Latest / Radically Genuine / 81. Drug tapering and withdrawal w/ Adele Framer
Transcript
- Sean: Welcome to the radically genuine podcast. I am Dr. Roger McFillin. I often Sean get questions either through email or through our podcast email, as well as from all my patients about antidepressant withdrawal, how to get off the drugs, how to taper the drugs in a safe and effective manner. And I'm very clear that I'm not an expert in that area. Just because I'm promoting what I, what is sound science. I'm clear that this is evolving. And in fact, we're learning from a lot of lay people and a global community of people who've been harmed by psychiatric drugs. That information is valuable. And I've been looking forward to this episode because this is a, uh, a person who was harmed from the drugs themselves and then created solutions. introduce Adele Framer. She is a lay expert in psychiatric drug tapering and withdrawal syndromes and a widely recognized patient advocate. She resides in San Francisco, California, or retired from Information Systems Design. She's a survivor of 11 years of antidepressant withdrawal syndrome herself. Many will know her as in which she founded survivingantidepressants.org, a peer support site for tapering psychiatric drugs and withdrawal syndrome. The site holds more than 6,000 longitudinal cased histories from its 19,000 members and receives more than 7 million page views a year. I have referred patients who've been trying to get off antidepressants to this support group Adele authored a paper, What I Have Learned, from helping thousands of people to taper off antidepressants and other psychotropic medications. A paper published in 2021 in Therapeutic Advances in Psychopharmacology. That's been viewed 108,000 times and cited by 27 papers. She also co-authored the paper, Protracted Withdrawal Syndrome After Stopping Antidepressants. a descriptive quantitative analysis of consumer narratives from a large internet forum. First author, Michael Hengartner, and that was published in 2020. That was viewed 36,500 times. It's cited more than 29 papers. I've read it myself. Adele, welcome to the radically genuine podcast. Adele Framer: Thank you, Roger, and thanks for that very gracious introduction. Sean: Well, I am really interested in the person behind Alta Estrada. I know that you are now, um, putting yourself out there publicly and talking more about your background and what you've learned over the past 15 plus years. Can you tell our listening audience, your background, your story, and how you got to the place of, of founding surviving anti-depressants.org. Adele Framer: Well, that's quite a long story, but I'll do my best. I was an ordinary person who wandered into my doctor's office. I was working at the time in the web industry, which was very new. And it was at the time of the dot-com crash. So there was a lot of work stress. My company was going under. And I had problems with that. And so I talked to my doctor and she said, well, you can have an antidepressant. They're all the same. And she tore off a prescription for peroxitine. So I took 10 milligrams of peroxitine for about a couple of years. And I started to feel some pretty discouraging adverse effects. Of course, sexual dysfunction, which is really common. And I started to really slow down. I got very sluggish and demotivated. And I just felt like a slug. And so I figured, well, at first I thought, oh, this must be aging. I was on the brink of menopause. But then I realized that it was probably the peroxitine. So I tried to go off and it was disastrous because I was following a psychiatrist's instructions. He said, well, prescribe Lexapro to you. And it has fewer sexual side effects, which wasn't absolutely not true. And he said, and I said, how should I do this? And he said, well, you just switch from proxitine to Lexapro. You know, just, you know, take, stop, take, take Paxil one day to take Lexapro the next day. And I had terrible, terrible, terrible withdrawal from that. So I went back on Paxil and I, well, when I told him that I had a terrible problem with going off, he immediately said, you know, you're not my patient anymore, and he was pushing me out the door, and I had to beg for another prescription for Paxil from him, which he threw at me as I was going out the door. So I went back on I was, you continue to be miserable on it. And then I decided that I go to an elite medical center up here in San Francisco to the psychiatry department because I thought they might be the experts to help me go off. And when I spoke to them, they said, well, you just go off over a few weeks. It's very easy. You just go off. They didn't give me any instructions. that and again and over a few weeks and actually what happened was I probably developed brain zaps while I was I can't even say was tapering but I was you know I was reducing the drug over a few weeks but I didn't pay any attention to them I thought well that's peculiar but you know I continued to go off and then when after I quit I developed hypomania which actually was a very delightful period where I was very uncharacteristically busy Sean: This is Adele Framer: and Sean: the end. Adele Framer: optimistic Sean: This is the rest Adele Framer: and Sean: of Adele Framer: friendly Sean: you. Adele Framer: and outgoing and chatty and that lasted for perhaps a month or so, a month and a half, and then I went into a more typical withdrawal pattern of disorientation and sporadic spells of incredible deep despair and anxiety and poor sleep. And it just wasn't good. In the meantime, I was still going back to that psychiatry clinic, and they were trying to convince me I had relapsed. So they gave me several prescriptions. I did take well-begotten for a period, blood pressure spikes, so I had to quit that. In the meantime, I was still having the brain zaps for seven months, but all through in this particular period, I was having a more typical withdrawal pattern that clearly wasn't right. And it took me, I was a believer that they knew what I thought that they had some kind of way of repairing this. But after a while, I realized that they didn't really know, and they were just experimenting. Then I went to a private psychiatrist, and it was sort of the same thing, except that he was so expensive. And I would Sean: Thank you. Adele Framer: see him. And when, you know, I would tell him I really needed help with withdrawal syndrome. And I had, by that time, gone to the medical library, and I had printouts of all these papers about withdrawal syndrome. And he didn't pay any attention. None of them paid any attention to the literature that I brought to them. And I thought, you know, surely they're scientists, and they'll want to know about this. And I'm an example of it. They'll want to know so that they can prevent other patients from having the same problems that they would want to learn, but they would ignore it all of it. And Sean: That's Adele Framer: he Sean: a very Adele Framer: had. Sean: reasonable assumption of you, right? Adele Framer: Well, I mean, I was truly a believer in, you know, that doctors were scientists and helpful and continually updated their knowledge and really knew what was best. I didn't start out to be a person who questioned my doctors. So, he spent a lot of time trying to convince me that I was diluted. And finally, and this went on for seven months. So finally I said to him, you know, I really don't like our dynamic. And he said, what do you mean? And I said, well, I keep on telling you what's going on with you and you keep on telling me that I'm deluded. And I don't think that that's right. So I left and he was quite surprised. Then I, I was still feeling, I was barely hanging on, you know, working at the time. And I really felt like I needed to find some kind of a solution to my problem. And very reluctantly, I started looking around on the web and I joined a peer support site myself. And this was something that I had avoided for a couple of years because I didn't think that the, you know, that the patient run sites were credible. thinking that medical authority was really what I wanted. And so I found really large communities of people who had the same problem. At that time, which was about 2007, there were like there were five or six forum sites devoted to different withdrawal from different antidepressants. The one I joined was And there was another one, Benzo Buddies for withdrawal from Benzo Diasopines, which is still an operation. It's probably the largest and oldest forum site for drug withdrawal. So I very reluctantly went to patients, went to people like myself to ask what is going on here. And there was... even then quite a very large subculture of patients. So I was a member of that site for six or seven years. I was still hanging on to working, although my concentration and my, I wasn't sleeping well and I was very disoriented but I would do my best at work and I managed to get by. And then I changed jobs and I got into a more stressful job and I became much worse. And I stopped sleeping altogether. That was a very terrible time. I just got much, much worse. And I had to stop working. I went on disability. Yeah, it just, I just didn't see any end to it. I couldn't find any medical help. And I was seriously thinking of driving up to Santa Rosa and buying a gun. But I didn't Sean: Thank you. Adele Framer: know if I had enough ability to concentrate, to go through the required course of instruction. You had to do a couple hours of instruction before they let you have a gun in California. So I didn't know if I could handle that much less the drive. So just in the nick of time, I had been working and working. I had been Sean: Thank you. Adele Framer: contacting every possible person who might know anything about someone, a doctor who could help me with withdrawal. And finally, in the very nick of time, somebody suggested a psychiatrist who was actually right here in San Francisco walking distance in my apartment, who had sort of a subspecialty in adverse effects of antidepressants. So I took my stack of papers to him because I thought I would have to convince him that I had this problem. And he said, I don't need to look at that. I've seen it all. And he did, in fact, Sean: Mm. Adele Framer: there's any definite cure for it, but I did well with extremely tiny doses of lamotrigin to settle my nervous system and I believe just a tiny, there was a tiny bit of allureka to sleep and what I'm talking about is much less than two milligrams of either drug. And it took me about three years to stabilize on that. And it was a real up and down time, and that was, it was very difficult. So, and then after that, it took me another few years to go off of those two drugs. Sean: Unfortunately, your story is quite familiar. Adele Framer: Yeah. Sean: We see this way too often where someone is dealing with life stress, work related stress or a life event that would be typical of the lifespan. And you turn to your doctor and they provide a prescription. And that prescription provides some adverse reactions or responses, or the attempt of trying to get off the drug creates that. I'm surprised that you were not diagnosed disorder, given some of the symptoms that you reported, which is often the case. And we have doctors who are still proclaiming this today, that some of the adverse effects of being on an antidepressant, which provide, create symptoms that are similar to bipolar disorder, are just kind of stating, well, you were undiagnosed bipolar. How did you avoid that diagnosis? Adele Framer: Well, I did, in fact, get that one suggested to me. But it was so stupid, I just rejected it. Sean: Well, that's the difference here. I think you're such a, first of all, you're a strong advocate and you're certainly a very smart woman who did a lot of research. Unfortunately, there is just blind trust in the medical authority for way too many and they just assume that to be true. And then they go on their next regimen of psychiatric drugs. How were you able to under those conditions in that state and being able to being someone who trusted their physicians previously? How are you able to question that? Adele Framer: I guess I have a lot of issues. I have a lot of personal issues. But I always thought that I knew my own mind. So, of course, I have many habits of mine that work against me. But I always, which I'm still working on. that anybody else knew my mind better than I did. Sean: Yeah. So that leads, that leads me to a question. Excuse me. When you were going into the doctor and they were saying some of your, your feelings were, were relapse. How did you distinguish between withdrawal symptoms and relapse? How did you navigate that? Adele Framer: Well, I had a very clear idea of how I felt before I took the drug, and then after I took the drug, and then after I went off. I mean, there was no, you know, I wasn't muddled about that at all. You know, when I went on the drug, I was in very good health. I felt good in my body. And I, you know, I had a lot of distress because of my job and, you know, all the problems that come from a, you know, deteriorating. social environment. I mean, it was company going under, people were not happy there, or they were very worried. You know, I knew what was going on. I have, of course I have, as so many of us do, a history that might suggest that our emotional problems are deep rooted in our family history and experiences up until that point. But I was clear about how I was feeling. Sean: It's interesting, we just published a podcast with Rob Wipand, Adele Framer: Mm-hmm. Sean: who is the author of the book, Your Consent is Not Required. And he has a chapter in that book around, you know, insight and Adele Framer: Hmm? Sean: how the psychiatric professional, if you are in any way resisting the diagnosis or the treatment, is that then your resistance in itself is labeled as poor insight and a symptom of your mental illness. And you were able to clearly have a conversation with your treating psychiatrist. who wanted to present you as somebody who was delusional to, you know, clearly present not delusional in the manner in which you interacted with this professional and get out of that unhealthy relationship. Adele Framer: Well, I guess I'm just not very differential. Sean: which is an important quality. Adele Framer: So, you know, like, yeah, I mean, just, and he was quite an imposing person. But I, it's like, you know, no, that doesn't make sense to me. See, I'm a very, you know, I'm very logical. So, so that's kind of my retreat is like, you know, does not compute. Sean: Right. Right. Ha ha ha. Adele Framer: You know, enough of that. So I was done with that. I was like, you know, I gave it a good shot. You know, I listened to him for seven months. But I was just, you know, I could feel in my body that it was like, you know, this was like, you know, I was allergic to it. Sean: Can you share a little bit about that in terms of the withdrawal symptoms? You mentioned brain zaps and I'm just curious. I had never heard that before. Maybe I had read it, but just didn't focus on it too much. What's that experience like? Adele Framer: Well, the way that I felt it was tiny little, I mean, when people call them zaps, it's a good way to describe them. Tiny little sensations in my head that were like something snapping. It was Sean: Thank Adele Framer: like, Sean: you. Adele Framer: it's a little snap. And they would occur now for me, well, okay, this is also part of my history. Well, being a baby boomer, way back when, I did some drugs. So I could also distinguish what was a drug effect and what wasn't a drug effect. So anyway, I felt the zap. Well, I knew I'd gone off of peroxidine and I felt the zap and I thought, that must be like an effect of the drug. It was distracting, but it didn't hurt. them. Oh, I don't know. It depended. You know, maybe like, you know, half a dozen times a day, some people have them much, much worse. Mine persisted for seven months. But from my website, I know that people experience them in different ways. But I personally felt it as a little, a little snap in my inside, and it definitely felt like it was inside my head. Sean: So take us up to the founding of this, of anti-depressant.org. I'm interested in to know like how you went about doing this and everything that it took to get this off the ground. Adele Framer: Yeah, well, what happened was, again, going back in my history, I was a very early adopter of social media on the internet. So I had been involved in what you might call social media since the 90s. And so I joined the peer support site and I was active member that was Paxil Progress while I was experiencing the first half of my withdrawal syndrome. And Because these online communities often do, this community started to deteriorate. And some of the people there said, well, where will we go if we can't be here? Because this is our home and this is our support network. It was really important to them. So I, among us, I probably had the most, the skills appropriate to start with. a website, but there's nothing very fancy about surviving engine depressants.org. It's a very plain off-the-shelf forum software that requires a minimum of attention, which was all I could handle at that time because I was also experiencing withdrawal syndrome. I was in protected withdrawal. So I started this site and I pay the bills from donations and the members have been very kind in in in supporting with donations and So that's how I opened it. We had a core people a core people who came from Paxil Progress and then as as these things do over the years it attracted more and more people in a very typical kind snowball kind of fashion because the The search search results would bring in people. So more and more people came in. Now there are about 19,000 members now that have accumulated since 2011 when I started this site. But there are millions of people who peek in through the web who don't register. Sean: Yeah, I did that before this interview. I spent some time on there and I was just reading through some of the materials that were there and I think you require them to register only if they want to ask a question. Is that correct? Adele Framer: Yeah, Sean: Yeah. Adele Framer: I mean if they want to interact, otherwise, all of them, well, almost all of the material is publicly viewable. And some of those, I don't have the figures right now, but many of those topics about tapering, different kinds of drugs have been viewed thousands and thousands of times. And I'm going to presume that that was by people who wanted information about going off of those specific drugs. Sean: Del, before I tap into your vast experience in this area with some specific questions that I know a lot of patients have, I am curious to know your thoughts on the general mental health field and psychiatric community. There's a lot of ignorance out there that continues to be promoted by doctors and primary care physicians who are prescribing these drugs. How have they fallen so far behind the science on this issue and failed to inform? their patients. Adele Framer: You know, one of the very, I guess you'd say, the consistent questions that people have about this situation is, why don't doctors understand what's going on? I don't know if I've ever found an answer to that. They don't get any, they get very, very, very little information about drug withdrawal issues in their medical training. This is true to this very day that whatever they get before an MD degree, very little about drug withdrawal. And it's usually in the context of addictive drugs. So they believe that the psychiatric does mostly are not addictive, although benzodiazepines are. So they think that not addictive means that the withdrawal problems are virtually non-existent. Now, why don't they hear what their patients are telling them or the information that's been coming out over the last probably five years. There's probably an element of cognitive dissonance involved that they don't want really want to believe that that's true. They haven't heard it from official sources that they recognize as official, meaning in their medical training. at their conferences. So they don't want to believe it. It's been called misinformation. I think that we're making a dent, but it just takes a long time for a very conservative specialty such as tree to make changes. Sean: So you had shared your story about when you wanted to start getting off the drug you were on, there was no specific information that was provided. And you've also published that paper that pulled from all the resources that are on surviving antidepressant.org in terms of, the one thing that kind of stood out to me is when it comes to withdrawal symptoms, there's two specific times. There's the acute and then there's the protracted. For our listeners and even for the doctors that may be listening, What point does it go from acute into protracted? Adele Framer: Well, this is a distinction that's been made by addiction medicine. And from what I've seen in having to do a psychiatric drug withdrawal symptoms, it's also true of them. That initially, when people go off of the drugs, they'll have some very dramatic symptoms. For instance, your heroin addicts might be vomiting. Or, and that's also true of people who might go off of antidepressants and other drugs. when they go off, they might be nauseous, they might be sweating, they might be trembling, and these are recognizable physical withdrawal symptoms. This period, according to Lerner and Klein from 2019, who written by two people who were psychotropic drugs last for maybe like four to six weeks and then this and there seem to be you know some types of these these acute symptoms are particularly to the drug you know like it's more likely you're going to be vomiting coming off of heroin than off of let's say sertraline but the So the acute symptoms last for maybe a month, a month and a half. And then it seems as though all the withdrawal syndrome settled down into a protected withdrawal that typically involves disorientation, insomnia, spells of despair, and anxiety, or what's called anxiety, these surges that are They're physical in nature, but the only term that we can come to them, we can call them is anxiety. We don't have the vocabulary to really describe these things. These are typical Sean: Thank you. Adele Framer: post-acute with symptoms across all drugs. There may be emotional symptoms as well. Very, from my observation, very common is an emotional anesthesia. I'm going to call it emotional anesthesia because it is distinguished from the so-called emotional blunting that is supposed to be associated with depression, in that the person gets no sense or reward from anything. And this was something that I experienced for many years. It's only, I guess, probably in the last six or seven years that I have come out of this. So the emotional anesthesia as opposed to acute withdrawal syndrome from what I've seen is extremely common across psychiatric drugs and lasts a long time. And that's the symptom that people most often describe as depression, which may be interpreted as relapse. Sean: Hmm. Adele Framer: So, so again, we have a lack of terminology to describe this stuff. And so when people, and this is an extremely alien feeling, because even when you're depressed and in my lifetime, I have experienced real depression, you get pleasure in something. So you know, even, you know, anhedonia is not an absolute either. So the, the, so this is an absolute. you know, completely numb and then it's often accompanied by depersonalization, derealization, lack of motivation, and all of these are, could be interpreted again as psychiatric symptoms or relapse, but they're typically more complete and more intense in the protracted withdrawal stage. Plus they appear across psychotropic, excuse me, across all psychotropic withdrawal syndromes, including alcohol, methamphetamine, fluoxetine, every, every psychotropic has has a similar effect. And, you know, it's, it takes a long time for the nervous system to rebuild itself. Sean: curious in terms of a prevalence rate when somebody is going through withdrawal symptoms acute and maybe moving into the protracted withdrawal, do we understand how many percentage of people actually go through these symptoms? Adele Framer: Well, you know, my site, since my site is all self-selected, we can't say that I can't come up with any statistics of frequency. But the other studies have estimated that about half of people will experience withdrawal symptoms coming off of antidepressants. And it appears that perhaps another half of those, which are 25%, might have experienced symptoms going past four or six weeks. So there's a very, you know, the cutoff is about, you know, a month or so. Now, coincidentally, and I think that this is significant, in the psychiatry textbooks, they'll say that with all symptoms only last a few weeks. And I think that what they're talking about are the acute symptoms, and they've missed entirely the post-acute symptoms. So the area where they're most confused are the post-acute symptoms. And because the post-acute symptoms, which have a lot in common with post-acute symptoms from addictive drugs, they can be interpreted as psychiatric disorder or relapse. So I think most commonly people who experience protected withdrawal past a few or a month or so are diagnosed as relapse and they're remedicated. I think that's the usual, I think that's the usual scenario. So the people who are, who come to my website who have protected withdrawal are the stubborn ones who, Sean: Ha ha ha. Adele Framer: they rejected their diagnosis of relapse. Sean: Do we know anything about the various drugs, whether it's in SSRIs or SNRIs? Are there certain drugs that seem to be more dangerous? In fact, it's harder to get off of when you talk about the various drugs within the classes. Adele Framer: Definitely. Peroxatine seems to be the star. And since probably the 80s, it's been known to be a, I think that it goes back to the 80s, it's been known to be a real problem in terms of adverse effects and withdrawal. So it's always at the top of the list of every single paper about withdrawal. So peroxatine is the worst in terms, antidepressants. There's an indication that fluoxetine might be somewhat easier than the others because it has a much longer half-life than the others, but there's still a potential of withdrawal syndrome from going off of fluoxetine too fast. So that can be a problem because doctors will say, oh, fluoxetine is self-tapering, they told people to quit. And what happens is the, you know, let's say the 50% who could handle, you know, practically any type of tapering won't have any problems coming off of fluoxetine as it fades out over its half-life, which is over a month. But the other half will, and then the, you know, half of that half, which is 25%, will get protracted after all symptoms from fluoxetine. So, so even if... complacent about phyloxidine. And among the antipsychotics, well the antipsychotics are an issue in tapering because even if you're taking them for reasons other than psychosis, and in the United States they're prescribed very, very frequently for sleep for a very inexplicable Sean: වවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවවව Adele Framer: reason. fast you can get symptoms that might be interpreted as psychosis even if you've never had psychosis. If you've had psychosis then you're in real trouble because if you go back to the hospital with your history of psychosis you're going to be put on a batch of other drugs of other anti- psychotics. So the anti-psychotics Sean: Thank you. Adele Framer: need to be diagnosis is and even at low doses. I have a woman who's developed heart of dyskinesia on 25 milligrams of cotypene and she's tapering but her sign for tapering too fast is that her heart of dyskinesia gets worse. So we have to taper so that she doesn't trigger symptoms. really tricky, but she's very good at it. Sean: And I know I'm really quite interested in trying to determine, I'm sure, as a lot of people are, who would be more vulnerable to experiencing these withdrawal symptoms. It's taking me into literature on those who are more likely to have an adverse reaction based on their metabolic system, how they metabolize the drugs, and even potential genetic kind of variations of a specific metabolizing that would lead someone to become suicidal or even homicidal. Are you aware of who may be most vulnerable to these drugs where they could develop this protracted withdrawal syndrome? Adele Framer: I'm glad you asked that, Roger, because I do have an opinion about it. Yeah, in my observation, and again, like, I don't know how I did it, but I managed to review thousands of these narratives, the people who are most prone to the worst difficulties are people who have a history of going on and off drugs, adverse reactions to psychiatric drugs, previous failed tapers, I guess that probably covers it. Now the thing is, is that switching people from drug to drug especially among antidepressants is extremely common. So I would say that, you know, if you've been on your antidepressant for several years and you've had a bunch of drug switches, you're probably, you know, it's you're in a zone that might be more prone to withdrawal. But I don't think that there really are any metabolic or genetic predictors of who's going to have withdrawal symptoms. I think it has to do with your drug history. Now, there is a special subset of people who had initially gotten really bad, adverse effects from an antidepressant within a couple of doses and or you know or a few and when they go off they have symptoms that are very similar to protracted withdrawal syndrome. They've got the disorientation, depressalization, emotional anesthesia, simply not feeling like perhaps, and they probably have a genetically determined sensitivity to the serotonergic or to whatever type of drug it is. And what we've seen is that their trajectory of recovery is identical to that of protective withdrawal, but fortunately on the shorter side because they hadn't had that much drug exposure. There was something that happened that destabilized their nervous system and it takes them, you know, some months, many months to recover, but probably not as long as people who have protected withdrawal from, let's say, cold turkeying, Zoloft after being on it for 15 years and having a million drug switches. Sean: Got it. I asked this question to a psychiatrist that was on our podcast, Dr. Greenberg, who's nutritional psychiatrist, and he's trying to do some work in this area as well. Do you believe that there are some people who are just never able to get off their antidepressants? Adele Framer: Oh, that's a tough one because apparently, and David Healy found this, that there are some people who just really, I mean, they cannot get past that last, that last small dose. Typically it's easier, well, it can be hard to taper at any rate, but when people get down to low doses of the drug, it becomes harder and harder to taper. that he's found people who are stuck at a low dose. And they can't go off completely. And drug substitutions are disastrous, so they just have to cope. Sean: They, in terms of the dosage, if they're, um, if they're going through that process, is it because they're breaking it down into such a small amount? It gets difficult at a certain point. I'm sorry. I was having a hard Adele Framer: Yes, Sean: time Adele Framer: it Sean: understanding. Adele Framer: does get difficult. Right. OK. So Markowitz has done a lot of work in this. And he has shown that, or he's found evidence that the, let's say, the drug saturation is hyperbolic. So that you, so a small, when you're starting the drug, a small amount will have a larger effect on receptor occupancy. dose of the drug, it has less and less effect. There's a less rate on return, right? So you reach this plateau of effect or receptor occupancy saturation. And going past that, there's, you know, you don't get any marginal, any marginal additional effect. Sean: Is it like the point of diminishing return? Adele Framer: Yeah, Sean: Does Adele Framer: there's Sean: that Adele Framer: a Sean: translate? Adele Framer: point of, right, right, right. That's as you increase, right? So, and this has been found in studies that there are doses beyond which you don't get any, any supposed benefit. So, going off, you go in the reverse direction. So, you're at the plateau, and so you can cut, make larger cuts, but then once you get over to the shoulder of the curve, your cuts need to be proportionately smaller so you can follow the shoulder of the curve and not fall off the curve. So when you get down to the lower doses, a little tiny cut proportionately has more effect on the receptor occupancy than you had when you were up at the plateau. I hope that that makes sense to people. Sean: No, it does. And then that visualization, kind of, you know, if you have your XY-WAC access, you can kind of see when that shoulder happens how complicated it can be. Adele Framer: Right, so when you hit the shoulder, that's like, you know, that's where you gotta be careful. Sean: Thank Adele Framer: Now, Sean: you. Adele Framer: some people get very complacent because they say, you know, they'll start off and they'll cut their dose in half and it's fine because they're still on their plateau. Sean: Thank you. Adele Framer: And then if they try that again, this is typically what the doctors will tell people, this is how doctors tell people to tape or cut it in half, then cut it in half again, then quit. So, you know, so you go to 50% of the dose, then you go to, where are you? Where are we? Sean: at 25% Adele Framer: 25% Sean: and then down to like 12.5. Adele Framer: and then right right then 12.5% and and the thing is that your 50% might take you to the shoulder of the curve and then when you make another cut you're going to be sliding down and then you're going to crash at the end. So that's it's very typical. I would say it's extremely common for people to come to my website at after a taper has failed using this particular method. Sean: Yeah, it's really challenging for myself as a practitioner in my practice in my setting, especially in communicating to my staff here, is that it's very difficult for our clients who are on these drugs to be able to get accurate information, safe information from their, from their physicians. It seems like they're following some protocol that is developed. Are you aware of the protocol that these doctors are following and ordered a taper? Adele Framer: Do you mean half and half and then go off? Sean: Yeah, I mean, I hear them say that there's a protocol for each drug on how to safely tape. Adele Framer: Oh well, they're just making a man up. Sean: Oh, okay. I know they make up a lot of things. So, Adele Framer: Now Sean: you Adele Framer: they're Sean: know, Adele Framer: just Sean: I Adele Framer: saying that. Sean: okay. Adele Framer: Now, they don't know how to taper. Sean: Yeah, I don't think so. Adele Framer: The half and half and half and then go off is just pure folk wisdom among doctors. There's no documentation of that at all. The documentation is that patients have tried it or are stalking all of these pure support groups. It's a failed method. Or at least, it was. results in 50% failures. So, yeah, that's where our customers come from that very method. Sean: So then with, and listen, I'm very clear that this is not medical advice. And we're not asking you to provide medical advice. What I am asking for is your experience over 15 years. What have you found to be the safest way to go off anti-depressants when you've been on them for an extended period of time? And I don't even know how to define extended period of time. Maybe you can, maybe you can define that for me. Adele Framer: Okay, so... This is going back to when I joined peer support sites, way back in 2005, 2006. So the patients themselves recognized that this 25% taper rate was not working. So they figured, well, if that's not working, let's try 10%. So they started trying 10%. And this seemed to work better. So, you know, fast forward to 2011 when I started my website, I compiled that information and I made it into what looks like a protocol, but I have to say it's not medical advice. And but it involves a 10% exponential taper, which results in a, it's a decaying curve that has, you know, takes you off the plateau. off the plateau, pass the shoulder, and then down a gentle slope. It's 10% of the last dose you took. So if you start at 100 milligrams, 10% of that is 90 milligrams. So that's your dose for the first reduction. And Sean: for Adele Framer: then, Sean: how long. Adele Framer: well, we advise a month interval between reductions. And this is so that the half life of the drug can wash out. And the half lives of most endopressants are about 24 hours, give or take a few. And so the washout period is five times half life. So that would be about five days. I allow six days for complete washout. So that would be six days. So then at the... People generally develop withdrawal symptoms while the drug is washing out. In other words, the amount in your bloodstream is decreasing, the amount in your brain is decreasing, the amount of the drug is decreasing, and that's when you develop withdrawal symptoms. But some people don't develop withdrawal symptoms during that period, during that washout period, because a tiny bit of the drug is still in in their system, right? Because it's washing out on a curve and another exponential curve. So that tiny amount is supporting their, I guess you say, receptor sensitivity enough so that it doesn't cause withdrawal symptoms right then. So we let the wash out occur over, let's say, a week and then we observe for withdrawal symptoms after that because it can take some time escalate. You know, they'll start out with, you know, like, I feel like I have a cold or a mild headache, and then they can get worse. So we want to allow time for observation to see if that particular reduction was successful. So that's why we're saying a month. I mean, it seems like a seems like a long time, and it does mean that the tapers take a long time. But if you do another reduction prematurely, you're going to have a lot of time to do that. to compound the withdrawal symptoms up, they're going to get progressively worse. So you have to pay attention to mild withdrawal symptoms and take that as a sign that you possibly might need to either extend the amount of the length of the observation period or make a smaller reduction. Sean: Um, are there risks during this period that are observed from your community? Adele Framer: the risk. Sean: Yeah, the risks as they go off in terms of anything that they need to be more mindful of or aware of. Adele Framer: Well, what we find is that drinking alcohol probably causes it will make it all worse. Sean: Mm-hmm. Adele Framer: If by any chance they get COVID or they take an antibiotic, they should not be tapering. Antibiotics can cause symptoms. That seems to be very much like withdrawal symptoms. If you're sensitive to that, there's some kind of a susceptibility when people are in that You know when their nervous systems are in a vulnerable state from tapering it seems as those bad stuff happens with antibiotics and really bad stuff happens with alcohol COVID is a wild card Sean: Thank you. What about supplements or a specific diet or nutrition? Have you found at all anecdotally that this could somehow ease the symptoms? Adele Framer: Well, I don't think there's any real remedy for withdrawal symptoms. But I think that, you know, you have to picture it as your nervous system rebuilding itself. And your nervous system is part of your body. So if you do stuff that's healthy for your body, your nervous system, it's going to assist your nervous system to recover. So if you have a diet of like beer and junk food, it's not going to be as helpful to you in rebuilding. your general health as, you know, like perhaps not having any alcohol and eating like, you know, fresh, fresh food and fresh veggies. I'm a big proponent of fresh veggies, by the way, because of the folate and, which is good for your nervous system and general circulation and digestion and so forth. So I think that if you're a person who doesn't then maybe you should add some. But in general, our diets are terrible and if you wanna heal from any type of injury, it's better for you to eat well. Sean: This barrigus is a great source for folate. I'm eating it tonight. I have f- Adele Framer: Also, oh yeah, you said about supplements. Okay, so over the years, and I think that the withdrawal communities borrowed this from the CFS communities, people have found that the omega-3 fish oil can be really helpful. Now, omega-3 fish oil is another, it's another dietary. issue with the modern diet that we don't get enough Omega-3s. And the fish oil is a good concentrated way to get them to boost our Omega-3s. And the nervous system, Omega-3s play a big role in the biophysiology of the nervous system. So it's possible that Omega-3s will of the whatever readjustments and nervous system has to make. We also find that magnesium as magnesium citrate or magnesium glycinate has a calming effect. And again, this is something that's missing from our modern diets because factory farming has leached minerals out of the soil. So magnesium is important and we don't get enough of it. supplementing with magnesium at small doses periodically throughout the day can cause, you know, can assist in calming and it also has a good effect on restless legs, so which is caused from magnesium is a muscle relaxant. So, so, so we suggest omega-3 is in a magnesium but we're very about supplement packages for withdrawal. Sean: Thank you. This is all great information. I have to ask you a question. I've thrown myself into the literature on antidepressants and I use that term quite loosely, whether or not they should even be part of the mental health care system and approach. And I can't help but come to the conclusion that they were fraudulently brought to market, that any positive effects that are attributed to the drugs may be nothing more than an amplified positive effect. placebo response or part of the natural recovery or doctor-patient interaction. And when it comes to weighing benefits versus costs, given all the safer and more effective alternatives when somebody is struggling, it's very hard for me to ever make a recommendation that an antidepressant should be part of the entire treatment plan. But I seem to stand out on that. I, Adele Framer: You too. Sean: There's not many people like me who are out there making these type of claims, but I call it like I see it. I've been doing this work for quite some time. I don't really come across people who say my life has significantly improved because I found this anti-depressant. I do see a lot of neutral responses. I'm not sure it might be working, it might not be working, but I'm inundated with people who've experienced problems, acute withdrawal, protracted withdrawal, I can't imagine this being a frontline kind of intervention. Now you took antidepressants to start. Do you believe they actually have a place in our system? And do you support their use? Adele Framer: Okay, good question. I understand from our specialist colleagues in psychiatry that there is something that is called, I don't know, extremely major depression that requires antidepressants. Now, I don't treat people, so people don't come to me for treatment of this. So I can't say anything about it. I'm gonna grant, maybe it exists. So I don't know. I mean, I give it, I don't know anything about that. that it seems as though antidepressants are vastly, vastly oversold. The huge minority, the majority of people who are taking antidepressants do not have this extreme condition of depression. And it seems as though that most of their problems are probably the usual family, their history, their lack of emotional support, poverty, things that are not unrelenting, extreme depression that might be resolved by other means. So, My understanding is that a general rule in medicine is to use the least invasive method first Sean: Not anymore. Adele Framer: and Yeah, well and drugs are considered to be an invasive method So so I think that you know that in a perfect world It would be least in bed invasive methods that would be the first resort rather than drugs But but we get the drugs because they're cheap and fast That said My position is that if somebody likes their drug, I'm not going to tell them that they shouldn't be taking their drug. And for all I know, the drug is causing them to, keeping their, whatever their problem is at bay. So, the people who come to my website have voluntarily, on their own, decided that they want to come off their drugs. I don't try and persuade anyone their drugs. Further, and this is only my personal opinion, I think that we're in the last phase of the antidepressant era and that prescribed amphetamines are going to be taking over. Now, prescribed amphetamines are actually much better antidepressants than antidepressants are. I'm not selling them because they're terrible drugs and they're going to bring I will not be counseling people about tapering amphetamines. I'm gonna leave that to the doctors. It's their problem. So, yeah, so I think they were seeing a real, real serious upswing in the prescription of amphetamines. And in fact, amphetamines make everybody feel more competent, Sean: more confidence Adele Framer: more Sean: for Adele Framer: active, Sean: that dance. For some confidence, Adele Framer: more self-confident, Sean: more energy to dance. Adele Framer: more imaginative, Sean: For that dance. Adele Framer: more everything, and that's why they've been so popular as street drugs. So, but again, you know, they have their downside, which is very, Sean: Thank Adele Framer: very Sean: you. Adele Framer: richly profiled in the addiction medicine literature. And you don't have to be overdoing antidepressants and lying in the gutter as a tweaker in order to become dependent on them and having those medical problems that arise from taking into taking amphetamines long term. And we're seeing here in California just an absolute rash of ADHD diagnoses, which in some cases are really absurd, especially down in Silicon Valley. So that's where I am with Andrew's prescription. Did I cover your question? Sean: It's a reasonable response Adele Framer: Thanks. Sean: and it doesn't differ much from my viewpoint on it. I think most people who are coming for help when they're struggling want to feel better. So that's our point right there, is we give them accurate information in order for them to take the steps to improve their life. That, in my opinion, is not drugs. And I hope you're wrong that we're moving into amphetamines to be viewed as anti-depressants, because I mean, it's the same idea of saying alcohol is our social anxiety drug. Right? Adele Framer: Yeah. Sean: So, like, to think about our, the quality of our lives and our mental health in terms of decreasing any, you know, emotion that is viewed as uncomfortable or difficult through drugs. I think it's a dangerous ideology be to be honest with you because it always leads to the same road. I mean, the path that one takes is now you have a drug abuse problem and rather than a what we would, you know, cause a mental health problem, mental health problems are something that can be, you can evolve through Adele Framer: Well, Sean: with so many different ways. Adele Framer: yeah, Sean: Go ahead. Adele Framer: I would say it wouldn't be a drug abuse problem. It would be a drug dependency problem because it's not, they could be taking the drug as prescribed, but they'll be dependent. Sean: Exactly. Adele Framer: So, you know, so we're not saying that people are going to be, you know, like, end up as, you know, like. type of addicts that they see in movies, but they're going to become dependent on the droves so that they won't be able to function without it. Sean: I make that mistake all the time. Adele Framer: Yeah, Sean: I Adele Framer: yeah. Sean: use that word abuse instead of dependence and I apologize. Uh, I get that sometimes in a background social media and I have to apologize Adele Framer: Yeah, you're Sean: again, Adele Framer: gonna get Sean: it's Adele Framer: some Sean: a Adele Framer: big Sean: slip. Adele Framer: jobs Sean: Yeah. Adele Framer: for that. Sean: It is dependence, right? Your body is now dependent upon it. Adele Framer: Yeah, it's dependence. Yeah, well, it could be that amphetamines won't be the drug of choice, but it seems like, boy, it seems like there's a real, it seems like they're going up on the charts right now. But I think that also that psychiatric prescribing, whether it's done by GPs or done by psychiatrists, is truly moving into the area of lifestyle medicine. What they're doing is they're helping they're enabling people to continue certain lifestyles with the drugs. Which I think is a real ethical slippery slope for medicine. But we could be moving into an era where it's okay. However, we don't have any structures to deal with the dependence. and cis issues that might arise from this. So we have no structures for that and the doctors are not informed about it at all. So what we have is kind of like, you know, it's one of those, there was that old ad that, you know, for this, you can get in, but you can't get out, kind of thing. What was it for Roche motels? Sean: Oh yeah, the Roche Motel, yeah. Adele Framer: Yeah, yeah, yeah. Sean: So Adele Framer: So Sean: true. Adele Framer: you get into the sticky part of it and then you're stuck. So you might want to cut that part out. Sean: No, no, that's perfect. That's a great analogy. It's so true. It is. It's honest. I'm just curious. You know, willing or unwillingly, you've become a great resource regarding antidepressants. What leaves you hopeful? What's coming up that makes you think that we're really kind of moving into some improvements? What are you seeing? Adele Framer: Oh boy, well, I think that the, I think something new and unusual is happening here in that the, there's so many people who have been exposed to psychiatric drug withdrawal. And they're finding each other on social media. And some of them are influential in high places. So I think that this is a patient movement that maybe medicine hasn't seen before. There are patient movements, but this one is, I think there are good reasons for people to coalesce, and they are determined, and some of them are really angry. Sean: Mm. Adele Framer: So there's, I think, quite a lot of, and members for this, are created all the time because of the ongoing prescription. So there's like generations upon generations of people coming in, you know, the Zoomers are about to have difficulty with going off of drugs. So they're gonna be joining, you know, it's just, it keeps on getting refreshed and it can't help but get bigger because there are so many people on psychiatric drugs. So that I think is a new thing. And I think that we're, we're seeing, I mean, those of us who view this through the lens of Twitter is that psychiatrists have been quite a hard time dealing with this. And they really don't want to hear the outcry from the patients. Again, some of them are very angry. And that might be hard for professionals to listen to. But, but I think there's a lot of patient activism that is unprecedented. In the UK, the reformers have gotten very well organized and have been moving forward with working with the NHS to change their guidelines. So there's some improvements that are actually being codified in medical practice in the UK. Sean: Thank you. Yeah, I think that's a brilliant analysis. Um, and I see the same thing on Twitter. I'm relatively new to Twitter past couple of years. And one of the things that has absolutely. Appalled me has been the reaction from some of the psychiatrist to those who have been harmed, um, the level of arrogance and, uh, repeating pseudo, pseudo scientific ideas that just invalidate the experience of the patient is so, uh, anti their ethics. And it's been really, really disappointing. I think it's fueled a backlash and an anger and an anti-psychiatry movement. Adele Framer: Yeah, I think that they don't do the profession any services. But I would like to point out that some people make more noise than others. And there are sympathetic psychiatrists and sympathetic GPs. And among my followers, and I think I'm real clear about where I stand, this is a secret. I do have psychiatrists following me. Sean: Yes, it's very important to not over generalize. We've had some great discussions with some outstanding psychiatrist on this podcast. There are psychiatrists who have kind of innovated and moved outside of what has been typical contemporary DSM drug model. It's still the overwhelming majority, Adele Framer: Yeah. Sean: but there are innovators out there. And like anything, right? There's great people who are very compassionate and kind. Doug Beach on here, I put him in that category. There's a lot of really good doctors and physicians who just want to help. Oh, and they're kind of victims of the, the Adele Framer: Thank Sean: system Adele Framer: you. Sean: in which they're, they're trained and the power of the pharmaceutical industry and the allopathic medical model, the training, the academics that have been on the payroll. So they believe that they are following best available evidence and they believe what's written in their textbooks. really understand some of the corruption that's behind it. And that's the unfortunate part. I think they're post COVID, especially there is a bit of a mass awakening, uh, to not blindly trust the, the medical authority and to be able to take some responsibility for your health by doing research, listening to podcasts, getting alternative information and asking critical questions. I want to end this podcast by just asking this final question. If an antidepressant is recommended by a medical professional, even what you've known now for 15 plus years and what you've experienced yourself, what questions should patients be asking? Excellent. This has been a conversation that exceeded my expectations. I am really glad that you are more public now because you're really, really smart. And I got better analysis today on antidepressants and antidepressant withdrawal than any physician that I've tried to consult with. And I know that you're hesitant to put yourself out there as an expert. because you don't have that medical degree. But I think all our listeners would probably agree that you have a vast amount of knowledge, you follow the scientific literature, you have experience, you have lived experience, and you have hands-on work with thousands of members to try to develop some headway here in science and safety. So Adele, I really wanna thank you for your contribution, everything that you're doing for those who have been experiencing what is amounts to health for too many people. And then just your work as an advocate because you're bringing attention to a really important issue that's I think saving lives and helping people. So just from the bottom of my heart, I want to thank you. I want to thank you for this excellent conversation. Right. The Dell, that was excellent.