Mark Horowitz, who is based in London, UK, was on the path to becoming a psychiatrist when his own experiences with psych drug withdrawal forced him to rethink everything he had been taught. Prescribed an antidepressant during his studies, Mark believed he was following sound medical advice. Yet, when he attempted to taper off, he encountered severe withdrawal symptoms that none of his training had prepared him for. This episode explores Mark’s personal journey, the systemic ignorance surrounding withdrawal, and his efforts to bridge the gap between medical education and lived experience. His story serves as a cautionary tale and a call to action for greater awareness and reform within psychiatry.

You can find out more about Mark, related organizations, and resources here:

• Mark Horowitz on Bluesky: https://bsky.app/profile/markhoro.bsky.social
• Mark Horowitz on X: https://x.com/markhoro
• Mark Horowitz’s website: https://markhorowitz.org
• The UK's Royal College of Psychiatrist’s guide to stopping antidepressants: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants
• Official publisher page for the Maudsley Deprescribing Guidelines (also available from other bookstores, including Amazon): Wiley.com

Transcript (AI generated)

00:00:00    I've taken a drug I don't feel very proud about that I don't think I said it to very many people for many years that I was taking such a drug so I'm going to go back on the drugs that have caused me all this trouble but coming off them causes me you know even worse trouble and I felt really trapped I quickly realized hold on the evidence for all the drugs we use are based on cromy studies you they are all based on stopping the drugs quickly they all ignore withdrawal effects it's bloody obvious to me that anybody that comes

00:00:28    off these drugs quickly is going to get into huge trouble that's nothing to do with relapse so Mark um thanks for being here today let's just jump right in sure um I'd like to I want to start and ask you well I want to ask you about your initial experiences with psych diagnosis and psych drugs but before we get to that um could you fill in for us a little bit about your life prior to encountering the system okay um so I I'm Australian I grew up in Sydney I grew up in the Eastern suburbs of Sydney if you've

00:01:15    heard of Bondi Beach it's a very nice part of the world I grew up near there I wasn't very good at surfing um I grew up in a Jewish Family probably very focused on uh professional achievement um in in in the in Sydney my father is an eye surgeon my mother's a pharmacist lot of people in our family are doctors or something uh medical Associated um I went to a uh selective private school in Australia it's a uh it's an Aussie knockoff uh of of Ean basically TR well but it's but a lot a lot more a lot more basic the Aussie

00:02:01    version so uh three piece suits uh gray suits um uh standing up for the Masters when they walk into class uh examinations from the age of five onwards uh basically um uh that's that's and I and I was a very good student very academically inclined very good at memorizing things for exams uh and maybe my in my family uh there's a big a big sense of humor a lot of watching Seinfeld and Woody Allen films and The Simpsons growing up and I've got two younger sisters uh that was that's a that's a broad brush Strokes of my of my world

00:02:54    and I went to medical school after high school and was Medical school always sort of the plan for you what what Drew you towards medicine so I was a very conflicted young man so I I was yearning to rebel against everything around me um and uh and so I wanted to be I was an aspiring writer and scientist I would have said if You' talked to me back then and yet I felt a uh a magnetic pull towards things like medicine and which were the kind of that was sort of marching that was the that was the song

00:03:35    in the background of my school um and so when I when I applied for different courses I had down medicine philosophy and physics and I ended up getting into medicine although I was very very ambivalent about it right from the beginning I was very reluctant to do it yeah you know there was I guess there was some inbuilt there was some inbuilt nothing explicit but there was some inbuilt cultural expectations of of the sort of person I was at the sort of school I was on I was at sort of family I was in that that that made sense and

00:04:10    of course my father was a doctor that was sort of it was in the it was in the water around meh it was not it was not a shock to hear that you were that you were considering entering medicine as a field there was no no no it was it not a shock y y exactly so from there what you know I don't want to say what changed because ites doesn't sound like anything necessarily had to change but in hindsight your first encounter with you know psychiatric treatment or or say let's just say the the broader Paradigm of of mental health

00:04:56    mental health care whatever you want to call it you know was that that sort of destined for you just sort of the the type of kid that you were and the situation that you were in do you feel like that was probably an eventuality that you were going to find yourself in a first appointment at some point I think the thing that got me the thing that put me on a trajectory towards the mental health system or towards mental health medications was um my experience in primary school and high school so I was very

00:05:28    short uh very young I think I was one of the youngest in the year if not the youngest uh you know very good academically and I wanted people to know that and I think that's where a refugee mentality comes into things so I was taught at home you know to strive and I think you know the polite the polite term would be I attracted negative attention from my social group in other words I was I was badly bullied for years uh you know I I also had a je fro now my hair is uh I'm I'm rearranging the deck chairs on the Titanic but back

00:06:01    then you know I had I had like a a 30 cm High I I'll send you a photo 30 cm High je uh which also uh was the uh was a was a became made me a figure of fun and so I was I was bullied particularly by a guy in my year who was an academic rival of mine but a foot taller went through puberty you know he he may as well been four years older than me um and he sort of led a group and they threw me in the bin at lunchtime they made fun of me you know I went through whatever probably uh regular level horrific bullying during during primary

00:06:42    school and that had a huge effect on me you know it was very caused me huge amounts of Shame um you know it created my self-esteem uh it made me very uh nervous to go to school and it continued in differing degrees at high school with a little bit more sophistication not quite person in the bin but but uh the kind of emotional Warfare that that young young young people can can generate towards each other so you know that was probably the major thing in my life if if I was told if I was asked at

00:07:13    the age of 15 why are you so miserable horage which I was if I to articulate it would have been because I felt you know bullied very very malign by uh groups at school and I was extremely um dysfunctional in my response to it although I've been told it's not the most abnormal response I spent rather than running from it I spent years trying to make these people like me so I had this incredible um response someone told me there's fight flight fright and also there's another one where you're trying to make them like you I can't

00:07:45    remember the word is uh for for for yeah for so I did I did I went I went hardcore on foring um which I think was with highly pathological when I look back on things that I'm ashamed about I'm particularly ashamed about my response to the whole process but anyway I actually met a friend of mine recently who said I said I spent all Primary School being bullied and all of secondary school trying to make the bullies like me and she said I did the same thing which was a bit nice to hear um and and that basically meant so I

00:08:14    sort of had this kind of duel world I did have some friends in high school some genuine friends but I I sort of had this kind of negative thing on me all the time I was very academically successful so I think I was putting out a lot of green lights to people people thought look this guy topping exams getting prizes you know everything's okay so I had the opposite orientation to most people I felt class was safe lunchtime was was much less uh less of a happy place um and so I was quietly miserable I kept a diary at that time

00:08:46    which I've got which I plan to look through when I write my uh comic Memoir um uh you know that's full of misery that's full of I feel miserable I'm you know life is awful and so when I sort of it it a little bit informs why I did medicine actually um if I'd been a self-confidence person I would have done writing and I would have done you know science and and and uh and and writing I would have taken a bit of a risk but because I sort of had such a low sense of my self-worth I sort of thought I'm

00:09:21    clever but I you know but basically I feel so worthless I kind of didn't make a bold move I sort of thought ah I'll sort of do I don't know I sort of thought I'll do what is sort of safe or easier in some way and so medicine was kind of I sort of thought of it as a low low self-esteem choice for me you know I had the marks for it so I know I know lot of people out there aspire to do medicine but for me it was sort of it was it was a bit of a uh safe choice so basically I'm kind of a miserable character I'm doing a course I

00:09:53    don't really love I come in with without a great sense of my my selfworth um I go away I'm also not I'm also not doing that well at medical school because I'm very unengaged uh I decided to go away for a year and going away to that small town was very isolating you know I felt it sort of it it made me feel quite lonely and quite depressed I sort of too embarrassed to to borrow a book that said you know how to feel better but I would uh I I I so I stole books from the library I stole um I apologize to the Port mcari library for

00:10:28    listening I'll I'll I'll I'll I'll bring the book back I I um I I I um I I I took a book called why you can't afford the luxury of a negative thought which is basically a CBT book and another couple of CBT books on on on how to be less of a miserable uh bastard um and you know I was also reading cfar and I was reading um nii you know I was sort of trying to work out you know I sort of had a sense of myself that I'm miserable because you know I'm a I'm a great intellectual and just like kafu and just like nii and if

00:11:05    I can you know it's part of my intellectual and philosophical journey to work through whatever I I had all sorts of different ideas I'm reading CBT on one hand and I'm reading n on the other hand and I basically thought look I am miserable you know I wake up in the mornings I'm exhausted I can't keep up with people at work um I my sleep patterns were off you know I also it's another little thing I I definitely have a delayed phase sleep kind of thing you know I'm definitely a night owl a lot of

00:11:32    teenagers are but I think I've got it worse than the average I remember kind of thinking I either need to change everything in my life about what I'm doing and who I am or there's something wrong with me I don't I don't know if I articulated it that clearly to myself but I had something like that in my in my mind and for whatever reason I decided you know I'm going to go see a doctor so I I don't know if I decided that it must be something wrong with me rather than being this philosophical existential

00:12:00    dilemma but I ended up in my family doctor's office at the age of about 21 saying you know sort of very full of Shame very nervous you know work out the courage to say to her I think I'm depressed and I think I need something and I and I sort of think about where did those ideas come from you know I think in my family you know one my mother's a pharmacist that I mentioned you know it is a very it is a very medical kind of millu there so that growing up with my in my family there was a ceiling to floor cupboard in in

00:12:38    our kitchen full of medications for nausea for headache for whatever I sort of wonder if it was her influence if it was lectures at University I heard about these drugs and they all sounded pretty safe and effective and I sort of think people in my family or my friends may have been on them so for whatever reason it seemed incredibly normal for me to walk in on a afternoon to my gp's office to ask for an anti-depressant which is basically what I did and I remember being extremely excited to try it I

00:13:06    remember thinking you know all these troubles that I've had for months or years you know all these dark thoughts it's about to be washed away you know this is this is amazing you know I and I basically ran to the pharmacy to get the script filled you know there was green and white capsules and you know I popped them open and I was excited to put it in my mouth and and I I think the main things I had were you know I had a lot of weird side effects I remember feeling um a bit intoxicated a bit drug

00:13:41    affected I had used ecstasy maybe three times by the age of 21 uh in my more in my more Wayward youthful years and I felt a little bit like that not as strong as that but I felt a bit like things around me were a bit different you know they were a bit uh altered you know it wasn't that I was going to you know go raging for six hours at the local nightclub but I just felt like things were a bit like I had one and a half beers and I had this funny yawning and I felt a bit dizzy and I think I went back after about two

00:14:15    weeks and said I don't think I'm I don't think these things suit me very well I've got all these funny this funny sensation he said okay let's try another one I don't know if that one with Zoloft or something else but I tried Zoloft and I had similar effects to coming to to the to the pro Z of flutin again I felt a bit drug affected I felt a bit woozy I came back a a third time a few weeks later I said I don't think this one suits me and she gave me Lexa Pro apram and I went and took that and I I I

00:14:45    can't remember the exact details of it but I think I had similar effects but I just sort of thought oh they're obviously all the same I'll just stick on this one I can't be bothered going back again um and people always ask me did it and did it improve your mood you know did it fix things and I can't even I can't even really remember I certainly don't think it made me you know feel a whole lot better I can't really remember it made me feel differently definitely I do remember at that point I was actually doing a psychology

00:15:13    degree alongside my medical degree uh and I remember writing an essay in which I knock the crap out of psychology and I I remember thinking this is a little bit uncharacteristic for me to be so kind of rude you know I sort of having a go at my lecture I I remember thinking I'm a little bit disinhibited actually um you know I'm being a little bit risque in this essay and I'm being a little bit I wouldn't normally you know be like this I'd normally be trying to get a good Mark so I remember feeling I'm a little

00:15:42    bit High maybe on these drugs and then when I got the mark back which wasn't very good I sort of wrote by then I was a little bit more sober and I wrote something back saying oh I think you misunderstood this and I rewrote the essay a little bit I tried to make it a little bit more conventional during the you know in school you're being bullied quite a lot um as you get older you and you're experiencing as a result of that bullying a sense of inadequacy in yourself I mean this is what I'm hearing

00:16:10    you describe yeah um did you have you know at at at any point and I think this is true for most people and it shifts over time but at any point did you have any sort of specific name for or any specific at all around the deficit that you possessed like what was wrong with you or what were you lacking yeah and then sort of the natural followup to that is you know did that square with what led you to seek psych treatment because oftentimes people do pursue psych treatment because you know they they they

00:16:55    understand that especially drug treatment can correct an imbalance or a deficiency yeah so the answer is I definitely didn't think that sorry to ruin the narrative you know I if you if I go back to my adolescent diary I'm sure it was full of the word depression you know I've got depression um but I I guess you know I never I never really thought that means I've got a biochemical deficit that there's something wrong with me I mean I sort of understood it as being I'm having a miserable time in life so I'm

00:17:25    depressed I also thought this sort of fits into the kafkan nii Woody Allen Philip Roth you know this this this low mood is a little bit a part of being talented you know this is a sign of uh you know artistic depth you know I was reading a lot of Salinger you know I like any adolescent I'm listening to radio head you know I kind of thought this is you know I if I was brave enough I would have worn eyeliner and and and black clothes but I wasn't I wasn't brave enough so I you know I was uh I sort of thought this all yeah this all

00:17:57    fit into this this uh uh you know deep deep deep uh deep feelings um uh so I I sort of I mean in some ways I remember I remember saying to a family member who who also had low mood something about you know you shouldn't use anti-depressants um because you know you know n didn't use anti-depressants you know this is part of the Dilemma of Being Human you know and you and solve existential Problems by solving them not by using drugs so that was a little mini lecture I gave to a family member early

00:18:35    on so something in my mind must have been you know read or reading this philosophy you know thinking about things in a different way and so I sort of remember you know whenever I went in at the age of 21 with my tail between my legs to my GP you know there was something shameful really about asking for drugs and about you know I remember going into the gp's office you know to squeak out in my little voice you know I I think I'm depressed uh I want drugs felt very shameful like giving in like I wasn't

00:19:05    taking you know I wasn't doing whatever nii would have done safe to assume though for some people they they you know encounter sort of like the biological reductionist perspective on whatever their diagnosis might be or whatever the treatment um they're engaging in is and and it feels like a revelation to them that was certainly yeah not your experience I don't I don't I don't think so I sort of you know going back to that thing where I thought everything is wrong in my life and I need to change

00:19:41    everything and I sort of still felt that I sort of still felt like I you know I try to formulate myself in my in my diary I'd say you know I'm like this because of what happened at high school and because I'm you know haven't taken decisive action to change my course and I you know I'm too introspective and I ruminate too much and the self- book is saying I should you know write down 10 things to do for the day and I should so I sort of felt like I've taken a bit of a cop hour you know I I haven't changed

00:20:08    who I am I haven't solved these existential dilemmas I've taken a drug I don't feel very proud about that I don't think I said it to very many people for many years that I was taking such a drug so I I don't I didn't really walk out with that thing that some people have well I've got a diagnosis now it's not my fault the drug will fix things I hadn't taken the high road is what I felt mhm was there formal diagnosis I guess is is something I didn't hear more follow yeah I mean I walked into my G's office and said I think I'm

00:20:38    depressed she said yeah you seem I mean I I can't remember what she said I think she would have said yeah you seem depressed I don't I don't remember there being you know there wasn't sort of a DSM pulled out or a major depressive disorder anointed so it was I think things were a bit more casual in Australia probably altogether but I think it's probably true of most doctor interaction is not it wasn't all very formal um were further drugs added so so then the story after that was I had a lot of trouble for years with daytime

00:21:06    tiess and fatigue and memory and concentration issues so I I had real issues with tightness at during University so I would fall asleep in lectures I was exhausted a lot of the time I began to take naps in different places I would steal away especially at hospital so to some degree University it's a bit more you know taking naps in the library is kind of almost normal it became more abnormal as I got into working as a doctor um you know I remember thinking I'm I really can't keep up with people around me and I

00:21:41    would steal off to the on call room to have a nap in the middle of the day I would uh you know I'd close my eyes in the bathroom I was doing things you know to to to get to have rest um to the point where I was I was a first year Psychiatry trainee now now I'm sort of 28 um in Sydney and I would go to my car almost every lunchtime to have a nap and I would set up um you know in in Sydney is very sunny so I set up these kind of um aluminium things that you'd put up to protect your car from from Sun but I'd use it to hide

00:22:17    from people around me so they wouldn't see that I was in my car asleep and I had this fear that you know my bosses would would walk by and catch me asleep in the car and I was exha I mean I was I was exhausted going through the day I'd have hug huge amounts of coffee to try to wake myself up and I you know I I felt it was it was like the overriding sensation of that entire time just how how exhausted I was um and again being medically inclined I went to see doctors to get diagnosis and I got various

00:22:46    different diagnosis I went to a chronic fatigue doctor and I got a diagnosis of chronic fatigue syndrome um and I went to a doctor who who was a sleep position and they diagnosed with narcolepsy I was given stimulant medication for that um uh that was that was Rin mfil and I and all of these drugs made me feel horribly anxious and so I tried this one and I tried that one I stopped that and I and I developed a spreadsheet to work out if I take half a dose at midday and 3/4 at 3:00 and I stop and I

00:23:20    have nothing after 5: can I sleep at night and not feel too anxious and feel a bit more awake and if I use so I became this kind of um self-experiment menting um person with stimulants went to take them to try to maintain wakefulness and alertness and not become very anxious and basically it never quite worked I became a bit of a wellness bro um or a self- experimenter because I was just trying to do whatever I could to become less tired so you know I took up intermittent fasting I took up carnivore sorry paleo diet exercise you

00:23:58    know this supplement that's you know I did anything I could to try to get an edge on feeling tide uh light box in the morning no light at night time melatonin I did everything possible you know with spreadsheets to try to work it because it was really having a big effect on my life you know I was I was um I was not performing well at work and that's the point at which I went to do a PhD in London and I did that for two reasons one because you know I wanted to sort of in the cliche I wanted to work out you

00:24:27    know what was happening with me why I was depressed what do antidepressants do but number two because I couldn't keep up with clinical work I found it I was so tired that I I I thought I'm not doing a very good job here I should go back to academic work where it's a bit more flexible that basically brings me into my early 30s where I'm doing a PhD in London and and then I read about an article about withdrawal effects manity to presence so was your your first exposure to the idea of anti-depressant

00:25:00    withdrawal was in an article Yeah so basically there was a a Blog semi- poopular in the UK that would explore psychiatric um issues in an easy easily digestible way called the mental elf so rather than being about mental health it was mental elf that was the that was the gag and it was an article about it was by there's a Giani fa wrote a review about withdrawal effects from anti depress in 2015 and this was a Blog about that paper and I read it and I found it shocking basically shocking shocking

00:25:39    how um you know it was basically talking about anti-depressants you know they sounded like people were coming off heroin you know they people getting withdrawal they were getting electric shocks they were getting fatigued they were getting uh headaches and I thought you know this little drug that I've been taking out for 13 years is causing people to have all these symptoms and I had two thoughts about drugs that cause withdrawal effects number one you know which my field spends a lot of time denying but any drug that causes

00:26:09    withdrawal effects also causes tolerance effects the more you become accustomed to a drug the more you miss it when you when it's gone so tolerant to withdrawal the flip Sid of the same coin that was obvious to me then it's obvious to me now so I thought hot on a drug that causes withdrawal I've been on for 13 years how can it be doing anything after 13 years you know uh the same you know if you have the same kind of cup of coffee for 13 years it doesn't do almost anything to you and number two I mean

00:26:35    drugs that cause withdrawal are drugs like Valium and uh and and and Adavan and Xanax which I know America is a different culture but those drugs you know are are seen as very dangerous drugs in Australia and the UK you know those are drugs you don't want to be taking I was taught you know don't give these to patients unless you really need to because they cause all sorts of trouble and of course Oxycontin or op oids cause withdrawal so I thought hold on I'm on a drug that causes the same sorts of things as these dangerous drugs

00:27:05    uh you know what's what's going on here I was sort of irritable I'm thinking I can barely keep up with my PhD you know and have a relationship you know I'm barely holding things together so I had you know it was a huge stress in my life and one of the things on my list it wasn't at the top but it was somewhere in the middle was maybe the drugs that I'm on are causing this umh and so reading this article but antidepressant withdrawal was sort of enough to push me over the edge to think well it's been on

00:27:32    my to my list at number 10 maybe come off my anti-depressant you know this pushed it to number one and so I thought I'm going to I'm going to try to come off my drug if it causes withdrawal effects I don't think I should be on this and that's what that's what sort of stimulated me to try to come off the drug so so walk us through what happened when you did you know start on this this new Mission it's your new it's now your top priority it's the top of your spreadsheet it's it's you know but you're focused on your eyes are open in

00:28:02    the morning and you're like okay this is my new number one thing so so walk us through that a little bit I basically went and read all the papers that my professors had written on how to come off the drugs you know I I was working with you know I was working at one of the top institutes in the world when I do this so a lot of them you know were were top people and the and they said you know discontinuation symptoms are brief and mild and you come off in 4 weeks I thought oh that doesn't sound too bad I looked it up and I found I

00:28:30    think surviving antidepressants pretty soon and a few other I don't know answers.com or whatever and people said these drugs are really hard to come off we get horrible symptoms um it's taken us months to years and I read about you know filing down tablets and opening up capsules and Beads and liquids and I thought I thought that sounds pretty plausible you know that makes sense to me that doesn't sound crazy and so I sort of was a bit I sort of split the difference I thought I'll kind of go halfway I won't go as quickly as my

00:28:58    profess and the guidelines say and I won't go into fullon Overkill like people online and I thought I'd come off over 4 months I'd have my dose every month for for four or five months I got down to a milligram of Lexapro which is you know much smaller than the smallest tablet things got pretty awful uh you know I had trouble sleeping I'd wake up you know in fullone panic you know my heart beating Palm sweaty feeling like I was being chased by wild animal on the edge of a cliff and I would feel that level of of

00:29:32    Terror and panic you know for 10 or 11 hours of the day I'd feel a bit of relief in the evenings I felt very derealized things around me appeared not real I felt dizzy and I was working at that time at the national psychosis unit one of the kind of top units in the country for dealing with people with psychosis I I was working I think 3 days a week I'd finished my PhD um and I was sort of like crawling to work I remember I was getting a lift with my with a with sort of another Psychiatry trainee and I was thinking I

00:30:03    just got to hold it together for this car ride you know just try to act normal you know I kind of got through the day I'd sort of take naps in the in the bathroom I'd sort of run away at the end of at the end of the day I would I would uh I would the day off I would sort of spend in bed I took up running you know I ran kilometer after kilometer I ran onto my feet bled because it gave me a bit of relief um I would I would sort of you know i' live in Terror of the mornings the mornings were were were sort of absolutely

00:30:34    terrifying to me um I thought the other thing is in reading these forums I came across all these people saying that being on anti-depressants had made them fatigued that they ended up napping during the day that some of them had been diagnosed with chronic fatigue syndrome and narcolepsy and I thought you know oh my God you know this is this must be what has happened to me and for the first time in my life I thought you know maybe I'd be better off dead um and I thought I thought or or I thought

00:31:01    I should go back on the drug because you know I think that going back on the drug makes things better but now but now I'm going to go back on a drug that's caused me all these health problems I started to think probably the last 10 years or 13 years of being tired all the time is probably because of these drugs so I'm going to go back on the drugs that have caused me all this trouble but coming off them causes me you know even worse trouble you I felt really trapped I ended up going back on the

00:31:25    drugs I think I went up by a milligram every week or two and after a couple of months things settled down and I thought you know I'm bloody I'm back on these drugs you know not because they're helpful but because I can't get off them because I almost died coming off them and I I put it in the back of my mind for a couple years I went back to training in Psychiatry I sort of didn't really I didn't really stick my finger into all this stuff I sort of thought the drugs are harder to come off than people are

00:31:49    telling me at work but I didn't really get into you know what do the drugs do or what does this mean about the drugs I kind of had this sense that smaller doses do more than people think and the drugs are harder to stop but I basically went back into mainstream Psychiatry without major qualms you know I had I had the OD debate with somebody they laughed at this person of being on a small dose and I said that's not a small dose because of the way the drugs work but I basically went back into normal

00:32:14    normal psychiatric play so now I'm on five drugs I'm on two anti-depressants I'm on a stimulant um I'm on a sleeping tablet or a zed drug and I'm on zym the specialist drug for narcolepsy and I'm seeing a lot more that's actually the first time I saw a psychiatrist in my life um and I was basically worse than I've ever been you know I I was finding it hard to think straight at work I was sort of wandering around my hospital with a clipboard writing down anything that anybody said to me cuz if I didn't write

00:32:43    it down I couldn't remember anything my memory you know was like a goldfishes I you know I I began to think I'm napping I I'd arranged to have naps in the on call room for my narpy I was working 2 and 1 half days a week it's all I could it's all I could handle I remember thinking you know this is starting to get unethical for me to practice medicine because I am faking it you know I can't remember things and basically I had a supportive boss at that time and I rather than take rather than have ECT or take lithium or Cline

00:33:14    or be admitted I elected uh for the the Bourgeois middle class alternative and I went for a trip to Thailand to yoga Meditation Retreat I took the um the uh the slightly cliched uh option there uh and I and I took a break for eight days I went to this uh Retreat and I uh I did all this um walking meditation and I basically decided you know I'm on all these drugs now I'm doing as I'm doing as badly as I've ever done in my life you know why am I even on these drugs to start with it's because I have these you know

00:33:54    negative thoughts about what happen at school that come up sometimes do I really need to have these drugs to deal with that and that's when I decided to come off the drugs and I to to sort of to um summarize a long story I read surviving anti-depressants I read the withdrawal project uh I read and I you I didn't read papers by my professors I read I thought I know who the experts are now you know the people on these websites that have had trouble coming off the drugs and I basically followed you know

00:34:24    what's now called a hyperbolic taper reducing by a certain proportion every month and you know I started in Thailand I took a couple of months I took leave I never went actually I never went back to that job after I left it you know I I uh I think I started off with tablets I got a liquid I went down by 10% every month a lot of my daytime fatigue and memory and concentration problem started to resolve as I went down on the drugs you know and I started to think you know things that I've been taught about

00:34:49    psychiatric drugs nothing was as it as it seems and that's when I really you know I felt like the scales dropped from my eyes and I went to work with j monrie in London you know on this trial to help people stop anti psychotics because I thought you know this is the most important work to be doing in this area is to is to is to how to how to help people stop these drugs and then you know that's what I've done the last few years that's what my work has been about so the so this moment when the scales fall off your

00:35:18    eyes it's interesting that your first your first you know trip around the merrygoround that initial attempt at a taper yeah that was not enough you know going back up on the drug and and discovering that through reinstatement like this resolves you know that's pretty you know clear confirmation of what's going on that was obviously not enough and you know sort of what I'm hearing correct me if I'm wrong but I'm hearing you know a sense even at the time of you felt as though you had more or less hit a bottom because you had you

00:36:03    you're now on five drugs and doing worse than ever um and even that was not enough to sort of you know uh awaken some people would call an aha moment or like there's an internal paradigm shift that gets hard to ignore after a certain point so so in your experience that happened once you started tap in and feeling better from the five from the five drugs and and and how was that Revelation or reorientation was that you know was it important to have read the work of researchers and and journalists working

00:36:47    in this space was that part of yeah yeah yeah so so I I thought about this a bit so the first time I came off the drugs and had this huge trouble it did not trigger a huge huge um you know maybe I'm not maybe I'm just not very clever but it didn't trigger a huge questioning of the psychatric Paradigm I basically thought these drugs are obviously much harder to come off than people say they are you know that was clear to me um uh and the smaller doses have bigger effects than than people think and I

00:37:17    remember when I went back to practice I remember that I did spot a couple people with withdrawal effects some old guy came off his drugs and became suicidal for the first time in his life and I said this is probably a withdrawal effect so it it had had some you know imprint on me but no it didn't make me think that the entire psychiatric Paradigm was nonsense um but I think the thing that unraveled things for me was the books you know I I'll tell you what actually I can tell you I can even tell you what

00:37:43    page it was the thing that got me so on on Surviving anti-press they recommended Joseph Glenn mullen's book um it's called coming off anti-depressants or the or the anti-depressant solution and that book is basically you know the drugs and cause withdrawal affair and um coming off them slowly makes more sense doesn't quite get the hyperbolic stuff but he says a lot of useful things it's a very good book that didn't make me question the Paradigm he had an afterward in it in the afterward he said

00:38:13    how has this all happened how come most doctors don't understand what's going on and so many people have this trouble and he wrote It's a 10-page afterward um and he basically goes through this is what happened they reported withdrawal effects in the 1990s the companies got nervous they put together a consensus panel the consensus panel used this phrase discontinuation symptoms they wrote lots of papers they send it around to lots of doctors to say these are brief and Mild um so that people would

00:38:40    become so people wouldn't get nervous about the issue and they would save their product and on that consensus panel in 1996 organized by ili liy was the head of my department so I'd done a PhD uh under a professor and my professor was under another professor who was the head of the department and that that Professor Alan Young hi Alan um uh was one of the people paid by Eli Lily to write papers to say that these withdrawal effects were not a big deal and suddenly I thought you know it was a bit like The Usual Suspects you know I

00:39:13    don't know if you've seen that film where everything is different at the end I thought hold on the guy that was the head of my department I thought it was you know too big a shot to even speak to is being paid by drug companies to minimize the effects of the drugs that I'm now on that I almost died from that that page you know changed the course of my life I thought you know what the hell is going on I realized that if I'd walked into a doctor's office with these withdrawal effects I would have been

00:39:37    told I've got a panic disorder or I've got depression or I've had a relapse and I I hadn't understood in my training that the all the evidence for the long-term use of these drugs was based on these trials where they were stopped quickly so it was obvious to me that all of these studies were based on withdrawal effects being misclassified as relap so I sort of thought you know this is in Reading Anatomy epidemic I quickly realized hold on the evidence for all the drugs we use are based on crummy studies you that are all based on

00:40:05    stopping the drugs quickly they all ignore withdrawal effects it's bloody obvious to me that anybody that comes off these drugs quickly is going to get into huge trouble there nothing to do with relapse and so you know within two chapters of reading anatomy of an epidemic I thought well 95% of my field is based on you know [ __ ] studies taking a parts from this I but I think we should come back to this but just to check in so where are you at in relationship to these drugs now so I was in I was in Thailand in

00:40:39    August 2018 so when I started tapering it's now October 2024 so it's 6 years later uh I um I I I I came off I started coming off my SRAM or Lexapro I tried to be tricky i p and Other Drugs I then I came off stimulants came off a sleeping tab without too much trouble I made all sorts of errors in the process I went too quickly at different points and I've had to reinstate or sorry go up a higher dose at different points and hold I've had some setbacks I was given antibiotics and steroids at one point

00:41:15    that made me feel very unwell for about 9 months afterwards I've also worked incredibly hard for the last few years um I hope people have noticed uh and and and in part that has really slowed down my taper I've often made which I'm occasionally kicked myself for um I've often prioritized doing my work over coming off the drugs which I wish I hadn't actually but so I've gone slower than I would have that I would have otherwise the last drug that I'm on is metazine or raron which I found particularly hard to come off I think

00:41:49    even harder than than than Lexapro I started on 15 Mig maybe I was at 30 Mig at some point and today I'm on .15 mg which might which might induce some sniggering but I find every tiny little reduction at this point incredibly hard so uh I'm sort of still I'm microt tapering off that using a liquid and dilutions and I really really really hope I'm off that in the next few months uh when I've gone too quickly I've had some very Bleak periods where I felt very low very anhedonic very cognitively impaired but mostly I'd sort of say I've

00:42:25    been at a sort of three out of 10 in my symptoms and I've sort of worked through the whole period uh whilst doing all the different bits and pieces that I've been doing and so I'm I'm I'm hoping on the final lap of the race here one thing that seems sort of striking to me is there's a somewhat of a full circle element to this story where you know this all sort of kicked off because you found yourself in a context where you know maybe you were a bit of a smart alec and uh or what we might call a

00:43:06    grade grubber you know and your classmates find your you know they don't necessarily like the way in which you're using your intelligence um and now you find yourself in a somewhat similar scenario is that fair to say because I'm just and I'm sort of imagin but many of your colleagues in the profession um of Psychiatry I'm sure find uh the work that you're doing ranges probably from inconvenient to to intolerable for some of these people I mean yes it's it's it's a parallel that I've yeah thought of

00:43:48    before I mean in some ways I am being bullied Again by by colleagues you know if you go on Twitter you'll see you see it happen every day of the week I guess the difference is you know when I was younger I thought it was my fault and now I don't think that so it's it's uh I know they're angry at me because of what I'm saying not because of who I am well I didn't understand that at the age of 12 um so has it come full circle maybe in some ways maybe I'm yes in a much the dragon ended up being a paper dragon or

00:44:16    paper tiger uh yeah something like that I hope you know Mark when you are on Twitter getting uh hared by humorless um experts uh when you are being diminished in stature by bullies uh in white coats or not just remember that there are Legions of people out there who um have never you know never felt particularly warm towards any uh psychiatrists or at least not for a very long time who are huge fans of you and and deservedly so cuz you're work is is is vital and uh it's my belief and I hope you can see

00:45:03    this that you are sort of standing in the Gap and um either the general public will clue in to the idea that uh they're going to get better outcomes if they at least take into account the experiences of those who have been through this stuff for themselves or the sort of expert class is going to say we're going to lose credibility unless we kind of get with the program so one way or another um this particular problem I think is is going to at least shift and maybe even resolve I'm sure there are going to be

00:45:34    plenty others that remain but um I think your role in all of this could not be overstated and just thank you so much for this unique view into how you got there and how you came to do this um thank truly thanks thanks Cuba I I'll get you to write that to my mother so she understands why I've tanked my career as well thank you [Music]