Transcription
Psychologist Anders Sorenson began his career in talk therapy. But over time, he noticed something disturbing. Many of his clients were too emotionally numb to benefit. Psychiatric medications had flattened their feelings and, in some cases, caused more harm than the original problem. And so, he changed course. He left mainstream therapy and began researching psychiatric drug withdrawal. And he discovered just how little the field understood about safe tapering.
In this interview, Anders shares what he's learned from years of clinical work and research, and from listening to countless patients harmed by medications. He's also written a new book, "Crossing Zero," a science-based guide for safely coming off psychiatric drugs. If you've ever felt stuck, numbed out, or worse after starting a medication, this conversation might explain why.
Anders, welcome to Park City, Utah.
Thank you. I was just around, just in the neighborhood.
Definitely not true. So, so you're in, you're in from Denmark doing your, you know, your US sort of visit for the year. I think you just saw Laura, uh, Laura Delano as well.
Exactly. Yeah. In New York.
Okay. Yeah.
Well, I'm glad I made the list and we were able to get you to fly out to the Rocky Mountains.
Of course.
And, um, talk about a few things. So the way, so the way Anders fits into this is, um, he's been doing this work for a long time. He's a PhD, he's a PhD, he's a psychologist. He's done some of the, I mean, really good research on, um, psychiatric drug tapering, specifically hyperbolic tapering. Um, and he's also read, written a recent book, and I just know you're going to love to hear his story. So, so let's, let's jump into that. Um, for people who, who aren't as familiar with who you are.
Yeah.
Which would be most, because most of my work and writing is in Danish, unfortunately.
Okay.
It's changing now.
It is changing now.
How, like, you're, you're a psychologist. People would usually just assume you would be doing like talk therapy, but you've become, um, a really a researcher in psychiatric drug tapering and a, I would say, a vocal critic of mainstream psychiatry. So tell us your story. How, how did, how did all of this happen?
Yeah. Well, I am basically a clinical psychologist and a talk, talk therapist, and that's what got me into this, really. The long story short, I found it difficult, and we're 10 years back now, just out of psychology, um, school. I found it hard to do the therapy I was trained to do with clients on medication. And that's not to say that one thing is good and the other is bad, but there are some fundamental differences that are sometimes they're incompatible with each other, like what we're trying to do in therapy, working with the emotions and the cognitions and the trauma and the body. And the idea of, of reducing symptoms by numbing emotions. And we could call it symptom reduction all we want. Like, it's a way of suppressing things and putting distance to, to tough things.
See, the thing I want to point out there is that's really, I mean, I was never taught that way. I mean, a lot of times I was, I always heard the best thing you could do for anxiety and depression is the drugs and the therapy, and that using them together is actually better than them individually. But this sounds like you, you're saying it could be counterproductive in a way.
At least to me, it is in my clinical experience. Like, it, it really is. Like, and, and that's the story out there. Numb it a bit. Get it a bit down so that you can access it in therapy.
Okay.
I haven't seen that idea play out, um, in the real. In fact, it would be the opposite. Of course, it requires that you know what you're doing as a therapist. Like, you need to be able to,
And that's what we're trained in, at least where I come from. We need to be able to navigate some pretty painful stuff, painful emotions, overwhelming trauma.
Okay.
And give our patients a, how can you say, a therapeutic experience, a good experience of being with that pain, whatever it is, and trying to navigate it without being overwhelmed by it. That in itself, to me, is therapeutic. That's what we aim to do in the sessions.
Okay.
And so how did, how did, how does all of this, all this drugging, you know, the use of antidepressants and sedatives, how does that get in the way of what you're trying to achieve psychotherapeutically?
It's pretty difficult to work with people's emotions if they're not there.
Okay.
Or if they're numbed, or you just have an idea that they are distorted or altered from their true, authentic,
Yeah.
nature. It's difficult to do.
Yeah.
If you can't access it. And obviously, that's the paradox because it'll feel relieving, obviously, for most, appealing even to have your pain reduced a bit. Obviously, it's not rocket science that drugs that can do that for some people will, will work in the sense that it can reduce the symptoms, make the pain go away a bit. For some, it does the opposite, obviously. But let's play along with where they work. But, but that's not the same as saying that they're working in the long term.
Mhm.
Like, what if your, what if the solutions to your problems was in the pain or in the substance of it?
Mhm.
So when you work on the symptom level with drugs or any other suppressing means, how do you know that that, that in the process of, of just saying numbing, that, I know that's a general choice, but suppressing that in any way.
How do you know that that's not also like, kind of distancing you from the solution to it, the true solution to it? That was kind of, to me, where these two, where the pharmacological solution and the psychological solution are incompatible in some sense.
Mhm.
So, so, and also like, and we can talk about that later, maybe. And obviously psychotherapy is not one thing. It, it's a lot of different things. But I take the word very literal. I, I just happen to be interested in how we use the mind, the psyche, to regulate our thoughts and our traumas and our emotions and stuff. How we can use this thing between our ears, or wherever the psyche is, to regulate that, like internally. And that is fundamentally incompatible with the idea of, of long-term, at least, taking a substance for it. So, and that's what got me. Because I haven't answered your question how this relates to tapering yet.
So,
Oh, well, hang on a moment, because I want to, I want to stay there because I think it's,
Um,
'cause it's refreshing for me to hear because,
I felt like we had a very, um, oversimplified and reduced understanding of depression and anxiety. At least the way I was trained, it was like, someone comes in, you know, they have these symptoms, these symptoms equals this diagnosis in the book. And at least in America, um, and I don't know if it's the same in in Denmark, it is,
It was kind of like a,
there was this undertone that it was probably biological. And even if it wasn't said explicitly, you kind of felt it because we would quickly give someone a medication afterwards. And, and so it kind of felt like that. But before I became, um, you know, I was trained in this way, I always felt like, you know, anxiety and depression, it meant something.
You know, something like, uh, you're lonely, maybe you don't have the social skills that you need to, to find a romantic partner or, or fulfilling relationships.
Maybe it's an existential problem. And,
the idea you had before, in before, intuitive, natural, human idea. Yes. And then that was kind of stripped away. And, and when you, and when you, and more so, and now I, I also worry about medical things like, uh, dietary things, you know, the using substances and, and how that can also influence. But when you look at these problems, you know, the, the reasons people are anxious and depressed through that perspective, that, that they mean something.
Yeah. I mean, it makes sense that if you would just numb it rather than kind of dig into those problems and say, "Maybe have some hard conversations. You know, there's some things that you really need to work on if we're going to get you in a better place." We're not doing that. Uh, now we're, we're just saying, you feel unhappy, you know, take one of these. This is a, you know, yeah. Take, take one of these. And you rob people of the opportunity to, um,
to fix that, to, to engage in the hard work.
Exactly. The hard work. It is, it is going to be hard, but I, I've never seen it not be. It's harder to not. That's what I'm trying to say. It'll be harder in the long term not to do it. And that's what we're here for. That's what we're trained to do as therapists. Navigating that pain, going down there, and getting a, a non-overwhelming experience out of it, actually understanding it. And then it'll hurt way less. And, and when we do that work, that's where the, like, the appeal of psychiatric drugs or anything that numbs or distances, that kind of vanishes. It goes away. So you, so we kind of fix the problem at its core. And those questions, that's the problem with the medical model. Are not asked in the medical model because there's an inbuilt, um, causality in it. It's almost like the diagnosis is causing, like the depression or the anxiety or the psychosis is this entity that can cause symptoms, not something in your life or your context or your upbringing or your life story or a trauma. So, it kind of shuts those doors with the medical model. That's why these, these different questions of how we taper and how the drugs work and what mental illness is are combined.
Yeah.
Yeah. Um, and I want to ask, you said something a moment ago which I think is worth unpacking because you work with a lot of patients coming off medications, and you said it's actually, to, to get on medications, although it's easier in the short term,
it's harder in the long term for people. Could you just unpack that a little bit about, you know, maybe, you know, what do you see? Like, what does this look like when someone takes that path, you know, the medicated path as opposed to, you know, engaging in the work?
I guess, and that's really where my work on, or, or the idea of introducing this psychiatric drug as a strategy on par with all, all sorts of strategies that we can use to, to, to cope. So I think that the pattern is the same for all other things that we can do that works in the short term but causes problems on the long term. All sorts of strategies, distraction, like short-term relief, impulse to, to, to, to downregulate emotions, staying busy all the time, like all the opposite of actually feeling it.
Mh.
And that, and then a psychiatric drug, um, where if you were to do, how to say that, theoretically, like to do the hard work now, and I wouldn't even call it harder work, it just has another element of it being uncomfortable at first because that's what emotions do. If you think about what an emotion is, it's a signal.
I use a pretty stupid metaphor, maybe, but just to get people to understand, maybe the, the hunger signal in the body, for example. Our bodies cannot seek out nutrition on its own. It needs to motivate us to do it.
Sure.
Through something that hurts.
Yeah.
It would be a stupid mechanism if, if it was pleasant.
So a lot of what our bodies are trying to communicate to us has to hurt. That's why it works. And now hunger is a very straightforward example because we, we know how to decode it and do what it's trying to ask of us. Then imagine the exact same thing, but, but with emotions. Sadness, grief, longing, anger.
Mhm.
That's really the work that, that would be the difference of it. And so that's just to say, obviously, it hurts when you have to look at what your body is trying to tell you, either that is missing or that is too much in your life.
Mhm. Yeah. And I mean, something I worry about, like, I mean, if you, if you just mask these things, the, the problems just fester and, and all of a sudden, I mean, you've got, because I, I've, um, I talk to people a lot, you know, I talk to some people and I bring them off 20 years of medications, and when they come off, they, they tell me that emotionally, they feel like teenagers, especially if they got on them when they were young. It's like they never, they've never dealt with social anxiety or anxiety at work or, um, anxiety about a romantic partner, and it's like, there's this relearning that takes place when, when I get them off the medication, and they're just like, "But I'm like, in my 40s now, and I'm, I'm, I'm going through things because I've, I've been stunted."
Yeah.
In a way. Um, and then, and then we, we help them learn all of those things.
Yeah. It's part of the process.
Yeah. And, and they come out of it.
So, and that really, really puts us into the question of what do we mean when a psychiatric drug works? Like, I would even say, I can say that on this channel. The most scary part is when it actually works to mask something that is there underneath, and it actually succeeds in hacking the brain in a way that you can't feel it. But you're still in it. You just don't feel it. And then obviously, when you wake up from that, you're just standing with your hand on the hot stove, and now certainly you can feel it, right? Waking up from that is really also something I hope to bring to this conversation in, in the broader withdrawal community, because that part of it is not withdrawal. That's just true underlying emotions resurfacing, obviously, because all the drug did was numb it.
Mhm.
So, and some of it will obviously be withdrawal, especially if you taper too fast. And that's where it gets complicated. Like,
Yeah, you're getting a double whammy when you're coming off one, you know, you're, you're going through withdrawal,
but two, the problems that led to you getting on the drug in the first place are still there, and all of the consequences of that, you know, of not dealing with that problem and how it's festered and transformed and, and gone into other areas.
And it'll mix. And that's part of the work we do here. How to, how to, how to distinguish between a withdrawal reaction and a true emotion because they call for different things. Whatever is withdrawal calls for, well, time, if it's tolerable, we, we endure, we stay in it, and then when the receptors are adapted to the new dose, it disappears. And obviously, if the symptoms are intolerable, it calls for increasing the dose.
Yeah.
So withdrawal symptoms, whether they're emotional or cognitive or gastrointestinal or physical, is communication too. It's just the other way around. That's your body calling to, well, really just to, to disturb it less and, like, introduce whatever it was used to, not because necessarily because it was a good thing, but because it's gotten used to it.
So those signals, we want to overhear in the sense that we, we want to not act on them because we have an idea that they're temporary and they say nothing about the person. That's confusing. Whereas the real emotions resurfacing, we do have to take seriously and try to understand and help people navigate.
And I mean, so the withdrawal communities, it's a small world. So I know, you know, Cooper Davies who came on my channel recently,
and his whole story was about getting on, uh, ADHD medications because he felt the need to succeed at school, and other people were on the medications and they were doing well.
Yeah. And so quite, like you said, you know, he, he takes a medication to, to mask that he's not able to focus and concentrate the way he sees his peers doing.
And then 17 years later, when he's had so many side effects from, from them, he comes off and he realizes that he doesn't like his job. You know, he's, he's a journalist. Yeah.
He doesn't like the, he doesn't like, you know, do doing the writing. He doesn't like the deadlines. And he's rebuilding his life, you know, in his, in his 30s now, trying to find a career that he only went into because he could tolerate it while being drugged.
Exactly. So the drug allowed him, when we say that it works, I'm sure whatever happened to him and any other person in that situation, if you measured in on these stupid symptom reduction scales, it would come out as effect. It was, it would be an effective drug. But what it really did was allow him, or allow people in that situation, to sustain that lifestyle that they didn't like, and maybe relationships and works.
Well, well, that's the thing. I mean, it could be it could be a lot more than work, right?
It could be, um, it could be being in an abusive relationship or a relationship that wasn't satisfying to you. It could be working in a job that really wasn't your calling.
Um,
Um, it could,
without feeling it. Without feeling.
Because you've cut off the emotional contact that you would otherwise use.
Yeah.
To, to, to be informed from your body or spirit or brain, or wherever you want to place that, to not do it. And, and that's really the emotional, like, decoding stuff again. And this, I just, at least back in Denmark, just a little, I get a lot because I'm a psychologist by trade. I did my PhD in psychiatry. So how can I, how can I talk about drugs and tapering? Because that's the doctor's area.
Sure. Yeah. This just reminds me, I would say it's the opposite. Like, what we're talking about here is the, the psych, the established psychiatric institutions entering our field. If we were to play that game, medicating emotions, medicating trauma. So I could see that argument going the other way around too, if that makes sense. Like, obviously, it's an interesting debate, debate to take, who can talk about withdrawal. But it's really also an interesting debate to take, who can talk about psychology and emotions in that way.
Yeah. Um, and so it seems so obvious, you know, I mean, to me, and, and, and for quite some time, that, um, our emotions mean things.
Yes.
And, um, they're trying to tell us things that need to be changed in our lives. Um,
how did we, and, and I'm really, and I'm, I'm going to sort of hit the ball over to you as a representative of the field of psychology now and, and say, how did we get to a point where psychologists have just fallen in line with the medical model, and that they're not there just saying,
"Damn it, like, we, you know, we shouldn't be doing this. Why do we have 20% of the US population on these drugs? We need to actually be helping people." Like,
what's happened?
What's happened?
I, I have some ideas. I don't really know. I guess one of them is just the, like, people, humans have tried to, you know, reduce discomfort always. Like, it's, it's an instinct. So obviously, that idea of it being, of it having one cause, one explanation, and a fix, and a pill to fix it, is just very appealing to the human suffering mind, if that makes sense. So I think part of it is, is that, and then obviously, it's, it's layered in all this fancy diagnostic.
Shouldn't that be antithetical to a clinical psychologist who?
Well, for me, it is too. Yeah. Yeah. Yeah. To,
and, and to me, truly, it is. So I don't know if, if I should represent that part of the therapist. But, and also obviously, because a lot of psychologists, in the way it's, in the way the hierarchy is built right now, wants to be small doctors, wants to be small psychiatrists. I don't, I would have the other way around. But there's some, like, they want to, to climb up the ladder.
What, what does that mean? What does that look like?
I don't know.
Yeah. Yeah. Okay. I just know that it's, that it's a thing that some psychologists see it as a step up to be able to diagnose and know something about when to use what drugs and stuff.
And the diagnosis are not our language, but it's in there.
It, it's not our language in, in psychology because it removes us from using normal words for tough emotions, stuff like that. I have, I have a few thoughts about this, and I'd love to, to share them with you and, and reflect, because I've, you know, I've spent a lot of time on inpatient units, on outpatient teams. I, I've, I've worked with therapists before on patients and, um, and helping them. And there's a few things that I, I worry about. One is that I think therapists, especially in the United States, where we have a very, um, we have a lot of medical malpractice, they're worried, like, if anything gets kind of too scary, like, too extreme, like someone has says some, you know, they're suicidal,
they worry about being perceived as being medically negligent unless they send the person
to, to the psychiatrist. Um, and because they can't, you know, that they can't stand the heat in the kitchen in another way, which to me is like a terrible thing, like,
a scaring mechanism.
Yeah. You know, that it's, that it feels a bit driven by by fear.
I also, and this is going to sound dark, but I do believe this.
Can be dark. You'll get up from.
Is that I sometimes suspect that some therapists want their patients to be on medications because it's less emotionally draining to work with them because if someone comes in and they're really intense and they have a lot of problems, and you are tasked with helping them in, like, a 40-minute visit every, like, month or two, and you don't really have that much time, like, you're going to say, "Whoa, that was really intense. Like,
Yeah.
I can't really help you in my current situation." And so,
get on the antipsychotic or the mood stabilizer. Uh, because that makes it feel
Um, more manageable to me professionally.
To, to me, which, which also makes me really sad.
That's a really sad. I'm sure that's there. It would be interesting if we could measure that in some way. And it is like, it is,
tough. It is intense. I tend to, I wouldn't say like it. That's too positive a word. Like, it's not fun. But I'm definitely in, in, in a state of flow when I'm doing therapy. Otherwise, I wouldn't be doing it.
So I, I'm just trying to imagine what it would be like for it to be tough and intense in the sense that, want me to,
to do that. I think we need the opposite in order to be good at it. Also, to visit people's very deep depressions and, and psychosis, even has to be some kind of interest in it.
Yeah.
Yeah. I mean, whatever, I mean, whatever it is, I mean, to me, I, I feel very disappointed, uh, with my social work and my psychologist colleagues in letting psychiatrists completely mess things up for people. Cuz, cuz I, I just be thinking like,
"You guys, you know, you can, you can see this, you, you must understand that
there's something deeply wrong going on," and there's just crickets.
It has entered into our field too. Sad.
But there's a movement against that. There are different therapeutic schools and approaches that directly oppose this idea. So, so, so things are happening. And I'm just a huge advocate of not even using diagnostic words for anything, almost. Like, we need to label it something obviously to, to talk about it. But if you go through these diagnostic module manuals, sorry, ICD and DSM, almost all you will see is behaviors. Like, symptoms in psychiatry are behaviors and ways of having it, like feeling.
Mhm.
And those behaviors are what we would call strategies. Now, it sounds, it sounds too active sometimes to use the word strategy, but it just means that it's something you do. It's motivated behavior. It's something you do to feel different than you do. Cutting yourself, worrying, ruminating, taking drugs, performing rituals, suppressing, staying busy. And go through almost all diagnostic categories and you'll fall, fall of behaviors. And that changes it a bit. If you see it instead of seeing it as someone is having an illness that makes them have these symptoms. So there's this inbuilt causality. And turning it around, saying, "Okay, this person is a lot of distress, and he, she's trying to cope with whatever means he, she has available." That changes it completely, and there's a lot of compassion in it when you understand it.
Yeah.
And that the fact that psychology can have, you know, you know, moved away from that is just horrible. I, I mean, it was, to me, it was, I, you know, you could say cardinal sin, original sin, like, when, when the DSM, you know, when they, because I think what happened, it was DSM-III, um, I think this is, you know, '80s, maybe early '80s, something like that. There's, there's these two warring factions in psychiatry. We have the psychoanalysts,
who really love, um, causal understanding of things, you know, um, they were talking about different reactions to childhood stresses and traumas and, um, I think they even used the word like, "anxiety or depressive reaction" to kind of,
it was in there.
herald to that. Um, and then there was the biological psychiatrist who was saying, "No, we think this is biological."
And the leadership at the time, I think Robert Spitzer was thinking, "Well, we got to find a way to make everyone happy."
Yeah. And so instead of doing the hard work and saying, "Well, these are some, some of the conditions we do think have, you know, are really grounded in life stresses and such, and, you know, we've got schizophrenia and bipolar. It's looking like these things, you know, while they can have some triggers that are psychological, there's probably some underlying biology going on there because, you know, it doesn't make sense that some people when they're stressed extremely, they become psychotic, and some people, you can stress them extremely and they don't." And, and so this is obviously very challenging. But to make everyone happy,
they just pull out, um, um, they make it agnostic. So they, they, they, they completely got rid of
that part of it, which you were mentioning a moment ago, where it's just like, you feel like this, and it's because of that. There's no, because it's just like,
you have these five symptoms, you have major depressive disorder. End of story. No one really cares about where it's coming from. And, um, I believe that's, that's why we're in the mess that we are today, where everyone thinks, "Oh, well, you know, I'll just, I'll, I'll jump on a medication." You know, it's major depressive disorder.
And people use it as an explanation. Like, you, you can't, at least in Denmark, you can't open the media any day without seeing some, some story about some person suddenly finding the explanations for all their suffering because it was the ADHD, or it was the depression, or it was like this causality in it again. And I understand it's a perfectly valid psychological mechanism that we seek explanation. But it's a psychological mechanism. And I have a whole chapter on that in the book, too, because I think it's missing from the conversation too. So, so we don't want to hear, take away people's experiences, sorry, their explanations where they find
validation right now. And that's really what happens when we, um, target the diagnosis, right? So, we obviously need to, to, to put in front another explanation why it's happening. But I think a lot of what people are seeking in the diagnosis, not the medication only, but the, the actual diagnosis, is validation.
Yeah.
Normalization. There's the demon. I know. And it's written exactly there. And I can recognize it. And people will maybe start validating it more when I can say that it's this or that condition. I think there are some really deep psychological mechanisms at play here that if we could just have a conversation about them,
would be good. I, I also think, I mean, there's something at play where people simply do not want to hear, um, you know, it's, it's, it's a lot more comfortable to, to hear that it's your brain is the problem, rather than it's something that's happened to you. It's something that you've done. It's your behavior that's that's led led you to this. There's, there's a lot of, I think, shame, um, along with that.
And,
and it's, and it, I think it has allowed people, because they, because they don't want the pain of looking at that, to be like, "Oh, please tell me it's just biological."
Exactly. There is something appealing in that, too. But I've never seen that shame app disappear too, when you truly trace the person's problematic behaviors and symptoms and feelings back to where they actually originated. I've never seen that not result in a sense of compassion. Actually, the opposite of shame, compassion for yourself and where you were and who you were and what happened to you, and the brilliant, wise ways you found through it, which are then the things you're battling with now. Almost nine out of 10 times, you could, you, you could trace that back. So, whatever you're fighting with now and causing you trouble now, if you trace it back, at one point it was a help. Whether that was hearing voices, being overly analyzing, overly empathetic, avoiding your emotions, whatever pleasing, whatever symptom you find, they'll have a flip side that is fundamentally good.
So I think we can reach the same, like, as you mentioned, what people find. Okay. It's my brain, it's a biology, it's not me.
Mhm.
Whatever that gives people.
Mhm.
We can find by, by, by digging into it too, in a much more authentic and true way.
Yeah. Well, you know, when I hear that, you know, so I'm a, you know, I run a business, and so, and I've also studied the business of psychiatry. Gosh, it sounds like a lot of work under, you know, to, to spend all that time getting to hear someone's story and their traumas and making sense of it and listening to them and being compassionate. And then after that, you have to, you know, you have to go and, you know, go motivate them and teach them all these things. It's no wonder that we like using drugs.
But you have to like that part of the process. I like it. Trust me, I would not be doing this still if I didn't like it. Every single time helping people do that.
Yeah.
Because on the one hand, you've got, oh, there's this long intervention where I'm going to have to spend all this time. I'm going to get in my car, I'm going to drive there. And we might, I mean, you might spend 10 hours working with someone to kind of say, you know, maybe three, you know, five hours is really understanding their story, validating them, making them feel safe enough. So you could say, like, "You really need to talk about what you do for work because what I understand about you, this doesn't seem like a fit." Or, you know, "We really need to talk about your relationships." Kind of doing those things. And you spend the rest of the time doing that. I, I mean, that's like, that's, I mean, for, for many doctors, I could see them, you know, just being like, "Oh, that's too much time."
That, that doctor should find another job then.
Yeah. Yeah. Yeah.
Cuz we wouldn't accept that in any other area.
In any other profession that you could just say, "I don't really feel like doing the hard work. I'd rather just not. I'd rather just circumvent it and and cut the symptoms."
Yeah. Well, I think about 80% of antidepressants are given out by family medicine doctors in the United States in situations just like that, where where they come in, you know, they, they, they have seven minutes of FaceTime, you know, five of them. Those minutes might be talking about cardiovascular issues or some other issues, and then you have two minutes to talk about their mental health. And that's really what's driving, uh, what I think of as really terrible mental health and an complete overprescription epidemic because they're just, they're just like, "It's too much." And I got to, and, and I want to be, um, a bit, uh, I guess a bit more kind to them because they don't actually have therapists that they can refer to. Because I've worked in the system, and even when I worked at the VA, which is meant to be the best public system in the US, like we were sending people to therapists and they would get like a 40-minute visit every month or every two months, like really, um, not, not a lot of care. But then we should have a conversation about that globally, like, then that should be the topic of it. Yeah. Well, tell me what you think about that. I mean, given the, the economics of healthcare, like, like, would there be a way to actually,
to help people in, um, in the way that they, we would want our loved ones to be cared for?
So two things. First, what I, I sat and had the feeling of wanting to be friendly too, actually, just before you, you said it too. And I think there is an element of, because now we're kind of, you know, making a bit fun of it, like people not wanting to do the hard work of jumping into it. But I think that another part of the explanation is actually worse than that. Like, if you genuinely believe that there is such a thing called a depression or a psychosis or something you can have, not to challenge whether or question whether the experiences are true, obviously they are, but the idea of them stemming from a biological malfunction in some way. If you genuinely, as a doctor, believe that that's the case, well then the rational thing to do is to prescribe the drug. So I think part of the explanation is actually worse in the sense that psychiatry, biological psychiatry, has succeeded in spreading that narrative. So a lot of the people we were kind of,
blaming just before, might act completely rational on, on bad information. Just wanted to say that. And some of them obviously, I think will are not equipped doing the therapeutic work.
That's a really good point.
I just wanted to,
I'm glad you bring that up because I, I know many of the listeners to this channel heard from their doctors originally that they had a chemical imbalance and that it was biological, and that doctor wasn't bullshitting them. I think they genuinely believed it because that's how they were trained. That's how I was trained.
And so,
Exactly. And so, I mean, that's the, you know, like you said, the additional context that we hope you, we have a profession who, I do think, is waking up to the fact that we don't have any biological underpinnings for these things now, and now they're in this, at least the ones that wake up will be in this awkward situation where they're tasked with helping people,
uh, with, um, where it doesn't really make sense to be using the drugs in the way that they are.
At least not in that way. This is not to not use drugs. We can, there are a lot of good ways to use them. And usually what would characterize that is that being open and honest about it being a strategy. It's a drug.
Yeah.
Can maybe numb or distance the way you feel. Can we use that? And for how long? That's really, it's not about not using it, but using it in a very different way and with a different rationale, obviously. Um, and it's, I hope psychiatry is starting to, you say, awaken, wake up to,
a lot of psych, psychology is, for example, in the manual to the therapy that I, I don't only use that, but I use that too. It's called metacognitive therapy. Just to tell you how far we are in psychology. In the manual for that treatment, one of the questions is whether your, it's talking to the therapist, whether your client patient believes that their depression is biological in origin, yes or no. And if the answer to that question is yes, which it obviously often is, then our job as therapists is directly and explicitly to challenge that idea. Not challenge the feeling of having a depression take, taken, taken you over, but whether it is truly uncontrollable.
That's just to say it's even in the question we have to ask for this. And if the answer is in alignment with the overall medical model, our job is to challenge that. I just find that very interesting because it's on, on the other extreme of where psychiatry would be, right?
Yeah. Yeah. That's different.
Yeah.
What I mean, what do you think about that? You know, people who, who say, "I think this is bi," like, how would you approach that, uh, clinic?
Yeah. Like, if a client says, "Oh, yeah, I, you know, I, you know, my mom was depressed. I feel like I've been depressed most of my life. It's, it's probably something wrong with me."
So obviously, that, that is the skill element of doing therapy. It is not not blaming it, but always how to validating, obviously, never questioning it directly, but kind of accepting the premise and then challenging it gently.
Mhm.
For example, are there ways that we could try to make sense of the way you feel? When did it start? When is it worse? When is it better? Like, when is your supposed biological depression not there? Are there areas in your life when it's not there? Funny illness acting like it's there and then it's not. Let's see if we can find some patterns. So, you would, you would, in a gentle, compassionate way, play along on the idea. Okay, let's try to explore whether this is truly
just a course of nothing. And then you'll find patterns, if that makes sense to, to do it like that way.
It makes a lot of sense. I mean, from a medical perspective, if someone came in and they said, "I have, you know, I don't know, multiple sclerosis." I wouldn't just say, "Okay, you've got multiple sclerosis." I would say, "Well, what are all of the alternative explanations?" Like you said, I'm not going to dismiss it, but I'm going to say, you know, "Are there other neurological problems? Are there any, you know, you know, medical issues that I'm missing?" And it sounds like you're doing it in the same way. "Oh, you think it's biological? Okay. Well, let's, I mean, let's look at some other things going on. You know, tell me about your relationships. Tell me about your childhood. Tell me about, you know, your work. Tell me about your physical health." And just kind of getting into it and then just saying, "Oh, well, you know, we, we've got these other things. Like, what role do you think these other things
could be playing?" And, and kind of let it bubble up and so you can create this awareness. Well,
yes, maybe I am anxious or a bit more depressive in temperament. I could see that. But there's actually all of this other stuff
Yes.
going on, which I didn't really
pay too much attention to. But yeah, these things are real, and luckily, they, they can be fixed.
It, it will point, when you do that work, it will point to something that you can do something within our control to change. So really. Yeah, you'd be a great therapist. You're already obviously, you could do the work. That's exactly the, the idea. So, what the client, what my client is telling me has to meet my, um, expertise or knowledge and how the psyche works and how the, the emotions react to adversity and trauma and, just, just basic psychology of how the mind works. That's the study of psychology. So what they're telling me has to meet that, and my curiosity, I would say,
for when this started,
and what then happened, and trying to figure out some function it has had. That is really the key word for me. Whatever, however destructive and problematic and maladaptive it has since become in a person's life, when did it serve a function? And it's in that exact moment that that shame, we talked about before, that a lot of people feel relief from by having an external, um, explanation, completely turns around to compassion for themselves too, which is healing in itself.
Yeah. I, I, I want to segue because something kind of popped up into my mind and I want to ask you about this.
Tell me if I'm going too far, but I, I noticed that, um, um, do you think a therapist has to have their own life in order to be effective? Okay. Okay. Because what I've noticed is, you know, there's a lot of, and, and you notice this when you're a psychiatrist or because your colleagues are therapists and psychiatrists. I'm like,
many of these people, their lives are in disarray. You know, they have terrible relationships with their children. You know, they're frustrated with their job.
Yeah.
And then they're out there giving advice.
Yeah.
Do you think, can, can you do this work if you don't have your own house in order?
I think you can. Yes. Okay.
I think you can. I think there are ways to, to have the knowledge,
and be able to apply it to others,
while not doing it yourself. But still, like, for whatever reason, people may have to, to, to not do it themselves.
But I think it helps to have something to relate to personally. Like, obviously therapy is a skill set too, on what to listen to and what questions to ask and how to navigate it and have, like, an general sense of how the mind works, which I would just completely disagree with anyone saying that we don't know that. Obviously, there are some unanswered questions, but I would say we've come pretty far in understanding how the mind works. I would say,
do you feel like therapists really get a good education these days on, like, relationships? You know, how to, how to have, you know, good relationships, romantic, platonic, like, you know, finding purpose in work, like more of an existential, like, like, how much, because to me, if, and I, I didn't train to be a psychologist, but I, I've encountered a lot of the materials as a psychiatrist, kind of, you know, on the side, it just seems so fragmented. It doesn't really seem like there's like a unified way that we look at people and like, these are the things that we really need to help people with their relationships and their work and like, it, it doesn't seem unified. Psychology.
Psychology.
Oh, not at all. There are many fractions that, that would
hate each other, almost, I would say, just as much as psychiatry and psychology is very fragmented in, in, in what we should ask for and what's valued. Yeah, no, there's no unified way.
Yeah. And I think I can tell, you know.
Yeah.
Yeah. But what it does, though, like, while psychiatry and now psychology, as we talked about before, because it has infiltrated, while psychiatry has been having this overall mission of differentiating different ways, different diagnosis, like how many diagnosis can we find under the idea that they're different
things you can have.
Psychologists done the opposite in the trans diagnostics. That's the complete opposite question. Okay, let's see how few mechanisms we can boil it down to that then has different expressions, I would say. So what cuts across different
diagnosis, whether OCD, depression, anxiety, psychosis, whatever. So the, the, and that's to me, what would be a unifying factor in psychology, that we could agree, okay, we'll look at at mechanisms.
Yeah. And then we'll understand that those mechanisms have very different manifestations. And those different manifestations doesn't really matter. That's really why psychiatry hates it too, because if we both take the long-term drug use out of it, and the idea that we need to categorize a condition before we can treat it, what's left?
Yeah. And, and when you say that, are you talking about how, I mean, you could have an event like, um, a terrible childhood trauma.
And then depending on the person, um, and and their constitution or the genetics, you know, they become psychotic, or they become depressed, or they develop severe anxiety, or they get, uh, you know, PTSD. And and so the, the trauma is really the underlying factor.
>> Or adversity, or how you define it. Trauma might be too big a word for some, but trauma, adversity, something happening.
Exactly. Yeah. So I think there is, there must be some kind of random element to it too. But it's also like, why does one person ex fall into this category, another in the other category? But there's also just an element of what was it that you found how to say, soothing? What was your strategy? What did you come across that helped you? And whether that was to, um, avoid things and worry a lot and become anxious, or retreat into yourself and criticize yourself and ruminate a lot and become depressed, or start using drugs or distract. You can see we're already having the same mechanism, but different expressions. Or maybe if it was truly traumatized, you you'd become not as a deliberate strategy, but something that just happens indifferent.
>> Yeah.
>> Like that's a strategy, too. That's what psychiatrists would call negative symptoms of schizophrenia. But the idea of just numbing yourself and just becoming flat,
>> apathetic, is that a word?
Apathetic.
>> Yeah.
>> Apathy. Yeah.
>> That's those are strategies, too. And they stem from a, always from a time in that person's life where it was needed because there was so much pain that they had to turn everything down, also the positive ones. And then that's strategy tends to just move on, right? So you can see already from this one minute presentation of it, we have a lot of different expressions, but the mechanism is the same. So I think there is some kind of random element to it, and then there is just, well, what did that person find to cope?
>> Yeah.
Whether it's withdrawing from the world, whether it's cutting themselves, whether it's drowning it in alcohol, whether it's, um, you know, um, becoming obsessed with pornography or, um, sex addiction. Like there's all these different ways that people will deal with the same hurt.
Exactly. And we might not think of it as strategies. I don't know what else to call it. That's what we call it because it sounds too deliberate. I'm just going to use a strategy here to cope. Obviously, it just happens naturally, but that's just the way to to explain that these are motivated behaviors. They have a function. They serve a function. And if those strategies, emotion regulation strategies, just happen to update when we don't need them anymore. I think there'd be very little mental illness left, just as a way to say that that's what it is. It's that it keeps keeps going. So, you'll find yourself stuck in stuck in ways that helped you. And now your job is to break free from them.
>> Yeah.
So, well, let's go there now because I think, I mean, you've helped a lot of people taper off medications before. Like how do you do that? Like how like how do you like what does that process look like, you know, for someone who's, you know, they've been on
>> SSRIs or maybe you know, for you know, 10 years like how
>> how do you help people come off these medications and find different ways of of of coping?
So that's the other or the main, depending on where you focus, part of it. So to me, coming off psychiatric drugs is both, it's the actual taper.
>> Yeah.
>> And it's all we've talked about until now.
>> Yeah.
>> Helping people manage once that chemical veil lifts and you have your true authentic self. So, and the other part is the actual taper. And I think it's technically simple. It can be difficult to do in practice because people vary. But the overall principle of the body having adapted to something that you've done to it every day for months or years is pretty straightforward. Like the body just adapts. It comes to expect
>> what we're doing to it. It happens psychologically. It happens biologically. And then when we want to change course, which is the metaphor I use in the book too, it needs to happen gradually. Otherwise, your body will scream at you. Not because it wants to keep the course, the medicated course, but because it's gotten used to it. So tapering is really just about solving the problem that we can't just remove a drug from one day to another because the body will react.
So tapering comes in as the idea of of instead of just jumping from 100% to zero, which would be too big a disturbance for the body to keep up, that's why it communicates with the brawl. We want to give the body a series of smaller tasks, tasks that it knows how to complete. And that's where we introduce this this general idea of reducing and stabilizing, reducing and stabilizing. Now, just as an overall principle, we want to, every time we change a dose, reduce it. We're kind of not kind of, we're actively disturbing the brain chemistry that was there adapted. And we want to do that in a way that the body either does not respond with withdrawal because it's within the limit of what it can
>> handle without sending us signals, or sending some mild to moderate symptoms that we then
>> endure and go through. And what we use for that are these hyperbolic. Like that's that's where these graphs we already show always show plotting dose and occupancy come into the place. That's an interesting story because I know we talked about your suspicion about the medications because it was blocking the emotions that you were trying to work with.
>> How did you end up doing this big PhD on, um,
>> Yeah, we missed that part.
>> on antidepressant tapering? Like why, why didn't you just stay in your lane and you're just like, I don't like the drugs because they're numbing people. Why, why did you go and become an expert in tapering?
Yeah. So, so back to start 10 years ago, it was pretty simple. I just, for the reasons we've talked about here, it it became clear to me and my patients, I would never do that to them. They agreed that in some part, there will be a point in therapy where the next step will be to come off the drug. So, and this is 10 years back before I knew,
>> we knew anything about this.
So, it was just logical for us to withdraw the drug and come off. And none of us were told that it's going to be a problem, like most people are still today. So we obviously tapered it off slowly, slowly, but with the drugs, the standard available doses you can buy. So I just, and it was really just an observation. I just saw right in front of me that my client had has a way harder time coming off these drugs than I was just taught in university, and that they were taught by their doctor. So, it was really just a discrepancy between what we were taught and not taught, and how the person right in front of me reacted with symptoms, withdrawal symptoms.
>> What were you taught
>> as a psychologist?
Nothing like that. We, we, we were just not taught that it was a thing that they can be hard to come off. So, nothing. So, but then obviously I started looking at the books and and the the guidelines and the textbooks, which sadly in many countries, including Denmark, still include these descriptions of withdrawal symptoms being mild and self-limiting and brief. Uh, so really what I decided to do was, and I remember that moment very clearly. I decided to go with what my, what the person in front of me was experiencing instead of what was in the books, and that set me on a path to this. And then I, I really, so I, I just from an, and I knew at that point because I did some other thesis at university about psychiatry, I knew that they'd had it wrong before. So it was not new to me that there would be something completely off in psychiatry. So I just started helping people through those initial reactions,
>> just under the idea that maybe this is withdrawal.
And often times, and I'll still say the day, if the doctors or prescribers just spend two minutes
>> investigating what are these symptoms and are they actually overlapping enough with your original condition for it to make sense to be a relapse?
It's often not. Obviously, a problem is that the symptoms, withdrawal symptoms can be emotional and cognitive, too. So they can mimic the original problem, but they can certainly also not mimic it with very specific, um, physical symptoms. So, and yeah, and then I decided to, I wanted to write my, uh, final thesis, if that's what it called, about this. I wanted to write about the psychologist's role in helping people come off psychiatric drugs, and anyone I asked at the university was like, "That's not your area. That's the doctors. Don't cross that. Like, cool idea, Andrew, but that's none of your business." And that kind of
>> made you want to do it?
>> Made me want it. Kind of provoked me
>> in a way.
In a sense, this is off. How can we as a
>> profession just outsource that whole thing of taking medication for your emotional suffering and coming off it to another, like as if there was no psychological element to it?
And then I just kept going from there. And I based on my thesis, is it called like the final thesis you do at university?
>> Yeah.
>> Final thesis. Yeah. Great.
>> Yeah.
>> I got a PhD based on that, actually. So I moved to Copenhagen to the general hospital and and and started digging into the lack of knowledge on how to do it, not whether we should come off or not, but when a person is ready, how to do it. And that transitioned into these occupancy things of understanding how the drugs work. It was just intuitive for me, and it still is today, that if we want the body to gradually adapt
>> to the absence of a drug, well, we need to know what effect the different doses have.
>> Yeah.
>> And we should follow the tapering. And you found something very interesting and, um, so I know some, some of the listeners to this channel are totally up to speed and you say hyperbolic tapering and it makes sense, but we also have a lot of people who may not be aware of that.
>> And, and to just provide context, Anders, along with Mark Horowitz, I would say were the two leading, uh, researchers who were able to to provide a scientific, uh, a scientifically informed, uh, perspective on on why coming off these medications was so, is so difficult, that matched with the clinical experience of people. So, so most doctors would tell patients, you know, cut the dose in half, cut it in half in two weeks, take it every other day, and stop. And that would fail terribly. And then these patients, they would start congregating in these online communities. And what they learned was that like, every time they did a reduction, the next reduction should be half the size. So if they went from 100, they'd go to 50, and then they'd go from like 50 to 20, you know, and and so on and so forth, where it's almost they, they would do smaller and smaller amounts as they got down. And many found that it actually worked when they did it that way, but we didn't really know why, um, until I, you, and Mark started looking at this. And so could you tell me a little bit more about that story? Like how did you even start hearing about, like, I want to look at PET studies, and if you could explain it in a way to someone that isn't familiar with a lot of like,
>> then the audience who is familiar will just fast forward.
Yeah.
Um, so there's a, it has different elements that story, but really, and, and you're absolutely right, and I'm very aware of all always stressing this in my work and in my book. The knowledge that we had to to to to make reduction smaller and smaller as you approach zero, and at some point much smaller, down to the three, five, 10% range. That idea has been known in the withdrawal community for decades. Like they knew way before academia did.
>> There just wasn't enough, at least to my experience, we didn't really know how to confirm it for the academic establishment. Is that really what we did? So it's really important to say that this knowledge was not invented by academia researchers, it was confirmed
>> by these scans.
So, but my way, my own personal way into it, before meeting it in the online withdrawal communities, was really just the observation. Back to the story before. I just observed that the closer my my clients got to zero, the tougher it went. So, it was just an interesting idea for me. Why does it get worse the less medication that's in the system? It was counterintuitive for me. And I could tell you, I even have a picture of it on my office at the hospital I worked where I did my PhD. I had like all, I had 30 clients in my first group that I helped come off the drugs, and each was represented with a post-it with their name, and then I had drawn on a board like five columns, 100%, 75, 50, 25, and 0%, and a smiley, like as a way to keep track of where are my clients in there.
>> Now, the mistake I did was to use dose as the indicator of how far they were.
So I just visually observed that when they reached the 25, the low doses, the 25% of their original dose, it got difficult for them to get down to the zero. So I just really observed there was something be wrong here.
>> Yeah.
You mentioned that you, that that using dose was the wrong thing to look at. What should you have been looking at?
We should have been, as we are now, looking at the effect that that dose has in the brain, which is completely different. A dose is a weight, basically. It's just a unit of how much that drug weighs. That doesn't say anything about the degree to effect it has. And that's what we plot on these occupancy curves that are all over the withdrawal community now. And it just really plots dose in milligram against the effect that that drug has in the brain. And we can measure that in PET and SPECT scans. Now.
>> I do think it's interesting because I know there's going to be some people out there who are going to say, well, how do you measure that?
>> Yeah.
>> Could you just briefly talk about, like, it's in the paper, it's even difficult for me, years after writing it, to understand it. But you can. So we cannot measure the, it's called occupancy. Occupancy is just the word, the the technical word for what the drug does. It it blocks or occupies receptors in the brain. So it's just a measure of of what the drug does. We cannot measure, to my knowledge, occupancy in a person already taking a drug because we need the before and after.
>> So we could take a person with no off drugs, and then we could measure in a, in a PET SPECT scan, use this, it's called a ligand. We can measure the amount of receptors of a certain type available, and then you get a number. Don't ask me how the specifics of that tracer works, but just know that we can measure how many of a certain type of receptors that there are.
>> So, is this kind of like you give, um, you give someone one of these ligands, which
>> which allows, I guess, it attaches to the unoccupied receptor and it gives a signal that's picked up by the scanner?
Exactly. That's a much better description than I just had. But then when you put a drug in now, that drug is going to occupy some of them, and then and then that ligand, then the the image is going to change because the ligand will bind to less of it
>> because they compete.
Because they compete.
>> So, so exactly. So you do a before and after. You do a scan first, just with the ligand, and then you get a measure,
>> and then you wait some time for it to to wash out, and then you give a drug at whatever dose, and then you measure again with the ligand, and then the the amount that that has decreased
>> yes
>> equals the effect of the drug.
So, so we get an an inverse number of the the occupied series. That's how they, they work. And so I guess what I mean, what we know now is that, you know, sometimes like if you're on a really high dose of that drug,
>> you might not even experience withdrawal until you're down to the bottom 20%.
Exactly.
>> And I've seen a lot of these curves in your papers. You look at all of the antidepressants, and what it seems like is that when they've done these, these, these scanning studies, that that there's not a lot of change when you go from 100 down to 20%. It, it still looks, I, I guess it would be that that there's the same amount of receptors, um, unoccupied.
>> Yes.
>> And then all of a sudden, when you drop below the 20%, that starts to to decrease rapidly, and that's what's causing the withdrawal.
Exactly.
>> Yeah. Yeah.
Because it's not the, it's not the the drug per se we want. It's not the dose as such we want to remove, reduce gradually. It's what that dose does. And that's why, so, so a way to think of it is that the, the, the most of the effect of the drug
>> is in a very small portion of the dose, and that's what's illustrated in these curves because you'll see them, and maybe you can get one up on the screen here when we talk, but you can see it increase rapidly in the beginning, and then it kind of plateaus. So the difference between taking nothing and a tiny dose of something is huge, whereas the m, the difference between taking a tiny dose and a little bit more is less. So it kind of tapers off. Yeah.
>> So, and when we taper the drug, when we reduce it, we go the other way around. So, you go to the left on these curves. So, the idea is to understand that there is a saturation point as to how much we can affect the receptors where if you add more drug, you're free to add more drug into the system, but there's no difference because the body is already saturated. And that translates into in the context of tapering that that part of the dose that has no effect. Obviously, we can remove without causing withdrawal now because it doesn't have any effect. So, and that the really important, important thing for me to stress here, that when you look at these graphs, they're based on group data from a lot of people, and that curve is the average. So you cannot just enter the graph saying, I'm on this drug and that that many milligrams, I'm exactly at that occupancy. That means I can drop this much. It will vary. So there is an individual element to it too. Hope that makes sense. So, so you can be 100% sure that if you taper, there will be a reduction that even though that reduction wasn't bigger than the previous one, it'll suddenly hit harder because you got under that plateau. But we don't know exactly when it is. So people will hit that at different doses.
>> Yeah.
And and even though it's it's it's coming from averages, it's that principle. And that's what I think the most important part of this was to the scientific community was to show, like you just said a moment ago, that there is a huge amount of pharmacological activity at these supposed low doses. I mean, they're low doses only in name because of the weight of the drug, but they're incredibly pharmacologically active.
>> Exactly.
And that's why we need to go below them when we taper.
>> Yeah.
Because something that I see is like, I'll have someone who, you know, they're on 200 of certain or zolaf, you know, 200 to 50, that's fine. You know, 50 to to 100, that's fine. Down to like 50, oh, tapering's so easy. And then they go 50 to 25, and they go, "Oh, this sucks."
>> You know, and but they, but they're better. And they go, "Oh, this was awful." And then they think to themselves, they go, "Why am I doing this? This is let me just rip the band-aid off. I I've been fine." And and then they drop the last 25% and, uh, they cause a brain injury.
Hell breaks loose. Yeah. Because ironically, that step from 25 to zero is bigger than the one from 200 to 25. In fact, when you look at the data from 10 to zero, however crazy it may sound, is a bigger step for the body than 200 to 10. That's how massive that difference is.
>> Yeah.
So, and that hyperbolic tapering is just called hyperbolic tapering because that's the shape of the curve.
>> Yes.
>> That shows when we plot dose against biological effect. So, we really just want to, and that's what I meant. It's it's it's simple in theory. It can be very, very complicated to navigate in practice,
>> because you need small doses, and you need them to be extremely precise at the lower end.
>> Yeah.
But the, the overall principle is really just, we want to follow that curve all the way down to zero. And that means sometimes bigger reduction in the beginning. Then there will be a point when you need to slow down with slow down, slowing down meaning doing smaller steps.
>> Yeah.
>> Not necessarily waiting longer. It's the steps that that's the problem. Right. So, so while the main message of all this work and all the also the work that you're doing and anyone is in this field is to taper slower than we were taught.
>> Yes.
>> There's also an element to it that not necessarily all the way because if you would continue, sorry, if you would start with your 5% reductions at 200 milligrams of certain, you'd be prolonging the process unnecessarily. And that's where the art part comes into it.
>> Yes.
>> That's what we know how to do. How to sit with a person and take their story and talk about previous withdrawal attempts, and then help them navigate. And then that individual occupancy curve for that person will will start to present itself as we reduce the dose.
And it's as much of it is it is an art because you're really, you know, that there's no firm protocol for the person, and it's really based on them. I would also say that in principle, um, it is generally simple for people, and then they wouldn't need to be intimidated because what I, what I find I usually do with someone, if they're on a high dose, you know, we might start at 5 to 10% a month, you know, if I'm using liquid, I'll check in with them in two to four weeks. Hey, how do you feel about this? Oh, you know, symptoms at all? We'll bump it up, you know, we'll go, we'll go up, you know, 2.5% or 5%. And, you know, okay, how's this rate going? You know, I have a bit of withdrawal, but I'm managing. That's perfect. We're just going to keep on doing this. And eventually, that person will tell me, I nearly missed work this week, or, you know, I was having a hard time. Then I know, okay, I'm going to slow it down.
>> That was your sign to
>> Yeah.
>> Okay. That's where your
>> Yeah.
>> plateau happens to be. Now we know.
Exactly. And and and so I think as long as you're doing a, we call patient-led tapers, where where it's it's based on how they're feeling, and you go, okay, so now we're we're going out of mild withdrawal into something that's more moderate to severe. We don't want that. We're going to slow the rate down. And that's the fastest way to get off. Like, I mean, if you're listening to this, like do it. I mean, this might take you 18 months, but if you do it that way, it's it's a lot faster than than pushing it and just being like, I'm going to white knuckle it. I'm going to, I'm going to, you know, try and tolerate something that's a bit more severe.
>> Yeah. Yeah.
That that won't work. And, you know, it's it's it's simple in theory, but it's tedious. And people, they often think, ah, you know, it's just
>> Yeah.
>> I'm just going to rip the band-aid off, but but it doesn't work.
Which is obviously not going to work. Like, I know, and I've seen this, and I I know you have too. Like,
>> if and that's the the the bit the the the darker chapter, not to end with that.
Well, well, the scary thing is, it does work for some people.
>> It does work, obviously. Yes.
>> There's a lot of people who, who they have very elastic brains. They they come off suddenly, and then and then they're fine. And then you have the patient who's like, "Oh, my mom, she's come off and on like multiple times. Why am I having all of these problems?" And so there's this, there's this strange variance in just the elasticity or the neuroplasticity, however you want to put it, for for reasons I don't know. Some people, they can come off really quickly, but other people
>> can adapt. The the the principles we talked about before. They work way faster. And just, and that's reflected in the statistics too. And the incidence is not 100%.
>> It's depending on who you ask, 50, 60, 70% who get withdrawal even after long term.
>> Yeah.
>> So, so, so, but still, there's no way for us to know. There's no way to predict that. So I would never risk it because there, there's another extreme too, of people getting seriously injured about it. So, and that's why I just couldn't help but comment before, don't play a hero. Don't tough the severe withdrawal symptoms out because we don't know when it gets permanent for a person. Meaning that even though they were caused by a disruption of brain chemistry by reduction,
>> there is a, there seems to be a a window of like reinstatement where after that, even though you introduced the drug, and it was clearly caused by that, now the body doesn't accept it anymore. So either it works to reinstate, either it does not work, or the third very unfortunate situation where it makes it worse, even because now the body's reacting to the drug again. So there's definitely a limit as to how much we should play around with bigger reductions.
And, and this is one of the things that really bothers me because I, I argue with people on Twitter because that's just what you do.
>> So, sorry, so
>> I should answer Twitter. Twitter.
>> Yeah.
>> Um, there's people out there who say, you know, I've come off medications. It's not a big deal. Slow tapering is a scam, you know, and, um, and I hear what they're saying because yes, some people do come off quickly, but the price, I mean, if you are an unlucky person, and I don't know who that is, maybe it's like one in 20, one in 50, I don't know.
>> But if you're one of those people that comes off and you have a brain injury because of it, I mean, you would give your arm to to go back and taper the right way.
And so for that, I think everyone needs to do a patient-led taper. They should never be finishing it in moderate or severe withdrawal. Like you finish it with mild withdrawal symptoms. You're much less likely to get hurt. And everyone should do it because the, the cost of doing it wrong, I mean, it's just devastating for people.
And, Exactly. And, and that's really where it gets a bit serious here, really. Like, it's not a game. These drugs, they enter the brain, for God's sake. Like, obviously they can they can mess things up. But I don't think it's, I I think incorrect tapering or discontinuation is a bigger, you know, threat to to injury than taking the drug long term. I think the brain knows how to, provided we do it in the way it wants to, it knows how to adapt back. And obviously also, just to, to, to, because there is an idea of not going, being afraid of the symptoms when we have to endure them. So, just to, to add that on, there's nothing wrong with being in with, like, it's not the dangerous to being in withdrawal. It's the severe and long-term that if you stay in those, that's the problem. Because reinstating or upping the dose a bit.
>> Mhm.
>> In a hyperbolic taper is a perfectly valid tool to have. Okay. Whoop. It was a bit too much. We didn't know because there is an, and
>> that's like another piece that is more in the withdrawal community. I think more in the past people would say don't ever updose.
>> You're just making it worse.
No. Yeah.
>> Yeah.
>> If you wait a long time and your nervous system gets kindled, and you then
>> of course, then. But within a couple, we don't know how long that window is, but days, weeks, I, it works all the time when I do it. Upping, and it can work extremely quickly too. And that's okay.
>> I see about three months. I think when I do reinstatements, there's a fairly good chance I can get someone stable in in three months. After that, it drops, and it's, and it's like, it's a dice roll. You know, maybe it's 50%, maybe it's 30%. We still try it. But
>> if, if, if you are going to reinstate, I mean, the sooner the better.
Um, but
>> well, let's, that was a great discussion on on on the on the receptors. What I want to ask you about, because we, we have covered a lot, is what haven't we talked about, um, which you think is important to share with the audience before we wrap up this conversation?
H I think we've been through a lot, really. Like, and there is a lot. And obviously, so
>> the goal of a taper is to avoid, ideally, withdrawal.
>> Yeah.
>> But because of how they work at the lower doses,
>> moderate to severe, mild withdrawal is perfect.
Yes. Yeah.
>> Mild or, or even at some
>> periods, moderate if the person wants to endure that.
So that's the goal. But the goal cannot be for most people, I would say, to avoid withdrawal because it, it's, it's unrealistic for most people because the reduction would have to be so tiny, even tinier than this.
>> Yeah.
>> To the end, it'll take. Yeah. So there's also an element of how to manage withdrawal, that okay, how to get through withdrawal symptoms is how to manage a period, days or weeks, or however long it is, without attaching to it, without worrying about it, without overanalyzing it, without letting you it control your life. Like that aspect of managing withdrawal, I find there's a whole chapter on that in the book, is is interesting too. Okay, now we've minimized it. How can we help people through that? And there's a huge overlap of what I would do there and what I would do in in psychotherapy. Like the psychotherapeutic toolbox is is is applicable here. That's not to say that it takes a psychologist to help people through withdrawal. It's not, because a lot of it is common sense. But just to say that that question, I really hope we, we to to add to the conversation too. And really, the important part is to understand that once withdrawal is minimized to a tolerable level, it tends to step into the background when you do stuff. So it's an attention thing, right? And everyone will know this
>> from other symptoms or ways of having it that yet we can kind of make it step back.
And some people would call it distraction. I would just call it like using attention. Like so we can, we can, we can definitely train our attention muscle, I would say, to be better at having sorts of storms going on, symptoms, while not attaching to them. And then it will feel almost like they're not there because you're not paying attention to them. And just imagine that as a, a, a skill that can be learned, and we do it all the time. I have two pretty silly examples, but they, they just to explain it. For example, for you and I, if, for everyone listening here, it will feel a certain way on the surface we're sitting on, for example.
>> And it will also, 10 out of 10 times, have this characteristic feel inside your mouth, for example.
>> Mhm.
>> Like these are just two examples of stimuli that were here, but I'm pretty sure you didn't pay attention to it before I said it. Yes. Is that right? Like, because it's a completely irrelevant stimuli. Why would we? But it shows the power of attention, right? Attention is like a, it's like a gatekeeper for what enters our awareness. So, and the moment I said that, I'm sure you could feel it. Like it's always there. In fact, it's never not there. And unless you're flying, you're always in contact with the surface somewhere.
>> So, what changed? Attention. The only thing that changed was that someone sitting in front of you drew your attention to it, and then it just stood out. Now, obviously, withdrawal symptoms, and that's why I say when they are minimized, because there's no way to do this with severe withdrawal, in no way. It it insists on taking the the the driver's seat. But when they're minimized, we can learn to do what we're doing with these sensations to withdraw, too. The only difference is that they're painful. So, they tend to drag or pull in our attention.
>> Yeah.
>> Does that make sense?
Well, it makes a lot of sense. And, um,
>> it's a skill.
>> It is. It it is a skill. I, I also personally, when I, when I do this work in my practice, I find that there's a very natural grieving process at the beginning, especially if someone's been hurt.
>> Um, where they're really afraid of the symptoms. They think they're dying, you know, their heart is beating. Am I going to have a heart attack? What's happened to my body? And you're right, if it's really severe,
>> you know, there's no distracting. You just kind of lie in bed on TikTok and Instagram, and you just you watch TV. But, but eventually, there's a part, a place where people can, they're not as afraid of what's happening. They're just like, this is just my brain going haywire. I've got neuropathy. My hands hurt. You know, I have light sensitivity.
>> But I'm less afraid of it.
>> Um, and, and so, well, I mean, that, so that's in the book. Well, why don't, why don't you tell people how can they, how can they get a copy of this book? What's, how do you find it? What's the name?
It's, it's coming. It's, it's, it's release date is coming soon. So, it'll be, if you follow my channels, which actually I'm just building because, as I said before, much most of my stuff is in Danish. So, I'm only building my international
>> Yeah.
>> presence here now with Twitter and a Substack profile. And the book is called Crossing Zero, the Art and Science of Coming and Staying Off Psychiatric Drugs.
Okay.
>> Long title because I wanted it to include both coming and staying off, and the idea that it's an art and a science.
Um, having read this, um, because you kindly shared a copy with me, this is exactly the type of book that I wish I had when I was, um, coming out of medical school, going into residency, in, you know, very understandable, accessible way. It really goes through all of the, I would say, the most relevant criticisms about psychiatry and the way we help people.
>> It's, and it's, it's very thorough. It touches on everything, and it is a great way to get oriented to a very conceptually complicated space in a very accessible way. And so I really enjoyed it. I think, um, if that's speaking to you, I would highly recommend you run out and get a copy of Andrew's book. And, you know, outside of that, where can people find you online if they want to interact with you?
Yeah. So that's what's happening now. They can, if they want to learn Danish or translate, they can find us on Facebook and LinkedIn. But I'm, I'm building, I'm building the international presence now, and that will happen on X and on Substack.
Okay. Well, thank you so much for coming out to Park City for this interview.
>> Of course.
>> Let's go.
>> I have one thing I want to read to you before we end. Can I do that? I didn't know when to put this in. It's a greeting from Denmark.
Okay.
>> So, it's, uh, some of my close friends who wrote this to me.
Okay.
>> That, and she wrote, "Say hi to Joseph and tell him he has a Danish fan who got through suicidal thoughts from hell due to withdrawal by listening to one podcast after another, thereby realizing that I'm not alone at all, and that this isn't a personal problem, but a systemic, structural, political one." Joseph's first interview with Mark Horowitz, hi Mark.
>> Yeah.
>> May very well have saved my life.
Thank you. Wow. That's amazing. And that is
>> true.
So
>> well, thank you. I, I don't think I'll ever get sick of, um, hearing messages like that.
No, it's meaningful, right? It really adds meaning to this
>> Yeah.
>> space, does.
Cool.
>> Well, well, that's great. Let
>> I hope it was helpful for someone.
>> Very helpful. Let's go get dinner.
>> Let's go get dinner.
>> Okay. If Andrew's story resonated with you and you're starting to question whether your meds are helping you or holding you back, you're not going to want to miss the next video where I talk to you about the safe way to come off the medications and avoid the common mistakes that hold people back.