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The Truth About Antidepressant Withdrawal Symptoms · Metabolic Mind

• 0:00
  To
• 0:00
  use
• 0:00
  analogies
• 0:00
  to
• 0:00
  make
• 0:01
  it
• 0:01
  simple.
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  I
• 0:01
  sort
• 0:01
  of
• 0:01
  think
• 0:01
  about,
• 0:02
  you
• 0:02
  know,
• 0:02
  a
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  heavy
• 0:03
  rock
• 0:03
  sinking
• 0:03
  into
• 0:04
  wet
• 0:04
  mud.
• 0:04
  You
• 0:04
  know,
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  it
• 0:05
  sinks
• 0:05
  more
• 0:06
  and
• 0:06
  more,
• 0:06
  you
• 0:06
  know,
• 0:06
  each
• 0:07
  week
• 0:07
  or
• 0:07
  month.
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  And
• 0:08
  so
• 0:08
  if
• 0:08
  you
• 0:08
  take
• 0:08
  it
• 0:08
  out
• 0:08
  in
• 0:09
  10
• 0:09
  years,
• 0:09
  it's
• 0:09
  really
• 0:09
  hard
• 0:10
  to
• 0:10
  pull
• 0:10
  out.
• 0:10
  It's
• 0:10
  pretty
• 0:11
  easy
• 0:11
  after
• 0:11
  a
• 0:11
  couple
• 0:11
  of
• 0:12
  hours.
• 0:12
  And
• 0:12
  so
• 0:12
  that's,
• 0:12
  I
• 0:13
  mean,
• 0:13
  that's
• 0:13
  a
• 0:13
  general
• 0:13
  law,
• 0:14
  you
• 0:14
  know,
• 0:14
  of
• 0:14
  pharmacology,
• 0:15
  of
• 0:15
  drugs
• 0:16
  that
• 0:16
  affect
• 0:16
  the
• 0:16
  brain,
• 0:17
  drugs
• 0:17
  that
• 0:17
  cause
• 0:18
  withdrawal.
• 0:19
  You
• 0:19
  know,
• 0:19
  the
• 0:19
  longer
• 0:19
  you
• 0:20
  use
• 0:20
  them,
• 0:20
  the
• 0:20
  more
• 0:21
  severe,
• 0:22
  long
• 0:22
  lasting,
• 0:23
  you
• 0:23
  know,
• 0:23
  and
• 0:23
  common
• 0:24
  withdrawal
• 0:24
  effects
• 0:24
  are.
• 0:29
  Welcome
• 0:30
  to
• 0:30
  the
• 0:30
  Metabolic
• 0:31
  Mind
• 0:31
  Podcast.
• 0:32
  I'm
• 0:32
  your
• 0:32
  host,
• 0:32
  Dr.
• 0:32
  Brett
• 0:33
  Scher.
• 0:33
  Metabolic
• 0:34
  Mind
• 0:34
  is
• 0:34
  a
• 0:34
  non
• 0:35
  profit
• 0:35
  initiative
• 0:36
  of
• 0:36
  Bouzouki
• 0:36
  Group
• 0:37
  where
• 0:37
  we're
• 0:37
  providing
• 0:37
  information
• 0:38
  about
• 0:38
  the
• 0:39
  intersection
• 0:39
  of
• 0:39
  metabolic
• 0:40
  health
• 0:40
  and
• 0:40
  mental
• 0:41
  health
• 0:41
  and
• 0:41
  metabolic
• 0:42
  therapies
• 0:42
  such
• 0:43
  as
• 0:43
  nutritional
• 0:43
  ketosis
• 0:44
  as
• 0:44
  therapies
• 0:45
  for
• 0:45
  mental
• 0:45
  illness.
• 0:46
  Thank
• 0:46
  you
• 0:46
  for
• 0:47
  joining
• 0:47
  us.
• 0:47
  Although
• 0:48
  our
• 0:48
  podcast
• 0:49
  is
• 0:49
  for
• 0:49
  informational
• 0:50
  purposes
• 0:50
  only
• 0:50
  and
• 0:50
  we
• 0:51
  aren't
• 0:51
  giving
• 0:51
  medical
• 0:52
  advice,
• 0:52
  we
• 0:53
  hope
• 0:53
  you
• 0:53
  will
• 0:53
  learn
• 0:53
  from
• 0:53
  our
• 0:54
  content
• 0:54
  and
• 0:54
  it
• 0:54
  will
• 0:54
  help
• 0:55
  facilitate
• 0:55
  discussions
• 0:56
  with
• 0:56
  your
• 0:56
  healthcare
• 0:57
  providers
• 0:57
  to
• 0:58
  see
• 0:58
  if
• 0:58
  you
• 0:58
  could
• 0:58
  benefit
• 0:59
  from
• 0:59
  exploring
• 0:59
  the
• 0:59
  connection
• 1:00
  between
• 1:00
  metabolic
• 1:01
  and
• 1:01
  mental.
• 1:07
  If
• 1:07
  you're
• 1:07
  taking
• 1:07
  or
• 1:07
  thinking
• 1:08
  of
• 1:08
  taking
• 1:08
  an
• 1:08
  antidepressant,
• 1:09
  it's
• 1:10
  important
• 1:10
  to
• 1:10
  know
• 1:10
  the
• 1:10
  risks
• 1:11
  and
• 1:11
  the
• 1:11
  benefits.
• 1:12
  And
• 1:12
  one
• 1:12
  of
• 1:12
  the
• 1:12
  risks
• 1:13
  could
• 1:13
  be
• 1:13
  what
• 1:13
  happens
• 1:14
  when
• 1:14
  you
• 1:14
  eventually
• 1:15
  want
• 1:15
  to
• 1:15
  come
• 1:16
  off
• 1:16
  the
• 1:16
  medication.
• 1:17
  What
• 1:17
  is
• 1:17
  the
• 1:17
  risk
• 1:17
  of
• 1:18
  withdrawal?
• 1:18
  Because
• 1:19
  just
• 1:19
  because
• 1:19
  you
• 1:19
  start
• 1:19
  a
• 1:19
  medication
• 1:20
  doesn't
• 1:20
  mean
• 1:20
  you
• 1:20
  have
• 1:21
  to
• 1:21
  take
• 1:21
  it
• 1:21
  forever,
• 1:21
  right?
• 1:22
  Well,
• 1:22
  what
• 1:22
  is
• 1:22
  that
• 1:23
  risk?
• 1:23
  Well,
• 1:23
  a
• 1:23
  new
• 1:23
  paper
• 1:24
  was
• 1:24
  just
• 1:24
  published
• 1:25
  suggesting
• 1:26
  that
• 1:26
  that
• 1:26
  risk
• 1:26
  is
• 1:27
  very
• 1:27
  small,
• 1:27
  that
• 1:28
  the
• 1:28
  risk
• 1:28
  of
• 1:28
  discontinuing
• 1:29
  antidepressants
• 1:30
  is
• 1:31
  extremely
• 1:31
  mild
• 1:31
  and
• 1:32
  not
• 1:32
  even
• 1:32
  really
• 1:33
  clinically
• 1:33
  significant.
• 1:34
  But
• 1:34
  is
• 1:34
  that
• 1:35
  true?
• 1:35
  Well,
• 1:35
  I'm
• 1:36
  joined
• 1:36
  by
• 1:36
  Dr.
• 1:36
  Mark
• 1:36
  Horowitz,
• 1:37
  who's
• 1:37
  an
• 1:37
  MD,
• 1:37
  PhD,
• 1:38
  he's
• 1:39
  a
• 1:39
  psychiatry
• 1:39
  researcher
• 1:40
  and
• 1:40
  he
• 1:41
  specializes
• 1:42
  in
• 1:42
  withdrawal
• 1:43
  from
• 1:43
  medications
• 1:44
  and
• 1:44
  runs
• 1:45
  a
• 1:45
  clinic
• 1:45
  called
• 1:45
  Outroclinic
• 1:46
  that
• 1:46
  really
• 1:46
  specializes
• 1:47
  in
• 1:47
  this.
• 1:47
  And
• 1:48
  he
• 1:48
  has
• 1:48
  some
• 1:48
  problems
• 1:48
  with
• 1:49
  this
• 1:49
  study
• 1:49
  or
• 1:49
  concerns
• 1:50
  with
• 1:50
  this
• 1:50
  study
• 1:51
  about
• 1:51
  the
• 1:51
  short
• 1:52
  term
• 1:52
  nature
• 1:52
  of
• 1:53
  it
• 1:53
  and
• 1:53
  has
• 1:53
  a
• 1:53
  very
• 1:54
  different.
• 1:54
  A
• 1:55
  different
• 1:55
  perspective
• 1:56
  about
• 1:56
  what
• 1:56
  the
• 1:56
  potential
• 1:57
  risks
• 1:57
  of
• 1:57
  coming
• 1:58
  off
• 1:58
  antidepressants
• 1:59
  are.
• 1:59
  So
• 2:00
  I
• 2:00
  hope
• 2:00
  you
• 2:00
  really
• 2:01
  enjoy
• 2:01
  this
• 2:01
  interview.
• 2:02
  It's
• 2:02
  really
• 2:02
  enlightening
• 2:03
  to
• 2:03
  have
• 2:03
  this
• 2:03
  sort
• 2:03
  of
• 2:04
  different
• 2:04
  perspective
• 2:04
  from
• 2:05
  maybe
• 2:05
  what
• 2:05
  a
• 2:05
  lot
• 2:05
  of
• 2:05
  people
• 2:05
  are
• 2:06
  reading
• 2:06
  about
• 2:07
  the
• 2:07
  conclusions
• 2:07
  of
• 2:08
  this
• 2:08
  study.
• 2:08
  Many
• 2:09
  of
• 2:09
  the
• 2:09
  interventions
• 2:09
  we
• 2:09
  discuss
• 2:10
  can
• 2:10
  have
• 2:10
  potentially
• 2:10
  dangerous
• 2:11
  effects
• 2:11
  if
• 2:11
  done
• 2:11
  without
• 2:12
  proper
• 2:12
  supervision.
• 2:13
  Consult
• 2:13
  your
• 2:13
  healthcare
• 2:14
  provider
• 2:14
  before
• 2:14
  changing
• 2:15
  your
• 2:15
  lifestyle
• 2:15
  or
• 2:15
  medications.
• 2:16
  In
• 2:16
  addition,
• 2:17
  it's
• 2:17
  important
• 2:17
  to
• 2:17
  note
• 2:17
  that
• 2:18
  people
• 2:18
  may
• 2:18
  respond
• 2:18
  differently
• 2:19
  to
• 2:19
  ketosis
• 2:19
  and
• 2:20
  there
• 2:20
  isn't
• 2:20
  one
• 2:20
  recognized
• 2:21
  universal
• 2:21
  response.
• 2:28
  Dr.
• 2:29
  Mark
• 2:29
  Horowitz,
• 2:30
  welcome
• 2:30
  back
• 2:30
  to
• 2:30
  Metabolic
• 2:31
  Mind.
• 2:31
  It's
• 2:31
  good
• 2:31
  to
• 2:31
  see
• 2:31
  you
• 2:32
  again.
• 2:32
  Good
• 2:32
  to
• 2:33
  see
• 2:33
  you
• 2:33
  again
• 2:33
  too,
• 2:33
  Brett.
• 2:34
  Yeah.
• 2:34
  And
• 2:35
  I'm
• 2:35
  excited
• 2:35
  to
• 2:35
  get
• 2:36
  into
• 2:36
  this
• 2:36
  study
• 2:36
  with
• 2:37
  you
• 2:37
  because,
• 2:37
  gosh,
• 2:37
  looking
• 2:38
  at
• 2:38
  Twitter,
• 2:38
  there's
• 2:38
  been
• 2:39
  so
• 2:39
  much
• 2:39
  controversy
• 2:40
  about
• 2:40
  this
• 2:40
  meta
• 2:41
  analysis
• 2:41
  of
• 2:41
  studies
• 2:42
  looking
• 2:42
  at
• 2:43
  the
• 2:43
  severity
• 2:44
  and
• 2:44
  the
• 2:44
  impact
• 2:44
  of
• 2:45
  antidepressant
• 2:46
  discontinuation.
• 2:48
  But
• 2:48
  before
• 2:48
  we
• 2:48
  get
• 2:48
  into
• 2:49
  that,
• 2:49
  because
• 2:49
  I
• 2:49
  know
• 2:49
  you've
• 2:49
  got
• 2:49
  a
• 2:50
  lot
• 2:50
  to
• 2:50
  say
• 2:50
  about
• 2:50
  it,
• 2:50
  but
• 2:50
  before
• 2:51
  we
• 2:51
  get
• 2:51
  into
• 2:51
  that,
• 2:51
  give
• 2:51
  us
• 2:52
  just
• 2:52
  a
• 2:53
  brief
• 2:53
  summary
• 2:53
  of
• 2:53
  your
• 2:54
  background,
• 2:54
  how
• 2:54
  you
• 2:54
  got
• 2:55
  into
• 2:56
  this
• 2:56
  field
• 2:56
  of
• 2:57
  medication
• 2:57
  tapering
• 2:58
  and
• 2:58
  discontinuation
• 2:58
  and
• 2:59
  why
• 2:59
  it's
• 2:59
  so
• 2:59
  important
• 2:59
  to
• 3:00
  you.
• 3:00
  Right.
• 3:00
  Well,
• 3:01
  I
• 3:01
  guess
• 3:01
  I'm
• 3:02
  on
• 3:02
  sort
• 3:02
  of
• 3:02
  both
• 3:03
  sides
• 3:03
  of
• 3:04
  the
• 3:04
  desk
• 3:04
  on
• 3:05
  this.
• 3:05
  I
• 3:06
  started
• 3:06
  my
• 3:06
  training
• 3:06
  as
• 3:07
  a
• 3:07
  psychiatrist
• 3:07
  in
• 3:07
  Australia
• 3:08
  and
• 3:08
  the
• 3:08
  UK.
• 3:09
  I
• 3:10
  did
• 3:10
  a
• 3:10
  PhD
• 3:10
  in
• 3:10
  how
• 3:10
  antidepressants
• 3:11
  work
• 3:12
  at
• 3:12
  King's
• 3:13
  College
• 3:13
  London.
• 3:13
  And
• 3:15
  I
• 3:15
  also
• 3:15
  was
• 3:16
  a
• 3:16
  patient
• 3:16
  who
• 3:16
  took
• 3:16
  antidepressants
• 3:17
  for
• 3:17
  many
• 3:17
  years.
• 3:18
  I
• 3:18
  was
• 3:18
  a
• 3:18
  miserable
• 3:19
  young
• 3:19
  man
• 3:19
  in
• 3:20
  my
• 3:20
  early
• 3:20
  20s
• 3:21
  and
• 3:21
  I
• 3:21
  was
• 3:21
  given
• 3:21
  Lexapro
• 3:22
  Arrest
• 3:22
  Telepram.
• 3:23
  I
• 3:23
  tried
• 3:24
  to
• 3:24
  come
• 3:24
  off
• 3:24
  it
• 3:25
  now
• 3:25
  several
• 3:25
  years
• 3:26
  ago
• 3:26
  in
• 3:26
  a
• 3:27
  way
• 3:27
  that
• 3:27
  I
• 3:27
  thought
• 3:27
  was
• 3:27
  quite
• 3:28
  slow,
• 3:28
  much
• 3:28
  slower
• 3:28
  than
• 3:29
  what
• 3:29
  guidelines
• 3:30
  said.
• 3:30
  And
• 3:31
  I
• 3:32
  had
• 3:32
  the
• 3:32
  worst
• 3:33
  experience
• 3:33
  of
• 3:33
  my
• 3:33
  life.
• 3:33
  Basically
• 3:34
  I
• 3:35
  developed
• 3:35
  or
• 3:35
  I
• 3:36
  now
• 3:36
  realize
• 3:36
  was,
• 3:37
  I
• 3:37
  think,
• 3:37
  mild
• 3:37
  to
• 3:37
  moderate
• 3:38
  akathisia.
• 3:38
  I
• 3:39
  was
• 3:39
  full
• 3:39
  of
• 3:39
  terror.
• 3:41
  I
• 3:41
  had
• 3:42
  panic
• 3:42
  attacks
• 3:42
  that
• 3:43
  lasted
• 3:43
  for
• 3:43
  hours
• 3:43
  and
• 3:43
  hours
• 3:43
  of
• 3:44
  a
• 3:44
  day.
• 3:44
  I
• 3:44
  had
• 3:45
  not
• 3:45
  experienced
• 3:45
  that
• 3:45
  before
• 3:45
  in
• 3:46
  my
• 3:46
  life.
• 3:46
  I
• 3:47
  didn't
• 3:47
  think
• 3:47
  it
• 3:47
  was
• 3:48
  anything
• 3:48
  like
• 3:48
  the
• 3:48
  issues
• 3:48
  that
• 3:49
  had
• 3:49
  put
• 3:49
  me
• 3:49
  on
• 3:49
  the
• 3:49
  drug
• 3:49
  in
• 3:49
  the
• 3:49
  first
• 3:50
  place.
• 3:50
  I
• 3:50
  understood
• 3:50
  it
• 3:50
  was
• 3:51
  withdrawal.
• 3:52
  That
• 3:52
  was
• 3:52
  a
• 3:52
  big
• 3:52
  surprise
• 3:53
  to
• 3:53
  me.
• 3:53
  I
• 3:53
  had
• 3:53
  not
• 3:54
  been
• 3:54
  taught
• 3:54
  about
• 3:54
  that
• 3:54
  in
• 3:55
  my
• 3:55
  training.
• 3:57
  All
• 3:57
  the
• 3:57
  guidelines
• 3:58
  at
• 3:58
  the
• 3:58
  time
• 3:58
  said
• 3:58
  it
• 3:58
  was
• 3:58
  mild
• 3:59
  and
• 3:59
  brief.
• 4:00
  When
• 4:00
  I
• 4:00
  found
• 4:00
  out
• 4:00
  that
• 4:01
  it
• 4:01
  wasn't
• 4:01
  just
• 4:01
  me,
• 4:01
  it
• 4:01
  was
• 4:02
  tens
• 4:02
  of
• 4:02
  thousands
• 4:02
  of
• 4:02
  other
• 4:03
  people
• 4:03
  who
• 4:03
  had
• 4:04
  been
• 4:04
  forced
• 4:04
  to
• 4:04
  go
• 4:04
  onto
• 4:05
  online
• 4:05
  peer
• 4:05
  support
• 4:06
  groups.
• 4:06
  I
• 4:07
  realized
• 4:07
  that
• 4:07
  there
• 4:07
  was
• 4:07
  a
• 4:08
  significant
• 4:08
  issue,
• 4:09
  a
• 4:09
  mismatch
• 4:09
  between
• 4:10
  what
• 4:10
  guidelines
• 4:11
  said
• 4:12
  and
• 4:12
  people's
• 4:12
  experience.
• 4:13
  And
• 4:13
  that
• 4:14
  got
• 4:14
  me
• 4:15
  very
• 4:15
  interested.
• 4:15
  As
• 4:15
  Nietzsche
• 4:16
  said,
• 4:16
  pain
• 4:16
  is
• 4:17
  the
• 4:17
  majority
• 4:17
  of
• 4:17
  the
• 4:17
  teacher.
• 4:18
  I
• 4:19
  got
• 4:19
  a
• 4:19
  very,
• 4:19
  very
• 4:19
  painful
• 4:20
  lesson
• 4:21
  and
• 4:21
  that's
• 4:21
  what
• 4:21
  has
• 4:22
  motivated
• 4:22
  me
• 4:22
  to
• 4:22
  try
• 4:22
  to
• 4:23
  work
• 4:23
  out
• 4:23
  what's
• 4:23
  going
• 4:23
  on
• 4:23
  here
• 4:23
  and
• 4:24
  how
• 4:24
  can
• 4:24
  we
• 4:24
  help
• 4:24
  people
• 4:25
  to
• 4:25
  avoid
• 4:25
  the
• 4:26
  issues
• 4:26
  that
• 4:26
  I
• 4:26
  went
• 4:26
  through.
• 4:27
  Yeah,
• 4:27
  and
• 4:27
  it's
• 4:27
  such
• 4:28
  an
• 4:28
  interesting
• 4:28
  position
• 4:29
  to
• 4:29
  be
• 4:29
  in
• 4:30
  when
• 4:30
  you're
• 4:30
  learning
• 4:31
  this,
• 4:31
  you're
• 4:31
  getting
• 4:31
  trained
• 4:32
  in
• 4:32
  this
• 4:32
  and
• 4:32
  everything
• 4:33
  you're
• 4:33
  reading
• 4:33
  and
• 4:34
  being
• 4:34
  trained
• 4:34
  is
• 4:35
  mild
• 4:35
  and
• 4:35
  short
• 4:36
  lived
• 4:36
  and
• 4:37
  not
• 4:37
  a
• 4:37
  big
• 4:37
  clinical
• 4:38
  concern.
• 4:38
  But
• 4:39
  then
• 4:39
  your
• 4:39
  personal
• 4:40
  experience
• 4:40
  and
• 4:41
  the
• 4:41
  experience
• 4:41
  of
• 4:42
  thousands
• 4:42
  of
• 4:42
  others
• 4:43
  is
• 4:43
  directly
• 4:44
  at
• 4:44
  odds
• 4:44
  with
• 4:44
  that,
• 4:45
  which
• 4:45
  really
• 4:45
  is.
• 4:46
  Is
• 4:46
  an
• 4:46
  uncomfortable
• 4:46
  feeling.
• 4:47
  It's
• 4:47
  uncomfortable
• 4:48
  for
• 4:48
  you,
• 4:49
  I'm
• 4:49
  sure,
• 4:50
  like
• 4:50
  you
• 4:50
  said,
• 4:50
  you're
• 4:51
  sort
• 4:51
  of
• 4:51
  on
• 4:51
  both
• 4:51
  sides
• 4:51
  of
• 4:52
  the
• 4:52
  equation
• 4:52
  as
• 4:53
  a
• 4:53
  learning
• 4:53
  and
• 4:53
  practicing
• 4:54
  psychiatrist,
• 4:54
  but
• 4:55
  then
• 4:55
  experiencing
• 4:56
  this.
• 4:56
  So
• 4:57
  I
• 4:57
  guess
• 4:58
  one
• 4:58
  big
• 4:58
  question
• 4:59
  is,
• 4:59
  and
• 5:00
  it
• 5:01
  could
• 5:01
  be
• 5:01
  a
• 5:01
  long
• 5:01
  question,
• 5:01
  but
• 5:02
  why
• 5:02
  the
• 5:03
  disconnect?
• 5:03
  What
• 5:03
  do
• 5:03
  you
• 5:03
  think
• 5:04
  is
• 5:04
  the
• 5:04
  big
• 5:04
  reason
• 5:04
  for
• 5:05
  the
• 5:05
  disconnect?
• 5:05
  And
• 5:06
  then
• 5:06
  we'll
• 5:06
  see
• 5:06
  how
• 5:06
  that
• 5:07
  applies
• 5:07
  to
• 5:07
  this
• 5:07
  study.
• 5:08
  So
• 5:09
  it
• 5:09
  took
• 5:09
  me
• 5:09
  a
• 5:09
  while
• 5:10
  to
• 5:10
  work
• 5:10
  out
• 5:10
  what
• 5:10
  the
• 5:10
  disconnect
• 5:11
  was.
• 5:11
  You're
• 5:11
  right.
• 5:11
  And
• 5:12
  so
• 5:12
  as
• 5:12
  you
• 5:12
  say,
• 5:12
  it
• 5:12
  was
• 5:12
  a
• 5:13
  bewildering
• 5:13
  experience
• 5:14
  for
• 5:14
  me
• 5:14
  because
• 5:15
  I'm
• 5:15
  a
• 5:15
  very
• 5:15
  institutionalized
• 5:16
  person.
• 5:16
  I've
• 5:17
  got
• 5:17
  six
• 5:17
  academic
• 5:18
  degrees.
• 5:18
  I'm
• 5:18
  used
• 5:18
  to
• 5:19
  memorizing
• 5:19
  textbooks
• 5:20
  and
• 5:20
  learning
• 5:20
  from
• 5:20
  professors
• 5:21
  from
• 5:22
  Ivy
• 5:22
  League
• 5:22
  universities
• 5:23
  and
• 5:23
  the
• 5:24
  equivalent
• 5:24
  in
• 5:24
  the
• 5:24
  UK
• 5:24
  and
• 5:25
  Australia.
• 5:26
  So
• 5:27
  I
• 5:27
  spent
• 5:27
  like,
• 5:28
  you
• 5:28
  know,
• 5:28
  any
• 5:29
  doctor
• 5:29
  spends
• 5:29
  a
• 5:29
  lot
• 5:29
  of
• 5:29
  time
• 5:30
  memorizing
• 5:30
  things
• 5:30
  from
• 5:30
  textbooks.
• 5:31
  So
• 5:33
  I
• 5:34
  was
• 5:34
  bewildered
• 5:34
  that
• 5:35
  I
• 5:35
  had
• 5:35
  this
• 5:36
  firsthand
• 5:36
  experience.
• 5:36
  It
• 5:36
  was
• 5:36
  mirrored
• 5:37
  by
• 5:37
  lots
• 5:37
  of
• 5:37
  other
• 5:37
  people
• 5:37
  and
• 5:38
  it
• 5:38
  didn't
• 5:38
  match
• 5:38
  what
• 5:38
  was
• 5:38
  in
• 5:39
  guidelines.
• 5:39
  And
• 5:40
  then
• 5:40
  I
• 5:40
  began
• 5:40
  to
• 5:40
  understand
• 5:41
  by
• 5:41
  reading
• 5:41
  different
• 5:41
  books
• 5:42
  and
• 5:42
  papers
• 5:42
  about
• 5:43
  what
• 5:43
  had
• 5:43
  happened.
• 5:44
  And
• 5:44
  really
• 5:44
  the
• 5:44
  setup
• 5:45
  is
• 5:45
  the
• 5:45
  following.
• 5:47
  The
• 5:47
  drug
• 5:48
  companies
• 5:48
  that
• 5:48
  got
• 5:48
  their
• 5:48
  drugs
• 5:49
  approved
• 5:49
  for
• 5:49
  antidepressants
• 5:50
  did
• 5:51
  eight
• 5:51
  to
• 5:52
  12
• 5:52
  week
• 5:52
  studies
• 5:53
  in
• 5:53
  order
• 5:54
  to
• 5:54
  get
• 5:54
  past
• 5:54
  the
• 5:54
  regulators,
• 5:55
  the
• 5:55
  FDA
• 5:55
  and
• 5:56
  the
• 5:56
  MHRA
• 5:56
  and
• 5:57
  other
• 5:57
  around
• 5:57
  the
• 5:58
  world.
• 5:58
  And
• 5:59
  these
• 5:59
  regulators
• 6:00
  demand
• 6:00
  that
• 6:01
  you
• 6:01
  show
• 6:01
  two
• 6:01
  positive
• 6:02
  studies
• 6:02
  that
• 6:02
  beat
• 6:03
  placebo
• 6:04
  over
• 6:04
  about
• 6:04
  eight
• 6:04
  to
• 6:05
  12
• 6:05
  weeks.
• 6:05
  And
• 6:05
  so
• 6:05
  these
• 6:06
  companies
• 6:06
  did
• 6:06
  many
• 6:06
  of
• 6:06
  these
• 6:06
  studies
• 6:08
  and
• 6:08
  in
• 6:08
  some
• 6:08
  of
• 6:08
  the
• 6:09
  studies
• 6:09
  they
• 6:09
  stopped
• 6:10
  antidepressants
• 6:10
  after
• 6:11
  that
• 6:11
  8
• 6:11
  to
• 6:11
  12
• 6:11
  week
• 6:11
  exposure.
• 6:13
  And
• 6:13
  what
• 6:13
  those
• 6:13
  studies
• 6:14
  mostly
• 6:14
  showed
• 6:15
  was
• 6:15
  mild
• 6:16
  and
• 6:16
  brief
• 6:16
  symptoms.
• 6:17
  It's
• 6:17
  worth
• 6:17
  noting
• 6:17
  that
• 6:18
  not
• 6:18
  true
• 6:19
  for
• 6:19
  everybody.
• 6:20
  In
• 6:20
  some
• 6:21
  studies,
• 6:22
  people
• 6:22
  given
• 6:22
  sertraline,
• 6:23
  Zoloft
• 6:24
  and
• 6:24
  especially
• 6:25
  Venlafaxine
• 6:26
  or
• 6:26
  Effexor
• 6:27
  already
• 6:28
  after
• 6:28
  eight
• 6:28
  weeks
• 6:28
  of
• 6:29
  exposure,
• 6:29
  some
• 6:30
  people
• 6:30
  had
• 6:30
  extremely
• 6:31
  severe
• 6:32
  symptoms
• 6:32
  coming
• 6:32
  off.
• 6:32
  So
• 6:33
  I
• 6:33
  don't
• 6:33
  want
• 6:33
  to
• 6:33
  say
• 6:34
  that
• 6:34
  it's
• 6:34
  nothing
• 6:35
  for
• 6:35
  everybody
• 6:35
  on
• 6:36
  short
• 6:36
  term
• 6:36
  treatment,
• 6:36
  but
• 6:37
  it
• 6:37
  is
• 6:37
  true
• 6:37
  to
• 6:37
  say
• 6:38
  that
• 6:38
  for
• 6:39
  most
• 6:39
  people
• 6:40
  after
• 6:40
  8
• 6:40
  to
• 6:41
  12
• 6:41
  weeks
• 6:41
  of
• 6:41
  exposure
• 6:41
  to
• 6:42
  antidepressants,
• 6:43
  there
• 6:43
  are
• 6:43
  mild
• 6:43
  and
• 6:43
  brief
• 6:44
  symptoms.
• 6:44
  I
• 6:44
  think
• 6:44
  that's
• 6:44
  a
• 6:45
  fairly
• 6:45
  accepted,
• 6:47
  well
• 6:47
  documented
• 6:48
  statement.
• 6:49
  The
• 6:49
  companies
• 6:50
  published
• 6:51
  those
• 6:51
  papers,
• 6:51
  they
• 6:52
  distributed
• 6:52
  them
• 6:52
  widely
• 6:53
  to
• 6:54
  psychiatrists,
• 6:54
  key
• 6:55
  opinion
• 6:55
  leaders
• 6:55
  around
• 6:56
  the
• 6:56
  America
• 6:57
  and
• 6:57
  around
• 6:57
  the
• 6:57
  uk.
• 6:58
  And
• 6:59
  because
• 6:59
  there
• 6:59
  was
• 6:59
  a
• 7:00
  dozen
• 7:00
  such
• 7:00
  studies,
• 7:01
  when
• 7:01
  guideline
• 7:02
  committees
• 7:02
  came
• 7:02
  to
• 7:03
  rights,
• 7:03
  the
• 7:03
  guidelines
• 7:04
  they
• 7:04
  wrote
• 7:04
  down
• 7:05
  that
• 7:05
  withdrawal
• 7:06
  effects
• 7:06
  or
• 7:06
  the
• 7:07
  discontinuation
• 7:07
  symptoms,
• 7:08
  which
• 7:08
  is
• 7:08
  the
• 7:08
  preferred
• 7:09
  industry
• 7:09
  euphemism
• 7:10
  for
• 7:10
  withdrawal,
• 7:12
  are
• 7:12
  mostly
• 7:13
  mild
• 7:13
  and
• 7:13
  brief.
• 7:14
  Now
• 7:14
  in
• 7:15
  the
• 7:15
  guidelines,
• 7:15
  they
• 7:15
  didn't
• 7:16
  say
• 7:16
  mostly
• 7:16
  mild
• 7:16
  and
• 7:16
  brief
• 7:17
  for
• 7:17
  people
• 7:17
  who've
• 7:18
  been
• 7:18
  on
• 7:18
  the
• 7:18
  drugs
• 7:18
  for
• 7:18
  eight
• 7:18
  to
• 7:18
  12
• 7:19
  weeks,
• 7:19
  they
• 7:19
  just
• 7:19
  said
• 7:20
  mild
• 7:20
  and
• 7:20
  brief.
• 7:21
  And
• 7:21
  the
• 7:21
  reason
• 7:22
  why
• 7:23
  I
• 7:24
  think
• 7:24
  it's
• 7:24
  fairly
• 7:24
  innocent.
• 7:25
  They
• 7:25
  only
• 7:25
  saw
• 7:26
  studies
• 7:26
  that
• 7:26
  showed
• 7:27
  mild
• 7:27
  and
• 7:27
  brief
• 7:27
  symptoms.
• 7:28
  And
• 7:28
  so
• 7:29
  they
• 7:29
  were
• 7:29
  reflecting
• 7:29
  what
• 7:30
  the
• 7:32
  the
• 7:33
  study
• 7:33
  showed.
• 7:34
  Now
• 7:35
  the
• 7:35
  problem
• 7:36
  with
• 7:36
  that
• 7:36
  is
• 7:37
  like
• 7:37
  for
• 7:38
  any
• 7:38
  drug,
• 7:38
  the
• 7:39
  longer
• 7:39
  you
• 7:39
  take
• 7:39
  it,
• 7:40
  the
• 7:40
  more
• 7:40
  you
• 7:41
  get
• 7:41
  used
• 7:41
  to
• 7:41
  the
• 7:41
  drug
• 7:42
  and
• 7:43
  the
• 7:43
  more
• 7:43
  withdrawal
• 7:44
  effects
• 7:44
  you
• 7:44
  get
• 7:44
  when
• 7:44
  you
• 7:45
  stop
• 7:45
  it.
• 7:45
  I
• 7:45
  mean,
• 7:45
  if
• 7:46
  you
• 7:46
  drink
• 7:46
  coffee
• 7:47
  for
• 7:47
  two
• 7:47
  days,
• 7:48
  there's
• 7:48
  no
• 7:48
  issue
• 7:48
  stopping
• 7:49
  it.
• 7:49
  If
• 7:49
  you
• 7:49
  drink
• 7:49
  it
• 7:49
  for
• 7:49
  10
• 7:50
  years,
• 7:51
  there's
• 7:51
  bigger
• 7:51
  issues.
• 7:52
  And
• 7:52
  the
• 7:52
  same
• 7:52
  is
• 7:53
  true
• 7:53
  for
• 7:54
  opioids,
• 7:54
  benzodiazepines,
• 7:56
  any
• 7:56
  drug
• 7:56
  you
• 7:56
  care
• 7:57
  to
• 7:57
  mention.
• 7:59
  And
• 8:00
  what
• 8:00
  is
• 8:00
  probably
• 8:00
  happening
• 8:01
  there
• 8:01
  is
• 8:02
  you're
• 8:03
  getting
• 8:03
  more
• 8:03
  and
• 8:03
  more
• 8:03
  used
• 8:04
  to
• 8:04
  accustomed
• 8:04
  to
• 8:05
  the
• 8:05
  drug,
• 8:05
  your
• 8:05
  brain
• 8:06
  and
• 8:06
  body
• 8:06
  are
• 8:06
  adapting
• 8:07
  to
• 8:07
  it,
• 8:07
  and
• 8:07
  when
• 8:08
  you
• 8:08
  come
• 8:08
  to
• 8:08
  pull
• 8:08
  it
• 8:08
  out,
• 8:09
  it's
• 8:09
  harder
• 8:10
  to
• 8:11
  use
• 8:11
  analogies
• 8:11
  to
• 8:11
  make
• 8:12
  it
• 8:12
  simple.
• 8:12
  I
• 8:12
  sort
• 8:12
  of
• 8:12
  think
• 8:12
  about
• 8:13
  a
• 8:13
  heavy
• 8:14
  rock
• 8:14
  sinking
• 8:14
  into
• 8:15
  wet
• 8:15
  mud.
• 8:16
  It
• 8:16
  sinks
• 8:17
  more
• 8:17
  and
• 8:17
  more
• 8:18
  each
• 8:18
  week
• 8:18
  or
• 8:18
  month.
• 8:20
  And
• 8:20
  so
• 8:20
  if
• 8:20
  you
• 8:20
  take
• 8:21
  it
• 8:21
  out
• 8:21
  in
• 8:21
  10
• 8:21
  years,
• 8:21
  it's
• 8:22
  really
• 8:22
  hard
• 8:22
  to
• 8:22
  pull
• 8:22
  out.
• 8:23
  It's
• 8:23
  pretty
• 8:23
  easy
• 8:23
  after
• 8:24
  a
• 8:24
  couple
• 8:24
  of
• 8:24
  hours.
• 8:25
  And
• 8:25
  so
• 8:26
  that's
• 8:26
  a
• 8:26
  general
• 8:26
  law
• 8:27
  of
• 8:28
  pharmacology
• 8:28
  of
• 8:28
  drugs
• 8:29
  that
• 8:29
  affect
• 8:29
  the
• 8:29
  brain,
• 8:30
  drugs
• 8:31
  that
• 8:31
  cause
• 8:31
  withdrawal.
• 8:33
  The
• 8:33
  longer
• 8:33
  you
• 8:33
  use
• 8:33
  them,
• 8:33
  the
• 8:34
  more
• 8:34
  severe,
• 8:35
  long
• 8:35
  lasting
• 8:37
  and
• 8:37
  common
• 8:37
  withdrawal
• 8:38
  effects
• 8:38
  are.
• 8:38
  And
• 8:39
  that
• 8:39
  makes
• 8:39
  a
• 8:39
  lot
• 8:39
  of
• 8:39
  sense.
• 8:40
  And
• 8:40
  then
• 8:40
  so
• 8:40
  applying
• 8:41
  that
• 8:41
  to
• 8:41
  this
• 8:41
  paper,
• 8:42
  I
• 8:42
  mean,
• 8:42
  in
• 8:42
  a
• 8:42
  way
• 8:42
  I
• 8:42
  guess
• 8:43
  you
• 8:43
  could
• 8:43
  say
• 8:43
  it's
• 8:43
  more
• 8:43
  of
• 8:44
  the
• 8:44
  same.
• 8:44
  But
• 8:44
  so
• 8:45
  the
• 8:45
  paper
• 8:45
  is
• 8:45
  called
• 8:45
  Incidence
• 8:46
  and
• 8:46
  Nature
• 8:46
  of
• 8:46
  Antidepressant
• 8:47
  Discontinuation
• 8:48
  Symptoms
• 8:49
  and
• 8:49
  it's
• 8:50
  a
• 8:50
  systematic
• 8:50
  review
• 8:50
  and
• 8:51
  meta
• 8:51
  analysis
• 8:52
  published
• 8:52
  in
• 8:52
  JAMA
• 8:53
  Psychiatry.
• 8:54
  And
• 8:54
  the
• 8:55
  main
• 8:55
  conclusion
• 8:56
  is
• 8:56
  more
• 8:57
  of
• 8:57
  the
• 8:57
  same,
• 8:57
  brief
• 8:58
  and
• 8:58
  mild.
• 8:58
  So
• 8:59
  there
• 8:59
  were
• 8:59
  statistically
• 9:00
  significant
• 9:01
  increase
• 9:02
  in
• 9:02
  symptoms,
• 9:03
  but
• 9:04
  it
• 9:04
  was
• 9:04
  determined
• 9:05
  that
• 9:05
  those
• 9:05
  were
• 9:05
  not
• 9:06
  really
• 9:06
  clinically
• 9:07
  significant
• 9:08
  and
• 9:08
  did
• 9:09
  not
• 9:10
  constitute
• 9:10
  a
• 9:11
  significant
• 9:11
  withdrawal
• 9:12
  effect.
• 9:12
  Now
• 9:13
  looking
• 9:13
  at
• 9:13
  the
• 9:13
  details
• 9:14
  of
• 9:14
  the
• 9:14
  study,
• 9:14
  actually,
• 9:15
  I
• 9:15
  mean
• 9:15
  it
• 9:15
  gets
• 9:15
  a
• 9:15
  little
• 9:16
  confusing.
• 9:16
  So
• 9:16
  I'd
• 9:16
  love
• 9:16
  to
• 9:17
  help
• 9:17
  you
• 9:18
  have
• 9:18
  you
• 9:18
  help
• 9:18
  clarify
• 9:19
  because
• 9:19
  they
• 9:19
  say
• 9:20
  they
• 9:20
  use
• 9:20
  50
• 9:21
  studies
• 9:23
  in
• 9:24
  the
• 9:24
  analysis,
• 9:25
  but
• 9:25
  then
• 9:26
  they
• 9:26
  have
• 9:26
  a
• 9:26
  whole
• 9:26
  bunch
• 9:27
  of
• 9:27
  different
• 9:27
  conclusions
• 9:28
  that
• 9:28
  they
• 9:28
  draw.
• 9:29
  And
• 9:29
  it
• 9:29
  sounds
• 9:29
  like
• 9:29
  the
• 9:30
  main
• 9:30
  one
• 9:30
  was
• 9:30
  based
• 9:30
  on
• 9:31
  11
• 9:31
  studies.
• 9:32
  And
• 9:33
  so
• 9:33
  it's
• 9:34
  different
• 9:34
  because
• 9:34
  some
• 9:34
  of
• 9:34
  the
• 9:35
  50
• 9:35
  studies
• 9:35
  that
• 9:35
  they
• 9:35
  included
• 9:36
  had
• 9:36
  longer
• 9:37
  term
• 9:37
  studies,
• 9:38
  but
• 9:38
  as
• 9:38
  you
• 9:39
  pointed
• 9:39
  out
• 9:40
  on
• 9:40
  social
• 9:40
  Media,
• 9:40
  in
• 9:41
  the
• 9:41
  11
• 9:41
  studies
• 9:42
  they
• 9:42
  were
• 9:42
  basically
• 9:42
  all
• 9:43
  shorter
• 9:43
  term
• 9:43
  studies.
• 9:44
  So
• 9:44
  tell
• 9:44
  us
• 9:45
  a
• 9:45
  little
• 9:45
  bit
• 9:45
  about
• 9:45
  the
• 9:45
  setup
• 9:46
  and
• 9:46
  the
• 9:46
  conclusion
• 9:46
  of
• 9:47
  the
• 9:47
  study
• 9:47
  and
• 9:47
  that
• 9:48
  difference
• 9:48
  between
• 9:49
  the
• 9:49
  and
• 9:49
  11,
• 9:50
  if
• 9:50
  you
• 9:50
  could.
• 9:50
  Right,
• 9:51
  so
• 9:51
  I'll
• 9:51
  just
• 9:51
  lay
• 9:52
  out
• 9:52
  what
• 9:52
  they
• 9:52
  did.
• 9:52
  So
• 9:53
  they
• 9:53
  set
• 9:53
  out
• 9:54
  to
• 9:54
  look
• 9:54
  at
• 9:54
  studies
• 9:55
  that
• 9:55
  had
• 9:55
  looked
• 9:55
  at
• 9:55
  withdrawal
• 9:56
  effects
• 9:57
  from
• 9:57
  antidepressants
• 9:58
  and
• 9:59
  compared
• 9:59
  them
• 9:59
  to
• 9:59
  either
• 10:00
  people
• 10:00
  who
• 10:00
  had
• 10:00
  stopped
• 10:01
  a
• 10:01
  placebo,
• 10:01
  that's
• 10:02
  a
• 10:02
  sort
• 10:02
  of
• 10:02
  control,
• 10:03
  or
• 10:03
  continued
• 10:03
  an
• 10:04
  antidepressant.
• 10:04
  So
• 10:04
  they're
• 10:05
  trying
• 10:05
  to
• 10:07
  isolate
• 10:07
  what's
• 10:08
  just
• 10:08
  due
• 10:08
  to
• 10:08
  the
• 10:08
  drug
• 10:09
  and
• 10:09
  what's
• 10:09
  due.
• 10:10
  You
• 10:10
  know,
• 10:10
  there's
• 10:10
  obviously
• 10:11
  psychological
• 10:11
  factors
• 10:12
  that
• 10:12
  might
• 10:12
  play
• 10:12
  a
• 10:12
  role.
• 10:12
  And
• 10:13
  so
• 10:13
  they're
• 10:13
  trying
• 10:13
  to
• 10:13
  work
• 10:13
  that
• 10:13
  out.
• 10:14
  They
• 10:15
  did
• 10:15
  a
• 10:15
  search
• 10:15
  and
• 10:15
  they
• 10:16
  found
• 10:17
  50
• 10:17
  studies
• 10:18
  and
• 10:18
  they
• 10:18
  included
• 10:19
  49
• 10:19
  in
• 10:20
  different
• 10:20
  meta
• 10:20
  analyses.
• 10:21
  There
• 10:22
  were
• 10:22
  two
• 10:22
  main
• 10:23
  studies
• 10:23
  that
• 10:24
  they
• 10:24
  did
• 10:24
  here.
• 10:25
  One
• 10:25
  was
• 10:26
  looking
• 10:26
  at
• 10:26
  the
• 10:29
  overall
• 10:29
  withdrawal
• 10:30
  effects
• 10:31
  and
• 10:31
  when
• 10:31
  you
• 10:31
  say
• 10:32
  it
• 10:32
  didn't
• 10:33
  meet
• 10:33
  significant
• 10:34
  threshold,
• 10:35
  that's
• 10:35
  what
• 10:35
  you're
• 10:35
  talking
• 10:35
  about.
• 10:36
  That
• 10:36
  was
• 10:36
  the
• 10:36
  main
• 10:36
  finding,
• 10:37
  that
• 10:38
  after
• 10:38
  a
• 10:38
  week,
• 10:38
  the
• 10:39
  average
• 10:39
  increase
• 10:40
  in
• 10:41
  withdrawal
• 10:41
  effects
• 10:42
  in
• 10:42
  the
• 10:42
  group
• 10:42
  that
• 10:42
  stopped
• 10:43
  antidepressants
• 10:43
  compared
• 10:43
  to
• 10:44
  control
• 10:44
  groups
• 10:44
  was
• 10:44
  1.08
• 10:45
  symptoms.
• 10:46
  That
• 10:46
  was
• 10:46
  the.
• 10:47
  That
• 10:47
  was
• 10:47
  what.
• 10:48
  And
• 10:48
  they
• 10:48
  said,
• 10:49
  well,
• 10:49
  the
• 10:49
  threshold
• 10:50
  is
• 10:50
  normally
• 10:50
  4
• 10:51
  symptoms,
• 10:52
  1.08
• 10:53
  is
• 10:53
  less
• 10:53
  than
• 10:53
  4.
• 10:53
  And
• 10:54
  so
• 10:54
  this
• 10:54
  is
• 10:54
  not
• 10:54
  a
• 10:54
  significant
• 10:55
  withdrawal
• 10:55
  syndrome.
• 10:55
  And
• 10:55
  that
• 10:56
  was
• 10:56
  the
• 10:56
  main.
• 10:56
  You
• 10:56
  know,
• 10:57
  that's
• 10:57
  been
• 10:57
  the
• 10:57
  main
• 10:57
  takeaway
• 10:58
  of
• 10:58
  the
• 10:58
  paper.
• 10:59
  When
• 10:59
  you
• 10:59
  see
• 11:00
  headlines
• 11:01
  in
• 11:01
  papers
• 11:02
  saying
• 11:02
  there's
• 11:02
  not
• 11:02
  significant
• 11:03
  withdrawal
• 11:03
  syndrome,
• 11:04
  that's
• 11:04
  what
• 11:04
  they're
• 11:05
  talking
• 11:05
  about.
• 11:06
  That
• 11:06
  particular
• 11:06
  analysis,
• 11:07
  yes,
• 11:08
  only
• 11:08
  used
• 11:08
  11
• 11:08
  studies
• 11:09
  in
• 11:09
  the
• 11:09
  meta
• 11:09
  analysis.
• 11:11
  So
• 11:11
  the
• 11:11
  other
• 11:12
  38
• 11:13
  odd,
• 11:13
  although
• 11:14
  there's
• 11:14
  some
• 11:15
  overlap.
• 11:15
  So
• 11:15
  there
• 11:15
  was
• 11:16
  45
• 11:16
  studies
• 11:17
  that
• 11:17
  they
• 11:17
  used
• 11:18
  to
• 11:18
  look
• 11:18
  at
• 11:18
  individual
• 11:18
  symptoms.
• 11:19
  So
• 11:19
  they
• 11:19
  looked
• 11:19
  at
• 11:20
  how
• 11:20
  common
• 11:20
  is
• 11:20
  dizziness,
• 11:21
  how
• 11:22
  common
• 11:22
  is
• 11:22
  nausea
• 11:23
  and
• 11:23
  nervousness,
• 11:24
  which
• 11:24
  we
• 11:24
  can
• 11:25
  talk
• 11:25
  about.
• 11:25
  But
• 11:27
  that
• 11:28
  was
• 11:28
  a
• 11:28
  part
• 11:28
  of
• 11:28
  what
• 11:28
  they
• 11:29
  did.
• 11:29
  That
• 11:29
  was
• 11:29
  not
• 11:30
  the
• 11:30
  main
• 11:31
  analysis
• 11:32
  that
• 11:32
  they
• 11:32
  announced
• 11:33
  in
• 11:34
  their
• 11:34
  press
• 11:34
  release
• 11:34
  and
• 11:34
  in
• 11:35
  all
• 11:35
  the
• 11:35
  media
• 11:35
  around
• 11:36
  it.
• 11:36
  So
• 11:36
  the
• 11:37
  subset
• 11:37
  of
• 11:37
  studies
• 11:38
  that
• 11:38
  they
• 11:39
  used
• 11:39
  for
• 11:39
  the
• 11:39
  main
• 11:40
  analysis
• 11:41
  was
• 11:42
  11
• 11:42
  studies.
• 11:43
  Those
• 11:44
  11
• 11:44
  studies
• 11:45
  went
• 11:46
  for
• 11:46
  8
• 11:47
  to
• 11:47
  26
• 11:47
  weeks.
• 11:49
  10
• 11:49
  of
• 11:49
  them
• 11:50
  went
• 11:50
  for
• 11:50
  8
• 11:51
  to
• 11:51
  12
• 11:51
  weeks.
• 11:51
  So
• 11:51
  these
• 11:52
  actually,
• 11:52
  these
• 11:52
  are,
• 11:53
  I
• 11:53
  sort
• 11:53
  of
• 11:53
  talked
• 11:53
  at
• 11:53
  the
• 11:53
  beginning,
• 11:54
  guidelines
• 11:54
  are
• 11:54
  based
• 11:54
  on
• 11:54
  these
• 11:55
  8
• 11:55
  to
• 11:55
  12
• 11:55
  week
• 11:55
  studies.
• 11:56
  Some
• 11:56
  of
• 11:56
  the
• 11:56
  studies
• 11:57
  included
• 11:57
  were
• 11:57
  those
• 11:57
  original
• 11:58
  8
• 11:58
  to
• 11:58
  12
• 11:58
  week
• 11:58
  studies
• 11:59
  that
• 11:59
  guidelines
• 11:59
  were
• 11:59
  originally
• 12:00
  based
• 12:00
  on.
• 12:00
  So
• 12:00
  it's
• 12:00
  a
• 12:00
  little
• 12:00
  bit
• 12:01
  of
• 12:01
  a
• 12:01
  sense
• 12:01
  of
• 12:01
  deja
• 12:01
  vu
• 12:02
  here.
• 12:02
  This
• 12:02
  is
• 12:02
  a
• 12:02
  bit
• 12:03
  of
• 12:03
  a
• 12:03
  repetitive
• 12:03
  story.
• 12:04
  The
• 12:05
  26
• 12:05
  week
• 12:05
  study,
• 12:05
  you
• 12:06
  probably
• 12:06
  think,
• 12:06
  oh,
• 12:06
  that
• 12:06
  sounds
• 12:06
  a
• 12:06
  bit
• 12:07
  longer
• 12:07
  and
• 12:07
  it
• 12:07
  is.
• 12:08
  But
• 12:09
  that
• 12:09
  study
• 12:09
  was
• 12:10
  looking
• 12:10
  at
• 12:10
  an
• 12:10
  antidepressant
• 12:11
  called
• 12:11
  agomelatine,
• 12:12
  which
• 12:13
  is
• 12:13
  sold
• 12:13
  as
• 12:13
  Valdoxin.
• 12:14
  I
• 12:14
  don't
• 12:14
  think
• 12:14
  it's
• 12:14
  even
• 12:14
  approved
• 12:15
  in
• 12:15
  the
• 12:15
  us
• 12:15
  so
• 12:15
  you
• 12:15
  probably
• 12:16
  have
• 12:16
  never
• 12:16
  Heard
• 12:16
  of
• 12:16
  it,
• 12:17
  but
• 12:17
  it's
• 12:18
  a
• 12:18
  bit
• 12:18
  famous
• 12:18
  for
• 12:18
  not
• 12:19
  having
• 12:19
  withdrawal
• 12:19
  syndrome.
• 12:20
  It
• 12:20
  acts
• 12:20
  not
• 12:21
  on
• 12:21
  serotonin
• 12:21
  and
• 12:22
  not
• 12:22
  on
• 12:22
  norepinephrine.
• 12:23
  It's
• 12:23
  a
• 12:23
  different
• 12:24
  sort
• 12:24
  of
• 12:24
  drug
• 12:25
  and
• 12:25
  it
• 12:25
  doesn't
• 12:25
  have
• 12:26
  a
• 12:26
  withdrawal
• 12:26
  syndrome.
• 12:27
  So
• 12:27
  the
• 12:27
  single
• 12:28
  study
• 12:28
  that
• 12:28
  went
• 12:28
  for
• 12:29
  26
• 12:29
  weeks
• 12:30
  is
• 12:30
  with
• 12:31
  a
• 12:31
  drug
• 12:31
  that
• 12:31
  no
• 12:31
  one
• 12:31
  thinks
• 12:32
  causes
• 12:32
  withdrawal.
• 12:32
  So
• 12:32
  it's
• 12:33
  a
• 12:33
  bit
• 12:33
  irrelevant.
• 12:34
  So
• 12:34
  in
• 12:34
  essence,
• 12:35
  the
• 12:35
  main
• 12:36
  analysis
• 12:36
  was
• 12:36
  based
• 12:36
  on
• 12:37
  10
• 12:37
  studies
• 12:39
  that
• 12:39
  had
• 12:39
  people
• 12:39
  on
• 12:40
  antidepressants
• 12:40
  for
• 12:40
  eight
• 12:41
  to
• 12:41
  12
• 12:41
  weeks
• 12:41
  before
• 12:41
  they
• 12:42
  stopped.
• 12:43
  So
• 12:43
  it's
• 12:43
  exactly
• 12:44
  history
• 12:44
  of
• 12:45
  repeating.
• 12:45
  We're
• 12:45
  back
• 12:45
  to
• 12:46
  the
• 12:46
  original
• 12:47
  studies
• 12:47
  done
• 12:47
  by
• 12:48
  drug
• 12:48
  companies
• 12:49
  that
• 12:49
  the
• 12:49
  analysis
• 12:50
  is
• 12:50
  based,
• 12:50
  that
• 12:50
  they
• 12:50
  base
• 12:51
  their
• 12:51
  analysis
• 12:51
  on.
• 12:52
  Yeah,
• 12:52
  and
• 12:52
  that
• 12:53
  gets
• 12:53
  kind
• 12:53
  of
• 12:53
  frustrating,
• 12:54
  I
• 12:54
  think,
• 12:54
  when
• 12:54
  you
• 12:54
  repackage
• 12:55
  old
• 12:55
  studies
• 12:56
  and
• 12:56
  try
• 12:56
  and
• 12:56
  present
• 12:56
  it
• 12:57
  as
• 12:57
  new
• 12:57
  data
• 12:59
  and
• 12:59
  look
• 12:59
  what
• 12:59
  we
• 12:59
  now
• 13:00
  have
• 13:00
  found
• 13:00
  and
• 13:00
  have
• 13:01
  proven.
• 13:01
  But
• 13:02
  you
• 13:02
  know,
• 13:03
  if
• 13:03
  you
• 13:03
  look
• 13:03
  at
• 13:03
  the
• 13:04
  debates
• 13:04
  on
• 13:04
  social
• 13:04
  media,
• 13:05
  you
• 13:05
  know,
• 13:05
  you
• 13:05
  say,
• 13:06
  look,
• 13:06
  this
• 13:06
  is
• 13:06
  the
• 13:07
  meta
• 13:07
  analysis
• 13:08
  of
• 13:08
  randomized
• 13:08
  controlled
• 13:09
  trials.
• 13:09
  This
• 13:09
  is
• 13:09
  sort
• 13:10
  of
• 13:10
  the
• 13:10
  pinnacle
• 13:10
  of
• 13:11
  research
• 13:11
  quality
• 13:12
  as
• 13:12
  opposed
• 13:12
  to
• 13:13
  saying,
• 13:14
  you
• 13:14
  know,
• 13:14
  you've
• 13:14
  pointed
• 13:15
  out
• 13:15
  that
• 13:15
  you
• 13:15
  have
• 13:15
  survey
• 13:16
  data,
• 13:16
  right.
• 13:17
  And
• 13:17
  that
• 13:17
  is
• 13:17
  really
• 13:18
  impactful
• 13:18
  for
• 13:18
  people's
• 13:19
  individual
• 13:19
  experiences.
• 13:20
  But
• 13:21
  if
• 13:21
  you're
• 13:21
  just
• 13:21
  looking
• 13:22
  at
• 13:22
  it
• 13:22
  from
• 13:22
  an
• 13:22
  academic
• 13:23
  standpoint,
• 13:24
  they
• 13:24
  don't
• 13:24
  compare.
• 13:25
  But
• 13:25
  when
• 13:25
  you
• 13:26
  break
• 13:26
  it
• 13:26
  down
• 13:26
  to
• 13:27
  the
• 13:27
  specifics,
• 13:27
  they
• 13:28
  are
• 13:28
  so
• 13:28
  different
• 13:28
  and
• 13:29
  represent
• 13:29
  so
• 13:30
  such
• 13:30
  different
• 13:30
  populations.
• 13:31
  I
• 13:31
  guess
• 13:32
  the
• 13:32
  question
• 13:32
  is,
• 13:33
  the
• 13:34
  question
• 13:34
  is,
• 13:34
  what
• 13:34
  are
• 13:34
  we
• 13:35
  missing?
• 13:35
  Like
• 13:35
  is
• 13:36
  there
• 13:36
  longer
• 13:36
  term
• 13:37
  data
• 13:37
  that
• 13:37
  isn't
• 13:38
  included
• 13:38
  in
• 13:38
  this
• 13:39
  meta
• 13:39
  analysis
• 13:40
  that
• 13:40
  should
• 13:40
  have
• 13:40
  been,
• 13:40
  or
• 13:41
  is
• 13:41
  that
• 13:41
  something
• 13:41
  that
• 13:42
  we
• 13:42
  need
• 13:42
  to
• 13:43
  make
• 13:43
  sure
• 13:43
  is
• 13:43
  studied
• 13:45
  and
• 13:45
  done
• 13:46
  in
• 13:46
  the
• 13:46
  future
• 13:46
  so
• 13:47
  that
• 13:47
  it
• 13:47
  could
• 13:47
  be
• 13:47
  included?
• 13:48
  Yeah,
• 13:48
  so
• 13:48
  there's
• 13:48
  a
• 13:49
  few
• 13:49
  points
• 13:49
  to
• 13:49
  make
• 13:49
  there.
• 13:50
  Number
• 13:50
  one,
• 13:51
  I
• 13:51
  agree
• 13:51
  it
• 13:51
  is
• 13:51
  frustrating
• 13:52
  to
• 13:52
  see
• 13:52
  old
• 13:52
  data
• 13:53
  repackaged
• 13:53
  because,
• 13:54
  you
• 13:54
  know,
• 13:54
  this
• 13:54
  is
• 13:54
  exactly
• 13:55
  all
• 13:55
  the
• 13:56
  press
• 13:56
  release
• 13:57
  and
• 13:57
  the
• 13:57
  media
• 13:57
  said,
• 13:58
  this
• 13:58
  is
• 13:58
  a
• 13:58
  meta
• 13:58
  analysis,
• 13:59
  it's
• 13:59
  done
• 13:59
  very
• 13:59
  well,
• 14:00
  it's
• 14:00
  in
• 14:00
  a
• 14:00
  big
• 14:01
  journal
• 14:01
  and
• 14:01
  in
• 14:02
  a
• 14:02
  lot
• 14:02
  of
• 14:02
  respects
• 14:02
  it
• 14:02
  was
• 14:02
  done
• 14:03
  well.
• 14:03
  They
• 14:03
  looked
• 14:03
  at
• 14:04
  the
• 14:04
  quality
• 14:04
  of
• 14:04
  studies,
• 14:04
  they
• 14:04
  did
• 14:05
  a
• 14:05
  risk
• 14:05
  of
• 14:05
  bias
• 14:05
  assessment,
• 14:06
  they
• 14:06
  did
• 14:06
  a
• 14:06
  meta
• 14:06
  analysis
• 14:07
  using
• 14:07
  latest
• 14:08
  techniques.
• 14:08
  So
• 14:08
  there
• 14:08
  are
• 14:08
  a
• 14:09
  lot
• 14:09
  of
• 14:09
  good
• 14:09
  things
• 14:09
  there.
• 14:10
  But
• 14:10
  they
• 14:11
  are
• 14:11
  looking
• 14:11
  at
• 14:12
  8
• 14:12
  to
• 14:12
  12
• 14:12
  week
• 14:12
  studies.
• 14:13
  It
• 14:13
  doesn't
• 14:13
  matter
• 14:13
  how
• 14:14
  brilliant
• 14:14
  the
• 14:15
  techniques
• 14:15
  you
• 14:15
  use,
• 14:16
  you're
• 14:16
  still
• 14:17
  looking,
• 14:17
  I
• 14:17
  would
• 14:18
  say
• 14:18
  the
• 14:18
  old
• 14:19
  sort
• 14:19
  of
• 14:19
  joke,
• 14:19
  the
• 14:20
  drunk
• 14:20
  is
• 14:20
  looking
• 14:20
  for
• 14:20
  his
• 14:20
  keys
• 14:21
  under
• 14:21
  the
• 14:21
  lamplight
• 14:21
  because
• 14:22
  that's
• 14:22
  where
• 14:22
  the
• 14:22
  light
• 14:22
  is.
• 14:22
  If
• 14:23
  you're
• 14:23
  looking
• 14:23
  there,
• 14:23
  you're
• 14:24
  not
• 14:24
  going
• 14:24
  to
• 14:24
  find
• 14:25
  the
• 14:25
  issues
• 14:25
  which
• 14:25
  are
• 14:25
  of
• 14:26
  course
• 14:26
  what
• 14:26
  happens
• 14:26
  to
• 14:26
  long
• 14:27
  term
• 14:28
  people
• 14:28
  on
• 14:29
  long
• 14:29
  term
• 14:30
  use
• 14:30
  of
• 14:30
  antidepressants.
• 14:31
  It's
• 14:32
  not
• 14:32
  true.
• 14:32
  So
• 14:32
  I
• 14:32
  just
• 14:33
  say
• 14:33
  on
• 14:33
  the
• 14:33
  survey
• 14:33
  data
• 14:33
  things
• 14:34
  I
• 14:34
  talk
• 14:35
  about
• 14:35
  a
• 14:35
  survey
• 14:35
  that
• 14:35
  we
• 14:35
  did,
• 14:36
  not
• 14:36
  to
• 14:37
  say
• 14:37
  that
• 14:37
  it's
• 14:38
  a
• 14:38
  fantastic
• 14:38
  representation
• 14:39
  of
• 14:39
  the
• 14:39
  risk
• 14:39
  of
• 14:39
  withdrawal
• 14:39
  effects,
• 14:40
  because
• 14:40
  it's
• 14:41
  not.
• 14:41
  It
• 14:42
  could
• 14:42
  be
• 14:42
  a
• 14:42
  self
• 14:42
  selected
• 14:42
  sample.
• 14:43
  That's
• 14:43
  the
• 14:43
  problem
• 14:43
  with
• 14:43
  surveys.
• 14:44
  I
• 14:44
  point
• 14:45
  to
• 14:45
  that
• 14:45
  to
• 14:45
  show
• 14:46
  it
• 14:46
  clearly
• 14:47
  shows
• 14:47
  what's
• 14:48
  called
• 14:48
  a
• 14:48
  biological
• 14:48
  gradient,
• 14:50
  that
• 14:50
  the
• 14:50
  longer
• 14:50
  you're
• 14:50
  on
• 14:51
  a
• 14:51
  drug,
• 14:51
  the
• 14:51
  worse
• 14:51
  withdrawal
• 14:52
  effects.
• 14:52
  And
• 14:52
  a
• 14:53
  survey
• 14:54
  is
• 14:54
  a
• 14:54
  perfectly
• 14:54
  reasonable
• 14:55
  place
• 14:55
  to
• 14:55
  find
• 14:56
  such
• 14:56
  a
• 14:56
  thing.
• 14:56
  So,
• 14:56
  for
• 14:57
  example,
• 14:58
  there
• 14:58
  are
• 14:58
  no
• 14:58
  randomized
• 14:59
  controlled
• 14:59
  trials
• 14:59
  showing
• 14:59
  that
• 15:00
  smoking
• 15:00
  causes
• 15:00
  lung
• 15:01
  cancer.
• 15:01
  It's
• 15:01
  not
• 15:02
  ethical
• 15:02
  to
• 15:02
  randomize
• 15:02
  autistic
• 15:03
  smoking.
• 15:03
  It
• 15:04
  is
• 15:04
  found.
• 15:05
  Dose
• 15:05
  response
• 15:06
  relationships
• 15:07
  are
• 15:07
  found
• 15:07
  from
• 15:08
  surveys.
• 15:08
  People
• 15:08
  that
• 15:08
  smoke
• 15:09
  more
• 15:09
  cigarettes
• 15:10
  have
• 15:10
  more
• 15:10
  lung
• 15:10
  cancer.
• 15:11
  And
• 15:11
  yes,
• 15:11
  there
• 15:11
  are
• 15:12
  lots
• 15:12
  of
• 15:12
  other
• 15:12
  factors,
• 15:13
  but
• 15:13
  if
• 15:14
  you
• 15:14
  control
• 15:14
  for
• 15:14
  them,
• 15:15
  you
• 15:15
  can
• 15:15
  see
• 15:15
  that.
• 15:15
  And
• 15:16
  we
• 15:16
  saw
• 15:16
  something
• 15:16
  similar,
• 15:16
  so
• 15:17
  that's
• 15:17
  why
• 15:17
  surveys
• 15:17
  were
• 15:17
  introduced.
• 15:19
  But
• 15:19
  there
• 15:19
  are
• 15:20
  long
• 15:20
  term
• 15:20
  studies
• 15:21
  that
• 15:21
  are
• 15:21
  randomized
• 15:21
  controlled
• 15:22
  trials
• 15:22
  that
• 15:23
  are
• 15:23
  double
• 15:23
  blinded
• 15:24
  that
• 15:24
  should
• 15:24
  have
• 15:25
  been
• 15:25
  included
• 15:25
  in
• 15:25
  the
• 15:25
  main
• 15:26
  analysis
• 15:26
  in
• 15:27
  this
• 15:27
  study,
• 15:27
  as
• 15:27
  far
• 15:27
  as
• 15:28
  I
• 15:28
  can
• 15:28
  see.
• 15:28
  So
• 15:29
  there
• 15:29
  are
• 15:29
  three
• 15:30
  studies
• 15:30
  that
• 15:30
  come
• 15:31
  to
• 15:31
  mind,
• 15:32
  Rosenbaum
• 15:33
  98,
• 15:36
  Judge
• 15:36
  2002
• 15:36
  and
• 15:37
  Mickelson
• 15:37
  2000.
• 15:38
  They
• 15:39
  involved
• 15:39
  people
• 15:39
  who've
• 15:39
  been
• 15:40
  on
• 15:40
  antidepressants
• 15:40
  for
• 15:40
  four
• 15:41
  to
• 15:41
  12
• 15:41
  months.
• 15:42
  They
• 15:42
  were
• 15:43
  done
• 15:43
  very
• 15:43
  well
• 15:43
  by
• 15:44
  drug
• 15:44
  companies.
• 15:44
  Like
• 15:44
  all
• 15:44
  these
• 15:45
  other
• 15:45
  studies,
• 15:45
  they
• 15:46
  were
• 15:46
  taken
• 15:46
  off
• 15:46
  their
• 15:47
  drugs.
• 15:47
  There
• 15:48
  was
• 15:48
  control
• 15:48
  conditions
• 15:49
  with
• 15:49
  people
• 15:49
  who
• 15:50
  continued
• 15:50
  their
• 15:50
  drugs.
• 15:51
  It
• 15:51
  was
• 15:52
  all
• 15:52
  double
• 15:52
  blinded.
• 15:53
  They
• 15:53
  carefully
• 15:54
  measured
• 15:56
  withdrawal
• 15:56
  effects
• 15:57
  using
• 15:57
  the
• 15:57
  des,
• 15:58
  this
• 15:58
  scale
• 15:58
  that
• 15:59
  is
• 15:59
  focused
• 15:59
  on
• 15:59
  in
• 16:00
  the
• 16:00
  CALFAS
• 16:01
  meta
• 16:02
  analysis
• 16:03
  and
• 16:03
  it
• 16:03
  showed
• 16:04
  huge
• 16:04
  levels
• 16:04
  of
• 16:05
  withdrawal.
• 16:06
  The
• 16:06
  average
• 16:06
  number
• 16:07
  of
• 16:07
  death
• 16:07
  symptoms
• 16:08
  coming
• 16:08
  off
• 16:08
  paroxetine
• 16:09
  was
• 16:09
  8,
• 16:10
  coming
• 16:11
  off
• 16:11
  sertraline,
• 16:11
  Zoloft
• 16:12
  was
• 16:12
  5.
• 16:13
  The
• 16:14
  proportion
• 16:14
  of
• 16:14
  people
• 16:14
  that
• 16:15
  had
• 16:15
  a
• 16:15
  withdrawal
• 16:15
  syndrome
• 16:16
  was
• 16:16
  60%
• 16:17
  for
• 16:18
  Zoloft
• 16:19
  and
• 16:19
  66%
• 16:20
  for
• 16:20
  Paxil.
• 16:21
  And
• 16:22
  that's,
• 16:23
  you
• 16:23
  know,
• 16:23
  I
• 16:23
  don't
• 16:23
  know
• 16:24
  why
• 16:24
  they
• 16:24
  didn't
• 16:24
  include
• 16:25
  that
• 16:26
  Rosenbaum
• 16:26
  study
• 16:26
  in
• 16:27
  their
• 16:27
  analysis,
• 16:28
  but
• 16:28
  it
• 16:28
  clearly
• 16:29
  shows
• 16:29
  incredibly
• 16:30
  high
• 16:30
  levels
• 16:31
  of
• 16:31
  withdrawal
• 16:32
  in
• 16:32
  longer
• 16:33
  term
• 16:33
  users.
• 16:34
  So
• 16:36
  those
• 16:36
  are
• 16:36
  not
• 16:36
  surveys,
• 16:37
  those
• 16:37
  are
• 16:37
  randomised
• 16:37
  controlled
• 16:38
  trials.
• 16:39
  And
• 16:39
  so
• 16:41
  they
• 16:41
  did.
• 16:41
  What
• 16:42
  is
• 16:42
  interesting
• 16:42
  is
• 16:43
  the
• 16:43
  Rosenbaum
• 16:44
  study
• 16:44
  was
• 16:45
  captured
• 16:45
  in
• 16:45
  those
• 16:45
  49
• 16:46
  studies
• 16:46
  in
• 16:47
  their
• 16:47
  paper
• 16:47
  and
• 16:48
  it
• 16:48
  is
• 16:48
  included
• 16:48
  to
• 16:49
  look
• 16:49
  at
• 16:49
  the
• 16:49
  individual
• 16:50
  risk
• 16:50
  of
• 16:51
  symptoms.
• 16:51
  So
• 16:51
  they
• 16:52
  did
• 16:52
  have
• 16:52
  the
• 16:52
  data.
• 16:53
  I'm
• 16:53
  not
• 16:53
  exactly
• 16:54
  sure
• 16:54
  what
• 16:54
  the
• 16:54
  rationale
• 16:55
  was
• 16:55
  for
• 16:55
  not
• 16:55
  including
• 16:56
  those
• 16:56
  much
• 16:57
  higher
• 16:57
  rates
• 16:58
  of
• 16:58
  withdrawal
• 16:59
  in
• 16:59
  their
• 16:59
  primary
• 16:59
  analysis.
• 17:01
  Fellow
• 17:01
  mental
• 17:01
  health
• 17:01
  clinicians
• 17:02
  and
• 17:02
  healthcare
• 17:03
  providers,
• 17:03
  you
• 17:03
  now
• 17:04
  have
• 17:04
  access
• 17:04
  to
• 17:05
  a
• 17:05
  suite
• 17:05
  of
• 17:05
  free
• 17:06
  CME
• 17:06
  lectures
• 17:07
  on
• 17:07
  metabolic
• 17:08
  psychiatry
• 17:08
  and
• 17:09
  metabolic
• 17:09
  health.
• 17:10
  Each
• 17:10
  of
• 17:10
  these
• 17:10
  CME
• 17:11
  sessions
• 17:11
  provide
• 17:11
  insight
• 17:12
  on
• 17:12
  incorporating
• 17:13
  metabolic
• 17:13
  therapies
• 17:14
  for
• 17:14
  mental
• 17:14
  illnesses
• 17:15
  into
• 17:15
  your
• 17:15
  practice.
• 17:16
  These
• 17:16
  CME
• 17:17
  sessions
• 17:17
  are
• 17:17
  approved
• 17:18
  for
• 17:18
  AMA
• 17:18
  Category
• 17:19
  1
• 17:19
  credits,
• 17:20
  CNE
• 17:21
  nursing
• 17:21
  credit
• 17:21
  hours
• 17:22
  and
• 17:22
  continuing
• 17:23
  education
• 17:23
  credit
• 17:23
  for
• 17:24
  psychologists.
• 17:25
  And
• 17:25
  they're
• 17:25
  completely
• 17:26
  free
• 17:26
  of
• 17:26
  charge
• 17:26
  on
• 17:26
  mycme.com
• 17:28
  now
• 17:28
  back
• 17:28
  to
• 17:28
  the
• 17:29
  video.
• 17:29
  Well,
• 17:30
  it's
• 17:30
  really
• 17:30
  important
• 17:30
  to
• 17:31
  notice
• 17:31
  that
• 17:32
  those
• 17:32
  data
• 17:33
  do
• 17:33
  exist
• 17:34
  and
• 17:34
  that
• 17:34
  they
• 17:35
  are
• 17:35
  contrary
• 17:35
  to
• 17:36
  what
• 17:37
  the
• 17:37
  I
• 17:37
  guess
• 17:38
  the
• 17:38
  conclusion
• 17:38
  of
• 17:39
  this
• 17:39
  paper
• 17:39
  is.
• 17:40
  So,
• 17:40
  I
• 17:40
  mean,
• 17:40
  that's
• 17:41
  really
• 17:41
  important.
• 17:42
  But
• 17:42
  I
• 17:42
  guess
• 17:43
  another
• 17:43
  question
• 17:43
  is
• 17:45
  why
• 17:46
  is
• 17:46
  it
• 17:46
  so
• 17:46
  important?
• 17:47
  And
• 17:48
  part
• 17:48
  of
• 17:48
  the
• 17:48
  reason
• 17:49
  is,
• 17:49
  you
• 17:50
  know,
• 17:50
  determining
• 17:51
  withdrawal
• 17:52
  from
• 17:52
  a
• 17:52
  recurrence
• 17:53
  of
• 17:54
  the
• 17:55
  depression
• 17:55
  that
• 17:56
  required
• 17:56
  the
• 17:57
  treatment,
• 17:57
  which
• 17:57
  is
• 17:58
  so
• 17:58
  important.
• 17:58
  And
• 18:00
  of
• 18:00
  course,
• 18:00
  you
• 18:01
  know,
• 18:01
  I've
• 18:01
  been
• 18:01
  trying
• 18:02
  to
• 18:02
  read
• 18:02
  all
• 18:03
  the
• 18:03
  conflicting
• 18:03
  views,
• 18:04
  but
• 18:04
  one
• 18:04
  is,
• 18:04
  well,
• 18:04
  if
• 18:05
  you
• 18:05
  call
• 18:05
  everything
• 18:05
  withdrawal,
• 18:06
  then
• 18:07
  that's
• 18:07
  your
• 18:07
  only
• 18:07
  tool
• 18:07
  in
• 18:08
  the
• 18:08
  toolkit
• 18:08
  and
• 18:08
  you
• 18:08
  have
• 18:08
  to
• 18:08
  recognize
• 18:09
  that
• 18:09
  there's
• 18:09
  a
• 18:09
  recurrence
• 18:10
  of
• 18:10
  symptoms.
• 18:10
  So
• 18:11
  how
• 18:11
  did
• 18:12
  they
• 18:12
  try
• 18:12
  to
• 18:12
  differentiate
• 18:13
  in
• 18:13
  these
• 18:13
  studies
• 18:14
  what
• 18:14
  is
• 18:14
  a
• 18:14
  discontinuation
• 18:15
  effect
• 18:16
  from
• 18:16
  the
• 18:16
  medication
• 18:17
  and
• 18:17
  what
• 18:17
  is
• 18:17
  a
• 18:18
  recurrence
• 18:18
  recurrence
• 18:18
  of
• 18:19
  their
• 18:19
  initial
• 18:20
  symptomatology
• 18:21
  of
• 18:21
  depression?
• 18:22
  So
• 18:22
  it's
• 18:23
  a
• 18:23
  very
• 18:23
  interesting
• 18:23
  point
• 18:24
  because
• 18:25
  they
• 18:25
  focus
• 18:25
  on
• 18:26
  this
• 18:26
  issue
• 18:26
  a
• 18:26
  lot
• 18:27
  in
• 18:27
  their
• 18:28
  reporting
• 18:28
  of
• 18:28
  the
• 18:28
  study.
• 18:29
  So
• 18:29
  they
• 18:29
  argued
• 18:31
  that
• 18:31
  they
• 18:31
  didn't
• 18:31
  find
• 18:32
  much
• 18:33
  depression
• 18:34
  as
• 18:34
  a
• 18:34
  withdrawal
• 18:34
  effect
• 18:35
  and
• 18:35
  therefore
• 18:36
  if
• 18:36
  people
• 18:36
  get
• 18:37
  depressed
• 18:37
  after
• 18:38
  stopping
• 18:38
  an
• 18:38
  antidepressant,
• 18:39
  it
• 18:39
  must
• 18:40
  be
• 18:40
  relapse
• 18:41
  or
• 18:41
  return
• 18:41
  of
• 18:41
  their
• 18:41
  underlying
• 18:41
  condition.
• 18:43
  And
• 18:44
  that
• 18:44
  was
• 18:44
  one
• 18:44
  of
• 18:44
  their
• 18:44
  kind
• 18:44
  of
• 18:44
  major
• 18:45
  talking
• 18:45
  points
• 18:45
  in
• 18:46
  their
• 18:46
  press
• 18:46
  release.
• 18:47
  And
• 18:47
  what
• 18:47
  they've
• 18:47
  done
• 18:48
  is
• 18:48
  if
• 18:48
  you
• 18:49
  look
• 18:49
  down
• 18:49
  in
• 18:49
  the,
• 18:49
  I
• 18:50
  mentioned
• 18:50
  the
• 18:50
  secondary
• 18:51
  analysis
• 18:51
  where
• 18:51
  they
• 18:52
  looked
• 18:52
  at
• 18:52
  individual
• 18:52
  symptoms,
• 18:53
  one
• 18:53
  of
• 18:53
  them
• 18:54
  is
• 18:54
  depressed
• 18:54
  mood.
• 18:55
  They've
• 18:56
  looked
• 18:56
  at
• 18:56
  five
• 18:56
  studies
• 18:57
  and
• 18:57
  they
• 18:58
  found
• 18:58
  very
• 18:59
  low
• 18:59
  levels
• 19:00
  of
• 19:00
  depressed
• 19:00
  mood,
• 19:01
  both
• 19:01
  in
• 19:02
  the
• 19:02
  control
• 19:02
  group
• 19:02
  and
• 19:03
  in
• 19:03
  the
• 19:03
  people
• 19:03
  coming
• 19:03
  off
• 19:03
  antidepressants,
• 19:04
  something
• 19:05
  like
• 19:05
  one
• 19:05
  and
• 19:05
  a
• 19:05
  half
• 19:06
  percent.
• 19:06
  And
• 19:06
  there's
• 19:07
  no
• 19:07
  difference.
• 19:07
  And
• 19:07
  they
• 19:07
  say,
• 19:08
  so
• 19:08
  we
• 19:08
  didn't
• 19:08
  detect
• 19:09
  depressed
• 19:09
  mood.
• 19:10
  The
• 19:10
  trouble
• 19:11
  with
• 19:11
  what
• 19:11
  they've
• 19:11
  done
• 19:11
  is
• 19:12
  some
• 19:13
  of
• 19:13
  the
• 19:13
  studies,
• 19:13
  so
• 19:13
  it's
• 19:14
  a
• 19:14
  small
• 19:14
  number
• 19:14
  of
• 19:15
  studies
• 19:15
  they've
• 19:16
  used.
• 19:17
  Most
• 19:17
  of
• 19:17
  some
• 19:17
  of
• 19:17
  those
• 19:17
  studies
• 19:18
  have
• 19:18
  used
• 19:18
  what
• 19:18
  are
• 19:19
  called
• 19:19
  spontaneous
• 19:19
  adverse
• 19:20
  effect
• 19:20
  reporting.
• 19:21
  That
• 19:21
  means
• 19:22
  if
• 19:22
  you're
• 19:22
  in
• 19:23
  the
• 19:23
  study,
• 19:23
  you've
• 19:23
  got
• 19:24
  to
• 19:24
  kind
• 19:24
  of
• 19:24
  contact
• 19:24
  the
• 19:25
  researcher
• 19:25
  and
• 19:25
  say,
• 19:25
  I'm
• 19:25
  feeling
• 19:26
  depressed.
• 19:26
  Please
• 19:27
  put
• 19:27
  that
• 19:27
  down
• 19:27
  on
• 19:27
  my
• 19:27
  notes.
• 19:28
  They
• 19:28
  don't
• 19:29
  assess
• 19:29
  it
• 19:29
  systematically.
• 19:30
  So
• 19:30
  systematic
• 19:31
  assessment
• 19:31
  would
• 19:31
  be
• 19:31
  every
• 19:32
  patient,
• 19:32
  every
• 19:32
  participant
• 19:33
  in
• 19:33
  the
• 19:33
  study
• 19:34
  will
• 19:34
  give
• 19:34
  you
• 19:34
  this
• 19:34
  questionnaire,
• 19:35
  will
• 19:35
  ask
• 19:35
  about
• 19:35
  depression.
• 19:36
  Again,
• 19:37
  as
• 19:37
  it
• 19:37
  happens,
• 19:38
  there
• 19:38
  is
• 19:38
  a
• 19:38
  study
• 19:38
  that's
• 19:39
  done
• 19:39
  that
• 19:39
  extremely
• 19:40
  well
• 19:40
  after
• 19:40
  longer
• 19:41
  term
• 19:41
  use.
• 19:41
  It's
• 19:41
  the
• 19:41
  Rosenbaum
• 19:42
  study.
• 19:44
  It's
• 19:44
  a
• 19:44
  very
• 19:44
  good
• 19:45
  study
• 19:46
  worth
• 19:46
  reading.
• 19:47
  And
• 19:47
  they
• 19:47
  did
• 19:48
  something
• 19:48
  very
• 19:48
  careful.
• 19:50
  They
• 19:51
  took
• 19:51
  people
• 19:51
  who
• 19:51
  were
• 19:51
  on
• 19:52
  Zoloft,
• 19:52
  Paxil
• 19:53
  and
• 19:53
  Prozac.
• 19:54
  They
• 19:54
  stopped
• 19:55
  their
• 19:55
  drugs
• 19:55
  for
• 19:56
  five
• 19:56
  to
• 19:56
  eight
• 19:56
  days,
• 19:57
  and
• 19:57
  they
• 19:57
  measured
• 19:58
  withdrawal
• 19:58
  effects
• 19:59
  and
• 19:59
  depression
• 20:00
  scores
• 20:00
  at
• 20:00
  the
• 20:00
  same
• 20:01
  time,
• 20:01
  which
• 20:02
  is
• 20:02
  very
• 20:02
  rarely
• 20:02
  done.
• 20:03
  And
• 20:04
  you
• 20:04
  can
• 20:04
  see
• 20:04
  Prozac
• 20:05
  doesn't
• 20:06
  go
• 20:06
  up
• 20:06
  at
• 20:06
  all
• 20:06
  in
• 20:07
  terms
• 20:07
  of
• 20:07
  withdrawal
• 20:07
  effects
• 20:07
  because
• 20:08
  it's
• 20:08
  got
• 20:08
  a
• 20:08
  long
• 20:08
  half
• 20:09
  life,
• 20:09
  it
• 20:09
  takes
• 20:09
  a
• 20:10
  while
• 20:10
  to
• 20:10
  leave
• 20:10
  the
• 20:10
  body,
• 20:11
  and
• 20:11
  five
• 20:11
  to
• 20:11
  eight
• 20:12
  days
• 20:12
  is
• 20:12
  too
• 20:12
  short
• 20:12
  for
• 20:13
  it
• 20:13
  to
• 20:13
  come
• 20:13
  up.
• 20:13
  So
• 20:13
  it
• 20:13
  acts
• 20:13
  as
• 20:13
  a
• 20:14
  very
• 20:14
  useful
• 20:14
  control.
• 20:15
  Zoloft
• 20:16
  shot
• 20:16
  up
• 20:17
  five
• 20:17
  or
• 20:17
  six
• 20:17
  points,
• 20:18
  Paxil
• 20:19
  shot
• 20:19
  up
• 20:20
  eight
• 20:20
  or
• 20:20
  nine
• 20:20
  points,
• 20:21
  and
• 20:22
  the
• 20:22
  depression
• 20:23
  scores
• 20:23
  exactly
• 20:24
  match
• 20:24
  that.
• 20:25
  Depression
• 20:26
  scores
• 20:26
  didn't
• 20:26
  go
• 20:26
  up
• 20:26
  at
• 20:26
  all
• 20:27
  or
• 20:27
  very
• 20:27
  much
• 20:27
  for
• 20:28
  Prozac.
• 20:29
  They
• 20:29
  went
• 20:29
  up
• 20:29
  quite
• 20:29
  a
• 20:29
  lot
• 20:29
  for
• 20:30
  Sertraline,
• 20:31
  Zoloft
• 20:31
  and
• 20:32
  even
• 20:32
  more
• 20:32
  for
• 20:32
  Paroxetine.
• 20:33
  So
• 20:34
  that
• 20:34
  they
• 20:34
  were
• 20:35
  based
• 20:35
  on
• 20:35
  their
• 20:36
  criteria.
• 20:36
  They
• 20:37
  found
• 20:37
  that
• 20:37
  30%
• 20:39
  of
• 20:39
  people
• 20:39
  on
• 20:40
  Zoloft
• 20:41
  met
• 20:41
  the
• 20:41
  criteria
• 20:41
  for
• 20:42
  relapse
• 20:42
  on
• 20:42
  depression,
• 20:43
  36%
• 20:45
  met
• 20:45
  the
• 20:45
  criteria
• 20:46
  for
• 20:46
  Paxil
• 20:47
  on
• 20:48
  this
• 20:48
  depression
• 20:48
  score.
• 20:49
  And
• 20:49
  then
• 20:49
  when
• 20:49
  they
• 20:49
  gave
• 20:50
  the
• 20:50
  drugs
• 20:50
  back,
• 20:51
  the
• 20:51
  withdrawal
• 20:52
  shot
• 20:52
  to
• 20:52
  zero,
• 20:52
  and
• 20:53
  so
• 20:53
  did
• 20:53
  the
• 20:53
  depression
• 20:53
  scores.
• 20:55
  In
• 20:55
  other
• 20:55
  words,
• 20:56
  what
• 20:56
  they're
• 20:56
  telling
• 20:57
  a
• 20:57
  story
• 20:57
  of
• 20:58
  is
• 20:58
  that
• 20:58
  the
• 20:59
  increase
• 20:59
  in
• 21:00
  depressed
• 21:00
  mood
• 21:01
  is
• 21:01
  being
• 21:01
  driven
• 21:01
  by
• 21:02
  withdrawal.
• 21:03
  The
• 21:03
  degree,
• 21:03
  because
• 21:04
  you
• 21:04
  think
• 21:04
  about
• 21:04
  it,
• 21:04
  let's
• 21:04
  say
• 21:05
  that,
• 21:05
  let's
• 21:05
  assume
• 21:05
  that
• 21:05
  antidepressants
• 21:06
  are
• 21:06
  a
• 21:06
  bit
• 21:06
  effective
• 21:07
  for
• 21:07
  depression.
• 21:08
  When
• 21:08
  you
• 21:08
  stop
• 21:09
  them,
• 21:09
  you
• 21:09
  might
• 21:10
  see
• 21:10
  a
• 21:11
  bit
• 21:11
  of
• 21:11
  an
• 21:11
  increase
• 21:11
  in
• 21:11
  depression
• 21:12
  because
• 21:12
  the
• 21:12
  depression's
• 21:12
  coming
• 21:12
  back.
• 21:13
  But
• 21:14
  antidepressants
• 21:15
  improve
• 21:15
  depression
• 21:16
  scores
• 21:16
  by
• 21:16
  about
• 21:16
  two
• 21:17
  points.
• 21:17
  But
• 21:18
  on
• 21:18
  these
• 21:18
  studies,
• 21:19
  when
• 21:19
  you
• 21:20
  stopped
• 21:20
  antidepressants,
• 21:21
  the
• 21:22
  depression
• 21:22
  score
• 21:23
  shot
• 21:23
  up
• 21:23
  by
• 21:23
  way
• 21:23
  more
• 21:23
  than
• 21:24
  two
• 21:24
  points
• 21:25
  by,
• 21:25
  I
• 21:26
  think,
• 21:26
  eight
• 21:26
  and
• 21:26
  a
• 21:26
  half
• 21:26
  points
• 21:26
  for
• 21:27
  Paxil
• 21:27
  and
• 21:27
  five
• 21:28
  or
• 21:28
  six
• 21:28
  points
• 21:29
  for
• 21:29
  Zoloft,
• 21:30
  exactly
• 21:31
  similar
• 21:31
  to
• 21:31
  the
• 21:32
  increase
• 21:32
  in
• 21:32
  withdrawal
• 21:32
  effects.
• 21:33
  And
• 21:34
  they
• 21:34
  went
• 21:34
  away
• 21:34
  as
• 21:34
  soon
• 21:35
  as
• 21:35
  the
• 21:35
  drug
• 21:35
  was
• 21:35
  put
• 21:35
  back,
• 21:35
  which
• 21:36
  is
• 21:36
  not
• 21:36
  very
• 21:36
  typical
• 21:36
  of
• 21:37
  depression.
• 21:37
  In
• 21:37
  other
• 21:37
  words,
• 21:39
  this
• 21:39
  study
• 21:40
  shows
• 21:41
  this
• 21:41
  sort
• 21:41
  of
• 21:41
  parallel
• 21:42
  increase
• 21:43
  in
• 21:43
  withdrawal
• 21:44
  effects
• 21:44
  and
• 21:44
  depressed
• 21:44
  mood.
• 21:44
  It's
• 21:45
  making
• 21:45
  the
• 21:45
  argument
• 21:46
  that
• 21:46
  depressed
• 21:47
  mood
• 21:47
  is
• 21:47
  a
• 21:47
  very
• 21:47
  common
• 21:48
  withdrawal
• 21:48
  effect
• 21:49
  from
• 21:50
  antidepressants.
• 21:51
  And
• 21:51
  other
• 21:51
  studies
• 21:51
  also
• 21:52
  back
• 21:52
  that
• 21:52
  up.
• 21:53
  That's
• 21:53
  what
• 21:53
  I
• 21:53
  see
• 21:53
  all
• 21:54
  the
• 21:54
  time
• 21:54
  in
• 21:55
  clinical
• 21:55
  practice.
• 21:55
  And
• 21:56
  that's
• 21:57
  kind
• 21:57
  of
• 21:57
  confusing
• 21:57
  for
• 21:57
  the
• 21:58
  individual
• 21:58
  because
• 21:58
  I'm
• 21:58
  thinking
• 21:59
  if
• 21:59
  an
• 21:59
  individual
• 21:59
  is
• 22:00
  trying
• 22:00
  to
• 22:00
  come
• 22:00
  off
• 22:00
  an
• 22:00
  antidepressant
• 22:01
  and
• 22:01
  they're
• 22:02
  trying
• 22:02
  to
• 22:02
  determine
• 22:03
  for
• 22:03
  themselves,
• 22:04
  am
• 22:04
  I
• 22:04
  having
• 22:04
  a
• 22:04
  withdrawal
• 22:05
  effect
• 22:05
  or
• 22:05
  am
• 22:05
  I
• 22:06
  having
• 22:06
  a
• 22:06
  recurrence
• 22:06
  of
• 22:06
  my
• 22:07
  depression?
• 22:07
  If
• 22:08
  depression
• 22:09
  is
• 22:09
  also
• 22:09
  a
• 22:10
  withdrawal
• 22:10
  effect,
• 22:10
  that
• 22:11
  makes
• 22:11
  it
• 22:11
  very
• 22:11
  hard
• 22:12
  to
• 22:12
  determine,
• 22:12
  determine
• 22:13
  what
• 22:13
  the
• 22:14
  symptoms
• 22:14
  are
• 22:14
  because
• 22:14
  one
• 22:15
  would
• 22:15
  be,
• 22:15
  well,
• 22:16
  hopefully
• 22:17
  over
• 22:18
  time
• 22:18
  it
• 22:18
  will
• 22:19
  get
• 22:19
  better.
• 22:19
  Whereas
• 22:19
  the
• 22:20
  other
• 22:20
  is
• 22:20
  you
• 22:20
  may
• 22:21
  need
• 22:21
  to
• 22:21
  go
• 22:21
  back
• 22:21
  on
• 22:21
  your
• 22:22
  antidepressant
• 22:22
  or
• 22:23
  have
• 22:23
  other
• 22:24
  therapeutic
• 22:25
  approaches
• 22:25
  to
• 22:25
  address
• 22:25
  your
• 22:26
  depression.
• 22:26
  So
• 22:26
  how
• 22:27
  is
• 22:27
  someone
• 22:27
  to
• 22:27
  tell
• 22:27
  the
• 22:27
  difference?
• 22:28
  Right,
• 22:28
  so
• 22:29
  it's
• 22:29
  a
• 22:29
  really
• 22:29
  good
• 22:29
  point.
• 22:29
  And
• 22:30
  that's
• 22:30
  part
• 22:30
  of
• 22:30
  the
• 22:30
  confusion
• 22:31
  in
• 22:31
  the
• 22:31
  field.
• 22:32
  I
• 22:32
  think
• 22:32
  there's
• 22:32
  a
• 22:32
  few
• 22:32
  things
• 22:33
  to
• 22:33
  step
• 22:33
  back
• 22:34
  and
• 22:34
  how
• 22:34
  do
• 22:34
  you
• 22:34
  distinguish
• 22:34
  these
• 22:35
  things?
• 22:35
  I
• 22:35
  think,
• 22:36
  number
• 22:36
  one,
• 22:37
  just
• 22:37
  zooming
• 22:37
  out,
• 22:38
  most
• 22:38
  people
• 22:39
  are
• 22:39
  put
• 22:40
  on
• 22:40
  an
• 22:40
  antidepressant
• 22:41
  in
• 22:41
  the
• 22:41
  context
• 22:41
  of
• 22:42
  something
• 22:42
  going
• 22:42
  wrong
• 22:42
  in
• 22:42
  their
• 22:42
  lives.
• 22:43
  Divorce,
• 22:44
  job
• 22:44
  loss,
• 22:45
  being
• 22:45
  a
• 22:46
  young
• 22:46
  person,
• 22:46
  not
• 22:46
  being
• 22:46
  able
• 22:46
  to
• 22:46
  work
• 22:46
  out
• 22:47
  what
• 22:47
  to
• 22:47
  do
• 22:47
  with
• 22:47
  your
• 22:47
  life,
• 22:47
  moving
• 22:48
  cities,
• 22:49
  death
• 22:49
  of
• 22:49
  a
• 22:49
  loved
• 22:49
  one.
• 22:50
  All
• 22:50
  sorts
• 22:50
  of
• 22:50
  things
• 22:50
  go
• 22:51
  wrong.
• 22:51
  And
• 22:52
  so
• 22:52
  a
• 22:52
  lot
• 22:52
  of
• 22:52
  people,
• 22:53
  the
• 22:53
  idea
• 22:53
  of
• 22:53
  a
• 22:54
  relapse
• 22:54
  isn't
• 22:55
  very
• 22:55
  plausible
• 22:56
  as
• 22:57
  a
• 22:57
  first
• 22:57
  pass.
• 22:58
  If
• 22:58
  you've
• 22:58
  got
• 22:58
  divorced
• 22:59
  and
• 22:59
  become
• 22:59
  very
• 22:59
  depressed
• 23:00
  and
• 23:00
  you
• 23:00
  come
• 23:00
  off
• 23:00
  your
• 23:00
  drugs
• 23:01
  five
• 23:01
  years
• 23:01
  later,
• 23:01
  it's
• 23:02
  very
• 23:02
  hard
• 23:02
  to
• 23:02
  have
• 23:02
  a
• 23:02
  relapse
• 23:03
  of
• 23:03
  divorce.
• 23:04
  Possible,
• 23:05
  some
• 23:05
  people
• 23:05
  do
• 23:05
  it,
• 23:06
  but
• 23:06
  in
• 23:06
  general.
• 23:07
  So
• 23:07
  this
• 23:07
  framing
• 23:08
  of
• 23:08
  depression
• 23:08
  as
• 23:09
  this
• 23:09
  lifelong
• 23:09
  condition
• 23:10
  that
• 23:10
  relapses
• 23:11
  when
• 23:11
  you
• 23:11
  take
• 23:11
  away
• 23:11
  a
• 23:11
  drug
• 23:12
  is
• 23:12
  trying
• 23:12
  to
• 23:12
  compare
• 23:13
  it
• 23:13
  to
• 23:13
  asthma
• 23:13
  or
• 23:13
  something
• 23:14
  like
• 23:14
  that
• 23:15
  is
• 23:15
  relevant
• 23:16
  for.
• 23:16
  But
• 23:16
  mostly
• 23:17
  we
• 23:17
  feel
• 23:17
  awful
• 23:18
  when
• 23:18
  our
• 23:18
  lives
• 23:19
  are
• 23:19
  awful.
• 23:19
  We
• 23:19
  feel
• 23:19
  okay
• 23:20
  when
• 23:20
  our
• 23:20
  lives
• 23:20
  are
• 23:20
  better.
• 23:21
  So
• 23:21
  the
• 23:21
  idea
• 23:21
  of
• 23:21
  relapsing
• 23:22
  into
• 23:22
  your
• 23:23
  early
• 23:23
  20s
• 23:24
  being
• 23:24
  confused
• 23:25
  or
• 23:25
  whatever,
• 23:26
  it
• 23:26
  is
• 23:26
  already
• 23:27
  a
• 23:27
  little
• 23:27
  bit,
• 23:29
  it
• 23:29
  wouldn't
• 23:29
  be
• 23:29
  your
• 23:29
  first
• 23:30
  thought,
• 23:30
  but
• 23:30
  of
• 23:30
  course
• 23:30
  that's
• 23:30
  a
• 23:30
  lot
• 23:30
  in
• 23:31
  medical
• 23:31
  education.
• 23:32
  So
• 23:32
  that's
• 23:32
  the
• 23:32
  sort
• 23:32
  of
• 23:32
  broad
• 23:33
  point.
• 23:34
  Then
• 23:34
  on
• 23:34
  more
• 23:34
  specific
• 23:35
  points,
• 23:37
  the
• 23:37
  timing
• 23:37
  of
• 23:38
  symptoms
• 23:38
  matters.
• 23:39
  So
• 23:39
  if
• 23:39
  things
• 23:40
  come
• 23:40
  back
• 23:40
  in
• 23:40
  a
• 23:40
  few
• 23:41
  days,
• 23:41
  it's
• 23:42
  very
• 23:42
  likely
• 23:42
  to
• 23:42
  be
• 23:42
  withdrawal.
• 23:43
  There
• 23:43
  is
• 23:43
  a
• 23:44
  thing
• 23:44
  that
• 23:44
  confuses
• 23:44
  a
• 23:44
  lot
• 23:45
  of
• 23:45
  people
• 23:45
  though,
• 23:45
  which
• 23:46
  is
• 23:46
  delayed
• 23:46
  onset
• 23:47
  withdrawal
• 23:47
  effects.
• 23:48
  So
• 23:48
  when
• 23:48
  I
• 23:48
  first
• 23:48
  saw
• 23:49
  this
• 23:49
  in
• 23:49
  patients,
• 23:50
  they
• 23:50
  were
• 23:50
  coming
• 23:51
  off
• 23:51
  their
• 23:51
  antidepressants
• 23:52
  and
• 23:52
  six
• 23:52
  weeks
• 23:53
  later
• 23:53
  they
• 23:53
  developed
• 23:54
  brain
• 23:54
  zaps
• 23:54
  and
• 23:54
  headache
• 23:55
  and
• 23:55
  dizziness.
• 23:55
  I
• 23:56
  thought
• 23:56
  that
• 23:56
  is
• 23:56
  very
• 23:57
  strange.
• 23:57
  You
• 23:57
  know,
• 23:58
  the
• 23:58
  textbooks
• 23:58
  say
• 23:59
  three
• 23:59
  to
• 23:59
  five
• 23:59
  half
• 24:00
  lives
• 24:01
  should
• 24:01
  be
• 24:01
  a
• 24:01
  few
• 24:01
  days
• 24:02
  with
• 24:02
  these
• 24:02
  short
• 24:03
  half
• 24:03
  life
• 24:03
  drugs,
• 24:03
  but
• 24:04
  I
• 24:04
  saw
• 24:04
  symptoms
• 24:05
  weeks
• 24:05
  later.
• 24:06
  I
• 24:06
  don't
• 24:06
  know
• 24:06
  exactly
• 24:07
  what
• 24:07
  causes
• 24:07
  that,
• 24:07
  but
• 24:07
  I
• 24:08
  have
• 24:08
  seen
• 24:08
  it
• 24:08
  so
• 24:08
  many
• 24:09
  times,
• 24:09
  it's
• 24:09
  now
• 24:09
  recorded
• 24:10
  in
• 24:10
  various
• 24:10
  studies.
• 24:11
  There's
• 24:12
  one
• 24:12
  study
• 24:12
  that
• 24:12
  finds
• 24:13
  that
• 24:13
  the
• 24:13
  average
• 24:14
  time
• 24:14
  to
• 24:14
  onset
• 24:15
  for
• 24:15
  people
• 24:15
  stopping
• 24:15
  SSRIs
• 24:16
  is
• 24:16
  actually
• 24:17
  four
• 24:17
  weeks
• 24:18
  with
• 24:18
  a
• 24:18
  variation
• 24:19
  of
• 24:19
  a
• 24:19
  few
• 24:19
  months.
• 24:20
  I
• 24:20
  imagine
• 24:21
  it's
• 24:21
  something
• 24:21
  to
• 24:21
  do
• 24:21
  with
• 24:21
  downstream
• 24:22
  effects
• 24:22
  having
• 24:23
  to
• 24:23
  build
• 24:23
  up
• 24:23
  to
• 24:23
  some
• 24:23
  threshold
• 24:24
  before
• 24:24
  they
• 24:24
  manifest.
• 24:25
  I
• 24:25
  don't,
• 24:25
  I
• 24:26
  don't
• 24:26
  pretend
• 24:26
  to
• 24:26
  understand
• 24:26
  the
• 24:27
  biology
• 24:27
  of
• 24:27
  it,
• 24:27
  that's
• 24:28
  one
• 24:28
  issue.
• 24:29
  The
• 24:29
  second
• 24:29
  issue
• 24:30
  is
• 24:31
  the
• 24:31
  nature
• 24:31
  of
• 24:32
  the
• 24:32
  symptoms.
• 24:33
  So
• 24:33
  if
• 24:33
  you
• 24:34
  stop
• 24:34
  your
• 24:34
  antidepressant
• 24:35
  and
• 24:35
  you
• 24:35
  become
• 24:35
  dizzy
• 24:35
  and
• 24:36
  have
• 24:36
  headaches
• 24:36
  and
• 24:37
  you
• 24:37
  feel
• 24:37
  depressed,
• 24:38
  then
• 24:38
  it's
• 24:38
  very
• 24:39
  likely
• 24:40
  that
• 24:40
  it's
• 24:40
  a
• 24:40
  withdrawal
• 24:41
  syndrome.
• 24:42
  It's
• 24:43
  the
• 24:43
  old
• 24:43
  Ockins
• 24:43
  razor.
• 24:44
  If
• 24:44
  you
• 24:44
  have
• 24:45
  a
• 24:45
  runny
• 24:46
  nose
• 24:46
  and
• 24:47
  a
• 24:47
  cough
• 24:47
  and
• 24:47
  a
• 24:47
  temperature,
• 24:48
  it's
• 24:48
  most
• 24:49
  likely
• 24:49
  that
• 24:49
  those
• 24:49
  are
• 24:49
  three
• 24:50
  aspects
• 24:50
  of
• 24:50
  the
• 24:50
  same
• 24:51
  condition
• 24:51
  rather
• 24:52
  than
• 24:52
  three
• 24:52
  different
• 24:52
  conditions.
• 24:55
  And
• 24:56
  the
• 24:56
  physical
• 24:57
  symptoms
• 24:57
  really
• 24:57
  make
• 24:57
  it
• 24:58
  simpler.
• 24:58
  Headache,
• 24:58
  dizziness,
• 24:59
  brain
• 24:59
  zaps.
• 24:59
  No
• 24:59
  one
• 24:59
  thinks
• 25:00
  that's
• 25:00
  because
• 25:00
  of
• 25:00
  anxiety,
• 25:01
  depression.
• 25:01
  But
• 25:01
  I
• 25:01
  will
• 25:02
  say
• 25:02
  the
• 25:03
  most
• 25:03
  common
• 25:03
  withdrawal
• 25:04
  symptoms
• 25:04
  are
• 25:05
  psychological.
• 25:06
  I
• 25:06
  think
• 25:06
  maybe
• 25:06
  people
• 25:07
  find
• 25:07
  that
• 25:07
  a
• 25:07
  bit
• 25:07
  hard,
• 25:08
  but
• 25:08
  you
• 25:08
  think
• 25:09
  about
• 25:09
  coming
• 25:09
  off
• 25:09
  alcohol
• 25:10
  or
• 25:10
  benzos,
• 25:11
  you
• 25:11
  feel
• 25:12
  terrible.
• 25:12
  Yes,
• 25:13
  you
• 25:13
  can
• 25:13
  get
• 25:13
  physical
• 25:13
  symptoms,
• 25:14
  but
• 25:14
  you
• 25:14
  feel
• 25:14
  terrible.
• 25:15
  And
• 25:16
  we've
• 25:16
  seen
• 25:16
  in
• 25:16
  study
• 25:17
  after
• 25:17
  study
• 25:17
  that
• 25:18
  anxiety,
• 25:18
  low
• 25:19
  mood,
• 25:19
  suicidality
• 25:20
  are
• 25:20
  common
• 25:20
  symptoms
• 25:21
  of
• 25:22
  withdrawal,
• 25:23
  because
• 25:23
  you
• 25:23
  can
• 25:23
  see
• 25:24
  them
• 25:24
  even
• 25:24
  in
• 25:24
  people
• 25:25
  who
• 25:25
  would
• 25:25
  put
• 25:25
  on
• 25:26
  antidepressants
• 25:26
  for
• 25:26
  reasons
• 25:27
  other
• 25:28
  than
• 25:28
  mental
• 25:28
  health
• 25:28
  conditions
• 25:29
  that
• 25:29
  put
• 25:29
  on
• 25:29
  it
• 25:29
  for
• 25:29
  pain,
• 25:30
  for
• 25:30
  the
• 25:30
  menopause,
• 25:31
  or
• 25:31
  even
• 25:31
  in
• 25:32
  healthy
• 25:32
  volunteers.
• 25:33
  And
• 25:33
  so
• 25:33
  what
• 25:33
  I
• 25:34
  always
• 25:34
  ask
• 25:34
  patients
• 25:34
  is
• 25:35
  when
• 25:35
  you
• 25:35
  went
• 25:35
  on
• 25:35
  the
• 25:35
  antidepressant,
• 25:36
  what
• 25:36
  did
• 25:36
  you
• 25:36
  have?
• 25:37
  And
• 25:38
  if
• 25:38
  they
• 25:38
  say
• 25:38
  I
• 25:39
  was
• 25:39
  lethargic,
• 25:39
  I
• 25:39
  was
• 25:39
  sleeping
• 25:40
  all
• 25:40
  the
• 25:40
  time,
• 25:40
  I
• 25:40
  was
• 25:40
  really
• 25:40
  depressed,
• 25:41
  and
• 25:41
  I
• 25:41
  said,
• 25:42
  what
• 25:42
  did
• 25:42
  you
• 25:42
  have
• 25:42
  when
• 25:42
  you
• 25:42
  came
• 25:42
  off
• 25:43
  the
• 25:43
  drugs?
• 25:43
  They
• 25:43
  say
• 25:44
  I
• 25:44
  was
• 25:44
  anxious,
• 25:45
  I
• 25:45
  was
• 25:45
  panicked,
• 25:46
  I
• 25:46
  couldn't
• 25:46
  sleep.
• 25:47
  Those
• 25:47
  are
• 25:47
  very
• 25:47
  different
• 25:48
  symptoms.
• 25:49
  It
• 25:49
  could
• 25:49
  be
• 25:50
  that
• 25:50
  coincidentally
• 25:51
  they've
• 25:51
  developed
• 25:51
  a
• 25:52
  new
• 25:52
  onset
• 25:52
  panic
• 25:53
  disorder
• 25:53
  on
• 25:54
  just
• 25:54
  the
• 25:54
  day
• 25:54
  they
• 25:54
  stopped
• 25:54
  their
• 25:54
  antidepressant.
• 25:55
  But
• 25:55
  that's
• 25:55
  a
• 25:55
  bit
• 25:56
  implausible.
• 25:57
  What's
• 25:57
  more
• 25:57
  plausible
• 25:58
  is
• 25:58
  they've
• 25:58
  developed
• 25:59
  quite
• 25:59
  common
• 25:59
  withdrawal
• 26:00
  effects.
• 26:00
  So
• 26:00
  I
• 26:00
  do
• 26:01
  a
• 26:01
  lot
• 26:01
  of
• 26:01
  before
• 26:01
  and
• 26:02
  after
• 26:03
  and
• 26:03
  yeah,
• 26:04
  those
• 26:05
  are
• 26:05
  the
• 26:05
  main
• 26:05
  ways
• 26:05
  of
• 26:05
  telling.
• 26:06
  Yeah,
• 26:06
  that's
• 26:06
  a
• 26:07
  good
• 26:07
  point.
• 26:07
  I'm
• 26:07
  glad
• 26:07
  you
• 26:07
  brought
• 26:08
  up
• 26:08
  the
• 26:08
  specific
• 26:08
  symptoms
• 26:09
  because
• 26:09
  in
• 26:09
  this
• 26:09
  study
• 26:10
  they
• 26:10
  said
• 26:11
  the
• 26:11
  most
• 26:11
  common
• 26:11
  symptoms
• 26:12
  were
• 26:12
  dizziness,
• 26:13
  nausea,
• 26:13
  vertigo,
• 26:15
  nervousness,
• 26:15
  and
• 26:16
  then
• 26:16
  they
• 26:16
  talked
• 26:16
  about
• 26:16
  the
• 26:16
  electric
• 26:17
  shock
• 26:17
  type
• 26:17
  feeling.
• 26:18
  So
• 26:18
  like
• 26:18
  you're
• 26:19
  saying,
• 26:19
  those
• 26:19
  are
• 26:19
  usually
• 26:19
  not
• 26:20
  the
• 26:20
  depression
• 26:21
  type
• 26:21
  symptoms
• 26:22
  that
• 26:22
  someone
• 26:22
  was
• 26:22
  started
• 26:23
  on
• 26:23
  the
• 26:23
  medication
• 26:23
  for
• 26:24
  and
• 26:24
  those
• 26:25
  are
• 26:25
  more
• 26:25
  indicative
• 26:26
  of
• 26:26
  the
• 26:26
  withdrawal.
• 26:27
  And
• 26:28
  you
• 26:28
  talked
• 26:28
  about
• 26:28
  maybe
• 26:29
  just,
• 26:29
  you
• 26:29
  know,
• 26:29
  the
• 26:30
  majority
• 26:30
  of
• 26:30
  the
• 26:30
  people
• 26:30
  who
• 26:31
  are
• 26:31
  started
• 26:31
  on
• 26:31
  an
• 26:31
  antidepressant
• 26:32
  for
• 26:32
  a
• 26:32
  reason.
• 26:33
  But
• 26:33
  I
• 26:33
  think
• 26:33
  we
• 26:34
  also
• 26:34
  have
• 26:34
  to
• 26:34
  acknowledge
• 26:34
  there
• 26:35
  is
• 26:35
  this
• 26:35
  subset
• 26:35
  of
• 26:35
  people
• 26:36
  who
• 26:36
  are
• 26:36
  just
• 26:36
  have
• 26:37
  sort
• 26:37
  of
• 26:37
  a
• 26:37
  depressed
• 26:38
  mood
• 26:38
  without
• 26:39
  a
• 26:39
  specific
• 26:39
  trigger.
• 26:40
  Do
• 26:40
  you
• 26:41
  think
• 26:41
  those
• 26:41
  are
• 26:41
  the
• 26:41
  ones
• 26:41
  who
• 26:41
  are
• 26:42
  more
• 26:42
  likely
• 26:42
  to
• 26:43
  develop
• 26:43
  relapse
• 26:44
  as
• 26:44
  opposed
• 26:44
  to
• 26:45
  withdrawal
• 26:46
  or
• 26:46
  maybe
• 26:46
  unfortunately
• 26:47
  to
• 26:47
  develop
• 26:48
  both
• 26:48
  relapse
• 26:49
  and
• 26:49
  withdrawal?
• 26:49
  Even
• 26:49
  though
• 26:50
  it
• 26:50
  goes
• 26:50
  against
• 26:50
  Occam's
• 26:51
  razor,
• 26:51
  if
• 26:51
  they
• 26:52
  try
• 26:52
  to
• 26:53
  taper
• 26:53
  off
• 26:53
  for
• 26:53
  that
• 26:54
  specific
• 26:54
  population,
• 26:55
  maybe,
• 26:55
  yeah,
• 26:56
  maybe
• 26:56
  those.
• 26:56
  People
• 26:56
  are
• 26:57
  more
• 26:57
  prone
• 26:57
  to
• 26:58
  relapse.
• 26:59
  You
• 26:59
  know,
• 26:59
  if
• 26:59
  you're
• 26:59
  still
• 27:00
  in
• 27:00
  the
• 27:00
  same
• 27:00
  situation,
• 27:00
  if
• 27:01
  you're
• 27:01
  still
• 27:01
  in
• 27:01
  the
• 27:02
  difficult
• 27:02
  relationship,
• 27:03
  job,
• 27:04
  financial
• 27:04
  insecurity.
• 27:05
  Yes,
• 27:06
  that's
• 27:06
  more
• 27:06
  likely
• 27:06
  to
• 27:07
  relapse.
• 27:08
  I
• 27:08
  guess
• 27:09
  the
• 27:09
  other
• 27:09
  issue
• 27:09
  is,
• 27:10
  are
• 27:10
  antidepressants
• 27:11
  very
• 27:11
  good
• 27:11
  at
• 27:11
  preventing
• 27:12
  depression
• 27:12
  or
• 27:13
  relapse
• 27:13
  in
• 27:13
  the
• 27:13
  long
• 27:13
  term?
• 27:14
  And
• 27:14
  the
• 27:14
  evidence
• 27:14
  doesn't
• 27:15
  support
• 27:15
  that
• 27:16
  they
• 27:16
  have
• 27:16
  minimal
• 27:17
  effects
• 27:18
  in
• 27:18
  the
• 27:18
  short
• 27:18
  term.
• 27:18
  The
• 27:19
  overall
• 27:19
  effect
• 27:19
  of
• 27:19
  antidepressants
• 27:21
  is
• 27:21
  2
• 27:21
  points
• 27:22
  on
• 27:22
  a
• 27:22
  52
• 27:23
  point
• 27:23
  depression
• 27:24
  scale
• 27:24
  compared
• 27:24
  to
• 27:24
  placebo.
• 27:25
  There's
• 27:25
  all
• 27:25
  sorts
• 27:26
  of
• 27:26
  ways
• 27:26
  of
• 27:26
  the
• 27:26
  way
• 27:27
  they
• 27:27
  do
• 27:27
  those.
• 27:27
  Those
• 27:28
  studies
• 27:29
  inflates
• 27:29
  the
• 27:29
  effect
• 27:29
  of
• 27:30
  antidepressants.
• 27:30
  So
• 27:30
  everyone
• 27:31
  agrees
• 27:31
  that
• 27:31
  the
• 27:32
  average
• 27:32
  effect
• 27:32
  of
• 27:32
  an
• 27:32
  antidepressant
• 27:33
  is
• 27:33
  pretty
• 27:33
  small.
• 27:36
  Drugs
• 27:36
  tend
• 27:36
  to
• 27:36
  wear
• 27:37
  off
• 27:37
  over
• 27:37
  time.
• 27:38
  Most
• 27:38
  drugs
• 27:38
  do.
• 27:39
  Benzodiazepines
• 27:40
  can
• 27:40
  make
• 27:40
  you
• 27:40
  feel
• 27:40
  pretty
• 27:41
  good
• 27:41
  in
• 27:41
  the
• 27:41
  short
• 27:41
  term,
• 27:42
  but
• 27:42
  wear
• 27:42
  off.
• 27:42
  So
• 27:42
  do
• 27:42
  opioids.
• 27:44
  Drugs
• 27:44
  that
• 27:44
  cause
• 27:45
  withdrawal
• 27:45
  also
• 27:46
  cause
• 27:46
  tolerance.
• 27:47
  Those
• 27:47
  are
• 27:47
  flip
• 27:47
  sides
• 27:48
  of
• 27:48
  the
• 27:48
  same
• 27:48
  coin.
• 27:49
  The
• 27:49
  more
• 27:50
  that
• 27:50
  heavy
• 27:50
  stone
• 27:51
  sinks
• 27:51
  into
• 27:51
  the
• 27:51
  mud,
• 27:52
  that's
• 27:52
  tolerance,
• 27:52
  the
• 27:53
  harder
• 27:53
  it
• 27:53
  is
• 27:53
  to
• 27:53
  pull
• 27:53
  out
• 27:54
  at
• 27:54
  the
• 27:54
  end.
• 27:54
  That's
• 27:54
  withdrawal.
• 27:55
  So
• 27:55
  the
• 27:56
  small
• 27:56
  effects
• 27:56
  of
• 27:57
  beginning
• 27:57
  are
• 27:58
  very
• 27:58
  likely
• 27:58
  to
• 27:58
  wear
• 27:58
  off.
• 27:59
  And
• 27:59
  so
• 27:59
  when
• 28:00
  you
• 28:00
  see
• 28:00
  studies
• 28:00
  that
• 28:01
  say
• 28:01
  if
• 28:01
  you
• 28:01
  stop
• 28:01
  an
• 28:01
  antidepressant,
• 28:02
  there's
• 28:03
  a
• 28:03
  lot
• 28:03
  of
• 28:03
  relapse,
• 28:03
  it
• 28:04
  looks
• 28:04
  peculiar
• 28:05
  that
• 28:05
  a
• 28:05
  drug
• 28:05
  that
• 28:06
  has
• 28:06
  marginal
• 28:06
  effects
• 28:07
  at
• 28:07
  the
• 28:07
  beginning
• 28:07
  suddenly
• 28:08
  has
• 28:08
  quite
• 28:08
  a
• 28:08
  large
• 28:08
  effect
• 28:09
  when
• 28:09
  you
• 28:09
  stop
• 28:09
  it.
• 28:10
  That's
• 28:10
  not
• 28:10
  what
• 28:10
  drugs
• 28:11
  do.
• 28:11
  Drugs
• 28:12
  wear
• 28:12
  off
• 28:12
  over
• 28:12
  time.
• 28:12
  They
• 28:13
  don't
• 28:13
  get
• 28:13
  more
• 28:13
  effective
• 28:14
  over
• 28:14
  time.
• 28:14
  That's
• 28:15
  the
• 28:15
  opposite.
• 28:16
  And
• 28:16
  so
• 28:17
  a
• 28:17
  lot
• 28:17
  of
• 28:17
  people
• 28:17
  think
• 28:18
  the
• 28:18
  reason
• 28:18
  why
• 28:19
  those
• 28:19
  studies
• 28:19
  in
• 28:19
  which
• 28:20
  drugs
• 28:20
  are
• 28:20
  stopped,
• 28:21
  people
• 28:21
  show
• 28:21
  relapse
• 28:22
  is
• 28:22
  probably
• 28:22
  because
• 28:23
  it's
• 28:23
  withdrawal
• 28:23
  effects
• 28:24
  being
• 28:25
  missed,
• 28:25
  classified
• 28:26
  as
• 28:26
  relapse.
• 28:27
  As
• 28:27
  that
• 28:28
  study
• 28:28
  I
• 28:28
  mentioned
• 28:28
  earlier
• 28:28
  on
• 28:29
  made
• 28:29
  really
• 28:29
  clear
• 28:30
  because
• 28:30
  I
• 28:30
  just
• 28:30
  asked
• 28:31
  that
• 28:31
  Rosenbaum
• 28:31
  study,
• 28:32
  30%
• 28:33
  of
• 28:33
  people
• 28:33
  of
• 28:33
  sertraline
• 28:34
  met
• 28:34
  the
• 28:34
  criteria
• 28:35
  for
• 28:35
  relapse,
• 28:35
  36%
• 28:36
  for
• 28:36
  paroxetine.
• 28:37
  It
• 28:37
  happened
• 28:38
  in
• 28:38
  that
• 28:38
  study.
• 28:38
  They
• 28:38
  measured
• 28:38
  withdrawal
• 28:39
  effects.
• 28:39
  But
• 28:39
  imagine
• 28:40
  they
• 28:40
  didn't
• 28:40
  measure
• 28:41
  withdrawal
• 28:41
  effects.
• 28:41
  You
• 28:41
  just
• 28:41
  see
• 28:41
  a
• 28:42
  lot
• 28:42
  of
• 28:42
  depressed
• 28:42
  people.
• 28:42
  You'd
• 28:43
  be
• 28:43
  thinking,
• 28:43
  oh
• 28:44
  my
• 28:44
  goodness,
• 28:44
  do
• 28:44
  people
• 28:44
  need
• 28:44
  their
• 28:45
  drugs?
• 28:45
  And
• 28:46
  of
• 28:46
  course,
• 28:46
  that's
• 28:47
  what
• 28:47
  most
• 28:47
  studies
• 28:47
  do.
• 28:48
  They
• 28:48
  stop
• 28:48
  the
• 28:49
  drugs,
• 28:49
  they
• 28:49
  don't
• 28:50
  measure
• 28:50
  withdrawal
• 28:50
  effects
• 28:51
  and
• 28:51
  they
• 28:51
  just
• 28:51
  report
• 28:52
  that
• 28:52
  people
• 28:53
  get
• 28:53
  depressed.
• 28:54
  So
• 28:55
  I
• 28:56
  think
• 28:56
  that
• 28:56
  there
• 28:57
  is
• 28:57
  scant
• 28:57
  evidence
• 28:58
  that
• 28:58
  antidepressants
• 28:59
  prevent
• 28:59
  relapse
• 29:00
  in
• 29:00
  the
• 29:00
  long
• 29:00
  term
• 29:01
  from
• 29:02
  existing
• 29:02
  studies.
• 29:03
  Yeah.
• 29:04
  And
• 29:04
  I
• 29:04
  guess
• 29:06
  really
• 29:06
  the
• 29:06
  overarching
• 29:07
  theme
• 29:08
  here
• 29:08
  that
• 29:08
  we
• 29:09
  also
• 29:09
  should
• 29:09
  address
• 29:09
  is,
• 29:10
  are
• 29:10
  antidepressants
• 29:11
  sort
• 29:11
  of
• 29:11
  the
• 29:11
  best
• 29:11
  treatment
• 29:12
  or
• 29:12
  the
• 29:12
  only
• 29:12
  treatment?
• 29:13
  Obviously,
• 29:13
  they're
• 29:13
  not
• 29:14
  the
• 29:14
  only
• 29:14
  treatment,
• 29:14
  and
• 29:15
  there's
• 29:15
  a
• 29:15
  lot
• 29:15
  of
• 29:15
  debate
• 29:16
  about
• 29:16
  whether
• 29:16
  they're
• 29:16
  the
• 29:16
  best
• 29:17
  treatment.
• 29:17
  But
• 29:17
  then
• 29:18
  what
• 29:18
  else
• 29:18
  can
• 29:18
  we
• 29:19
  do?
• 29:19
  If
• 29:19
  someone
• 29:20
  wants
• 29:20
  to
• 29:20
  try
• 29:21
  augmented
• 29:21
  therapy
• 29:22
  or
• 29:22
  to
• 29:22
  taper
• 29:23
  off,
• 29:24
  of
• 29:24
  course,
• 29:24
  we
• 29:25
  talk
• 29:25
  a
• 29:25
  lot
• 29:25
  about
• 29:25
  lifestyle
• 29:26
  interventions,
• 29:26
  about
• 29:26
  metabolic
• 29:27
  therapies
• 29:27
  and
• 29:28
  how
• 29:28
  those
• 29:28
  can
• 29:28
  potentially
• 29:29
  help,
• 29:29
  and
• 29:30
  hopefully
• 29:30
  research
• 29:31
  will
• 29:31
  start
• 29:31
  investigating
• 29:32
  that
• 29:32
  so
• 29:32
  we
• 29:32
  can
• 29:33
  learn
• 29:33
  more
• 29:33
  about
• 29:33
  it.
• 29:34
  But
• 29:34
  what
• 29:34
  are
• 29:35
  your
• 29:35
  thoughts
• 29:35
  about
• 29:36
  augmenting
• 29:37
  someone's
• 29:38
  antidepressant
• 29:39
  treatment
• 29:40
  and
• 29:40
  helping
• 29:40
  them
• 29:40
  come
• 29:41
  off?
• 29:41
  What
• 29:41
  lifestyle
• 29:42
  interventions
• 29:42
  do
• 29:43
  you
• 29:43
  feel
• 29:43
  can
• 29:43
  be
• 29:43
  most
• 29:44
  impactful?
• 29:44
  So,
• 29:45
  again,
• 29:45
  just
• 29:45
  step
• 29:45
  back
• 29:46
  for
• 29:46
  a
• 29:46
  second.
• 29:47
  You
• 29:47
  know,
• 29:47
  I
• 29:47
  think
• 29:47
  this
• 29:48
  is
• 29:48
  one
• 29:48
  that
• 29:48
  we've.
• 29:48
  We've
• 29:49
  reified
• 29:49
  depression
• 29:50
  in
• 29:50
  our
• 29:50
  culture,
• 29:50
  which
• 29:50
  means
• 29:51
  we
• 29:51
  talk
• 29:51
  about
• 29:51
  it
• 29:51
  like
• 29:52
  it's
• 29:52
  a
• 29:52
  thing,
• 29:53
  you
• 29:53
  know,
• 29:53
  like
• 29:53
  heart
• 29:54
  disease
• 29:54
  or
• 29:54
  asthma.
• 29:55
  But
• 29:56
  we
• 29:56
  know
• 29:56
  sort
• 29:56
  of.
• 29:56
  I
• 29:57
  sort
• 29:57
  of
• 29:57
  go
• 29:57
  back
• 29:57
  to
• 29:58
  simple
• 29:58
  things
• 29:58
  that
• 29:58
  my
• 29:59
  grandmother
• 29:59
  would
• 29:59
  have
• 29:59
  said.
• 30:00
  You
• 30:00
  know,
• 30:00
  when
• 30:00
  life
• 30:00
  is
• 30:01
  awful,
• 30:01
  we
• 30:01
  feel
• 30:01
  bad.
• 30:02
  So,
• 30:03
  you
• 30:03
  know,
• 30:03
  that
• 30:04
  makes
• 30:04
  us
• 30:04
  understand
• 30:04
  what's
• 30:04
  going
• 30:05
  on,
• 30:05
  you
• 30:05
  know,
• 30:05
  so
• 30:06
  if
• 30:06
  we're
• 30:06
  feeling
• 30:06
  bad
• 30:07
  because
• 30:07
  our
• 30:08
  relationships
• 30:08
  are
• 30:08
  unsatisfying
• 30:09
  or
• 30:09
  full
• 30:09
  of
• 30:09
  conflict,
• 30:10
  if
• 30:11
  our
• 30:11
  work
• 30:12
  is
• 30:12
  unsatisfying,
• 30:13
  if
• 30:13
  we
• 30:13
  have
• 30:14
  financial
• 30:14
  problems,
• 30:15
  well,
• 30:15
  the
• 30:15
  solution
• 30:15
  to
• 30:16
  that
• 30:16
  is
• 30:16
  to
• 30:16
  try
• 30:16
  to
• 30:16
  solve
• 30:17
  those
• 30:17
  problems.
• 30:17
  It
• 30:17
  doesn't
• 30:17
  mean
• 30:17
  it's
• 30:18
  easy,
• 30:18
  of
• 30:18
  course.
• 30:18
  I'm
• 30:18
  sitting
• 30:18
  here
• 30:19
  glibly
• 30:20
  on
• 30:20
  a
• 30:20
  podcast.
• 30:21
  You
• 30:21
  can't
• 30:22
  wave
• 30:23
  a
• 30:23
  wand,
• 30:24
  but
• 30:24
  it's
• 30:24
  good
• 30:24
  to
• 30:24
  identify
• 30:25
  what
• 30:25
  the
• 30:25
  issue
• 30:25
  is,
• 30:25
  because
• 30:26
  otherwise
• 30:26
  you
• 30:27
  may
• 30:27
  not
• 30:27
  be
• 30:27
  aiming
• 30:27
  at
• 30:27
  the
• 30:27
  right
• 30:28
  target.
• 30:28
  So
• 30:29
  I
• 30:29
  think
• 30:30
  that
• 30:30
  the
• 30:30
  answer
• 30:30
  is,
• 30:30
  it's
• 30:31
  different
• 30:31
  for
• 30:31
  everybody.
• 30:31
  When
• 30:31
  people
• 30:32
  ask,
• 30:32
  how
• 30:32
  do
• 30:32
  you
• 30:32
  fix
• 30:32
  depression?
• 30:33
  It's
• 30:33
  a
• 30:33
  bit
• 30:34
  like
• 30:34
  saying,
• 30:34
  how
• 30:34
  do
• 30:34
  you
• 30:35
  fix
• 30:35
  people
• 30:35
  that
• 30:35
  are
• 30:35
  dissatisfied
• 30:36
  with
• 30:36
  their
• 30:36
  life
• 30:36
  or
• 30:36
  unsatisfied
• 30:37
  with
• 30:37
  their
• 30:37
  lives
• 30:37
  or
• 30:38
  overwhelmed
• 30:38
  by
• 30:38
  their
• 30:38
  lives,
• 30:39
  or
• 30:39
  don't
• 30:40
  have
• 30:40
  their
• 30:40
  emotional
• 30:40
  needs
• 30:40
  met?
• 30:41
  You've
• 30:41
  got
• 30:41
  to
• 30:41
  work
• 30:41
  out
• 30:41
  what's
• 30:42
  going
• 30:42
  on
• 30:42
  to
• 30:43
  try
• 30:43
  to
• 30:43
  work
• 30:43
  out
• 30:43
  what
• 30:43
  makes
• 30:44
  sense
• 30:44
  for
• 30:44
  an
• 30:44
  individual
• 30:45
  person.
• 30:46
  If
• 30:46
  you
• 30:46
  then
• 30:46
  want
• 30:46
  to
• 30:46
  go
• 30:47
  into
• 30:47
  what
• 30:47
  is
• 30:47
  generally
• 30:48
  helpful,
• 30:48
  that's
• 30:48
  a
• 30:48
  slightly
• 30:49
  more
• 30:49
  generic
• 30:50
  conversation.
• 30:51
  Well,
• 30:51
  there
• 30:52
  are
• 30:52
  lots
• 30:52
  of
• 30:52
  things
• 30:53
  I
• 30:53
  always
• 30:54
  refer
• 30:54
  to
• 30:54
  the
• 30:55
  NICE
• 30:55
  guidelines
• 30:56
  in
• 30:56
  the
• 30:56
  uk.
• 30:57
  That's
• 30:58
  a
• 30:58
  UK
• 30:58
  government
• 30:58
  department
• 30:59
  that
• 30:59
  assesses
• 31:00
  evidence
• 31:01
  to
• 31:01
  look
• 31:01
  at
• 31:01
  what's
• 31:01
  helpful
• 31:02
  for
• 31:02
  all
• 31:02
  sorts
• 31:02
  of
• 31:02
  medical
• 31:03
  conditions,
• 31:03
  and
• 31:03
  it
• 31:03
  guides
• 31:03
  treatment
• 31:04
  in
• 31:04
  the
• 31:04
  UK
• 31:05
  amongst
• 31:06
  doctors.
• 31:06
  It's
• 31:07
  extremely
• 31:07
  different
• 31:08
  to
• 31:08
  what
• 31:08
  is
• 31:08
  the
• 31:09
  guidelines
• 31:09
  in
• 31:09
  the
• 31:09
  American
• 31:10
  Psychiatric
• 31:10
  association,
• 31:11
  for
• 31:11
  example.
• 31:11
  And
• 31:12
  the
• 31:12
  difference,
• 31:12
  I
• 31:12
  suspect,
• 31:13
  between
• 31:13
  those
• 31:13
  two
• 31:13
  things
• 31:13
  is
• 31:14
  one
• 31:15
  of
• 31:15
  them
• 31:15
  is
• 31:15
  done
• 31:15
  by
• 31:15
  the
• 31:16
  UK
• 31:16
  government.
• 31:16
  It
• 31:17
  has
• 31:17
  very
• 31:17
  strict
• 31:17
  rules
• 31:18
  about
• 31:18
  conflicts
• 31:19
  of
• 31:19
  interest.
• 31:20
  You
• 31:20
  can't
• 31:20
  be
• 31:21
  part
• 31:21
  of
• 31:21
  the
• 31:21
  committee.
• 31:21
  It's
• 31:22
  done,
• 31:22
  they
• 31:22
  are
• 31:23
  charged.
• 31:23
  NICE
• 31:24
  is
• 31:24
  charged
• 31:24
  with
• 31:25
  using
• 31:25
  the
• 31:25
  public
• 31:26
  purse
• 31:26
  for
• 31:27
  the
• 31:27
  benefit
• 31:27
  of
• 31:27
  the
• 31:27
  public
• 31:28
  and
• 31:29
  it
• 31:29
  gives
• 31:29
  guidance
• 31:30
  to
• 31:30
  the
• 31:30
  NHS
• 31:31
  in
• 31:31
  America.
• 31:32
  The
• 31:32
  guidelines
• 31:32
  for
• 31:33
  depression
• 31:33
  are
• 31:33
  written
• 31:33
  by
• 31:33
  the
• 31:33
  American
• 31:34
  Psychiatric
• 31:34
  association,
• 31:35
  which
• 31:35
  is
• 31:35
  a
• 31:35
  group
• 31:36
  that's
• 31:36
  trying
• 31:36
  to
• 31:37
  forward
• 31:37
  the
• 31:37
  interests
• 31:38
  of
• 31:38
  psychiatrists.
• 31:38
  It's
• 31:38
  not
• 31:39
  for
• 31:39
  psychiatry,
• 31:39
  it's
• 31:40
  for
• 31:40
  psychiatrists.
• 31:41
  There's
• 31:41
  no
• 31:41
  conflict
• 31:42
  of
• 31:42
  interest
• 31:42
  rules.
• 31:43
  All
• 31:43
  of
• 31:43
  the
• 31:43
  members
• 31:44
  of
• 31:44
  these
• 31:44
  committees
• 31:45
  generally
• 31:45
  have
• 31:45
  conflicts
• 31:46
  of
• 31:46
  interest
• 31:46
  and
• 31:47
  the
• 31:47
  drug
• 31:47
  companies
• 31:47
  that
• 31:48
  pay
• 31:48
  the
• 31:48
  guideline
• 31:49
  committee
• 31:49
  members
• 31:50
  are
• 31:50
  always
• 31:50
  mentioned
• 31:51
  in
• 31:51
  the
• 31:51
  guidelines.
• 31:51
  It
• 31:51
  might
• 31:52
  be
• 31:52
  a
• 31:52
  coincidence,
• 31:52
  but
• 31:53
  there
• 31:53
  does
• 31:53
  seem
• 31:53
  to
• 31:53
  be
• 31:53
  a
• 31:53
  relationship.
• 31:54
  And
• 31:55
  so
• 31:55
  if
• 31:55
  you
• 31:55
  read
• 31:55
  these
• 31:55
  two
• 31:56
  texts,
• 31:56
  it's
• 31:56
  like
• 31:56
  completely
• 31:57
  different
• 31:57
  worlds.
• 31:57
  The
• 31:58
  American
• 31:58
  Psychiatric
• 31:58
  association
• 31:59
  guidelines
• 31:59
  list
• 32:00
  a
• 32:00
  series
• 32:00
  of
• 32:00
  medications
• 32:01
  to
• 32:01
  use.
• 32:01
  The
• 32:02
  NICE
• 32:02
  guidelines,
• 32:02
  it
• 32:02
  does
• 32:03
  include
• 32:03
  medications,
• 32:04
  but
• 32:04
  it
• 32:04
  actually
• 32:04
  recommends
• 32:05
  19
• 32:06
  different
• 32:06
  treatments
• 32:07
  for
• 32:07
  depression
• 32:07
  that
• 32:08
  are
• 32:08
  equally
• 32:08
  effective
• 32:09
  and
• 32:09
  cost
• 32:09
  effective,
• 32:10
  including
• 32:10
  for
• 32:11
  severe
• 32:11
  depression.
• 32:12
  And
• 32:12
  some
• 32:12
  of
• 32:12
  the
• 32:12
  non
• 32:13
  drug
• 32:13
  treatments
• 32:13
  include
• 32:15
  various
• 32:15
  forms
• 32:15
  of
• 32:16
  therapy.
• 32:16
  Cpt,
• 32:17
  individual
• 32:18
  psychodynamic
• 32:19
  mindfulness
• 32:20
  exercise.
• 32:22
  In
• 32:22
  fact,
• 32:22
  the
• 32:22
  number
• 32:23
  one
• 32:23
  most
• 32:24
  cost
• 32:24
  effective
• 32:25
  treatment
• 32:25
  for
• 32:25
  severe
• 32:25
  depression
• 32:26
  according
• 32:26
  to
• 32:26
  nice,
• 32:27
  is
• 32:27
  problem
• 32:27
  solving
• 32:28
  therapy,
• 32:29
  which
• 32:29
  means
• 32:29
  you
• 32:29
  write
• 32:30
  down
• 32:30
  your
• 32:30
  top
• 32:30
  three
• 32:30
  problems,
• 32:31
  the
• 32:32
  first
• 32:32
  step
• 32:32
  you'll
• 32:32
  take
• 32:33
  for
• 32:33
  each
• 32:33
  one
• 32:33
  and
• 32:34
  report
• 32:34
  back
• 32:34
  with
• 32:35
  barriers
• 32:36
  encountered
• 32:37
  or
• 32:37
  progress
• 32:37
  made.
• 32:38
  Which
• 32:38
  really
• 32:39
  gets
• 32:39
  to
• 32:39
  the
• 32:39
  idea
• 32:39
  that
• 32:40
  problems
• 32:40
  in
• 32:40
  our
• 32:40
  lives
• 32:41
  is
• 32:41
  what
• 32:41
  causes
• 32:42
  so
• 32:42
  much
• 32:42
  grief.
• 32:44
  Now
• 32:45
  NICE
• 32:46
  is
• 32:46
  only
• 32:47
  can
• 32:47
  only
• 32:47
  write
• 32:48
  in
• 32:48
  relation
• 32:49
  to
• 32:49
  what
• 32:49
  it's
• 32:49
  got
• 32:49
  studies
• 32:50
  for
• 32:50
  and
• 32:50
  so
• 32:50
  it
• 32:50
  doesn't
• 32:50
  cover
• 32:51
  a
• 32:51
  lot
• 32:51
  of
• 32:51
  lifestyle
• 32:52
  issues
• 32:52
  and
• 32:53
  so
• 32:53
  that's
• 32:53
  unfortunate.
• 32:54
  And
• 32:54
  I
• 32:54
  certainly
• 32:55
  think
• 32:55
  it
• 32:55
  does
• 32:55
  have
• 32:55
  exercise
• 32:56
  in
• 32:56
  it.
• 32:57
  I
• 32:57
  certainly
• 32:57
  think
• 32:57
  that
• 32:58
  diet
• 32:58
  and
• 32:58
  community
• 32:59
  must
• 33:00
  play
• 33:00
  a
• 33:00
  role.
• 33:00
  Access
• 33:01
  to
• 33:01
  green
• 33:01
  spaces.
• 33:04
  I
• 33:05
  hear
• 33:05
  people
• 33:05
  have
• 33:05
  different
• 33:06
  experiences
• 33:06
  with
• 33:06
  different
• 33:07
  diets
• 33:07
  and
• 33:07
  I
• 33:08
  think
• 33:08
  that
• 33:09
  ketogenic
• 33:09
  diet,
• 33:10
  intermittent
• 33:10
  fasting,
• 33:11
  I
• 33:11
  hear
• 33:11
  positive
• 33:11
  things
• 33:11
  from
• 33:12
  different
• 33:12
  people.
• 33:13
  I
• 33:13
  don't
• 33:13
  know
• 33:13
  if
• 33:13
  there
• 33:13
  are
• 33:14
  studies
• 33:14
  out
• 33:14
  there.
• 33:15
  I
• 33:15
  think
• 33:15
  those
• 33:15
  things
• 33:16
  have
• 33:16
  minimal
• 33:17
  side
• 33:17
  effects
• 33:17
  compared
• 33:18
  to
• 33:18
  medications
• 33:19
  and
• 33:19
  so
• 33:20
  are
• 33:20
  worth
• 33:20
  trying.
• 33:22
  You
• 33:22
  know,
• 33:22
  personally,
• 33:23
  as
• 33:23
  an
• 33:23
  N
• 33:23
  equals
• 33:24
  one
• 33:24
  experiment.
• 33:24
  When
• 33:25
  I,
• 33:25
  when
• 33:25
  I
• 33:25
  tried
• 33:25
  keto
• 33:26
  I
• 33:26
  felt
• 33:26
  much
• 33:27
  more
• 33:27
  calm.
• 33:27
  You
• 33:28
  know,
• 33:28
  I
• 33:28
  don't,
• 33:28
  that's
• 33:28
  not
• 33:28
  it,
• 33:29
  that's
• 33:29
  not
• 33:29
  proof.
• 33:29
  I
• 33:30
  don't
• 33:30
  know
• 33:30
  if
• 33:30
  it'll
• 33:30
  work
• 33:30
  for
• 33:30
  everybody.
• 33:31
  I
• 33:31
  suspect
• 33:31
  there
• 33:31
  might
• 33:31
  be
• 33:31
  differences,
• 33:32
  but
• 33:33
  I
• 33:33
  guess,
• 33:33
  you
• 33:34
  know,
• 33:34
  thinking
• 33:34
  about
• 33:34
  these
• 33:34
  things
• 33:35
  I
• 33:35
  always
• 33:35
  think
• 33:36
  what's
• 33:36
  the
• 33:36
  benefit
• 33:36
  and
• 33:36
  what's
• 33:37
  the
• 33:37
  harm?
• 33:37
  And
• 33:37
  I
• 33:38
  would
• 33:38
  say
• 33:38
  I
• 33:38
  think
• 33:38
  harm
• 33:38
  is
• 33:39
  more
• 33:39
  important
• 33:39
  than
• 33:39
  benefit.
• 33:40
  You
• 33:40
  know,
• 33:40
  if
• 33:40
  I
• 33:40
  had
• 33:41
  a
• 33:41
  child
• 33:41
  that
• 33:42
  was
• 33:42
  given
• 33:42
  a
• 33:43
  non
• 33:43
  beneficial
• 33:43
  treatment,
• 33:44
  I
• 33:44
  wouldn't
• 33:44
  be
• 33:45
  so
• 33:45
  happy,
• 33:45
  but
• 33:45
  I
• 33:45
  wouldn't
• 33:45
  mind
• 33:46
  if
• 33:46
  they
• 33:47
  were
• 33:47
  Given
• 33:47
  a
• 33:47
  harmful
• 33:47
  treatment,
• 33:48
  I'd
• 33:49
  be
• 33:49
  much
• 33:49
  more
• 33:49
  unhappy.
• 33:50
  So
• 33:50
  I
• 33:50
  think,
• 33:51
  you
• 33:51
  know,
• 33:51
  safety
• 33:52
  is
• 33:52
  more
• 33:52
  important
• 33:52
  than
• 33:52
  efficacy.
• 33:54
  And
• 33:54
  that's
• 33:55
  why
• 33:55
  I
• 33:55
  think
• 33:55
  things
• 33:55
  that
• 33:55
  don't
• 33:56
  have
• 33:56
  serious
• 33:56
  safety
• 33:57
  issues,
• 33:57
  you
• 33:58
  know,
• 33:58
  unlike
• 33:58
  antidepressants,
• 33:59
  which
• 33:59
  we
• 33:59
  haven't
• 33:59
  talked
• 33:59
  about
• 34:00
  all
• 34:00
  the
• 34:00
  safety
• 34:00
  issues,
• 34:00
  but
• 34:00
  I
• 34:01
  probably,
• 34:01
  probably
• 34:01
  known
• 34:01
  a
• 34:02
  bit
• 34:02
  to
• 34:02
  your
• 34:02
  audience
• 34:03
  and
• 34:03
  so
• 34:03
  I
• 34:03
  think
• 34:03
  those
• 34:05
  lifestyle
• 34:06
  options
• 34:06
  are
• 34:06
  worth,
• 34:07
  worth
• 34:07
  trying
• 34:07
  alongside
• 34:08
  the
• 34:08
  other
• 34:09
  things
• 34:09
  that
• 34:09
  I
• 34:09
  mentioned.
• 34:09
  Yeah.
• 34:10
  Gosh,
• 34:10
  it's
• 34:11
  fascinating
• 34:11
  to
• 34:11
  hear
• 34:12
  about
• 34:12
  the
• 34:12
  difference
• 34:12
  between
• 34:12
  the
• 34:13
  NICE
• 34:13
  guidelines
• 34:14
  and
• 34:14
  the
• 34:15
  APA
• 34:16
  and
• 34:16
  the
• 34:16
  US
• 34:16
  Guidelines.
• 34:17
  And
• 34:18
  I
• 34:18
  mean,
• 34:18
  the
• 34:18
  conflict
• 34:18
  of
• 34:19
  interest
• 34:19
  here
• 34:19
  in
• 34:19
  the
• 34:19
  US
• 34:20
  is
• 34:20
  just
• 34:20
  rampant.
• 34:21
  And
• 34:21
  the
• 34:22
  conflict
• 34:22
  of
• 34:22
  interest
• 34:23
  of
• 34:23
  the
• 34:23
  authors
• 34:23
  on
• 34:23
  this
• 34:24
  paper
• 34:24
  too.
• 34:24
  I
• 34:24
  mean,
• 34:25
  it's
• 34:25
  unusual
• 34:26
  to
• 34:26
  find
• 34:26
  a
• 34:26
  paper
• 34:27
  written
• 34:27
  like
• 34:27
  this
• 34:27
  by
• 34:27
  someone
• 34:28
  who
• 34:28
  isn't
• 34:28
  getting
• 34:29
  tons
• 34:29
  of
• 34:31
  grants
• 34:31
  or
• 34:31
  Medicare
• 34:32
  or
• 34:32
  money
• 34:32
  or
• 34:33
  compensation
• 34:33
  from
• 34:34
  pharmaceutical
• 34:34
  companies.
• 34:35
  And
• 34:35
  that's
• 34:35
  just
• 34:35
  accepted,
• 34:36
  right?
• 34:36
  That's
• 34:36
  just
• 34:36
  sort
• 34:37
  of
• 34:37
  the
• 34:37
  way
• 34:37
  it
• 34:37
  is.
• 34:37
  And
• 34:38
  we
• 34:38
  really
• 34:38
  do
• 34:39
  need
• 34:39
  to
• 34:40
  stand
• 34:40
  up
• 34:40
  to
• 34:40
  that
• 34:40
  and
• 34:41
  say,
• 34:41
  no,
• 34:41
  let's
• 34:41
  get
• 34:41
  rid
• 34:42
  of
• 34:42
  that
• 34:42
  and
• 34:42
  make
• 34:42
  it
• 34:42
  more
• 34:43
  like
• 34:43
  the
• 34:43
  European
• 34:43
  guidelines.
• 34:44
  So
• 34:44
  that's
• 34:44
  fascinating.
• 34:44
  We
• 34:44
  could
• 34:44
  have
• 34:45
  a
• 34:45
  whole
• 34:45
  discussion
• 34:45
  on
• 34:45
  that
• 34:46
  in
• 34:46
  and
• 34:47
  of
• 34:47
  itself.
• 34:47
  But
• 34:47
  that
• 34:48
  was
• 34:48
  really
• 34:48
  interesting
• 34:48
  to
• 34:49
  hear.
• 34:50
  But
• 34:50
  I
• 34:51
  really
• 34:51
  want
• 34:51
  to
• 34:51
  thank
• 34:51
  you
• 34:51
  for
• 34:52
  coming
• 34:52
  on
• 34:52
  and
• 34:52
  joining
• 34:53
  me
• 34:53
  on
• 34:53
  the
• 34:53
  show
• 34:53
  here
• 34:54
  to
• 34:54
  talk
• 34:54
  about
• 34:55
  this
• 34:55
  paper
• 34:56
  and
• 34:56
  more
• 34:56
  importantly,
• 34:56
  how
• 34:57
  it
• 34:57
  fits
• 34:57
  into
• 34:57
  the
• 34:58
  whole
• 34:58
  sort
• 34:59
  of
• 34:59
  the
• 35:00
  whole
• 35:00
  environment
• 35:01
  of
• 35:02
  antidepressant
• 35:03
  discontinuation,
• 35:04
  tapering
• 35:05
  and
• 35:05
  trying
• 35:05
  to
• 35:06
  differentiate
• 35:07
  the
• 35:07
  symptoms
• 35:07
  of
• 35:08
  relapse
• 35:08
  versus
• 35:08
  withdrawal.
• 35:09
  I
• 35:09
  think
• 35:09
  you
• 35:09
  really
• 35:09
  add
• 35:10
  a
• 35:10
  unique
• 35:11
  perspective.
• 35:12
  And
• 35:12
  the
• 35:13
  key
• 35:13
  being
• 35:13
  that
• 35:13
  this
• 35:13
  is
• 35:14
  nothing
• 35:14
  new,
• 35:15
  this
• 35:16
  is
• 35:16
  not
• 35:16
  new
• 35:16
  data.
• 35:17
  And
• 35:18
  it's
• 35:18
  easy
• 35:18
  to
• 35:18
  say
• 35:19
  it's
• 35:19
  a
• 35:19
  meta
• 35:19
  analysis
• 35:20
  of
• 35:20
  RCTs,
• 35:21
  therefore
• 35:21
  it's
• 35:21
  the
• 35:21
  highest
• 35:21
  quality
• 35:22
  data.
• 35:22
  But
• 35:22
  I
• 35:22
  think
• 35:22
  you've
• 35:23
  really
• 35:23
  pointed
• 35:23
  out
• 35:24
  what
• 35:24
  you
• 35:24
  put
• 35:25
  in
• 35:25
  the
• 35:25
  soup
• 35:25
  really
• 35:25
  makes
• 35:25
  the
• 35:26
  soup
• 35:26
  and
• 35:27
  there
• 35:27
  definitely
• 35:27
  is
• 35:27
  some
• 35:28
  weakness.
• 35:28
  So
• 35:30
  thank
• 35:30
  you
• 35:30
  very
• 35:30
  much.
• 35:30
  If
• 35:30
  people
• 35:31
  want
• 35:31
  to
• 35:31
  kind
• 35:31
  of
• 35:31
  learn
• 35:32
  more
• 35:32
  about
• 35:32
  you
• 35:32
  and
• 35:32
  your
• 35:33
  work
• 35:33
  and
• 35:33
  follow
• 35:33
  with
• 35:33
  you,
• 35:34
  where
• 35:34
  can
• 35:34
  we
• 35:34
  direct
• 35:34
  them
• 35:34
  to
• 35:35
  go?
• 35:35
  So
• 35:36
  I'm
• 35:36
  on
• 35:36
  Twitter,
• 35:37
  I've
• 35:37
  been
• 35:37
  quite
• 35:37
  active
• 35:38
  the
• 35:38
  last
• 35:38
  few
• 35:38
  days
• 35:38
  at
• 35:39
  Markhorro
• 35:40
  M
• 35:40
  I
• 35:40
  K
• 35:41
  H
• 35:41
  R
• 35:41
  O.
• 35:42
  I've
• 35:42
  got
• 35:42
  a
• 35:42
  Dinky
• 35:43
  website
• 35:45
  www.markhorowitz.org.
• 35:48
  can
• 35:48
  I
• 35:48
  just
• 35:48
  add.
• 35:48
  So
• 35:49
  I
• 35:49
  don't
• 35:49
  want
• 35:49
  to
• 35:49
  drag
• 35:49
  this
• 35:49
  out.
• 35:49
  Can
• 35:50
  I
• 35:50
  just
• 35:50
  add
• 35:50
  one
• 35:50
  safety
• 35:50
  message
• 35:51
  to
• 35:51
  the
• 35:51
  audience?
• 35:52
  Just
• 35:52
  so
• 35:53
  just
• 35:53
  maybe
• 35:53
  to
• 35:53
  summarize
• 35:54
  the
• 35:54
  study
• 35:55
  and
• 35:55
  then
• 35:55
  put
• 35:55
  in
• 35:55
  context.
• 35:56
  I
• 35:56
  think
• 35:56
  you've
• 35:56
  said
• 35:56
  it
• 35:56
  exactly
• 35:56
  right,
• 35:57
  Brett.
• 35:57
  Now,
• 35:57
  this
• 35:58
  study
• 35:58
  has
• 35:58
  shown
• 35:59
  again
• 35:59
  that
• 35:59
  short
• 36:00
  term
• 36:00
  use
• 36:00
  of
• 36:00
  antidepressants
• 36:01
  mostly
• 36:01
  doesn't
• 36:01
  cause
• 36:02
  severe
• 36:02
  withdrawal
• 36:02
  and
• 36:02
  I
• 36:02
  think
• 36:03
  that's
• 36:03
  true.
• 36:04
  There
• 36:04
  are
• 36:04
  25
• 36:05
  million
• 36:05
  people
• 36:05
  in
• 36:05
  America
• 36:06
  on
• 36:06
  these
• 36:06
  drugs
• 36:06
  for
• 36:07
  more
• 36:07
  than
• 36:07
  two
• 36:07
  years.
• 36:07
  There
• 36:07
  are
• 36:08
  millions
• 36:08
  of
• 36:08
  people
• 36:08
  around
• 36:09
  the
• 36:09
  world
• 36:09
  on
• 36:09
  these
• 36:09
  drugs
• 36:09
  for
• 36:09
  more
• 36:10
  than
• 36:10
  two
• 36:10
  years.
• 36:11
  All
• 36:11
  the
• 36:11
  studies
• 36:11
  suggest
• 36:12
  that
• 36:12
  long
• 36:12
  term
• 36:13
  users
• 36:13
  are
• 36:13
  at
• 36:13
  much
• 36:14
  higher
• 36:14
  risk
• 36:14
  for
• 36:15
  severe,
• 36:16
  long
• 36:16
  lasting
• 36:16
  and
• 36:17
  sometimes
• 36:17
  disabling
• 36:18
  withdrawal
• 36:18
  syndromes.
• 36:19
  That's
• 36:20
  what
• 36:20
  I'm
• 36:20
  concerned
• 36:20
  about.
• 36:22
  To
• 36:22
  some
• 36:22
  degree
• 36:23
  this
• 36:23
  study
• 36:23
  might
• 36:23
  be
• 36:23
  interpreted
• 36:24
  to
• 36:24
  say
• 36:25
  everyone
• 36:25
  should
• 36:25
  use
• 36:26
  these
• 36:26
  drugs
• 36:26
  for
• 36:26
  8
• 36:26
  to
• 36:26
  12
• 36:27
  weeks
• 36:27
  because
• 36:27
  they're
• 36:27
  not
• 36:27
  major
• 36:27
  issues
• 36:27
  when
• 36:28
  they
• 36:28
  stop.
• 36:28
  Now
• 36:28
  that
• 36:28
  wouldn't
• 36:28
  be
• 36:29
  a
• 36:29
  bad
• 36:29
  takeaway
• 36:30
  from
• 36:30
  this
• 36:30
  study.
• 36:31
  But
• 36:31
  if
• 36:31
  you
• 36:32
  are
• 36:32
  a
• 36:32
  longer
• 36:32
  term
• 36:32
  user,
• 36:33
  I'd
• 36:34
  be
• 36:35
  much
• 36:35
  more
• 36:35
  careful
• 36:35
  in
• 36:36
  coming
• 36:36
  off.
• 36:36
  The
• 36:37
  guidelines
• 36:37
  in
• 36:37
  America
• 36:37
  suggest
• 36:38
  to
• 36:38
  come
• 36:38
  off
• 36:38
  over
• 36:38
  a
• 36:38
  few
• 36:39
  weeks.
• 36:39
  That
• 36:39
  can
• 36:39
  be
• 36:40
  quite
• 36:40
  dangerous
• 36:40
  for
• 36:41
  a
• 36:41
  lot
• 36:41
  of
• 36:41
  people.
• 36:42
  It's
• 36:42
  better
• 36:42
  to
• 36:42
  come
• 36:43
  off
• 36:43
  more
• 36:43
  slowly.
• 36:44
  That
• 36:44
  means
• 36:44
  months,
• 36:45
  sometimes
• 36:45
  more
• 36:45
  than
• 36:45
  a
• 36:46
  year.
• 36:46
  There's
• 36:47
  a
• 36:47
  method
• 36:47
  of
• 36:47
  tapering
• 36:47
  called
• 36:48
  hyperlock
• 36:48
  tapering
• 36:48
  that
• 36:49
  I've
• 36:49
  done
• 36:49
  a
• 36:49
  lot
• 36:49
  of
• 36:49
  work
• 36:49
  on
• 36:50
  that
• 36:50
  involves
• 36:50
  smaller
• 36:51
  reductions.
• 36:52
  That
• 36:52
  is
• 36:52
  generally
• 36:52
  safer,
• 36:54
  I
• 36:55
  should
• 36:55
  say.
• 36:56
  I
• 36:56
  run
• 36:56
  a
• 36:56
  clinic
• 36:56
  called
• 36:57
  Altro
• 36:58
  in
• 36:58
  America
• 36:58
  that's
• 36:59
  operating
• 36:59
  in
• 36:59
  various
• 37:00
  states
• 37:00
  including
• 37:00
  New
• 37:00
  York
• 37:00
  and
• 37:01
  California
• 37:01
  that
• 37:02
  helps
• 37:02
  people
• 37:02
  to
• 37:02
  come
• 37:02
  off
• 37:02
  these
• 37:03
  drugs
• 37:03
  more
• 37:03
  safely.
• 37:04
  But
• 37:05
  even
• 37:05
  a
• 37:06
  doctor
• 37:06
  can
• 37:06
  follow
• 37:06
  these
• 37:06
  things
• 37:07
  with
• 37:07
  the
• 37:07
  latest
• 37:08
  guidelines.
• 37:08
  I've
• 37:08
  written
• 37:08
  a
• 37:09
  book
• 37:09
  called
• 37:09
  the
• 37:09
  Morsely
• 37:10
  Deprescribing
• 37:11
  Guidelines
• 37:11
  that
• 37:12
  outlines
• 37:12
  how
• 37:12
  to
• 37:12
  come
• 37:13
  off
• 37:13
  a
• 37:13
  lot
• 37:13
  of
• 37:13
  different
• 37:13
  psychiatric
• 37:14
  drugs,
• 37:14
  including
• 37:14
  antidepressants.
• 37:15
  And
• 37:15
  so
• 37:16
  I
• 37:16
  guess
• 37:16
  I
• 37:16
  hope
• 37:17
  that
• 37:17
  doctors
• 37:17
  and
• 37:18
  patients
• 37:19
  are
• 37:19
  not
• 37:20
  unjustifiably
• 37:22
  become
• 37:23
  complacent
• 37:23
  about
• 37:24
  withdrawal
• 37:24
  because
• 37:24
  of
• 37:24
  this
• 37:25
  study.
• 37:25
  I
• 37:26
  think
• 37:26
  short
• 37:26
  term
• 37:27
  people,
• 37:27
  yes,
• 37:28
  be
• 37:28
  complacent.
• 37:28
  That
• 37:28
  seems
• 37:29
  more
• 37:29
  reasonable.
• 37:29
  Not
• 37:29
  everyone,
• 37:30
  but
• 37:30
  most
• 37:30
  people.
• 37:30
  But
• 37:31
  longer
• 37:31
  term
• 37:31
  users,
• 37:32
  it's
• 37:32
  better
• 37:32
  to
• 37:32
  err
• 37:33
  on
• 37:33
  the
• 37:33
  side
• 37:33
  of
• 37:33
  caution
• 37:34
  when
• 37:34
  things
• 37:34
  go
• 37:34
  wrong.
• 37:36
  It's
• 37:36
  very
• 37:36
  unpretty.
• 37:37
  Better
• 37:37
  to
• 37:37
  be
• 37:37
  cautious
• 37:38
  than
• 37:38
  to
• 37:38
  become
• 37:38
  reckless.
• 37:39
  Very
• 37:39
  good.
• 37:40
  That's
• 37:40
  a
• 37:40
  very
• 37:40
  important
• 37:41
  message.
• 37:41
  So
• 37:41
  thank
• 37:42
  you
• 37:42
  very
• 37:42
  much.
• 37:42
  I
• 37:42
  appreciate
• 37:42
  that.
• 37:44
  Thanks
• 37:44
  Brian.
• 37:46
  Thanks
• 37:46
  for
• 37:46
  listening
• 37:47
  to
• 37:47
  the
• 37:47
  Metabolic
• 37:48
  Mind
• 37:48
  Podcast.
• 37:48
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• 37:49
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• 37:49
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• 37:49
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• 37:49
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• 37:50
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• 37:50
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• 37:50
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• 37:50
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• 37:51
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• 37:51
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• 37:51
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• 37:51
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• 37:52
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• 37:52
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• 37:52
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• 37:52
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• 37:52
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• 37:53
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• 37:53
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• 37:53
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• 37:54
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• 37:55
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• 37:57
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• 38:00
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• 38:00
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• 38:00
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• 38:01
  Mind.
• 38:02
  Lastly,
• 38:02
  if
• 38:02
  you
• 38:02
  know
• 38:02
  someone
• 38:03
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• 38:03
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• 38:03
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• 38:03
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• 38:05
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• 38:06
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• 38:07
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• 38:07
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• 38:07
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• 38:08
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• 38:08
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• 38:08
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• 38:08
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• 38:08
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• 38:09
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• 38:10
  Thanks
• 38:10
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• 38:10
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• 38:10
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• 38:11
  and
• 38:11
  we'll
• 38:11
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• 38:11
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• 38:12
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