Transcription
Today we're going to be talking about the ridiculous amount of psychiatric medications Americans are taking right now and what we can do about that. So what you're looking at here on these graphs is actually the use of psychiatric medications over time. And I want to focus on the female graph. You're seeing three different lines on here. The red line shows how medications were used at the end of the '90s into the 2000s. The green line shows mid-2000s and the blue line shows as recently as 2018. And you may have noticed this blue line cresting at around 60 here. Meaning that women over 60 in the United States, over a third of them are taking psychiatric medication now. And I want that just to sink in for a second because do you think that is normal for a third of women in the United States to be given psychiatric medications, uh, by a doctor for a mental health condition? That seems insane to me.
And you might be thinking that's just 2018, you know, maybe things have improved since then. It's been about 7 years. Yeah, not really because what we're looking at here is how prescribing trends actually changed in the early 2000s, um, from the start of the pandemic to the end of the pandemic. And what we're seeing here is actually increased prescribing in antidepressants, increased prescribing in stimulants and non-stimulant ADHD medications, and a slight decrease in benzodiazepine prescribing. Well, you might be wondering how that changes things. Well, it's going to lead to actually even higher numbers now. Now, I suspect we probably now have like low 20s, maybe 22, 23% of the American population taking psychiatric medications because if you look at this graph here, which breaks down the drugs that are making up this total of psychiatric medication use, it's strongly from antidepressants, then benzodiazepines, and then stimulants. And so, as antidepressants go up, the number of people on psychiatric medications is greatly affected by that number.
You might be thinking to yourself, that's kind of insane that we have that many people on psychiatric medications. But let's go now and have a quick look at counseling because that's the second thing, right? Every time there's a mental health problem, people say, "Well, you know, go and see a therapist." And if you actually look at what's been going on over the last recent years since 2019, you we've gone from 10% of people are actively receiving psychotherapy and counseling to 13%. And back in the early '90s, good god, it was 3 to 5%. Okay, so that's what people were doing back then. And just to tell you a little bit about antidepressant use since the early '90s, it was five times less. And so that's probably around again, yeah, 3 to 5% of people were probably taking antidepressants in the early '90s. And so we've had a 5x increase in therapy. We've had a 5x increase in, um, psychiatric medication use. And let's have a look at what we've gotten for that. Well, what we've gotten for that is not much, actually, because if you look at this graph here, steadily over time, the amount of suicides have increased. Okay, that's probably the most important, uh, metric that you want to know if you're judging whether mental health treatments are effective.
On top of that, mental health spending has also gone up dramatically. We are now spending 5 to 6% of our $4.9 trillion budget on mental health. And so that's about $350 billion there. And just to give you a sense to compare that to something, that's like funding NASA 12 times. That's like 40% of the annual defense spending budget in the US. 40% of, of essentially the system that keeps us safe from the rest of the world. This is an insane amount of money to be investing in mental health care. On top of that, what we have is worsening psychiatric disability. There's more people disabled, uh, with psychiatric conditions. We've had, um, teen suicidality go up. So that's been increasing by about 43% since, uh, the late 2000s. On top of that, depression is getting worse. It was thought that around 3% of the population was depressed in 1992. And now in 2025, it's looking like 16% of women and 10% of males report having been depressed in the last 2 weeks. And so if you're like me, you should be thinking, "What is happening here? Depression is getting worse. Treatments are going up. There's something really wrong."
And so before I jump into the treatments, which are clearly not working, and god, if you look at the graphs, they might be making some people worse. Let's talk about some real things that are going on. And so there's actually some real things that are making people depressed, and we have to talk about them. So economic stresses. I think since the early '90s to where we are now, um, inflation has really eroded the power of the dollar. Cost of living has gone up. Wages when adjusted for inflation have not gone up. If we look look at social media, social media has played a massive role in the mental health epidemic in the last 15 years. Life used to be a lot more simpler. There were very clear traditional paths for people to go down. There were smaller communities with deeper friendships. Now with social media, I think people, you know, there, there's a big push to be an individual, to do something unique, to do something special. I think it makes people very confused. Um, there's a big push to kind of chase things like fame and followers on Instagram. And I always think, you know, in your face, you're watching your peers kind of stunt on you around the place. Like, this person's making this much money, or they're going on this great trip, or they're going to this party that I'm not invited to. Never before have we been so aware of how, uh, pathetic our lives are, uh, before social media. And so, that is that is going on as well. And it's playing a huge role in Gen Z and younger generations. And man, I think I'm so lucky because as a millennial who finished high school in 2008, uh, things were really simple back then. You know, it still was quite traditional. You know, go to college, get a good degree, uh, get a stable job. That's great. When I talked to my younger friends, I mean, so many options and possibilities. You know, when I didn't get invited to a, you know, a cool party back when I was, uh, in high school, I didn't know about it cuz I was just hanging out with my friends. Younger people now, and that's like just shoved in their face. And so that's clearly not healthy.
And finally, we have to say that there is some increased diagnosis, increased awareness. And yes, this is all happening because of the, the pharmaceutical industry and the rise of medicine. As you saw, it's a $4.9 trillion business. This is by far the largest business in the United States is healthcare. And so when people make a lot of money out of it, there's going to be a lot of disease mongering where drug companies, hospital chains, hospital groups, they try and inflate, you know, the, the awareness of these conditions. So people drop by the drugs and use services. And so again, we have real cultural forces going on that are making people unhappy. But we have to acknowledge the fact that our treatments simply are not working because if they were, we wouldn't be seeing diagnoses going up. You know, suic, I mean, suicide going up. I mean, you could say, yes, okay, depression's creeping up. Maybe there's increased awareness. No, we're, you know, we're talking about dead bodies here.
And so, there are three main things why when you go and see a doctor and you try and get help, uh, it's not working and it might be making you worse. And so, firstly, the medications do not work the way people think they do. I mean, the first thing is, and if we're talking about anxiety and depression, and that's what we're talking about, let's put schizophrenia and bipolar over on this box. You know, depression, anxiety, trauma, those are 85% of the visits to mental health care professionals these days. Many people are sold the lie that the drugs are actually fixing something wrong with the person's brain. You know, they think they are fixing a chemical imbalance and they think that, you know, the drug is just this clean and neat solution for it. There has never been a chemical imbalance or a deficiency of serotonin that has resulted in anxiety and depression. If there is a genetic component to it, it's likely polygenic, meaning there's multiple different genes. Um, and there's just variations in the way humans are. Yes, you know, some people are nervous Nellies, but you can't necessarily say there's something broken in their brain. We have never found that. And so what this means, you know, because we're not just like boosting serotonin like people boost insulin and type 1 diabetics, uh, to help people. These drugs are just masking effects. I mean, it, it's more like taking, you know, OxyContin for, you know, a broken arm than it is like taking, you know, insulin for diabetes. We are actually fixing the underlying biological process. And so it's working through a drug effect. And so if you have people who are having anxious and depressed symptoms, I'm just going to ask you this. Do you think that in the long run, it's a good thing for those symptoms to be numbed out? To pause for a second. If there's a little itch in the back of your head saying, "No, that doesn't make any sense." You would want to actually address the problems because if you don't address the problems, they could probably get worse over time. Well, you're correct. And even if you're one of the other people who say, "Well, you know, it's a brave new world. Live and let live. You know, if someone wants to just, you know, ignore the problems and just say, 'Yes, you know, I've got these financial problems, relationship problems, but I just want to numb them. I want to, you know, use what I have from science and, you know, leave me alone.'" You are a philistine. You know, you, you are anti-science. You are living in the past. What I have to say to you is that these drugs lead to tolerance over time. You know, the brain is not a static machine. If you take a drug that disrupts your neurotransmitters, you're not just, you know, tweaking the little part in the brain that is helping you with your anxiety and depression. You're disrupting, you know, your cardiovascular system, your digestive system, your immune system, and it sends signals up into the brain that says, "Hey, make less serotonin. Hey, decrease receptor sensitivity. We need to be more balanced so our other physiological systems are working over time."
And if you talk to many people who use these medications, and over the last 10 years of doing this, this is what I see. I see people getting on medications. I see the effects wearing off over, you know, 6 months or so. Get on a higher dose, you know, over the course of several years. Sometimes two years, sometimes 3 years, they're now maxed out on a drug. And here's what they say. They say, "I don't even know what it's doing anymore." And sometimes they say, "Yeah, it's working like 10%." And at that point, people either stay on a drug that's not that effective, um, and they are dealing with the side effects, or they end up stacking drugs. And this is how like you'll meet people after like four or five years, and you'll look at their medication list, and you just go, "Five medications? How did this even happen?" You know, who was responsible for putting you on these meds like this? And invariably when I ask these people the story, they say, "Well, you know, I got on this med, it wore off. I saw a doctor. They told me my depression was getting worse. It was morphing. I had treatment-resistant depression. Now, you know, this mysterious brain illness was just evolving over time and becoming more and more resistant to the drug, you know, as if you had some kind of bacterial infection spreading through your body." Not once do they consider that, hey, maybe this was, uh, due to the drugs wearing off, which makes total sense. You know, if you think about them, you know, all drugs do that. That gets dismissed. They get told that it's a problem with their brain and they just, you know, keep on stacking the drugs on in a ridiculous manner. And if that wasn't worse enough, that, you know, the drug would just wear off. Well, actually many of these drugs lead to toxicity over time because again, you know, another question that I want people to kind of think about. But I wanted to bounce around in their head and that is, do you think our brains and our nervous systems are designed to be in a drug state for several years or decades? Do you think they can tolerate that? Do you think that's going to be just fine and it's not going to cause any problems? Well, if you're thinking, I'm not really sure, but something about that sounds concerning because maybe I've heard that people who use a lot of alcohol eventually they have problems over time. You know, maybe I've heard that. Maybe I've seen what people look like after they use, you know, methamphetamine, cocaine, things like that. They don't look too hot. Well, the same thing happens with psychiatric medications to a lesser degree. You know, these aren't as potent drugs as the other ones. I see a lot of toxicity with these things long term.
And if we're going to talk about the drug that is most used, let's talk about the SSRI, antidepressant medications. And this is what I see gradually over time. I see people become more and more fatigued. I also hear them start to complain about brain fog, a lot of the time, and low motivation. So that is the trifecta. They call that tardive dysphoria and people, they, they just say that they're, they have no quality of life at this point. They're just kind of floating through their life. They're not really experiencing much joy or pleasure from it, and their functioning has gone down. People are on benzodiazepines over time. They start to have develop obsessive thoughts and they start to become agoraphobic. They don't want to leave their home anymore. And what this is, this is just drug toxicity over time. And so one, we, we're using more of these drugs than ever before. They're wearing off over time. People are getting stuck on them. And I actually think they're making people worse. I believe that Robert Whitaker, and if you've never read his book, Anatomy of an Epidemic, it's a, it's a very popular book and it talks about how the medications themselves could be responsible for our mental health epidemic. I think his thesis is correct because I'm seeing a lot of people get worse gradually over time on these drugs. And I think it's due to direct drug effects. And so that's the first thing that, that's why I think the crisis is getting worse from a drug perspective.
And the second one is very crude because I'm going to title it, "Some therapists suck." And I just, gosh, I really want people to open their eyes when it comes to psychotherapy because it's seen as a panacea sometimes. You know, you're, you're arguing with your spouse and they're just like, "Go to therapy." Or you're really depressed and your life is in flames and someone's just like, "You know what you could do? You could go and see a therapist." And it's just kind of thrown off hand as this, you know, the therapist. The therapist will help the, the 23-year-old social worker who has no life experiences and has been trained with a cognitive behavioral therapy manual to help people who have, you know, thoughts that generate negative emotions. She will be able to unpack your life and understand it. And so I want people to have a bit more insight about what, uh, therapy is. And so let's go through some of the issues that I see with it. And, you know, I want to say this, if you're a therapist and you're listening to this or you've had a great experience with your therapist, that's good for you. This is one of the areas out there where there's so much variability in who's good and who's bad, and it's, it's kind of really hard to tell who's going to be helpful. But here, broad brush, these are the problems I see with therapy. I actually think that many therapists have become very passive and I think they don't give patients much direction in their life. You know, this is going to be controversial, but I'm in America. We're a very religious country over here, a very Christian country. And so, I'm going to sort of contrast this to, to the church, right? And so, when we talk about, uh, sort of eternal religious beliefs and values out there, and these aren't even that religious. I mean, some of these things are secular. You, you start talking about things like getting married, you know, having a family, living a life in service of others, you know, doing work that helps other people, honoring your parents, you finding a way to get along with them. These are kind of religious truths or just, you know, values that people have known over time that generally lead to good long-term outcomes. That sort of direction, those moral directions, those core beliefs that people stand behind and just say, "Yeah, this is really what life is about for most people. These are the things that make them happy." That's like missing from a lot of therapy. You know, a lot of the psychotherapies, they come out of academic institutions and they don't have like this kind of direction that they are very, um, lacking a moral framework. They are very much, you know, not wanting to say, you know, this is right and this is wrong. And a lot of it comes out of a place of being very secular, you know, which they are, but of not being judgmental. Therapists don't want to be judgmental. They don't want to impose, you know, a way of looking at the world on people. I was trained a little bit as a therapist when I was going through my training. And if you started to have judgments about how that your patients were living your life, uh, your supervisors and all of mine were psychodynamic, which is like coming out of Freud. They very much want you to be this kind of blank slate. And, um, you know, if you start having reactions to people, they say, well, you know, you should really consider where your reactions are coming from and you should consider, you know, are these really the right, you know, should you really be judging them in this way? You know, who are you to judge them? What it ends up being like a lot of the time is these sort of conversations where people just say, "Well, how do you feel about that?" and "What's your take on that?" And, you know, the patient kind of talks about it, but it's very rarely a more paternal energy in there, a more directionful energy where someone is like, "Okay, well, let's, let's have a talk about this. Okay, so we know relationships are good and you're socially isolated and you're very lonely. Let's talk about how to fix that. What is it about how, you know, how you are and how you're living your life that that's not working?" And actually calling people out on some of these things and just moving them in this direction of like community and people and hopefully having mutually satisfying, fulfilling relationships, finding jobs that, that you like. It's, it's very, very hands-off.
And the last point that I want to say about this is in general, I think to be a good therapist, you kind of have to have a good life as well. I mean, you need to be in a good relationship. You need to be doing work that you like. And we think that we can go with our relationship problems with our spouse or our lack of purpose and meaning in our jobs and, and, and how we kind of feel like sucked into that and how we've rationalized in that in our life. And we could go to like a CBT therapist who is like 25 and has a social work degree and she's like, actually hasn't really done much in her life. Or maybe even the opposite. You know, you know, she's, she's, you know, they've been divorced. Her kids aren't talking to her. She resents her job. And so, we have this label of being a therapist and we think that they're going to be able to solve our problems. I want to break that myth for you. If you have a specific problem in your life, go and see someone who actually has experience with that. They're doing it really well or they fixed it with lots of people. Don't just like blindly, you know, pick up the card in your wallet and just be like, "I'm just going to call this person and they're going to fix it." That is a mistake.
The number three reason why people are having a lot of problems is that our medical system, open your eyes, people, it's not designed to actually help mental health problems. It's designed to just kind of churn people through a medical system in the quickest amount of time. It's, it's designed to bill insurance. That's why you see your doctor for like 7 minutes of FaceTime and then they see someone else. If it was designed to actually help you, then they would be spending a lot more time with you and not just kind of half listening to you and typing away on the computer. And so, what is the solution to all of this? Well, I think the solution for many people, and this is going to sound very harsh, but I want it to sound harsh, and that is that the medical system is not coming. No one is coming from your PCP's office or the, you know, big psychotherapy, uh, organization to come and help you. We're living in a world where our mental health services are really not designed to help people in the way that they need help. And so, a lot of the responsibility for getting fixed is going to come from you. And so, here are the things that I recommend that you focus on. These four things I believe are making up like 95% of the reasons that people are unhappy right now. And also when we look at the clinical research supporting how these four factors influence your mental health, what I routinely see is an improvement between 20 and 30%. So a risk reduction for depression and anxiety of around 20 and 30%. And I talk a lot about this in my, um, tier list video where we, where we rank the interventions for depression. We'll put a link to that below so you can check it out. We go through all the evidence there. And I want you to think about that 20 to 30% improvement. And I want you to contrast that with the efficacy of antidepressants because when they studied that, here's what they found. They found that antidepressants improve depression on average by about two points on a 52-point scale. So that's about a 4% improvement. And so taking an antidepressant will get you 4% of the way there. Probably make you worse in the long run. But fixing these things, each of them can stack up to a 20 to 30% improvement.
So the first thing is your physical health. See a doctor. Make sure you don't have sleep apnea or an autoimmune condition or something like that. On top of that, healthier diets are also correlated with improved mood, reduced anxiety. Moving your body every day is also part of your normal physiology and that helps as well. Next thing is relationships. Being lonely, you need to figure out how to fix your loneliness. Are having a good marriage that's also correlated with improved mental health. Are having children that's correlated with better meaning later on in your life. This is where I think therapists are really good. If you can find a therapist that knows how to treat loneliness, knows how to help with your marriage and, um, all of that, that is a great place to use a therapist. Cuz relationships, men, they are a cornerstone to thriving for people. Next up is quality work. This is work where you have to have a decent pay. You know, you want to be making, I, I'd say about $100,000 is kind of when we see a lot of the happiness sort of pay off with the amount of money that you're making. So, try and aim for something $100,000 or more. The work ideally is meaningful, so you like what you're doing or it can be meaningful because you get meaning out of supporting your family and that feels good to you. And you also want to have some control over it. You don't want to be, um, working in a system where you really don't like what you're doing and you have no control over that. That leads to massive burnout. I see this with my family medicine colleagues all the time. Working in family medicine right now, if you take insurance, it's like the worst job in medicine. You're just like filling out administrative paperwork. Patients are always unhappy with you because you don't spend enough time with them. That is a low control job.
And the final thing is avoiding drugs. And so, you know, alcohol, cannabis, cannabis is not a safe and harmless herb. That can lead to a lot of problems. Avoid drugs, avoid alcohol, and avoid excessive caffeine use. And so I think if we actually built our mental health services around helping people with these four things, we would see that suicide curve start coming down. Unfortunately, I'm not holding my breath on that one-on-one work that would help people with this. It's really not scalable. There's not a whole lot of money to be made in it. And that's why it's not being done. That's why we're giving people the drugs instead. And so unfortunately, but also fortunately, this is something that you have to do yourself. You have to drive yourself. And don't look for a quick fix. A lot of these things can sometimes take decades to figure out, like a relationship, you know, finding the right partner, that can take a really long time. And so that's what I think is going on in the US today. I want to thank you so much for watching this video. Let me know what you think in the comments below.