into your life. And so the psychedelics are being used as this adjunct to therapy

And for some people, they may only need to do it once. But maybe other people might need to do it twice a year, something like that. And so the way I think about it is, well, what's better? A daily exposure to a medication or something that you do maybe like once in your life or maybe twice a year on an ongoing basis. And it's really grounded in therapy. And that's a lot more empowering than like, hey, you have a broken brain, take this drug every day.

And two, you have the power to fix your life. And we're going to use this, we're going to use this state of mind induced by this drug to kind of help you see it in a new way. And so for many reasons, I actually think that psychedelics are much more empowering and probably safer way to, to, to seek help. Um,

One thing that I do want to say is that, like all things, there's going to be a small group of people who don't tolerate these drugs. There is a condition called HPPD, hallucinogenic.

persistent perceptual disorder and a small group of people when they get exposed to things like LSD or psychedelics, they do have some neurotoxicity and they may experience for...

many months or sometimes one to two years, some tracing, like some some visuals, visual changes, and maybe some other abnormal sensations. And it is a form of neurotoxicity, but it's very rare. And so what what I would say is, you know, none of these things are always like 100% risk free. But if

If that's what you need to do because you're having a lot of problems and you can't get through it, you may take that risk and that's totally okay. The last thing that I want to say about psychedelics for people who are on medications, one of the biggest risks is that most people say, oh, you need to stop your SSRI, you need to stop these meds before you do your trip because you're going to be at risk of serotonin syndrome or it's going to blunt the effect of it.

you don't want to rush off your medications if you've been on them for a long time. And so if you really need this, you know, to do the trip, what I would say is stay on the drug while you do the trip, you know, yes, there will be an increased risk of serotonin syndrome, but if you are monitored correctly, it can be mitigated quickly. And then, and then taper off properly later on, because you might need to take like a year or so to taper off a drug if you've been on it for like a decade and

And so the biggest risk is that you go, oh, okay, I want to do this psychedelic trip. I'm going to quickly come off my medication. And it just completely destabilizes you because your nervous system is adjusted to it. So don't get pressured into any kind of rapid taper by being like, I've just heard about this psychedelic treatment and I really want to do it. That would be a big risk there. Yeah, I'm glad you brought that up because the serotonin syndrome is a...

A state that I think not many people are very familiar with and or they've just like maybe never come across it before. And I've also tried to raise awareness on this sort of state that can actually occur from...

yeah, not just combining psychedelics with antidepressants, but also certain herbal supplements such as St. John's wort, you know, rhodiola, L-tryptophan, 5-HTP, these supplements, if they're combined with antidepressants, they can lead to a state of serotonin syndrome. So maybe did you want to just sort of talk about like what actually is serotonin syndrome and what might be some of the manifestations of that?

Sure. Yeah. So serotonin syndrome is a, again, it's one of these things where you have to have like a genetic susceptibility to it, but the risk goes higher the more serotonergic drugs you're on or supplements, just like the ones that you mentioned. And essentially, either you're really sensitive to it or you take enough of these medications, you cross a threshold and it causes global neurological disorders

in multiple areas of your brain and body. It's almost like there's a circuit and it goes completely haywire because when this happens, people, they become very confused. Their temperature rises and they become very hypothermic. They can start to shake. They can start to tremor. And unfortunately, they can have seizures. And it's the seizures that occur when you're in this state of

overloaded like you know serotonergic activity that if you have a seizure long enough it can actually shut down your um your the the cardiovascular and the respiratory centers in in your brain and people code you know their hearts stop working and so it's a life-threatening emergency um the thing that you really want to look out for is confusion and kind of shakiness and sweatiness that's kind of how it starts so if you're having like a lot of that you're on your way to

to serotonin syndrome. Again, exceedingly rare, even for the people who are like on SSRIs doing psychedelics and then taking like St. John's warts. It's a very rare thing, but for some people, they're just susceptible to it and it's life-threatening when it occurs. Yeah. Yeah. Okay. You mentioning that tapering off aspect. I mean, that's an area that you guys absolutely specialize in. What are some of the biggest things

misconceptions about tapering off medications such as SSRIs and or switching gears the benzodiazepines as well. Sure, yeah. So I think we can probably handle the two together because they are very similar when it comes to tapering.

Probably the first thing is that many people are told by their doctors that withdrawal is mild and self-limiting and that it's usually over in a couple of months. That's not true. For many people, their brains have adapted to these drugs over years to decades. Essentially, the

The goal of safe tapering is you want to come off the medication without putting yourself into severe withdrawal because you want to avoid developing protracted withdrawal, even though that's rare. There are a lot of people who come off quickly and it doesn't happen to, but if it's something that happens to one in 20 people or something like that,

The consequences of it happening to you are so significant. I mean, it gets to the point that everyone should essentially be tapering safely because if it does happen to you, it's an absolute nightmare. So you...

What you want to do is you want to lower the drug in a way that's very controlled and where you can pace it to the speed at which your brain adapts to the drug leaving. Because let's say you're taking a benzo and it's causing extra GABA and now you've lost some GABA receptors in there because they've downregulated to maintain homeostasis. As you remove that drug...

the GABA receptors are going to regrow and they're going to kind of, you know, they're going to come back online. And essentially you need to pace the reductions with how quickly, you know, your brain is readapting to the absence of that drug. And if you get ahead of it,

you start to have a lot of insomnia, high anxiety, irritability, things like that. And that's the part that's dangerous. And so when we watch people kind of do these slow tapers, and sometimes we do tapers with syringes and liquids because it's very customizable and allows you to be really precise with your reductions. We noticed that it can take people one to two years to come off in this way, to do it in a way where you don't have substantial withdrawal.

And probably the part that trips up the most people is what happens at the end of the taper. And because there is something that's just a quirk with the pharmacology of how these drugs work such that, you know,

So the amount that the drugs bind the receptors and how they disengage from the receptors as you lower the dose of the drug kind of changes depending on how much drug you have. So for instance, if you're on a really high dose of it, imagine like there's...

In between the neurons, it's just like swimming in drug. So you could take out 10% of the drug and there's so much like leftover in there that it easily occupies the receptors again. And people don't really feel that much of it. And they go, I'm going to take out another 10% and another 10%. And each time they don't really feel much withdrawal.

But you reach a point with psychiatric drug tapers, and it's usually around the lowest therapeutic dose. So like the first dose that the doctor ever gave you, that's when you get to this high risk point, because at that stage,

there's not a lot of drug left, like kind of just floating around in that space. And so people will find that, oh, wow, you know, I've been, you know, if you're on 10 milligrams of a drug, I've just been taken off a milligram every month, it's been fine. And then they get down to like two milligrams, and they take off a milligram. And they just, you know, the floor falls out from underneath them, and they get

really, really bad withdrawal symptoms and then they panic and they go, I can't come off now. I'm never gonna be able to get off this.

But essentially what's happened is they've reached that tipping point where the area around the receptors is no longer flooded. And so people need to, one, be really a lot more careful when they get to that lower part and to not be dissuaded if they run into severe withdrawal. If that happens, you go back up to the previous dose, you wait a couple of weeks for it to go away. And then you need to start thinking about, well, how am I going to lower this down more steadily?

What I recommend in my practice is that you go to a compounding pharmacy, you turn that small amount of the drug into a liquid, and then you use precision syringes. And so if you used like, you turned it into a milliliter of liquid, and then you got a one ml syringe that had 100 little kind of spaces on it.

At that point, you just lower by like one space each day and then you're off in 100 days type of thing. But you need to liquefy it so you can get that level of precision because some people, they try and just shave off the tablets at the end, but that's also not really precise and it's fiddly. And so probably the biggest thing that I want people to be knowledgeable about is at the very end of the taper, it's very normal to have these symptoms and you need to find a way to kind of go down slower. And that's the safe way you get off.

Yeah, you've done a good job at breaking that down and sort of explaining that that last minute, like final stages are actually like the most critical stages to get right and do it properly and to use something like

you know, to gradually, when you say gradually taper, like you literally mean super gradual taper. Cause that's, you know, there's a certain threshold where that half-life of that medication, your brain is no longer swimming in, in the drug. Like the receptors are no longer swimming with the, the abundance of, let's say like chlorine in a swimming pool. It's like, it's no longer actually disinfecting the pool. So it's no longer effective, but, um,

What are the common reasons why people actually want to come off if it's resolving their symptoms in the first place? Yeah, so mostly it's for people when it's not working for them anymore. So if I think about like the people who come knocking on my door,

Unfortunately, actually, we get a lot of people who have failed their tapers. And so their doctor said that it could be done really quickly or they went to like a detox if it was like a benzo. And then they got hurt. And so they developed one of these protracted withdrawal injuries where their nervous system super sensitized them.

And then when they went through it, you know, a doctor threw a whole bunch of drugs at them and now they've kind of got this neurotoxicity and such. So mostly I see those people who have kind of had these neurological injuries and they're stuck on drugs. We get some people who have just bad side effects. I mean, we work with some people who have schizophrenia and they're really blunted and they're having cognitive dysfunction and sometimes neuromuscular disorders.

And they're essentially coming to us saying, Hey, I'd love to find like a way to come off if I can, or just to get to a lower dose where I'm not having side effects. And so troublesome side effects is like another reason people will come to come down.

Some people, they'll reach a point where they'll, let's say they, you know, you're like an anxious person growing up and maybe you went away to college and you didn't have a lot of self-esteem and you got put on an antidepressant. But now it's like 10 years down the line and you're a lot more confident, you're more sort of like established in your life and you've really grown into yourself.

And then they just have this kind of aching feeling. They're just like, I don't think I should need to rely on this. Like, you know, I'm not hating other people who use it. But like, for me personally, I think I would like to live a life where I'm not relying on something for my mood. And so sometimes they could just be like fundamental, just like personal beliefs of like, I don't, I just don't want this for myself. Other people might say, like, I feel kind of blunted on this. And I feel like I have low motivation. And I noticed that

It's hard for me to put my finger on anything apart from this drug. And I know I'll be anxious when I come off, but hey, I prefer that over this inauthenticity, the fact that I have to fake my emotions when I see things happening around me rather than them welling up genuinely. So it's kind of a mixture of all those things. Those tend to be the people who walk through my door at the moment. Yeah.

Now, Joseph, in terms of... I imagine over the years you've helped out an enormous number of patients successfully wean off these medications. I'm actually really curious to hear about some of your inspiring... You might have some recovery stories or something where there's a particular patient or scenario where you're like, this was incredible and I was so glad to be a part of that healing. So...

There's a couple, probably the most amazing ones are only one of these is someone that I directly helped. But two of them are people I know really well. One of them is a coach of mine called Trudy. Another one is a woman called Lauren Kennedy West, who runs the YouTube channel, Living Well with Schizophrenia. Big channel is like 300,000 people tune in to her channel.

The most transformative, crazy things that I've ever seen are people who have been on decades of antipsychotic medications with psychosis, with psychotic symptoms and severe depression. We're talking like people who have psychosis, they get ECT. I think that happened to all three of the people I'm thinking about. They either removed gluten or they tried a ketogenic diet and their symptoms completely went away. I mean, it's almost...

I mean, it's so life-changing and it sounds so far-fetched that I wouldn't blame you if you didn't believe me. But I'm going to back it up and say that they found evidence of this in a clinical trial that came out of Stanford last year. And there's now like 10 clinical trials out there trying to replicate the impact that a ketogenic diet can have on severe mental illness. And so...

by far the most dramatic kind of like, I wouldn't even believe it unless I saw it several times. Um, transformations happen with dietary interventions and people coming off like decades of antipsychotics that, that stuff is truly mind blowing. Trudy, who was my coach went from nearly, um,

I think nearly like losing custody of her kids and being in a group home, like for severe mental illness to essentially like, she's been off drugs for like five years now. She pretty much helps me run this company and she's planning on going to medical school. She hasn't relapsed in five years since she's come off. She's been, she's the most efficient, high functioning, like intelligent person that I've ever met. And it's just, it's just insane. Um,

how much it changed her life and she got on meds when she was like 17 i think she came off when she was 40 um and it's just been like it's it's crazy um this is someone that was just like yeah you have like severe bipolar disorder you're disabled like you know that that's just your life you know tough luck to to really um changing so

That's really cool. Lauren Kennedy-Wess, YouTube channel, Living Well with Schizophrenia, she talks a lot about that. It's really, really impressive. So those are probably the most impressive stories of the people with bipolar and schizophrenia who have been able to come off meds with dietary stuff. Yeah, I'm really stoked that you're mentioning and you're bringing that up to those that are listening to this podcast about just the true power and impact of

and I know you covered this in your recent video of lifestyle nutrition interventions, like let's not underestimate the impact of these interventions because these, I guess like food sensitivities or gut related dysfunction has a huge impact on mental health and neurotransmitter production, receptor sites, or gut microbiome is now strongly linked to all sorts of mental health issues. So

um yeah i'm i'm glad that you you're highlighting that and also emphasizing that because i'd imagine a lot of my audience will be happy to hear that and also hopefully those that are listening very hopeful that you know there's there's more to this than just simply some of these you know standard lines of treatment such as just pharmaceutical drugs totally

So, Joseph, in terms of, I know we're coming to the end of the episode. My audience would definitely, if they want to connect with you and or learn more about your clinic and or resources, where can they find you online? So the best place to find me is on my YouTube channel. So it's Dr. Joseph and it's spelt in the German way. I think it's on the screen now. So J-O-S-E-F, not P-H, Joseph.

And if you underneath all of the videos there, if you look at the description, there's a link to my website, it's taperclinic.com. And yeah,

you know, this is February 19th, 2025. But if you go back about a week from today, uh, I just released like a free drug tapering course. Um, I think it's titled, you know, giving away my trade secrets, but essentially it's a freebie. It's 80 pages of how to taper off, um, psychiatric medications in a safe way. And so if that's something that you're interested in, um,

you can find it there. I'll actually just send, I'm going to send the link to Lucas and hopefully he can post this content with a link to the free course as well. And so yeah, go to the YouTube channel and then you can find everything there. We're also on X, Instagram, TikTok, Facebook. We're all over the place. And so you can find me everywhere. Yeah, awesome. I'll make sure to leave those linked in the podcast show notes. But yeah, otherwise, Joseph, thank you so much for coming on the podcast. It was a pleasure chatting.

Thank you so much for taking an interest in this subject and for having me as well, Lucas.

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