20 Brutally Honest Truths About Psychiatry – part 1
Here are 20 brutally honest truths about psychiatry in about 20 minutes that could save you from wasting decades of your life on medications. I’m Dr. Josef Witt-Doerring, and I run the world’s largest practice dedicated to helping people come off psychiatric medications, and these are the things my patients wish they had known before they even started psych meds. Let’s get into it.
- To start with, psychiatric diagnoses, these are labels. These are not explanations. What that means is that there is no unified biological understanding for why these conditions occur. There’s, there’s nothing, there’s no lesion on a brain scan or chemical imbalance. This is why no diagnostic tests are used in psychiatry. How these conditions were created was essentially by a bunch of people voting on what symptoms they thought represented these conditions, so this has nothing to do with biology.
2. Number two, most people with psychiatric diagnoses, they do not have anything wrong with their brain. They’re simply suffering from life hardship issues or health issues. They’re, they’re struggling with things like loneliness, job dissatisfaction, financial stress, struggling to see a path for themself in the world. They also have problems with poor health driven by diet or substance abuse or lack of exercise. I think many people get kind of pulled into the psychiatric narrative where, you know, it’s a brain illness because it’s easier that way. It can simply be easier to say, you know, “I’ve got something wrong with my brain,” rather than contend with these much more complicated problems that people are facing.
3. Number three, psychiatric medications, these are not a cure. They do not fix any kind of chemical imbalance. This is just, uh, marketing slogans, not scientific fact. In fact, the way these drugs work, every single one of them, is by masking the symptoms that the person is, is experiencing. They’re not fixing or reversing any abnormality because we can’t find them, ’cause if (laughs) we could find that abnormality, we would test for it and show it to people. And so, that’s how the drugs work, not by fixing anything, but by papering over the symptoms.
4. Number four, most people who take psychiatric drugs long-term will run into the tolerance problem. What this means is that as you take these drugs over time, our body pushes against the effects of them and they wear off. And what this means is that if you’re gonna continue to use this as a solution, you will need to increase your dose over time. You may get maxed out on one medication and need to start another medication, and this is the way that we see someone who starts on, like, you know, a low dose of an antidepressant. After 10 or 20 years, they end up on, like, five different medications because they’re constantly trying to get that new drug effect as their body is fighting against it.
5. Number five, psychiatric drugs can actually worsen some people in the long term. This is the rule rather than the exception, and we see this across all of the drug classes. Antipsychotic medications, they can cause a permanent movement disorder called tardive dyskinesia. It’s highly correlated with cognitive decline. Benzodiazepines over time will make some people more anxious. It’s called benzodiazepine-induced neurological dysfunction. Sometimes they’ll even develop, uh, neuropathy, like tingling in their hands and feet or even, like, ringing in their ears or light sensitivity. That, that is a toxicity that happens long term with benzos. When we go into the mood stabilizers and we look at things like lithium, lithium can cause a condition called silent syndrome. Uh, this, this looks like dementia, and, and you have, like, tremors as well, and it can be irreversible in some people, and there’s no difference with antidepressants. S- particularly the serotonin antidepressants, like the SSRIs and the SNRIs, they, they can cause a condition called tardive dysphoria, where long term people will start to develop this feeling of being very blunted, having low motivation, um, some cognitive impairment, and high background anxiety, and it’s always there. You know, they try and increase the dose, it doesn’t really go away, they never feel quite themselves again, and unfortunately, what I see with many of these people who have these drug-induced worsenings is that it’s misdiagnosed and the doctors will tell them they’re treatment-resistant, and then they end up on ketamine or TMS or end up with, like, 60 treatments of ECT, and the docs never realize that it’s actually the drugs that were making people worse.
6. Number six, long-term users of psychiatric medications are essentially guinea pigs. Despite claims that these drugs are safe and effective, none of them have been studied in a placebo-controlled trial that lasted longer than a year. Uh, this is obviously really important because 50% of Americans are taking these drugs for five years or longer, and so we really don’t know what’s going on after a year. Are they still effective? Now, it doesn’t make sense to me that we’ve never done this study and that the NIMH has never extended these beyond a year to kind of match how long the people use these drugs for. You can do it, it’s not too expensive, and it would seem especially relevant given that the drugs wear off over time, they cause tolerance, and in some people they make them worse. We really should be seeing what these drugs are doing long term. So yes, the, the long-term users, um, we don’t really know what’s gonna happen to them. Yes, some people, they don’t develop a lot of tolerance, they use them long term and they’re fine. Other people, the drugs just wear off, they end up on multiple of them, and some people, they’re worse. Right now, because we haven’t done any clinical studies, we cannot predict who is gonna have what outcome and so your doctor doesn’t know the odds of that and you don’t know the odds of that, and so long-term use of these medications can really be a dice roll. People don’t understand that.
7. Number seven, coming off psychiatric medications, and this is especially true for antidepressants and benzodiazepines, can be one of the hardest things a person ever does in his life. Drop it in the comments below if that’s you so people can read about that. Um, this process can take years and it can be excruciating. This does not happen in everyone. Like, I have lots of people who come to my practice, I just talked to a mom the other day who was like, “Oh, I stopped my antidepressant, you know, essentially cold turkey during my first two pregnancies and it was fine,” but then the third time that she did it-… the bottom fell out and she completely fell apart. And so this is one of those nuanced things where some people, for reasons I don’t understand, even after using the drugs for several years, they can come off quickly, but eventually it breaks and then, and if they try that again, it doesn’t work. I’ve had some people on the first time they’ve tried to come off, they’ve had a really hard time, and so I think it’s something genetic. Some brains just seem to be more elastic, better able to adapt off the drug than others, but it can be a huge risk. Right now, we don’t know h- how to predict who is gonna be one of those people who will have a challenging withdrawal.
8. Number eight, withdrawing from antidepressants and benzodiazepines can cause severe neurological damage known as protracted withdrawal. Yeah, this is true, so for some people when they come off these medications, they go into severe withdrawal, they go, “Oh my God, I’m gonna hang on, I’m just gonna grit and I’m gonna bear it, I don’t wanna slide backwards, I’m just gonna deal with the withdrawal ’cause it’s going to go away.” That doesn’t happen for everyone, and some people will do this and then when they try and get back on the medication, the symptoms don’t go away, and I mean, I’m talking really bad symptoms, some people develop a condition called akathisia, where they pace a lot and they have severe anxiety and cognitive impairment and it stays for a really long time. This is, like, so disabling, people stop work, they go on disability and they are, uh, you know, essentially sick for several years when this happens. We have completely ignored these people within the medical community and if you, if you’ve never heard of this before, go onto Benzo Buddies or Surviving Antidepressants, like those two websites. There are hundreds of thousands of people out there in these groups who are supporting each other through it, and I think millions of people worldwide are suffering from this, um, condition right now, and we do a terrible job, um, educating doctors about this.
9. Number nine, cannabis is a major gateway drug for, um, bipolar and schizophrenia diagnoses, especially when it’s used in young adults and teens. Um, a lot of this is driven by big cannabis and the high potency THC products which are no- now out there, and also some chemical THC products, and essentially the cannabis industry has con- convinced people that these drugs are medicine, and that they’re harmless. That’s not true, you are much more likely to have a manic or psychotic episode if you’re using cannabis regularly, and many doctors will not think cannabis is that big of a deal, they will overlook it as something that can cause, um, bipolar or schizophrenia, and then people miss it, they’ll, they’ll get on any psychotic medications, they think they have these conditions and they keep on smoking cannabis and they could essentially avoid a lifetime of any psychotic and mood-stabilizing medication if they just cut the cannabis out.
10. Number 10, caffeine, nicotine, and inactivity are some of the biggest gateway drugs to anxiety disorders and ending up on SSRI antidepressants. Without a doubt, caffeine, especially if you’re having more than, like, a small cup per day or you’re s- drinking it after 10:00 AM, it will impact sleep, it will cause problems with anxiety. Nicotine does the same thing. People always tell me, “No, I smoke because it relieves stress,” you are relieving withdrawal, uh, you’re addicted to it, you’re going into withdrawal in between, um, cigarettes, and that’s what it’s getting rid of. When, when they’ve done controlled trials with caffeine and with nicotine, they increase anxiety and they decrease sleep for both groups. Inactivity is also another important thing, some people spend their whole days sitting behind computers, you know, nicotine products, drinking coffee, they don’t move their bodies. This, guys, this was me, I used to do this when I was at the FDA and I felt terrible, I started taking Xanax. I mean, that’s essentially the story. I know I’m not the only one, I see this all the time. If you’re having high anxiety, if you’re having difficulty sleeping, 5,000 steps a day, it’s not that much, you know, 30 to 40 minutes a day, cut out the stimulants and just see how you sleep and see how your focus and your energy is throughout the day. It might take five weeks or so, um, but it makes a huge difference.
