54 Why America Prescribes 90% of the World's Amphetamines

[00:00:00] ADHD is a real neurobiological phenomenon. And this is a marketing phenomenon. One, it's literally in the name. Adderall. ADD for all. Two, amphetamines are illegal most places around the world, even for medical providers to prescribe.

[00:00:22] And three, we prescribe 90% of the world's amphetamines to 4.5% of the world's population here in the United States. And it's really good at helping people focus, but not necessarily really good at helping people focus on the things that matter to them. Somebody get this guy some help.

[00:00:57] Hey, I need your help growing my platform. If you enjoyed this video, click the join button, subscribe, donate to the channel. I'm worried my channel's being suppressed and I need your support to extend this grassroots movement message and get us back to prioritizing progress over profit in medicine. 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.

[00:01:26] 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. Or put more simply, if you need help like this guy, call your own doctor.

[00:01:53] What is the most inaccurately overdiagnosed mental illness? All right. So probably what I would say is the most inaccurate diagnosis in general, and by inaccurate, I mean, it's not even a valid diagnosis, is generalized anxiety disorder or GAD. It is horribly nonspecific. And anxiety is a symptom of other diagnoses.

[00:02:22] Anxiety is a symptom of depression. It's a symptom of bipolar disorder during some phases of the illness. Symptom of schizophrenia or panic disorder. It's a symptom of PTSD. It's also a symptom of general existence as a human being. You know, symptoms alone do not establish a distinct disease. It's kind of like saying, oh, you've got a headache or you've got a fever.

[00:02:50] Well, then you have generalized headache disorder or you have generalized fever disorder. Those are symptoms. We use them in conjunction with other symptoms to lead us to a more unifying diagnosis. But the cause of fever or the cause of headache could be from various underlying diagnoses. It could be infection. It could be an intoxication or an overdose on something. It could be something autoimmune.

[00:03:20] It could be simple dehydration. It could be a slew of other diagnoses. The point being that we don't diagnose fever. We don't diagnose fever and headache disorder. We use those symptoms to further investigate what the underlying cause of those symptoms are. When you talk about generalized anxiety disorder, there's no consistency across diagnoses.

[00:03:47] And that makes the diagnosis wildly invalid. Compare it to something like schizophrenia. An individual diagnosed with schizophrenia tends to have a consistent course of illness. The illness emerges in adolescence or young adulthood. First, with the presence of negative symptoms or cognitive symptoms, where dopamine is not being transmitted to the frontal lobe at the same levels as non-deceased individuals.

[00:04:15] And later, typically, at a very minimum months, but usually a couple of years later, you have the onset of what are called positive symptoms. Psychosis, delusions, auditory hallucinations. And symptoms remain relatively consistent over time in a mostly non-episodic nature.

[00:04:43] And there's also some evidence or at least some consistency across family histories or genetics. And I would say that you then get further into sub-diagnoses of different things that cause the syndrome or the constellation of symptoms we call schizophrenia, where some are more genetically predisposed and some are not as genetically predisposed.

[00:05:11] There also seems to be, I want to say it's unifying, but maybe it's genetics crossed with environmental factors like severe childhood trauma or adverse childhood experiences. And so in terms of that validity, you use the symptoms in the context of these other factors, the course of illness, the response to treatment, what runs in the family, to dictate what is diagnostically unique from other conditions.

[00:05:40] So that's kind of my spiel or my shtick about generalized anxiety. To me, it's the clearest and most obvious way for pharmaceutical companies to sell more drugs for something that is so dramatically nonspecific that literally probably 90% of people could meet the diagnostic criteria.

[00:06:04] You're talking about how with schizophrenia and other clinical disorders, it's kind of like a order of symptoms. These symptoms appear at this age. Other symptoms appear later on. From like an epigenetic standpoint, is there anything positive about diagnosing symptoms early in terms of preventative medicine? So say somebody has the potential to develop something like that. They present with anxiety.

[00:06:33] They have it in their family. You treat their symptoms of anxiety. Is that something that could prevent worsening symptoms or kind of the development of a full-on disorder? I think it's important no matter what to try to recognize what you're dealing with as early as you can in an illness because there are so many interventions that can be made.

[00:06:57] But the thing we want the most is for an easy, quick fix intervention. And that's what the hope of medicine provides. But in reality, the most effective interventions in something like schizophrenia at those early stages are non-medication.

[00:07:18] If somebody's psychotic and they have the potential of, you know, throwing their life away because of something they do under the influence of psychosis or not doing things, like if they're in a state of catatonia where they're not moving and they're not doing much and they can't think, maybe those are a little bit different.

[00:07:38] But when it comes to dopamine blocking treatment, yeah, it may help those positive symptoms, the psychotic symptoms, but it usually worsens the negative or the cognitive symptoms. So it's a trade-off. And, you know, there's a lot of countries that I would say do it a lot better with a lot fewer medication.

[00:07:56] Not no medication, but Open Dialogue out of Finland represents one of those good programs where those individuals are identified early in the course of the illness and they're surrounded with a lot of social intervention primarily. And yes, about a third of those people end up on an antipsychotic or another medication to help control symptoms.

[00:08:20] But that's compared to dramatically higher numbers of medication treatment for schizophrenia here in the United States. I don't think that applies to anxiety. I think what you're saying heavily can apply to something like bipolar disorder or episodic mood disorder is probably the better way to say it. The manic depressive illness spectrum where there's the potential for worsening of the disease with each episode.

[00:08:49] And that goes for both bipolar disorder, which is episodic in nature, or true episodic depression, which we've watered down with calling major depressive disorder. Not to be confused with minor depressive disorder, but I'm talking about episodic depression where the two poles of that individual are severe depression and normal mood.

[00:09:13] They don't get manic, they don't get manic, but they may have the same essentially remission with something like lithium early in the illness. Whether it's bipolar disorder or whether the pole, whether it's major depressive disorder, but it's clearly episodic and there's a family history or there's a family history of suicide or suicide attempts.

[00:09:35] And it emerges again in adolescence or young adulthood as the frontal lobe starts to, you know, dramatically increase in its development. You know, one of the risks of just liberally treating these things with medications, you know, let's say that you're 16 years old and you come in for generalized anxiety. And I say, well, I know the answer. I read the book and the book says for me to prescribe you an SSRI.

[00:10:05] Okay. Most of the time that'll probably be fine. Some of the time it might reduce your symptoms. Occasionally that reduction in symptoms may last for a long duration, but what's the risk of that? Well, the risk is that you're 16. You course of illness wise, you're not far along enough in the non-specific illness of anxiety or depression to where I could say definitively, what's the underlying cause.

[00:10:35] And if I give you an SSRI and you just so happen to have some of those bipolar genetics or manic depressive genetics, you've got this family history of depression that comes on episodically, sometimes interspersed by mania, sometimes not. Or maybe you just don't really have the manic symptoms because that doesn't tend to come on until a little later in the illness.

[00:11:00] Well, if you've got these non-specific factors that I've got to know you for more than one visit or more than a half an hour, maybe even more than three or four visits to gain confidence in what I'm treating, you can have a manic reaction and try to take your own life to the medication that I'm using for your generalized anxiety.

[00:11:22] That's a situation where things could go drastically wrong when it comes to early treatment of something that's not yet well understood. I've heard you talk about that before a lot, the risk of trying an SSRI when you do have that predisposition. Because if you weren't going to have a manic episode, if you were to be treated properly at first, you might not ever have one. I'm to the point where I just think lithium works better.

[00:11:49] And if I can give you something that doesn't have many side effects, like a low dose of lithium or buspirone or buspar or lavender oil, lavender extract, which has pretty good data, none of that inducing mania stuff. Low dose of lamotrigine, lamictal, a mood stabilizer. There's so many other things that I can do that just make a lot more sense when there's a lack of clarity there.

[00:12:18] The other one, when it comes to overdiagnosed, and you know where I'm going with this one. Could you hurt me? I'm surprised you didn't start with this. Yeah, I thought about starting with it because it's really been on the front of my mind lately as I've learned more about Obitrol, the former methamphetamine amphetamine prescription drug. But this is one that I just continue to harp on.

[00:12:41] And I'm sure I'm making enemies out there, both in the form of folks who stand to not benefit as much if people are better educated about how we got into this Adderall epidemic. But also people who are on Adderall and they're very attached to it. And they don't want to hear somebody telling them that it might not be good for them in the long term, that it likely there's a lot of evidence that it's not good for them in the long term.

[00:13:10] I continue to harp on this because it's important. We've been unknowingly, both providers and patients and just society as a whole, we've been culturally co-opted into this pharmaceutical industry playbook. You know, Adderall is formerly Obitrol. Obitrol. It's an amphetamine stimulant used primarily for weight loss in the 60s and 70s, also investigated for depression,

[00:13:40] which if you use amphetamine for depression for a few weeks, the person will feel better. But again, it's a matter of is that going to last in the long term? And so by the late 80s, early 90s, Obitrol was pretty much academically deemed to not be helpful for either weight loss or depression in the long term and to have significant side effects, including tolerance and dependency,

[00:14:06] with a lot of evidence of chronic neurotoxicity in all the animal research that's been done on it. But even though it was brushed aside, in 1996, Richwood Pharmaceuticals here in Kentucky bought the rights to Obitrol.

[00:14:24] They literally renamed it under their marketing strategy, which was to promote this idea of ADD for all, a.k.a. Adderall. Later that same year, Adderall was approved for ADHD treatment.

[00:14:42] And through the subsequent three decades till today, it's just dramatically soared in popularity with crazy increases of ADHD diagnoses. You ask, how do I know that this is a marketing phenomenon? And by the way, ADHD is a real neurobiological phenomenon. And this is a marketing phenomenon. One, it's literally in the name.

[00:15:12] Adderall, ADD for all. Richwood Pharmaceuticals a year later sold to Shire Pharmaceuticals for $180 plus million. That same playbook was kept in effect. Two, amphetamines are illegal most places around the world. Even for medical providers to prescribe. And three, and this is a short list of three. There's a lot of other reasons that I could use to support this argument.

[00:15:41] But we prescribe 90% of the world's amphetamines to 4.5% of the world's population here in the United States. And it's really good at helping people focus. But not necessarily really good at helping people focus on the things that matter to them. And it has significant long-term cognitive and cardiac side effects.

[00:16:09] It's just too strong for the brain to handle with its mechanism of action. And it doesn't seem to aid in cognition after a year or two. Even for those that it does work for initially. Like, Adderall is a version of speed. So again, ADHD is real. And this is the pharmaceutical playbook. Take something that's real and nonspecific. Migraine. Anxiety. ADHD in 2026.

[00:16:39] Then dramatically find ways to over-diagnose it. Putting out all these public health messages about this condition that you need to know about. This goes way, way, way back in pharmaceutical marketing playbook. Let's educate the public about this condition. And we'll just keep educating. And you sit back and you say, well, why is Shire Pharmaceuticals keep putting out, promoting all this ADHD? Get your ADHD evaluation.

[00:17:09] Oh, because they make the first-line medication for it. So they're not promoting Adderall, right? Which carries with it restrictions like having to give a full side effect profile. They just promote the condition itself. Could be diabetes. It could be pre-diabetes, right? In efforts to get as many people diagnosed with this thing that they know that a lot of those are going to convert to Adderall prescriptions.

[00:17:36] And all you've got to do, Ellie, pull up your TikTok. Pull up your IG. Pull up your Snapchat. It will take you less than 30 seconds to find a convincing influencer whose life has been cured or fixed from their Adderall. So initially, children were the target for this ADHD campaign. Because, well, part of it sounds better to parents.

[00:18:02] My child might have ADHD rather than a mood disorder or schizophrenia or from being repetitively abused or assaulted as a child or an adolescent. Or normal, like a kid that wants to run around outside. For sure. And now companies are getting in trouble legally for carelessly addicting droves of more recently mostly adults due to all of their focus problems.

[00:18:30] But why all of a sudden can't we focus? Can we investigate that? Did we really just discover ADHD as this widespread medical disorder where the treatment is stimulants and amphetamines? Or is a real entity with a very diverse, effective treatment regimen being marketed and shoved down our throats in order to sell more drugs?

[00:18:58] And you mentioned you're going to Japan next week. What about Japan? Golly, they must really be struggling there in Japan where amphetamines are legal and ADHD is not overdiagnosed and people do not take stimulants and droves for their underlying medical condition.

[00:19:21] Why is it that we look so fondly on Japan and Japan's work ethic and how effective they run their country and how they're one of these economic powerhouses, even though they're a very small country. But they don't diagnose and treat ADHD like we do here. And that's one other country example.

[00:19:46] We could talk about a dozen other, you know, top echelon respected health care systems. Most of them aren't doing this like we are. I know there's a really delicate balance between a behavioral intervention like therapy or human contact or advice as a way to help with some of these behaviors that are causing issues with focus, like addictions and things.

[00:20:12] For example, if you get on your phone in the morning and you scroll for two hours every day, that might have something to do with why you can't sit down and read a book. And then that might end up being pathologized as something that is biological. And I know that there are things that are extremely biological in terms of behavioral issues. So like, what do you think a healthy balance is between those two things? If somebody's coming in and they're like, I need to be medicated for this or that. What are your thoughts on that?

[00:20:41] In an ideal world, everybody would start before their symptoms got severe with talking to somebody. That does two things. It's not just the treatment is in the externalizing what is happening all up in here. That can be very helpful. And it can be even more helpful when the person you're talking to knows the right questions to ask.

[00:21:05] Because if you come to me with a problem and I don't have credentials or experience treating this, most people's knee jerk reaction is to give you reassurance. And that's really not typically very helpful because you've already done that for yourself. Your mind's created a concern or an anxiety or a worry. And you and your frontal lobe has then reassured yourself in some form or fashion. But then it comes back.

[00:21:31] And so talking to a professional, not just for the specific direct treatment benefit that you might get from that, but also because you establish care earlier. You can get to know the person better over time to have more diagnostic clarity without jumping to medicating necessarily. That is very dependent on whether or not it is an emergency.

[00:22:00] But you also have the ability, like you just mentioned, what could I take out of my life that might be contributing or causing my symptoms? That should always be the first thing that we look at. What can I take away before I think that the solution is through addition?

[00:22:19] And this problem is so widespread and it's so frustrating for me because I see so many patients when they're so deep down the treatment road. Not just did they not start out with talking to somebody once a week for several weeks to better clarify or classify the condition and see how it changes over time, right?

[00:22:44] Did the person get better when they got through the breakup or maybe they were really depressed and suicidal because of the breakup. But then all of a sudden they met somebody new and they're excited about it. And that kind of removes the concern about losing the past relationship. You know, the kid who can't focus who's smoking weed every day and not just any weed smoking 60% or 90% THC weed.

[00:23:13] Okay, it's probably most helpful to start by removing that to see if you're able to concentrate better. So once you've ruled out that there's an emergency, somebody's psychotic, they're manic, they're, you know, delusional or they're responding to internal stimuli or they're catatonic. They're literally not moving. They're not eating. They barely talk. Moving through life like they're surrounded with a layer of molasses.

[00:23:41] Or they're an extremely high suicide risk. And they say, hey, I have a plan to take my life if you can't help me. Well, those situations are emergent. And those probably warrant inpatient admission to, again, better clarify and classify what you're dealing with. Because some of those psychotic symptoms, they may look like mania. They may look like schizophrenia. The person maybe used methamphetamine and they need time to clear. And you don't need to treat them with anything.

[00:24:11] But you need to remove the methamphetamine from their life, right? There's so many things we can take out. And when I see somebody come to me for the first time and they're already on five meds, it tells me not only did somebody not investigate what could we remove or how could we treat without medication, it also says that they just keep adding things without saying, hey, we added this for six weeks or eight weeks or two months or three months. It didn't work.

[00:24:41] Let's remove it and give you a week off of it before we go and add the next thing. So we have a better idea of what actually helps you, what doesn't, how long does it work, what side effects are associated with what medication. Now you just got me all worked up. I wanted to ask about something else that I've seen just kind of on social media about mental health as an outpatient provider.

[00:25:09] I want to get your take on how you handle diagnosing people or prescribing medications. And then somebody comes back to you in a week or two weeks and they're like, I really don't feel right. Like, what should I do? Say they can't get in for an appointment. Like, how do you deal with patients experiencing more severe symptoms, even if they're not experiencing severe mental illness,

[00:25:33] from getting off of a med or just a reaction from a med that they didn't sit right with? And how to avoid the 72-hour hold or maybe getting diagnosed with something maybe they don't have, but it's more of a symptom of an adverse reaction to a med. You have a patient. They have OCD. You prescribe them with an antidepressant. They come back two weeks later and they're like, I feel really off. And they send you a message through their portal.

[00:26:03] You don't have availability to see them for five more weeks. What do you do? Well, I probably would have already counseled them if I'm starting an SSRI. I would have already counseled them, hey, if this makes you feel weird, which, by the way, is probably the most useful indication is OCD or, you know, severe anxiety, which comes with OCD. The SSRI antidepressants are probably most useful in that regard.

[00:26:30] When they were coming on patent back in the 1980s, that's right around this wave of backlash against the anti-anxiety drug Valium, which so many people got addicted to throughout the 60s and 70s. By the 80s, I think it was Ted Kennedy in Congress was bringing hearings and talking about dependency. So they couldn't market SSRIs as anti-anxiety meds, even though that's what all the signals show.

[00:26:59] They reduce anxiety. And if somebody's situationally anxious or that anxiety builds and builds and builds until it drops them off the cliff of depression and shutdown, those drugs may work for that person. But again, I can't reliably predict. And what I would tell them at the onset is if you feel a major shift for the negative in your thinking,

[00:27:25] your automatic thinking really at that, because I do that at most initial appointments is try to delineate. There's this part of your brain we call the mind that you don't have control over. But what you do have control over is what you think and your conscious decision making. What makes us uniquely human is our ability to inhibit our mind or our animal instinct.

[00:27:52] I would have told them already, if you have a weird reaction, stop taking it. Number one, and let me know. Other than that, in terms of if they're still really struggling and they can't come in to see me, I would probably lay things out for them, try to understand how risky things are for waiting. And if they're too risky to wait, I'd probably recommend that they go to something like an IOP,

[00:28:20] intensive outpatient or partial hospitalization. Though in reality, sometimes that leads to inappropriate labeling due to insurance reasons or over-treatment with medication. If they have access to a therapist, I would certainly encourage regular engagement with that therapist until we would be able to meet again.

[00:28:44] But the other thing I do is I kind of set in motion a couple of contingencies in that initial appointment. If this doesn't work, the plan will be to stop that and prescribe this different medication or this different class of things. So when they email me, we've already got things set in motion for what the next contingency is.

[00:29:09] And I do that regularly because I tell people, yeah, we can give you a diagnosis, but a lot of them are just a label. And it's really empty to me right now. And if I don't have to give you a diagnosis, I'd rather honestly have six to 12 months to work with somebody before I say more definitively what it is I think they're dealing with. And I think that timeframe gets shorter and shorter the further along I get in my career.

[00:29:36] But I'd rather give myself more time than less time to have more confidence in the underlying diagnosis. And you know what? If I'm treating somebody for a couple of years and we have gone on and off of a half dozen to a dozen different meds, what does that tell you about whatever is afflicting them? That it's not clinical? We don't even necessarily have to put that label of it not being clinical because we could say,

[00:30:05] okay, this is still something that is clinically relevant. Your symptoms are real, but they just may not be responsive to a medication. Or the best response you get from a medication might just be acute symptom reduction. And we got to be careful with that because as good as Xanax might make you feel when you're having a panic attack or you're feeling severely anxious, if we lean on that symptom modifier too much,

[00:30:31] well, over time, it's not going to modify the symptom the same way that it did at the beginning. Right, right. There's so many things like that where it's like if you get a response from something, even like for an example, smoking a cigarette. You smoke a cigarette, you get this crazy reaction. And then you keep smoking cigarettes. And so then when you smoke it, you don't feel that same reaction from the beginning, similar to like anything addictive like Xanax.

[00:30:59] Do you see how all of this wraps back into the fact that you and me and, well, most of the people on this planet have this dynamic of having a mind, which binarily organizes information and it does it immediately. So when it's raining outside in the morning and I've got an afternoon tea time, my mind says you're not golfing today. That may be the case.

[00:31:25] It may be right, but it very well could clear up and become sunny and be totally good weather. When you take an amphetamine or you take a benzo like Xanax and you get this huge rush of energy and motivation to go to my chemistry class and really be engaged with the chemistry. Or when all of a sudden I feel this relief and I can just like let my shoulders relax and not be this ball of anxiety all the time.

[00:31:54] What does your mind do with that? It immediately locks it in. This works. And it takes a lot of conscious mental work to be open to the likelihood that maybe this won't work like this in the long term. It just seems too good to be true. But again, we get so automatically judgmental. And I truly mean that automatically. Our brains do that subconsciously behind the veil of awareness.

[00:32:24] And we've got to have conscious awareness of that so we can give a much better long-term appraisal of whether or not anything, medication, lifestyle habit, relationship is good for us. Right? This factors into everything. Somebody gets love bombed. Their mind locks in. This is good for me.

[00:32:45] And then months down the road, they're being abused, but they're struggling with this cognitive dissonance of part of them feels like this is a good thing for me. And then the other part, which is usually more rational and reasonable and wise, that frontal lobe, that seat of consciousness is like, gosh, it doesn't seem like it's good for me. I'm being abused. But I have this other pole and I don't, people want to feel like they're in unison.

[00:33:13] But if we could just look at our minds as this kind of separate connected entity to us. And yeah, it's got a lot of opinions. But what makes us uniquely human, its opinions have to go through us for final processing to figure out where is that gray area? Where is the context between the all or the nothing, the right or the wrong, the black or the white? No, that's so true. It really is anything.

[00:33:41] Anything that you think feels good right away, you're like, this is it. Yep, exactly. And it just happens automatically. So we've got to be intensely aware of that so that we can attach, you know, something like taking an amphetamine every day to one of the reasons why I can't overcome the death of my grandmother. And I'm just perseverating on that problem that doesn't have a solution.

[00:34:06] It's a problem where the solution is acceptance that that has happened. When you talk about a psychiatric randomized control trial or medical randomized control trial and how we study these things, we typically study them in isolation. We typically study the effect of Zoloft in somebody who's not on any other medications.

[00:34:33] And how often does that play out for me in real clinical practice? Pretty rarely. I mean, you're talking about my young adults, you know, late adolescence are where that situation emerges. Or people who have probably struggled for most of their life on and off, but have just, you know, gritted their teeth and, you know, bared down. And then they get to a point where they're like, ah, maybe I'll go see somebody in their 30s or 40s.

[00:35:02] And it's the first time they've seen somebody. But those are few and far between. Most people that I see are just on, at a minimum, three different medications. At that point, it's like, well, this really, it goes back to the earlier question. What do you do when somebody comes to see you and they're young and you don't know what you're dealing with? You theoretically could muddy up their whole clarity of their diagnosis.

[00:35:30] Or with SSRIs and bipolarity, you may make the underlying disease worse by early intervention if it's the wrong intervention. It's a really important point. Sometimes we're fucking things up before we've even had a chance to be successful with treatment. Right. Right. It's like maybe you put someone on an SSRI, they start having the bipolar symptoms. So you put another one on to help with those symptoms and then another one and another one over it.

[00:35:57] SSRIs don't cause that manic reaction at anything close to the clip that they do. Otherwise, if they're also on a mood stabilizer, the patient is. So again, my philosophy is, why don't we start a mood stabilizer first? And you can look into the legal side of things, right? Like the reality is, if you ask a thousand people who take a Tylenol, if they have a sexual side effect from it,

[00:36:26] there's going to be about 100 to 150 that endorse having a sexual side effect from something that has no mechanistic action of how it could cause that. Because the person believes that their underlying sexual dysfunction is related to the medicine as opposed to related to the belief. And belief is very important.

[00:36:51] And I could tell you that, well, mood stabilizers are known to induce mania, which they're not. But if I tell you that and you don't know otherwise, you may have a belief that you're going to have a manic reaction. And that belief may cause a manic reaction for a self-limited amount of time. There's a great story.

[00:37:15] And I tend to believe it because there's other research studies on expectancy and belief and how it actually causes biologic changes in the brain. But the one that comes to mind now is a guy who went to the ER with tanking blood pressure and vital signs. They say, what'd you do? He says, I overdosed on my antidepressant. Well, what were you taking? He says, I don't know. What do you mean you don't know? I brought my pill bottle in.

[00:37:42] He brings this pill bottle in and he's in one of these experimental drug trials. So they have to call the group that does the experimental drug trial and figure it. I mean, it's all emergency situation. His vitals are tanking. He looks horrible saying that he overdosed on a bunch of pills. And they kind of look through a hold on. We got to look up what group he's in and blah, blah, blah. It turns out he's in the placebo group. Once they tell him that within 15 minutes, he's dischargeable from the ER. His blood pressure comes back up.

[00:38:12] His breathing slows down. The belief was there. So anyway, this is a long-winded way of saying you could argue that because there is so much discussion societally about SSRIs causing manic reactions, you could say, oh, well, that's just another false signal. People talk about it and it's kind of taken on a life of its own in terms of people's belief. That's where I like to look at legal cases.

[00:38:41] There are dozens upon dozens of legal cases against manufacturers of SSRIs for a consistent response to the medication causing manic reactions with high impulsivity, suicide attempt, or some of these mass casualty events, I would argue are caused by bad reactions to SSRIs. And you look at that compared to something like lithium.

[00:39:09] Well, lithium causing suicide? There's not any real legal cases that get to a jury trial. I'm sure there's been frivolous lawsuits filed where somebody happened to take a prescription of lithium and then became suicidal or had a suicide attempt or, God forbid, died by suicide. But those don't ever make it to jury trial because there's not a precedent for it. There's not evidence that it could happen. It doesn't happen in high enough numbers.

[00:39:37] But when you see medical legal cases popping up that go to jury trial over and over and over again, where, hey, this person has never had any odd behaviors like that in their 65 years of life. And then all of a sudden, within days to a week of starting this new drug that has been implicated as doing this in other people, they have this crazy reaction to it. It's like, oh, OK, well, that is a much stronger signal.

[00:40:07] And it's not just related to belief. It kind of relates to the whole reason that I'm interested in this in the first place is I feel like there's so many medications or ideas about what medications you should be taking, what kind of therapies you should be doing. And with a family member, watching them be mismedicated over and over and over for years and years and years without posing the question of maybe try something else.

[00:40:32] I've lost a lot of trust in why would I listen to this if this is a study that was done so long ago and we're still using this as our main point. I feel like there's better ways to treat things that are available. But common sense needs to prevail over everything else.

[00:40:52] And I mean, again, something's not working and you do one medication followed by another medication, the same class that some will argue, oh, but it's got a unique pharmacologic activity and it hits these receptors a little bit differently. But primarily they're serotonergic agents. Why do we need to cycle through five of them before we say maybe we should try something different? Common sense number one.

[00:41:22] Common sense number two with those drugs. There's a potential for really, really bad, rare, but really severe and consequential reactions. Maybe we shouldn't jump to start every single person from PTSD to depression to anxiety on an SSRI. The same shit can happen with stimulants.

[00:41:44] So that same story exists with ADHD and immediately starting somebody on a stimulant without considering, hey, and again, in common sense number three, tell your patient that shit might happen. And if anything like that looks like it might be happening, maybe it's your belief, but I don't know. And the consequence of me being wrong is potential death or psychosis.

[00:42:13] Yeah, I'm going to err on the side of caution there and not do that thing or err on the side of caution and tell you the first sign of any change that is negative and dramatic. Stop doing that and seek help. Even just talking about the things that can happen that aren't catastrophic and aren't immediately awful in the moment, they may be on the wrong thing that's not working and making their symptoms worse for a really long period of time.

[00:42:42] And then just stacking things on top and they just don't get better for 10 years. That's almost worse. I feel like we've seen so many of those kinds of patients at our TMS clinic. It's kind of your head's against the wall. Here's the other situation. You have somebody who's 16 years old. Females are the ones that are being prescribed these at significantly higher clips. And SSRIs carry a known.

[00:43:06] It is part of their mechanism to flood serotonin, which affects sensation. So one of the most prominent effects of an SSRI is to blunt the sexual response or feeling in the genital region. Well, when it comes to dysfunction or sexual side effect, there's not any real difference in sexual desire between the placebo group and the SSRI group.

[00:43:36] But orgasm dysfunction occurs in 35% of people on SSRIs versus 10% on placebo in a short-term trial. There's a clear and obvious signal there. So now I've got a 16 or 17-year-old female who's come to me for their anxiety or depression or ADHD or whatever. And I give them an SSRI.

[00:44:04] And all of a sudden, something that maybe is really important, and it's important in a lot of our lives, our sexual activity and function and health. And now I've created something that can make orgasm really resistant or dysfunctional, that can then spin them out in terms of there's something wrong with me because I'm not able to perform in this situation.

[00:44:31] Like, we've got to think about some of these consequences. What is the impact of numbing your sensory input so much that you feel emotionally dull? And that you maybe don't chase things that made you really anxious, but the reason why they made you anxious is because they were probably really fucking important to you.

[00:44:52] And so you're nervous and you want to succeed, but because we've numbed out the anxiety, the symptom, well, maybe we also numbed out your ability to chase after a really lofty and transformative in terms of your life trajectory goal. So, yeah, there's a lot more than just the emergency situation that can come from this.

[00:45:19] The sexual side effects stuff or the changes in sensation with our vision or what I would say a lot, I don't know how much, but at least some of these cases of POTS where somebody is on an SSRI and part of your cardiovascular system, there's a couple of specific areas that are loaded with serotonin receptors to sense.

[00:46:10] It's positional changes. Side effect profile being given to young men and young women as they are entering into their effective sexual renaissance in life. They're learning about what it is, they're experimenting, and we're blunting that before they've ever had a chance to really get started. Right. Which has a lot of influence on people's happiness. We're not just talking about relationships.

[00:46:40] We're talking about individuals' own sexual experiences. It's so important for healthy overall organism function. And the hormonal parts of it, like the drive, like it's not just sexual drive, it's also like ambition drive and kind of just things that keep you on your toes and excited and wanting to keep moving forward.

[00:47:03] Or hormonal changes instigated in females by SSRIs to their menstrual cycle, their HPA axis. What are your thoughts on Wellbutrin as opposed to SSRIs? I feel like that's something that a lot of people are starting to use as an alternative. Welbutrin has always been kind of towards the top of my list because it primarily works on dopamine reuptake.

[00:47:32] Again, I think there are significant long-term problems with taking Welbutrin forever. Because if you're inhibiting the breakdown of what's already available in the synapse, that will send a natural signal in the long term to decrease production of that.

[00:47:52] But while Butrin doesn't carry some high risk of conversion to mania, there are not those same serotonergic side effects that you worry about. You don't have a strong signal for sexual dysfunction. I would say that just like most other psychiatric medications, one of the problems is not all of these should be used forever.

[00:48:16] I think Welbutrin is a great boost pick-me-up for seasons of life. I'm going through a really difficult breakup and I'm shutting down. Or I'm just in the midst of an episodic depressive episode. Lithium hasn't helped to, you know, cure my depression or gradually and substantially reduce intensity and duration of episodes. So I get in this habit throughout life.

[00:48:44] You know, I have a depressive episode every couple of years and I take Welbutrin for 12 weeks. And it helps me through kind of the natural cycle of that wave of depressive illness. Or for some people, yeah, I take Welbutrin for seasonal affective disorder, for wintertime depression. I think most knowledgeable psychiatrists would tell you depression is not a serotonin problem. It's not just a dopamine problem. It's not just an aura.

[00:49:14] It's probably more so a dopamine problem than serotonin problem though. And if you want to bring somebody out of their depression quickly, give them dopamine and they'll feel better. But also be aware of the chronic or the downstream consequence of how you're manipulating their biochemistry. Right. So yes, bupropion Welbutrin is undoubtedly better than SSRIs as a kind of jumping off point.

[00:49:41] But like with most medications, there are exceptions. Educate your patient on where's the off-ramp when you start the medication. When you say off-ramp, what do you mean by that? Like when do you need to get off of it or when will it stop working? Hey, we're going to utilize this stimulant for your ADHD treatment. And we're going to do it because right now you're taking all these prerequisite classes.

[00:50:07] And you're telling me that you're not inherently interested in, you know, physics 201. But you have to do it. It's a stepping stone for you to be able to get to where you need to get to. And you really want to be able to learn it a little bit and like be engaged with it so that you do retain some things. Okay, yeah, let's use a stimulant. Let's have a very clear purpose for why we're using it. Sure, you're diagnosed with ADHD.

[00:50:33] As you know, as a member of the 2026 U.S. community, it ain't hard to test positive for ADHD. But at that same time that we start something, don't immediately fall into the trap. We educate that there is a trap there where your mind will say, this works. Just like for somebody who's got chronic pain and they take an oxycodone or they take a fentanyl or heroin.

[00:51:02] Oh, wow, this works. I want you to be aware of that in advance so that we can look at what the effect is a week from now and a month from now and a year from now. And where I can say, hey, if we prescribe this now while you're in your second year of college, what do you anticipate about the future? Do you want to take it for the rest of your life?

[00:51:26] Vast majority of patients will say, no, I don't want to be dependent on something just to survive for the rest of my life. Okay, let's go over the facts that there will be a tolerance over time to the drug's effects. There is evidence that it could be bad for you in the long term or at least that the effectiveness wanes in the long term. And so let's talk about this off ramp. What are we going to look for as reasons to get off?

[00:51:53] Or maybe one of your goals is to be off of this at some point or to limit the use of it. So, again, just discussing at the onset of prescribing something what to look for as to why we would stop taking it. Even just saying, you know, this is something that I kind of recommend lifelong, that you take this or that supplement.

[00:52:15] Or if you have this condition, if you have cognitive impairment that's mild as a late 40s, early, middle 50s, I would recommend you take lithium or take and you just take it every day and you just stick with it. If it's not hurting you, then you just keep taking it. If you have bipolar disorder, I'm going to recommend that you take a mood stabilizer for the duration of your illness, because episodes when they come on can be pretty unpredictable.

[00:52:45] Outside of a few exceptions, PTSD, people don't need to be on a medicine forever. They need to learn how to behaviorally regulate their nervous system. And maybe medicine helps with that periodically or as needed or for a short amount of time. Maybe they're not willing to go to therapy if you don't give them some medication to reduce their symptoms first. You know, I remember seeing a few patients that we worked with where they didn't want to go to therapy. They just wanted to fix it.

[00:53:15] They just wanted to get the med or get the treatment, whatever it is, to skip the part of dealing with it. Or vice versa. People want to do therapy so they can avoid taking meds. I feel like it's kind of a difficult balance with how much of which do you need and what's going to work long term and what's not. Yeah, I think being open with people about that at the onset.

[00:53:36] You know, hey, we live in a culture where the quick fix and the hope and the promise is really, really exaggerated. There are fixes and there are, you know, probably the better thing to say is there are ways to manage symptoms. You are likely to experience some level of symptoms for the rest of your life because life brings on symptoms.

[00:54:02] But to be very, very clear from the onset, what effects you're looking for, what the limitations of those are. And really just that simple statement like, hey, there is not a cure for what you're going through, but a lot of people get better with time. And we can use medicine. We can use behavioral interventions. Medicine for most things in psychiatry is managing symptoms.

[00:54:32] And it's not getting to the root cause of the illness like lithium can do in depression or bipolarity in particular and possibly in dementia as well. Just that brief little comment. Otherwise, people live in their own heads. And if they have a belief that this thing, it's a quick fix. I saw a commercial about it or I saw a reel on TikTok about it and this other person, it worked for them. But you can't verify that stuff.

[00:54:59] And sometimes people need to hear from a professional that, look, this is not an antibiotic for an infection. Right. Until it is and somebody's got an encephalitis from a treatable infection and they end up on the psych ward. And really, they just needed an antibiotic. But that's a different caveat. Thanks again for watching and or listening. If you're passionate about the subjects I discuss on the channel, do me a favor. Hit that like button. Comment. Subscribe.

[00:55:29] Share. Sign up for membership. Join me in this fight. There are a lot of powerful, well-funded entities that don't want you to hear my message. So do whatever you can to make our voices heard by as many as possible. And let it be known that these are problems that we're demanding be addressed in our society.

[00:55:54] And if you have any questions, comments, concerns, or challenges to the information I've presented here, I want to hear it. Feel free to reach out on social media or email me at renegadesych at gmail.com. If you know of expert guests or allies with critiques of the broken, overpriced American health care system that could help promote and grow the channel, please connect us. Thanks again for listening. Thanks for listening.