19.1 The Problem with Rapid Benzo Detox; Patient Perspective with Nicole Lamberson, PA

[00:00:00] Over that time period, she drugged me on, I was by the end on six psych meds at the same time. So I was taking Xanax, Klonopin, Ambien, Adderall, which if you know anything about the mechanism of drugs, it's like here, let's, you know, tranquilize your brain and then give you this massive stimulant. Like in hindsight, it makes no sense.

[00:00:27] Somebody get this guy some help!

[00:00:37] Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis, or treatment. All listeners should consult with a medical professional, licensed mental health provider, or other healthcare provider if seeking medical advice, diagnosis, or treatment.

[00:01:03] It is nice to virtually meet you.

[00:01:07] Yeah, you too.

[00:01:09] I heard good things about you from Dr. Yosef.

[00:01:14] Okay, good.

[00:01:15] Yeah, I work with him, actually. He hired me as a coach for his taper clinic working with his patients. Yeah.

[00:01:23] I got you. Yeah, I talked to him a couple of months ago and posted something on my channel. I always find that it's just nice to talk to people that make me feel like I'm not so crazy or isolated in my opinions on my field.

[00:01:40] Mm-hmm.

[00:01:41] Oh, you're not.

[00:01:43] Yeah.

[00:01:43] Yeah.

[00:01:44] You know, I think when you say some of the things that Yosef says and you say some of the things that I say.

[00:01:49] So today on the podcast, I have Nicole Lamberson. Nicole was trained as a physician assistant, got your bachelor's of science at James Madison University, went on to complete a master's of physician assistant program at Eastern Virginia Medical School.

[00:02:05] You practice in urgent care and occupational medicine until severe illness from psychiatric polypharmacy, subsequent withdrawal, left her unable to work.

[00:02:18] Now you are working as a coach and a consultant for the taper clinic with a friend of mine, I guess, a virtual friend of mine, Yosef Witt-During, who runs the podcast Life on Less Meds and the taper clinic.

[00:02:32] I came across your story after a corporate addiction recovery center that I was, am working for for now told me that I was not allowed to prescribe Xanax to a patient in Xanax withdrawal, that it was against their policy, that the only benzo I was allowed to use was Valium.

[00:02:51] This led me on a literature search rampage, trying to accumulate all the papers available on something that I had seen clinically and is actually a decades-long established unique phenomenon with Xanax withdrawal.

[00:03:06] In doing so, I came across your five-piece article on why prescribed benzo patients shouldn't go to rehab slash detox.

[00:03:16] And knowing that stories like yours are not few and far between, but unfortunately rather commonplace, especially in our overtreat and under-deliver American healthcare system, paired with these 14- or 30-day cookie-cutter, corporate-run, addiction treatment centers,

[00:03:36] whose uniform approach to prescription or illicit drug or illicit drug or alcohol addiction and withdrawal causes so many patients to suffer protracted withdrawal symptoms, sometimes for years.

[00:03:51] Aggressively tapering drugs like benzos or antidepressants is just not good for our brains and can cause major imbalances in neurotransmitter and brain-body homeostasis.

[00:04:05] It really angers me when we don't individualize our treatment approach.

[00:04:10] And these centers claim to have helped you because they successfully brought you off of a drug and you didn't die.

[00:04:17] And they add you to the statistic of successfully treated addiction.

[00:04:22] It's refreshing for me to find stories like yours that others in the medical community are aware of the psychological and physical dangers and symptoms of withdrawing medications too rapidly.

[00:04:34] Nicole is not just a victim of this broken system.

[00:04:39] She has now used her experiences to promote awareness initiatives, including working with the Benzodiazepine Information Coalition, co-founded the Withdrawal Project.

[00:04:51] I was looking at your film that you helped work on, Medicating Normal, earlier.

[00:04:56] You're an associate at the International Institute for Psychiatric Drug Withdrawal.

[00:05:01] Serve on the American Society of Addiction Medicine's patient panel, advising on the development of a clinical practice guideline on the safe tapering of benzos for the FDA.

[00:05:11] And also, you're acknowledged for your contribution to the Maudsley Deprescribing Guidelines, a comprehensive resource for safely reducing and stopping antidepressants, benzos, gabapentinoids, and Z-drugs.

[00:05:28] Nicole, it is a pleasure to have you on today.

[00:05:31] And I really do thank you for being vulnerable and willing to tell your story.

[00:05:37] I know that that is not the easiest thing to do, especially repeatedly, as you've made a lot of different appearances on different podcasts and other places.

[00:05:48] So before we get into it, how's your day going?

[00:05:50] What did today look like for you?

[00:05:52] Actually, pretty kind of just chill.

[00:05:55] It rained last night and I kind of had the morning off in preparation for doing this.

[00:06:00] I still kind of have to plan my days where I don't overload myself too much because I still have nervous system dysregulation.

[00:06:09] So yeah, I just kind of hung out and was looking forward to talking to you.

[00:06:12] Awesome. I've been looking forward to it as well.

[00:06:14] Before we get into your story, can we start with a few just rapid fire questions about Nicole the human?

[00:06:21] Yeah, sure.

[00:06:23] What do or what did your parents do?

[00:06:26] My dad is an anesthesiologist and my mother was a lab tech actually, but she died when I was in like 10 years old.

[00:06:36] Yeah.

[00:06:36] Okay. I'm sorry to hear that.

[00:06:38] So two medical parents though, you and I share that in common.

[00:06:42] My dad's a urologist.

[00:06:43] My sister is an OB nurse.

[00:06:45] Yeah. Kind of runs in the family, I guess.

[00:06:48] Yeah. My dad's a urologist.

[00:06:50] My mom was a pharmacist and sharing in our trauma.

[00:06:54] My mom passed away when I was 16 years old.

[00:06:57] Oh, I'm sorry.

[00:06:59] Yeah.

[00:07:00] Yeah. It is unfortunate, but I always, I don't know.

[00:07:02] I guess I feel a sense of closeness to people that have had that similar experience growing up,

[00:07:09] even though you and I don't know each other.

[00:07:11] Yeah, it's true. I saw something, I can't remember who was saying it. I think it was like an Ed Sheeran interview or something like that.

[00:07:20] And he was talking about losing a friend, but he was much older when he lost the friend.

[00:07:25] And he was saying, it sort of made me understand my friends who had, who were kids and lost parents when they were young,

[00:07:32] that like they became adults as children, you know, because of that loss.

[00:07:38] And I, that was like profound for me.

[00:07:40] I was like, oh yeah, that really resonated.

[00:07:43] Yeah. I mean, it, it, I guess it's like an unstated bond, um, that you feel just knowing that somebody else,

[00:07:51] yeah, had to kind of rapidly grow up, uh, without that maternal influence.

[00:07:56] So, um, what did you want to be when you were growing up?

[00:08:01] I always wanted to be in medicine, even though my dad kind of begged me not to.

[00:08:07] And now I know why, but yeah, I think I just like, I just wanted to be like my dad, you know,

[00:08:15] you're a little girl and you watch him and I stayed in the hospital, you know, spent the night when he was on call

[00:08:23] and the nurses were so nice to me.

[00:08:25] And so I think that's kind of where it came from.

[00:08:28] I just, I wanted to be like my dad.

[00:08:31] Yeah.

[00:08:32] Yeah.

[00:08:33] Again, I, I spent plenty of nights sleeping in the physician lounge.

[00:08:38] Where lots of naps are taken in chairs and yeah.

[00:08:41] Yeah.

[00:08:42] What did your dad, why did he not want you to go into medicine?

[00:08:45] Or what was he counseling?

[00:08:46] What were kind of his reasons?

[00:08:49] And he didn't really, I mean, I guess we probably should have had a better conversation about it,

[00:08:54] but I, I think he probably wanted me to just sort of pick my own thing.

[00:08:58] He didn't want to discourage me too much, but I think it was just, you know,

[00:09:02] the hours, the trauma, you know, the just brokenness of the system, kind of all of it.

[00:09:11] I mean, he said to me after I got sick from psych meds, you know, that it caught him being a physician for him,

[00:09:20] caused him tons of trauma that, you know, he said it just doesn't, things don't end like they do in the movies.

[00:09:25] And it sort of changed his personality, he feels.

[00:09:28] And so probably, you know, all of those things burn out, you know, all the things we, we know about happen in medicine.

[00:09:36] Yeah.

[00:09:36] What about when you want to get away from work?

[00:09:40] What do you do?

[00:09:43] I love walking.

[00:09:45] And that's something I kind of took up in withdrawal.

[00:09:49] It was something that kept me alive.

[00:09:50] And now I just love kind of being outside and going on long walks and different places in the woods.

[00:09:57] That's one of my favorite things.

[00:09:59] Did it help to externalize some of that inner restlessness, what we call akathisia that can occur so frequently with psych meds,

[00:10:10] especially with poly pharmacy with psych meds?

[00:10:13] Completely.

[00:10:14] I mean, I had akathisia.

[00:10:16] And so in that phase of my withdrawal, I wouldn't call it walking.

[00:10:19] It was like frantic pacing, you know.

[00:10:22] And then I had a period of withdrawal where after that akathisia phase burned out, it kind of felt like the excitation from akathisia sort of.

[00:10:34] I don't know if I could compare it to like a computer.

[00:10:37] It felt like like my motherboard was kind of fried.

[00:10:39] And so for years, I couldn't walk or exercise.

[00:10:43] I was exercise and exertion intolerant.

[00:10:47] And then many years in is when I sort of started walking.

[00:10:52] But yeah, it did help with some of the agitation and just feeling like I had to move from how awful I felt.

[00:11:00] So I want to hear about your story.

[00:11:02] But since we're already on the subject, can you give a little bit more detail about what that akathisia feels like from the patient perspective?

[00:11:13] All I can say is it's the worst thing I've ever experienced in my entire life, ever.

[00:11:18] And if you told me there was something worse, I would be like, I don't believe you.

[00:11:22] It just felt like my spine was like kind of torture tickling me in a way where I couldn't get away from it.

[00:11:30] And the movement is mandatory.

[00:11:33] Like you can't not move.

[00:11:36] But it doesn't relieve the symptom.

[00:11:39] So you're just moving frantically, like trying to escape yourself.

[00:11:44] But the act of moving doesn't get you anywhere from the torture, really.

[00:11:50] Yeah, it has a strong association with suicidality and suicidal thoughts.

[00:11:56] And I mean, that's one thing that I did not get until towards the end of my psychiatric training.

[00:12:04] And luckily, I trained with a lot of really good conscientious and critically thinking residents where we went outside of our program to try to better understand, you know, this journey that we were about to embark on for, you know, a career.

[00:12:22] But absolutely.

[00:12:23] I understand in talking to patients that it is just one of the most uncomfortable, unbearable symptoms that can come from the treatment.

[00:12:33] So, yeah, I'd like to hear more about your story.

[00:12:37] Kind of if you could start, if you're comfortable with it, with what prompted you to make the appointment with a psychiatrist in the first place.

[00:12:46] And then how that process of going from one medicine to two to several, a practice that unfortunately I see every single day in my new patient appointments who come to me on three, sometimes up to 10 different psychiatric meds.

[00:13:05] Can you give us the rundown of what happened?

[00:13:37] Yeah, sure.

[00:13:38] I was having, you know, just like run of the mill, I guess, kind of anxiety at work.

[00:13:43] And I was given Xanax by one of the physicians on staff at my job, actually.

[00:13:49] So it wasn't a psychiatrist who initiated the drug.

[00:13:53] Typical story, no warning, no, you know, if you take this every day, this is what could happen.

[00:13:58] It was just like, oh, this will help.

[00:14:00] You have anxiety.

[00:14:01] Take it whenever.

[00:14:04] So everything I tell you is kind of in hindsight.

[00:14:06] You know, I didn't know any of this at the time.

[00:14:09] Otherwise, I would have done things completely differently.

[00:14:11] But I figured it out once it was too late that I was having adverse effects to Xanax pretty soon thereafter starting it.

[00:14:20] I think I was developing tolerance and interdose withdrawal but didn't realize that it was the drug.

[00:14:27] And we hear that often from people that it's kind of an insidious type thing.

[00:14:31] And the people who it happens to, and that's what happened to me, just kind of blame it on yourself and think like, oh, something's wrong with me or I must be developing an anxiety disorder.

[00:14:44] And that is when I entered psychiatry.

[00:14:47] I started having kind of random suicide ideation on the Xanax as well.

[00:14:54] And that scared me.

[00:14:55] I started seeing a therapist and a psychiatrist.

[00:14:59] And I stayed with the same psychiatrist for many years, like three or four after the Xanax.

[00:15:06] And over that time period, she drugged me on – I was by the end on six psych meds at the same time.

[00:15:15] So I was taking Xanax, Klonopin, Ambien, Adderall, which if you know anything about the mechanism of drugs, it's like here, let's, you know, tranquilize your brain and then give you this massive stimulant.

[00:15:29] Like in hindsight, it makes no sense to me.

[00:15:32] And it's not like the benzo is out of your system if you take it at night.

[00:15:36] It's not like it's completely out of your system by the next morning.

[00:15:39] Yeah.

[00:15:41] So also Seroquel for sleep, which we know is, you know, a no-no, really.

[00:15:47] Remeron because the Adderall made me lose weight and not hungry.

[00:15:51] So that one, you know, made me park a chair in front of the fridge and find myself in bed at night with Jell-O and cold chicken bones and weird stuff like that.

[00:16:02] Was that six?

[00:16:04] Yeah.

[00:16:05] That was the six.

[00:16:05] So really, really three drugs to help with sleep and the Seroquel, the Ambien and the benzo and then Adderall to get things going in the morning.

[00:16:16] And I guess the Remeron also, right, was another one that you probably took at nighttime as well.

[00:16:22] Yeah.

[00:16:23] Did your psychiatrist ever look at the regimen that you were on and say, maybe this isn't working?

[00:16:31] No, which to me in hindsight is crazy because when I showed up to her, yeah, I had these like, you know, tolerance, interdose symptoms.

[00:16:41] But by the time I left, I was in way worse shape than when I got there.

[00:16:47] And there was no acknowledgement of like it could be the meds.

[00:16:51] It was just you're getting your mental illness is getting worse.

[00:16:54] You know, oh, you're treatment resistant depression, stuff like that.

[00:16:59] So yeah.

[00:17:00] How much did your Xanax dose escalate over time?

[00:17:04] I think the first script was 0.5 milligrams PRN.

[00:17:09] And I was on 0.5 twice a day with the psychiatrist in between Klonopin one milligram three times a day and then Ambien at bedtime.

[00:17:20] So it was like almost 100 milligrams Valium equivalent when you, you know, do the math.

[00:17:27] Yeah, absolutely.

[00:17:29] My first exposure ever to Xanax was actually when I was 14 or 15.

[00:17:36] I was a freshman in high school and I snuck out of my house to go meet a friend who lived close by.

[00:17:44] And he comes out of his house.

[00:17:46] He brings me a Miller Lite.

[00:17:47] We have a conversation.

[00:17:51] I'm just excited that, you know, I had the gall to leave the house against my parents' permission.

[00:17:57] And I come back and the next day I see him at school.

[00:18:02] He has zero recollection of our conversation.

[00:18:06] What I didn't realize at the time is that he had drank a couple of Miller Lite's, but he was also on prescribed Xanax.

[00:18:17] Unfortunately, now he is no longer with us from what I think is getting a illicit Xanax that was cut with fentanyl off of the dark web after a long period of sobriety.

[00:18:31] But I don't doubt that he probably, you know, was kind of rapidly tapered as well at one of these, you know, treatment centers.

[00:18:38] Right.

[00:18:40] When and how did you realize that your drugs were causing akathisia and ultimately making everything a lot worse?

[00:18:50] Well, I did what's called like a geographical escape, I guess, at one point.

[00:18:56] I thought, oh, you know, let me just simplify my life because everything was sort of falling down around me.

[00:19:03] I was struggling to work.

[00:19:04] I was sleeping all the time.

[00:19:07] You know, I was having to like call out of shifts and have somebody come in and cover.

[00:19:11] And my life was like so unmanageable.

[00:19:14] But I was just taking prescribed psychiatric drugs.

[00:19:19] And so in my own mind, I believed this narrative from psychiatry that I was a mental patient, you know.

[00:19:28] And I didn't think for a second that it was the medications causing this to me, which some people find unbelievable.

[00:19:36] Like you went to PA school.

[00:19:37] But I literally did not question the drugs at all.

[00:19:42] And I think it's because I went to PA school and because I grew up in a household with medical people.

[00:19:48] I was so naive at the time thinking like doctors always help.

[00:19:53] They never harm.

[00:19:54] Why would they give me something damaging?

[00:19:57] You know, I really trusted in the medical system.

[00:20:01] And so I was really kind of like brainwashed, you know, in that time thinking that I was this mental patient.

[00:20:08] And it was such a hopeless message.

[00:20:10] The psychiatrist would say, you know, you're always going to have this and you're going to have to manage it.

[00:20:15] And, you know, we're going to have to be tweaking meds all the time and stuff like that.

[00:20:19] So what happened was my dad, like I said, who was an anesthesiologist, saw my decline and was like, what the hell is wrong with you?

[00:20:29] Essentially, I was selling my house because of this geographical escape idea that I had.

[00:20:35] Like, I'll just move and I'll get a simpler job and I'll not have a big house that I own by myself.

[00:20:41] And maybe that'll make everything better.

[00:20:44] I thought it's got to be my anxiety disorder.

[00:20:47] And if I just simplify my life, you know, and when I was selling the house, actually, the realtor said something to me like, oh, we got to pay for this termite thing or something.

[00:20:58] And I freaked out.

[00:20:59] Like I yelled at her.

[00:21:00] And my dad was like, I've never seen you like scream at someone, especially like a realtor, someone helping you, you know.

[00:21:07] And he knew that my behavior was not, you know, like me at all.

[00:21:14] And so he actually read in a journal that he was actually outside magazine.

[00:21:23] He had a subscription to it.

[00:21:24] If you've ever heard of it, it's like a, you know, outdoor type thing.

[00:21:29] And there's a journalist who writes for outside who had a severe benzo withdrawal.

[00:21:33] His name's Matt Samet.

[00:21:35] He's a wonderful writer.

[00:21:37] And he writes amazingly about withdrawal, if you're curious, over at Mad America is where his writings are.

[00:21:44] But anyways, my dad read it and was like, oh, you know, I think this is what's happening.

[00:21:52] And he gave me the article.

[00:21:54] And I read it and was like, oh, my God, I'm being poisoned by psychiatry.

[00:22:00] Like it was the light bulb moment for me.

[00:22:05] And so quickly thereafter, you know, I was like on the Internet searching.

[00:22:10] How do you get off of this stuff?

[00:22:11] And instead of finding things like the Ashton Manual, keep in mind, this was in 2009.

[00:22:19] Well, 2010.

[00:22:23] So there was not nearly as much information out then as there is now.

[00:22:28] Now there's so much stuff out there that you could find.

[00:22:31] But back then, you know, I would have had to come across the Ashton Manual, which I didn't.

[00:22:35] So what I found instead were these, you know, medical journal articles about detoxing people with phenobarbital.

[00:22:44] And so I was like, well, I don't care.

[00:22:47] Whatever I have to do to get off of this crap, I want to get off of it.

[00:22:50] Because it was the first time I had had a feeling like I could actually be normal again if I get these drugs out of my system.

[00:22:57] This is what's causing everything, you know.

[00:23:00] So it was not long after that I found a detox rehab place to check into because I was like, I'm going to get this stuff out of my system.

[00:23:10] I told my job I'll be back in 30 days, which to me is hilarious because more like 13 years.

[00:23:19] But, you know, whatever.

[00:23:20] My protracted withdrawal went on a really, really long time.

[00:23:23] So you can see from my story, though, that I thought it was going to be like a quick, oh, they're just going to get out of my system and everything's going to be fine type of outcome.

[00:23:33] And that is not what happened.

[00:23:36] Yeah, we'll definitely talk a little bit more about this in a hot minute.

[00:23:40] But I've had a couple of high school classmates who, you know, went to the 30-day rehab.

[00:23:47] Opiates were just huge.

[00:23:48] It was like I came back from my first year of college and, you know, the partying that was happening before college, you know, people drinking alcohol, maybe some people smoking weed.

[00:24:02] All of a sudden there was Oxycontin everywhere.

[00:24:05] And again, at the time I didn't understand kind of the bigger picture.

[00:24:09] But when I went to medical school, after I saw a couple of classmates go into these 30-day rehabs and come out and overdose because they had completely lost their tolerance to the opiate and die and then go to medical school, it made sense.

[00:24:29] The bigger picture did.

[00:24:30] I'm curious about your training and what kind of emphasis was placed on the side effect profiles of psychiatric drugs.

[00:24:42] Very little.

[00:24:43] I mean, more of our training was about like what drugs to prescribe for what.

[00:24:48] But there was almost no training on adverse side effects and zero on deprescribing.

[00:24:55] You know, it wasn't even a mention of like, oh, when you give people stuff that has a physical dependence risk, you better have an exit plan.

[00:25:04] And what does that look like?

[00:25:05] And how do you get them off?

[00:25:06] Like no discussion whatsoever, which is why probably I fell victim to this as a PA, you know.

[00:25:15] Yeah.

[00:25:16] Yeah.

[00:25:16] And I think that in terms of what I was taught, it seems like it was mostly directly based on the clinical trials that were run.

[00:25:25] And there are major problems, especially with the benzo clinical trials.

[00:25:30] Something that, again, I'll bring up again in a little bit.

[00:25:33] But it is kind of crazy to me how many ancillary sources I've had to look for to figure out what the true long-term side effect profile of, you know, even generally antidepressants, SSRIs, the first line.

[00:25:49] And you start to investigate further and be open to the possibility that maybe you didn't learn everything that there is to know in your training.

[00:25:59] And, I mean, it can be overwhelming at times from a prescribing standpoint.

[00:26:05] And so, you know, there's, I guess, part of me that understands why some physicians, I think there's ignorance.

[00:26:11] I think the negligent, intentionally bad physician is much more rare.

[00:26:18] But, yeah, I mean, I think that there's definitely a component of just poor training.

[00:26:22] And maybe that is kind of industry-sponsored training.

[00:26:27] There is a lot of industry sponsorship of the textbooks, of the medical schools that we attend.

[00:26:35] And if you're going to get those things paid for, you better play ball with whatever they're, you know, asking you to do or whatever books they want in the curriculum, et cetera, et cetera.

[00:26:46] So, yeah, I mean, it just takes an openness to, if you don't experience it yourself, to just be open to the fact that, hey, maybe there are more occult, longer-term effects that I'm not aware of.

[00:27:02] So, it's just so important to listen to your patients and not discount them just because they don't have medical training or don't have clinical experience.

[00:27:12] They're the ones taking the drug that can really tell you about what the effects are.

[00:27:18] Oh, totally.

[00:27:19] And just to touch on something you said, I mean, I'm on, as you mentioned, I'm on the patient panel for the American Society of Addiction Medicine as they're developing the deprescribing guidelines.

[00:27:31] They got a couple million dollar grant from the FDA to do that.

[00:27:35] And you were talking about literature searches.

[00:27:39] And they admitted, essentially, they, you know, part of coming up with the deprescribing guidelines was first a massive literature review of what exists on benzos.

[00:27:48] And they came back and said, not much as far as deprescribing is out there.

[00:27:53] We barely have anything to go by to make these deprescribing guidelines.

[00:27:58] So, even if you're a questioning, critically thinking medical provider and you're going looking, you're not going to find much stuff.

[00:28:08] You know, they just haven't been studied in the way that we need them to be.

[00:28:12] But there's tons of overwhelming anecdote.

[00:28:15] So, there's a quote I like, something about, you know, anecdote is not evidence.

[00:28:22] But if there's enough of it, we should probably apply some scientific rigor, right, and figure out what's going on here.

[00:28:30] And there's been massive amounts of overwhelming anecdote from benzo patients since the 60s, you know.

[00:28:38] Yeah, I mean, that is really crazy to me.

[00:28:41] I may come back and ask about some more specific protracted withdrawal.

[00:28:46] But it was refreshing to see in your article after not being able to, essentially seeing a patient and saying,

[00:28:54] I know what's going on and I don't think you should come off of this abruptly like they're trying to have you come off of.

[00:29:01] And I don't think we should substitute another benzo that's not going to completely cover your withdrawal symptoms.

[00:29:08] Setting up, you know, with their family member at home for when they leave the treatment center,

[00:29:13] hey, are you willing to hold on to this medicine and make sure in the early stages that you don't run into the addiction side of things

[00:29:21] and that you have that accountability and support?

[00:29:24] And so when all that happened, it was so refreshing to see your article and you citing Heather Ashton,

[00:29:31] who is a psychiatrist who passed away in 2019, is famous for what you've already referenced, the Ashton Manual,

[00:29:39] which gives legitimate evidence-based guidelines on how to effectively withdraw from psychiatric drugs.

[00:29:46] A lot of information on benzo withdrawal, as well as Malcolm Lader, who recognized the unique chemical structure of Xanax

[00:29:55] and therefore the unique withdrawal syndrome that isn't always responsive to other benzos.

[00:30:01] And he actually warned of a Xanax epidemic.

[00:30:04] If you've ever read his 1991 paper, History of Benzodiazepine Dependence.

[00:30:10] And you recommended that prescribed benzo patients should not go to rehab or detox.

[00:30:18] And so these two citations, these are two of the most experienced and knowledgeable psychiatrists in history about benzodiazepines and withdrawal.

[00:30:31] Yet I had never heard of them in all of my residency training.

[00:30:35] Their works are not frequently cited by large organizations that produce guidelines on how to withdraw without causing excess brain and body damage.

[00:30:46] Why do you think these experts in the area of benzo withdrawal specifically are not taken seriously?

[00:30:53] Or their professional opinions on how to effectively withdraw are not cited in very many official guidelines?

[00:31:01] I don't know.

[00:31:02] I mean, I just feel like medicine sort of like, you know, history repeats itself over and over again.

[00:31:08] And there's so many problems with guideline based medicine anyways, where we're just like sort of following a recipe where, like you said,

[00:31:16] you're not tailoring care towards a specific individual circumstance.

[00:31:21] So, you know, I think there's like an expert even who his whole spiel is the problems with guideline based medicine.

[00:31:29] You can research him.

[00:31:31] But, you know, so I don't know why.

[00:31:33] I mean, when we were meeting with the ASAM, we were basically saying, like, we don't have to reinvent the wheel.

[00:31:40] It's already done.

[00:31:42] You know, like there's good guidance from experts in this space that we can just build on and make better.

[00:31:49] And you can use it as the official guidelines, you know, maybe because Ashton was sort of a observational type data.

[00:32:00] You know, she opened her own clinic and saw her own patients there.

[00:32:05] Maybe that's why they don't like it.

[00:32:07] You know, I'm not sure.

[00:32:09] Well, I don't know that systematically that anybody who is promoting taking deprescribing and taking people off of meds,

[00:32:18] the guidelines usually are sponsored by an organization that is usually funded by somebody who has a vested financial interest in those guidelines.

[00:32:30] And so, you know, I always try to think about things in terms of what are people's motivations?

[00:32:36] And when you have any sort of new drug or any drug that creates a lot of sales, like Oxycontin,

[00:32:45] then those companies are going to be holding to their shareholders and they're going to do their job of trying to bring back as much return on investment for their shareholders.

[00:32:58] But that's not my job.

[00:33:01] I don't care about that.

[00:33:02] And it just bothers me to the core that there is so much manipulation and overlap of people like you and I who went into medicine to,

[00:33:16] you know, ideally try to help people in understanding their health and their health outcomes,

[00:33:22] but also as a scientific pursuit to try to understand the mind better,

[00:33:29] to try to understand what are the things that significantly affect our health outcomes and how can we study those systematically and come up with good evidence moving forward.

[00:33:39] But so much of that evidence base is it's just so watered down now with I mean, really with just bullshit data.

[00:33:48] Yeah, it's corrupted for sure.

[00:33:51] So the sad part is, you know, patients and physicians don't know what to trust.

[00:33:57] You know, there's it's like, where do you go for really good information that you can trust?

[00:34:03] Even having had the experience that I've had and knowing that I can't trust everything, I still get tripped up sometimes with like, well, where do I go to find the actual truth?

[00:34:16] You know, where's the best source of information?

[00:34:19] Yeah, I will tell you that coming out of psychiatric residency, it just so happened to coincide with my son being born six days later.

[00:34:29] First kid.

[00:34:30] I said, I said, I'm going to take three months off.

[00:34:33] I've been grinding for years and I want to enjoy this, this newborn period.

[00:34:39] Of course, I got a little restless because I was not very good at breastfeeding.

[00:34:44] And so I had always wanted to start a podcast, but I wanted to get through my training and have a good level of expertise in my field before that.

[00:34:55] So at that point in time, I started developing all of these outlines.

[00:34:59] I started doing these deep dives into research and really, you know, the best research that I think is out there.

[00:35:07] The lowest chance of manipulation comes with older research.

[00:35:11] You know, really pre-1997 before direct-to-consumer advertising was legalized here.

[00:35:19] And again, we are the only country, maybe New Zealand, that allows pharmaceutical companies to directly advertise.

[00:35:26] But I've learned more in talking to actual experts who have so much appreciation for nuance, who are such good critical thinkers.

[00:35:38] And it's just frustrating because that's not what is consistently reported in the guidelines and in the data.

[00:35:46] So that's kind of my imperative here is, is for me to learn and continue to learn about my craft, but also provide an outlet for patients or young trainees to where they can listen to in general.

[00:36:02] I'm not trying to produce a lot of specificity here with my podcast, but they can listen in general how actual experts approach these questions.

[00:36:12] And so often there's not a black and white answer to them.

[00:36:16] There's all these shades of gray.

[00:36:19] Completely.

[00:36:19] Yeah.

[00:36:20] I mean, you touched on it with the Xanax thing.

[00:36:22] You know, we see people who can cross over to Valium from Xanax and they actually get relief.

[00:36:29] They're glad they did because the Valium is super long acting.

[00:36:32] We have people who cannot tolerate Valium at all, who feel better on their original benzo and they taper directly from the benzo that they're on.

[00:36:42] Even if it's short acting, you know, and there's tips and tricks and ways around that.

[00:36:47] I mean, all you're doing is looking at the half life and somebody's introduced withdrawal presentation and saying, oh, OK, well, if you're if you're having introduced withdrawal in the middle of the day and you're taking two doses of Xanax.

[00:36:59] Well, you just split it into three and usually it solves the problem and they can taper, you know, directly off a shorter acting drug.

[00:37:05] But instead, when you were at that rehab place, right, they were like, it's Valium or nothing.

[00:37:11] And there was no listening to the patient or I mean, I hear providers who reach out all the time to some of the organizations I work for.

[00:37:20] And they say, well, how do you know if if the patient is just having relapse of their original anxiety or if they're in withdrawal?

[00:37:29] You know, and they're saying it in a way where I can tell that they're trying to be like it's just their anxiety coming through.

[00:37:36] You know, I'm like, they'll tell you they are the experts.

[00:37:40] You know, they'll tell you I've never felt anxiety like this before in my entire life.

[00:37:46] This is different.

[00:37:47] Something's wrong with me and it's not my old anxiety.

[00:37:51] Heather Eshin has a great piece on that, on how to create a distinction between symptoms of the original condition that was being treated and withdrawal.

[00:38:00] There are some that are so freaking obvious, one of which is genital numbing is not something people usually get with their original anxiety.

[00:38:10] Yeah.

[00:38:12] Zaps that people feel in those peripheral sensory nerves in their face.

[00:38:19] That is not something that anybody's ever come to me as a initial visit for anxiety that has reported that as a symptom of their anxiety.

[00:38:28] That that to me is just honestly, it's just a dumb question or a dumb statement.

[00:38:34] And it's it sounds like it was probably made or probably gets made by people who already think that they know the answer and don't have an openness or curiosity about that that truth.

[00:38:47] Which, again, we like to label the truth.

[00:38:49] But the truth is somewhat nebulous.

[00:38:51] I mean, it it it oftentimes there are truths and then there are exceptions to that truth on a little bit of a different note, but kind of still kind of revolving around psychiatry and pharmaceutical influence.

[00:39:06] So I do think that the field of psychiatry has been, you know, puppeteered by the pharmaceutical industry and that overall we do more harm than good based on the training that we get.

[00:39:18] But I also think that psychiatry practice with nuance, critical thinking, individualizing treatments, emphasizing non pharmacologic and minimal pharmacologic treatment or intervention can be very helpful for people.

[00:39:34] I do think that there is a biologic component to mental illness based on a decade of experience working with inpatients with severe mental illness conditions like schizophrenia and mood disorders that are not under the influence of any sort of psychiatric drug or any illicit drug.

[00:39:51] People struggling with addiction that have never had suitable trauma or mood disorder treatment and are trying to self medicate as well as outpatients.

[00:40:01] But the nebulousness associated with our diagnoses was ripe for exploitation, especially when direct to consumer advertising was legalized in 1997.

[00:40:14] Since then, I would say that the field of psychiatry is in a freefall.

[00:40:18] There are good and conscientious, intelligent psychiatrists out there and psychiatric practitioners, but we are trained in a way that promotes confidence and surety.

[00:40:29] We take tests where there are five possible answers and one of them is right.

[00:40:36] This is despite the fact that we don't have great overarching explanations for our illnesses.

[00:40:42] So many of them seem to have overlapping symptoms that make it hard to distinguish one diagnosis from the next.

[00:40:49] And that rapid expansion of diagnosis in the DSM-4 and the DSM-5 was never warranted by actual good research and good data.

[00:41:01] Most of them are not valid.

[00:41:03] Most of these diagnoses and a lot of psychiatrists that I've talked to understand this.

[00:41:08] I absolutely would not blame you for completely turning against the field of psychiatry based on your experience.

[00:41:15] But I wonder, is there a middle ground here?

[00:41:18] Do you think that you would have a different outlook if when you initially sought help, you were given better guidance, more individualized guidance, and quite frankly, not somebody whose answer was to add, add, add every time there seemed to be something going wrong?

[00:41:36] And maybe would have started with what I think is the most important piece of before you start a treatment is, is there anything we could take away that is negatively affecting your symptoms?

[00:41:49] Do you envision that your experience could have been drastically different?

[00:41:55] Oh, yeah.

[00:41:56] I mean, if I work with psychiatrists now that I love and respect.

[00:42:00] So I don't hate psychiatrists.

[00:42:02] I think there's good ones who are doing good work, mostly, you know, who are critically thinking and who are aware of the massive problems in the field.

[00:42:14] You know, a lot of them are doing deprescribing, too, as their primary focus.

[00:42:21] But, yeah, I think if somebody just would have identified from the jump, like, hey, you just added this new chemical.

[00:42:29] Maybe that's the cause of why you're feeling this way, you know.

[00:42:33] But nobody ever said that.

[00:42:35] No one ever questioned ever any of the medications that I was on.

[00:42:40] And to be fair, not just psychiatry, it was all the other specialists that I went to as well when I started having all kinds of problems.

[00:42:48] I had rheumatology visits because I had joint pains everywhere from polypharmacy.

[00:42:55] I saw a gastroenterologist because I had chronic GI problems from taking so many medications.

[00:43:01] I mean, multiple specialists.

[00:43:04] And no one said, oh, six psych meds at a time could potentially be causing the symptoms that you're having.

[00:43:11] So, yeah, I think things could have turned out differently if I would have encountered one of the psychiatrists that I respect and work with, you know, today.

[00:43:23] But there are few and far between, I think.

[00:43:26] And, I mean, the system is, I feel, I mean, in my experience, it's trying to weed us out, too.

[00:43:32] I mean, I lost a job at a treatment, at a recovery center because I was taking patients from like 10 psych meds to eight.

[00:43:44] Not trying to be too aggressive, but just saying, okay, this one, you know, I don't think we can say that you're in a place of stability.

[00:43:52] And I do feel like these are affecting you negatively.

[00:43:57] That just doesn't seem to be a very popular approach with some people.

[00:44:02] And it leads to a lot of frustration on my part.

[00:44:06] And trying to find that tribe of people that see things the same way that I do, but also trying to impact a system that is just huge.

[00:44:15] And has so much power and influence as just a, really a small fish in a small pond.

[00:44:23] Yeah.

[00:44:24] Well, you mentioned the rehab.

[00:44:25] I mean, one thing I kind of was like, this doesn't make any sense after the fact was I showed up on drugs that cause physical dependence and withdrawal syndromes.

[00:44:36] And I wanted to get off of them.

[00:44:38] And they ripped me off only the ones they deemed, quote unquote, addictive.

[00:44:42] So from the jump, they didn't even know the difference between physical dependence and addiction.

[00:44:48] I wasn't addicted to anything when I showed up there.

[00:44:51] But then the irony to me is they added more psychiatric drugs to my cocktail that also caused physical dependence.

[00:45:00] They were trying to put me on things like Cymbalta.

[00:45:03] And I'm like, you're just recreating the same problem as the benzos.

[00:45:10] You know, Cymbalta can have a horrific withdrawal syndrome, just the same.

[00:45:15] But they didn't see it like that.

[00:45:17] It was like, oh, we're just going to take everything that's in this bad category because it's a controlled substance away and put you on this other stuff and you'll be good to go.

[00:45:27] You know, yeah, I love the way that you put that in the sarcastic use of bad because I really like I think the way that I approach what I do.

[00:45:39] Again, there's a lot of questions about the field of psychiatry and our diagnoses and how we view treatments.

[00:45:45] And there's a lot of different perspectives on it.

[00:45:49] For me, I like to go all the way back to the thing that binds us all together as human beings.

[00:45:56] We have this unique internal situation where we have this thing we call a mind that operates quasi independently of our conscious self.

[00:46:07] And what I've found in talking to my patients in my own experience is that our minds are very orderly.

[00:46:17] They like to categorize things.

[00:46:18] They like to put that label of bad or good.

[00:46:22] And it is required of us consciously to provide that nuance, to appreciate all of the gray area that exists.

[00:46:34] But I see that all the time, not just in medicine, not just in psychiatry, in politics, in society.

[00:46:41] And I don't think most people are aware because I don't think most people consider that, OK, I've got a mind and it kind of does its thing and it really gets louder and produces emotions, especially when I go silent or when I'm not consciously engaged in something.

[00:46:58] But our minds, they present things as very extreme to us.

[00:47:02] And so I see that as kind of an overarching, I guess, societal contribution to this problem is we have this hell-bent nature of just wanting to order things, wanting to know that this is good or this is bad.

[00:47:17] Or this is a good person, this is a bad person, if you want to delve into the politics there.

[00:47:25] And it's just too simple of a way to look at life, I think.

[00:47:30] So I really – go ahead.

[00:47:32] Topic.

[00:47:32] You know, just quickly, Joanna Moncrief does a – she's a psychiatrist.

[00:47:37] She does a brilliant job at sort of breaking down that good drug, bad drug, you know, model that I just talked about.

[00:47:46] So if anybody's interested in sort of reading more about that topic, she's a great person to read.

[00:47:53] Yeah, absolutely.

[00:47:54] I'm familiar with Joanna Moncrief.

[00:47:57] I'm probably going to have to have her on the podcast at some point, if she'll come on, of course.

[00:48:01] Oh, I'm sure she would.

[00:48:03] She's awesome.

[00:48:04] So –

[00:48:04] I got another little stem here because I want to provide a little bit of information about kind of Malcolm Lader, Heather Ashton, kind of some of their work.

[00:48:15] And talk a little bit about why this is so obvious.

[00:48:19] So such an obviously poor thing to do is to prescribe specifically benzos long-term.

[00:48:25] So I rarely start a benzodiazepine in a patient.

[00:48:30] Not never, but if and when I do, I can't remember the last time I told somebody to take multiple doses in a day or even to take it every day.

[00:48:39] I like to use them for a week-long period to reset somebody's circadian rhythm or sleep cycle.

[00:48:46] They do not help with sleep in the long term.

[00:48:49] They do not produce quality sleep, but they can be good to reset a sleep cycle.

[00:48:54] They are very useful in acute mania.

[00:48:56] I would prefer to use a benzo over an antipsychotic for most manic patients and also for specific phobias.

[00:49:03] Limiting somebody from engaging in activities that they otherwise want to engage in – flying, traveling, large social gatherings, concerts.

[00:49:14] Always educate and warn the patient that there is a risk of dependence.

[00:49:18] There is a risk of addiction.

[00:49:20] That there is a rewarding quality of these drugs that the mind can, after just a few doses, right in line with our conversation,

[00:49:28] deem the benzo as a good drug for me.

[00:49:30] And let's not bullshit here.

[00:49:33] They're very effective at reducing anxiety in the short term.

[00:49:38] The problem with benzos is that patients quickly develop established tolerance, requiring higher, more frequent doses.

[00:49:47] And most people don't realize, something that I educate any patient asking about using or taking a short-term benzo,

[00:49:54] all of the clinical trials on different benzos only last four to six weeks.

[00:50:01] I think Klonopin lasted eight weeks.

[00:50:03] So essentially, again, this is – to me, it's a manipulated effort at finding good data to put out there.

[00:50:12] So they start the benzo on day one in the clinical trial.

[00:50:16] The person is not coming in on the benzo.

[00:50:18] They start the benzo at an average dose of 1.35 milligrams divided throughout the day for Xanax.

[00:50:25] And that's compared to total daily doses that I regularly see of three milligrams, six milligrams, or even more.

[00:50:32] They then ask questions about the person, the patient in the clinical trial's anxiety periodically throughout the trial until week four to week six.

[00:50:41] Then they stop the drug for the next six weeks and report that there's not any sort of significant withdrawal syndrome associated with –

[00:50:49] whether it's alprazolam, Xanax, or Klonopin, clonazepam, et cetera, et cetera.

[00:50:54] But we know, based on large cohort studies from countries with nationalized healthcare systems –

[00:51:02] specifically, I'm referencing a Finnish study, a study from Finland over a 10-year period from 2006 to 2015

[00:51:10] that showed that of 130,000 new benzodiazepine users, 51,000 became long-term users more than six months.

[00:51:21] But drug companies, they're not studying the long-term effects of benzo use because they know that they only stand to lose profit from those studies.

[00:51:33] So I know that is a big lead-in question stem, but I'm wondering in your experience with being prescribed a benzo,

[00:51:41] did your provider ever review any of this information with you?

[00:51:46] Do you think that they were even aware of this information, and would it have changed your outlook on the safety and efficacy of long-term use?

[00:51:58] Oh, yeah.

[00:51:58] I mean, if someone would have told me, you can become physically dependent, and here's what it means,

[00:52:03] because we have to tell patients what physical dependence means.

[00:52:06] They don't understand that, that you could have a withdrawal syndrome if you tried to stop.

[00:52:11] And it's not withdrawal, like people think about, like cigarettes, you know.

[00:52:16] It could be extremely painful.

[00:52:19] It could cause seizures and death if you do it wrong.

[00:52:23] And it could last for years.

[00:52:25] I would have been like, no, thank you.

[00:52:28] I'm good.

[00:52:29] You know, I will take some responsibility in that I didn't read the, you know, patient information leaflet or whatever that comes with the drugs.

[00:52:39] Like most patients don't.

[00:52:41] But in my defense, at the time, this information wasn't really in there.

[00:52:46] It's only been since the latest update in 2020 by the FDA that they put the black box about physical dependence and protracted withdrawal syndromes in the patient information and, you know, provider information sheet.

[00:53:01] So that was just a couple of years ago, you know.

[00:53:05] But no, I was not warned at all.

[00:53:08] And I don't think my prescriber knew because when I went back after I left the detox center and I was in florid benzo withdrawal, I mean, she was like, that would be rare.

[00:53:22] Benzos don't cause that.

[00:53:23] You know, she was very just sort of gaslighting me that it wasn't happening.

[00:53:28] And then she gave me like a prescription for Vistaril and a book written by like Claire Weeks or something on anxiety, which was laughable because I was in severe, you know, cold turkey benzodiazepine withdrawal at the time.

[00:53:45] And then she fired me as a patient, by the way, after that, because my dad was with me and spoke up and said, you know, I've made a career altering people's brain chemistry as a, you know, an anesthesiologist.

[00:54:01] And you're not supposed to give people benzos daily for years.

[00:54:06] And then she just kind of looked at me like you poor, poor mental patient.

[00:54:11] Your dad is interfering in your treatment and then sent me a letter the next day and fired me.

[00:54:17] Oh, there's not many things that grind my gears more than seeing that look from a provider.

[00:54:26] Like, no, you're one of them.

[00:54:29] No, we're we're all us.

[00:54:32] I mean, you know, like my patients are not they don't have these differences for me as a human being.

[00:54:41] Like, I think we're all susceptible to falling off the path and having trouble in life and developing different mental health symptoms.

[00:54:53] And I just I can't stand it when people because I've trained with, you know, a lot of different people.

[00:54:59] Residency is, you know, you get a lot of exposure to different specialties and you switch every month to train with different residents and different attendings.

[00:55:10] And that there's nothing that bothers me more than somebody who adds to the stigmatization, really, or just sees patients as them as opposed to, you know, we're all part of this human race on this big ball spinning through the cosmos.

[00:55:30] So I'm sorry that you had that experience.

[00:55:34] Yeah, I mean, there's nothing worse.

[00:55:36] And lots of benzo patients experience this than being desperate for help in benzo withdrawal and having the door slammed in your face by a medical provider when you need help.

[00:55:50] You know, it's what causes people to take their lives because they don't have a doctor who believes them.

[00:55:57] And then when the doctor doesn't believe them and gaslights them, the family doesn't believe them and gaslights them, too, because all the families believe what the doctor says, you know.

[00:56:07] Yeah, I know.

[00:56:09] I know it is a huge responsibility as a physician to maintain the ability to say, I don't know.

[00:56:16] And I don't know everything and I can't give you a specific answer there because, again, I think the system creates this sense of feigned certainty about things.

[00:56:29] You answer all of these questions for years and years and years on tests.

[00:56:34] And every test is written like there's one answer to each question.

[00:56:38] And then you go out into clinical practice.

[00:56:40] And if you retain that philosophy in your clinical practice, well, you're not only going to make mistakes, but you're not going to be as willing to take accountability and change the way that you practice based on those mistakes that you make.

[00:56:55] This is not a single issue.

[00:56:58] I mean, you know, you said, oh, I'll take some of the accountability.

[00:57:01] And yes, I mean, I think that our society, there's a burden of responsibility that rests on how our society promotes medications that alter how we feel and promotes this, you know, short term instant gratification at the expense of long term therapeutic benefit.

[00:57:21] I don't work in a deep prescribing clinic.

[00:57:24] But I see a lot of patients that I think are on too many meds.

[00:57:28] And it takes a lot of counseling.

[00:57:32] And that's difficult in 15, 20 minute appointments.

[00:57:35] But it takes a lot of time, energy and effort to help some people realize that their symptoms may be actually being caused by their medicine, not that we need to keep adding to it.

[00:57:46] But there's components of a legal system that slaps big pharma companies on the wrists and doesn't have a great system in place to rectify and retrain physicians who are either ignorant or educated and negligent in their patient care.

[00:58:02] You've got the obvious collusion that exists between the FDA and the regulatory agencies with big pharma and this recycling of major executives between the two.

[00:58:14] You've got the medical education problems with who and how we're being taught these things, as well as, you know, like we've talked physicians, providers needing to listen to their patients using their anecdotes in combination with available good research.

[00:58:35] And then, you know, of course, the pharmaceutical companies themselves and just being hellbent on profits and not caring as much about the pursuit of science and advancing our understanding of our medical diseases and what causes them and how to best treat them and prevent them, et cetera, et cetera.

[00:58:54] How would you like break down the kind of burden of responsibility between all of those entities and then any entities that maybe I failed to mention?

[00:59:04] I mean, lots of people who have this happen to them, what happened to me, be it from benzos or, you know, antidepressants or some other, you know, medical intervention that they accepted that harmed them will blame the doctor.

[00:59:22] And at first I was really pissed off, too.

[00:59:25] I was so angry at the psychiatrist.

[00:59:27] But then with more time and kind of perspective, I realized that I think a lot of the medical providers are victims as well of a system that's broken, that's not educating them properly.

[00:59:40] And most people, I think, are good and they want to help.

[00:59:44] You know, that's their motivation for being there.

[00:59:47] And so they just are ignorant.

[00:59:49] And they're trained by a system that is intentionally sort of keeping them that way.

[00:59:55] So I think most of the responsibility kind of lies with, you know, pharma and all of the corrupt science that's teaching providers the wrong information.

[01:00:10] But something that I've learned from going through this myself is, you know, we can cast blame all around.

[01:00:16] But at the end of the day, you have to be your best, your own best health advocate, period.

[01:00:23] You know, no one's like coming to save you.

[01:00:26] You have to look out for yourself.

[01:00:28] And it's sad that we live in that reality.

[01:00:31] But that is the reality, even if it's sad.

[01:00:33] And so never again will I walk into a medical practice of any kind.

[01:00:41] I don't care what specialty it is.

[01:00:44] And just at face value, let some physician or PA or nurse practitioner or whatever tell me, oh, this is what you're going to do and not go home and like do my own research or get a second opinion or look and see if there's a patient group of people who've tried this thing.

[01:01:03] And what are they reporting on the internet?

[01:01:04] And what are they reporting?

[01:01:05] You know, I will never make that mistake again.

[01:01:09] And I wish that we could sort of educate everybody in the world to be that way and to think that way because we would save ourselves tons of pain and suffering.

[01:01:21] And also, like you can put things out of business if you want to if you just stop buying them.

[01:01:28] If certain things are harming enough people and we all are aware of it and we just stop being consumers of them, then they're going to go away, you know.

[01:01:36] But I've encountered so much resistance from especially people who are taking psychiatric drugs about safety information.

[01:01:46] So if I'm providing you safety information, I'm not making a judgment about you taking psych meds or not.

[01:01:53] I don't care.

[01:01:54] It's your body.

[01:01:55] You can put anything in your system you want to.

[01:01:58] But when like, for example, Toyota offers a recall on a car, most people are happy.

[01:02:06] They're like, oh, thank goodness.

[01:02:07] They sent me a letter and told me that my airbags could be faulty or whatever.

[01:02:11] But I notice when we provide safety information about drugs, specifically psych drugs, and maybe it's because people like identify with their diagnosis.

[01:02:22] People get angry in some instances and they kind of push back or they say like, you're pill shaming me.

[01:02:29] And so that's probably like a whole philosophical topic to explore.

[01:02:33] Why are we welcoming of Toyota recalls?

[01:02:37] But when someone says, hey, FYI, that benzo you're taking, make sure you taper it slowly because it can have like a really severe withdrawal syndrome.

[01:02:45] And they kind of lash out at you and say, it helps me.

[01:02:48] Why would you tell me that?

[01:02:51] Just just food for thought.

[01:02:53] Yeah.

[01:02:53] Yeah.

[01:02:55] Did you see Jillian Michaels the other day?

[01:02:58] I guess she was testifying in front of a Senate subcommittee or something.

[01:03:03] But she was talking about big food.

[01:03:05] Oh, gosh.

[01:03:07] Biggest Loser or whatever.

[01:03:09] Yeah.

[01:03:09] I don't remember.

[01:03:10] I just recognize her name and I recognize her.

[01:03:13] But you should look it up when you get a chance.

[01:03:15] It's like a nine minute video.

[01:03:16] And it is one of the most passionate pleas to our senators to make an impact or create regulations around the food that we eat.

[01:03:29] And like it got me so fired up and jazzed up.

[01:03:32] And it's again, it's another example of somebody who just gets it.

[01:03:37] And I do think that's part of the reason why I do this podcast.

[01:03:40] I love hearing from people and learning from people.

[01:03:43] But it's also my outlet for this because working in a big academic center or being a resident, especially in one of those centers, you realize that there's a lot of people you're working under that are suffering from that imposter syndrome.

[01:04:01] And instead of being open and vulnerable to it, some people turn that into emotional abuse.

[01:04:10] And you feel like I can't ask these questions or I can't challenge or critique what the attending is doing here because it's just going to lead to a horrible day or a horrible month for me.

[01:04:22] I think that certainly plays a role.

[01:04:25] The other question that popped up, if you can't tell, my mind just kind of goes off on these.

[01:04:30] That's okay.

[01:04:31] Side roads often.

[01:04:33] So when you go to the doctor or a provider, which do you feel more comfortable with?

[01:04:41] The one who is regularly saying, I don't know and I'm not exactly sure, or the one that is just has the utmost absolute confidence about everything that they say?

[01:04:52] Oh, definitely now the unsure one, the one who's willing to admit.

[01:04:58] And also, like, I want a collaborative doctor at this point after everything that I've been through.

[01:05:06] I don't want someone who treats me essentially like they kind of own my body and I'll do what they say instead of like, well, what do you want?

[01:05:14] Or, you know, what do you think about that?

[01:05:19] Let's talk about it.

[01:05:20] I mean, obviously, you know, there's liability and stuff.

[01:05:24] You can't just like do whatever the patient wants at every single turn.

[01:05:27] But including someone in their care is so important.

[01:05:33] And I will, you know, fire doctors left and right if they're not that now because I've just kind of gained the perspective.

[01:05:42] Like they work for me essentially.

[01:05:45] Like they're providing a service.

[01:05:46] And if they're not doing a job that I feel safe and comfortable with, I'm going to find someone else, you know?

[01:05:54] Yeah.

[01:05:54] I mean, I am getting more in the habit of regularly telling patients at that first appointment of really trying to motivate them to be part of their care.

[01:06:03] The reality is that, you know, I say, look, you are more invested in your care than anybody else.

[01:06:11] And that does include me because it is your life.

[01:06:15] So I want you to do research.

[01:06:17] I want you to bring me information.

[01:06:20] My job is to make sure that I keep you in the guardrails and that I try to educate you as much as possible about whatever road that you're traversing down.

[01:06:32] But I do think that there is a component of the system that's like I go to the doctor and the doctor fixes me.

[01:06:40] Whatever is broken, the doctor will fix it.

[01:06:43] And it solves over and expect.

[01:06:45] Yeah.

[01:06:45] And I think, you know, that's what I was doing in my 20s, fresh out of PA school.

[01:06:50] And that's kind of what I thought the system was.

[01:06:54] You just show up and complain about whatever it is and then they fix it.

[01:06:58] Yeah.

[01:06:59] Yeah.

[01:06:59] So when is the last time that you took any of those psychiatric drugs?

[01:07:04] It was 2011, I believe.

[01:07:08] So I reinstated benzos after the cold turkey, but not anything else.

[01:07:13] I went back on one benzo because I found a psychiatrist, luckily, that believed what was happening to me.

[01:07:21] And then I tapered off of it over like 18 months.

[01:07:26] But most of the sort of neuronal injury from the cold turkey was done.

[01:07:32] It helped a little bit, the reinstatement, with sort of stopping some of the akathisia that I was having.

[01:07:38] And then I went on to develop protracted withdrawal.

[01:07:42] What kind of symptoms are you still experiencing today?

[01:07:46] So I still have some dissociation, which you probably can't tell, but I'm very aware of it.

[01:07:52] I just have gotten used to living with it.

[01:07:55] I have probably the most severe symptom that I have still is burning, like twisting, ripping, shredding nerve pain in my spine and my legs and feet.

[01:08:08] But I still get like pretty bad fatigue and I can get overwhelmed really easily.

[01:08:16] Like, you know, I know that my GABA system essentially is not working appropriately.

[01:08:22] So like if you're asking me to multitask a lot and I'm under a lot of stress, like I can feel like I'm going to lose it.

[01:08:29] Like it's too much.

[01:08:30] You know, the breaking system of my body is not what it used to be.

[01:08:34] But it's much, much better than it was in the early years of protracted injury.

[01:08:40] And still, like, you know, I get a positive Romberg at the neurologist, dizziness, proprioception type issues, stuff like that.

[01:08:52] Yeah.

[01:08:53] And that's good to hear that there are objective signs of this that you could take to anybody and say, look, there is a neurologic sign.

[01:09:02] Because I know that patients with protracted withdrawal, like you've been told, are so often told that, oh, no, it's just in your head.

[01:09:12] It's not a real symptom or it's the rebound of what your original condition was.

[01:09:19] Are you able to draw strength from the fact that you're here?

[01:09:24] You're still here.

[01:09:25] You've gone through this journey and you are, I don't necessarily want to say come out the other side, but you've survived.

[01:09:32] Oh, yeah.

[01:09:33] I mean, it almost killed me.

[01:09:35] I came very close to ending my life many times.

[01:09:38] It was that severe.

[01:09:39] So, absolutely.

[01:09:41] And, I mean, I kind of get annoyed at people who are like, oh, I'm so grateful for my withdrawal experience, you know, because I'm not grateful.

[01:09:50] Like, this is a horrible thing for people to have to experience and I wish we could eradicate it from the earth, you know.

[01:09:56] But I'd lie if I say that immense suffering doesn't result in, you know, perspective and beautiful things on the other side.

[01:10:08] So, yeah, I mean, I have benefited in many ways from having gone through this, but it was horrible and I wouldn't wish it on anybody.

[01:10:19] Well, I genuinely have a lot of respect and admiration for you talking about these things because, you know, I mean, similar to a friend of mine that passed away that I was referencing earlier and his family's willingness to talk about the addiction and be open about it.

[01:10:40] Like, these things are not easy to do and there are so many people who are not willing to do that after going through what you've gone through.

[01:10:47] But it is so important to get the message out there to keep promoting this.

[01:10:53] And in reference to our earlier discussion about the burden of responsibility, accountability, I think the solution may be a little bit jaded, but I think the only solution is for the American people to stand up and, like you mentioned, to say no more.

[01:11:11] We're not going to take this anymore.

[01:11:12] We're not going to buy into this.

[01:11:14] But that takes the courage of people like you telling your story over and over again.

[01:11:21] And so, seriously, like I really do appreciate it and have admiration for it.

[01:11:26] Wow.

[01:11:27] Well, thank you.

[01:11:28] Yeah.

[01:11:28] At first, in the thick of withdrawal, like paranoia is a really intense symptom of benzo withdrawal.

[01:11:34] So, I was terrified in the early years and I was not going to – I think I used like an alias online in the support groups and everything.

[01:11:44] And then eventually as I healed more, I was like, yeah, like especially being medical providers, we need to come forward and talk about this so that patients stop being gaslit.

[01:11:55] And there's more information out about this and then so many people now have come forward telling their stories.

[01:12:03] Like I said, just overwhelming anecdote online.

[01:12:06] And so, everybody who does that is brave.

[01:12:10] And really, I just did it because I thought I don't want anybody to go through this like I did.

[01:12:16] You know, I want people to have informed consent.

[01:12:18] I want them to be able to make decisions with all the information.

[01:12:23] And then what they do after that is their choice, their body.

[01:12:26] You know, I'm not here to tell people never take X, Y, or Z.

[01:12:30] It's bad for you.

[01:12:32] You know, but here's the information and now at least you know and you can choose.

[01:12:37] So.

[01:12:37] Right.

[01:12:38] And, you know, you're here for the reason of promoting a positive message, for promoting education.

[01:12:48] I don't get the sense from you that you have these ulterior motives.

[01:12:52] And to go back to the motivations, I mean, you don't have this major financial incentive to go out there and say what you're saying.

[01:12:59] And when I look at research, when I look at what people are touting as truth, it means a lot when you don't.

[01:13:08] There's not really much incentive outside of just promoting for public good.

[01:13:13] It makes the things that you're saying and the stances that you take a lot more believable and come off as a lot more genuine.

[01:13:21] So I really do appreciate you coming on.

[01:13:24] It's been a pleasure.

[01:13:25] And maybe one of these days I'll end up at one of Yosef's taper clinics.

[01:13:31] I like what he's doing.

[01:13:33] And yeah, I appreciate you.

[01:13:35] Yeah, sure.

[01:13:36] Well, thanks for having me.

[01:13:37] And yeah, thanks for just being like a critically thinking psychiatrist.

[01:13:42] I love Renegade Psych.

[01:13:45] Like what a great name.

[01:13:46] And I just wish there were more like you, especially young psychiatrists who are questioning.

[01:13:53] Well, thank you so much for having me.

[01:13:56] Yeah, absolutely.

[01:13:57] You have a good rest of your day and a good week.

[01:13:59] Okay.

[01:14:00] Take care.

[01:14:00] Thanks again for watching and or listening.

[01:14:03] If you're passionate about the subjects that I discuss on the channel, do me a favor and like, comment, subscribe.

[01:14:12] Do whatever you can to make your voice heard that these are problems that must be addressed in our society.

[01:14:20] If you have any questions, comments, or concerns, I want to hear them.

[01:14:26] Feel free to reach out on social media or email us at renegadesych at gmail.com.

[01:14:33] And if you'd like to be a guest of the show or you have a connection to somebody that you think would be a good guest, let us know.

[01:14:42] Thanks again for listening.