Show Notes

• Dr Mark Horowitz website
• Release Trial Australia 
• Outro Health website
• Dr Martin Whitely Unstress episode
• Overprescribing Madness book
• Dr Eli Kotler Unstress Episode
• Dopesick Series
• The Maudsley Deprescribing Guidelines by Mark Horowitz book

Timestamps

• • [00:00:00] – Introduction and Acknowledgment of Traditional Custodians
  • [00:02:26] – Introduction to Dr. Mark Horowitz and His Work
  • [00:05:32] – The Evolution of the DSM and Pathologization of Normalcy
  • [00:09:45] – The Role of GPs in Prescribing Antidepressants
  • [00:12:15] – Chemical Imbalance Myth and the Influence of Drug Companies
  • [00:18:23] – Key Opinion Leaders and Product Champions
  • [00:26:10] – Efficacy of Antidepressants vs. Placebo
  • [00:29:39] – How Antidepressants Affect Emotions and Numbness
  • [00:33:40] – Concerns About Prescribing Antidepressants to Children
  • [00:36:55] – Misconceptions About Withdrawal Symptoms
  • [00:40:17] – Debunking the Myth of Brain Cell Growth from Antidepressants
  • [00:47:13] – The Role of Inflammation in Mental Health
  • [00:51:13] – Dr. Horowitz’s Personal Experience with Antidepressant Withdrawal
  • [00:55:39] – Introduction to Outro Health and Its Mission
  • [01:01:59] – Holistic Wellness Practices and Their Importance
  • [01:04:00] – Conclusion and Final Thoughts

Dr Mark Horowitz: Antidepressants – A Critical Appraisal

Dr Ron Ehrlich [00:00:00] Hello and welcome to Unstress. My name is Doctor Ron Ehrlich. Now, before I start, I would like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal people of the Eora Nation and pay my respects to their elders, past, present and emerging. And when I say past, they have occupied this land for tens of thousands of years at least, and we have much to learn about respect for people and country and connection for people and country. The two are inseparable. Well, today we are exploring the world of mental health in general and the world of antidepressants in particular. And there are some very sobering statistics and points that we make during this discussion. I believe we have a health care system that is focussed on chronic disease management. And I also believe that we have, model that is a great economic model, just not a very good health model. And if you wanted an example of that, our approach to mental health in our community is perhaps the best example that we can pick. Now my guest today is doctor Mark Horowitz, and he is a collaborating investigator on the release trial in Australia investigating supported gradual hyper bollock tapering of antidepressants. Now, it’s sobering to learn that 1 in 6 Australians are on anti-depressants, and there is a great deal of misinformation about how one could possibly come off those medications and what the alternatives may be. He’s a member of the Critical Psychiatry Network and is associate at the International Institute of Psychiatric Drug Withdrawal. He’s also co-founder of Altro Health, which helps people who wish to stop unnecessary antidepressant medication in Canada and the US using gradual hyperbolic tapering. Look, we discussed this. And if you’re listening to this in Australia, the information is accessible to you. We will have links to that. I hope you enjoy this conversation I had with Doctor Marc Horowitz. Welcome to the show, Marc.

Dr Mark Horowitz [00:02:27] Thanks for having me here. Great to meet.

Dr Ron Ehrlich [00:02:28] You, Marc. I was introduced to you through our mutual friend Jocelyn Brewer, who’s been almost a regular on my podcast dealing with digital nutrition, digital, the world of technology, and its influence on mental health. But I want to just take a step back about mental health because it’s a huge problem. And, the Diagnostic and Statistical Manual, the DSM, is what is generally the code by which practitioners assess mental health. And I know the DSM one was about 150 pages. It was quite short. The DSM five, the more recent one, I think, about 15 years ago, actually was about 900 pages. Have we pathologized life? Is anyone normal?

Dr Mark Horowitz [00:03:12] It’s a good question. Actually there’s been there’s been there’s been two things that have changed in the DSM from 1 to 5. One you’ve pointed out is the volume, the number of, of disorders that exist. But the second one, I think maybe the most important shift actually happened in the DSM three, and it was a shift from describing mental health symptoms as reactions to illnesses so decent. One and two. It was very psychoanalytical based and everything was a reaction. There was depressive reaction, there was anxious reactions, it was psychotic reactions. And the reaction was reaction to life, to grief, to losses. That was that was a central understanding of why people became depressed or anxious. And in DSM three, in 1980, under Robert Spitzer, psychiatry was under attack by psychology, as it still is, in that what was psychiatrist doing that was different from psychologists? Why did they cost so much more? And DSM three’s answer to that was we are doctors and we treat illnesses. And that involves an intellectual exercise where depressive reaction was turned into major depressive disorder and anxious reaction was turned into generalised anxiety disorder. These were conditions with capital letters that sounded the same as myocardial infarction or diabetes. And what psychiatry was saying is we are medical doctors. We treat medical disorders. You know, often with, with, what was going to be medication, more widely at that time. And that was a very big turning point in the history of, of, of our culture, because suddenly we went from talking about the things that made us depressed and anxious to conditions that were depression and anxiety became decontextualised. So in DSM three through to five, major depressive disorder is defined by five symptoms out of nine, with no reference to what’s happening in life. So if you are, you know, sleeping more down, down in your mood, your, your appetite is lessened. You know, you have major depressive disorder in the context of has your mother just died? Have you just lost your job? You, you know, are you suffering from poverty that is suddenly removed from the situation because we’re now doing symptom checklists. And along with that, like you said, we now have hundreds of disorders. So I like to I like to I’ll give you a quick test. I’m sorry to turn the tables here for the age of 45. Have a guess what proportion of people meet criteria for a DSM mental illness? Okay, I would.

Dr Ron Ehrlich [00:05:32] Get I would guess about 80% or 90%.

Dr Mark Horowitz [00:05:35] Okay, well, you’re a very well informed. Contestant on my show is the answer is 86% of people.

Dr Ron Ehrlich [00:05:41] 86%.

Dr Mark Horowitz [00:05:43] 80. Most of that is depression or anxiety. So by the age of 45, 70% of people will meet the criteria for major depressive disorder or generalised anxiety disorder. In other words, it’s more of us that, don’t you? There’s more of us than don’t than don’t.

Dr Ron Ehrlich [00:05:56] Doesn’t that speak to a much bigger issue, which I have been following professionally for over 40 years? And that is the business of medicine. I mean, the more people that can be diagnosed with the disease and then managed makes very good business sense. And, and one only has to look at the evidence because we are very evidence based. And the evidence shows us that the pharmaceutical industry is now with us, $1.5 trillion. And I would argue that the medical profession has been a very major facilitator of that growth.

Dr Mark Horowitz [00:06:31] Yes. So it’s been said that that the drug companies market conditions more than medications. Yeah, more than products because, you know, you cannot get a drug licensed for no reason. It has to be licensed for specific indication. So as an example, obesity was recently listed as an illness which has allowed different drugs to be licensed for. That’s why there’s been this huge outpouring of drugs for obesity. And so if you if you, you know, in the there’s a great example of this in England, I don’t know the Australian example as well, but I think it’s very similar in England. There was a, there was a education campaign called Defeat Depression. It ran through the 1990s and 2000. The message was for the public to tell them that feeling down and low was a medical condition. And you go, you should go see your doctors about it. The two major barriers to that they found out from the public was that the public believed that being depressed was caused by life circumstances, by divorce and illness, and that if there was any medication to be treated, to be used to treat depression, it would likely be dependence or addiction forming. And so the campaign set about dissuading the public from those two ideas. They told them that no feeling down was an illness called depression. It wasn’t about life. It might be precipitated by life. But it wasn’t just about life. It wasn’t just sadness. And two, that medications for depression would not be dependent, so it would be easy to stop. That campaign was fronted by the Royal College of General Practice and Psychiatry, but it was funded by the drug companies, and it went from the beginning of that campaign. I think there were about 3 in 100 people were given antidepressants. By the end of the campaign, 1 in 6 of the public was given antidepressants. So it was a huge boon for drug companies. The expansion of the market was by 500%. And now we exist in that in the world created by that education program that, you know, that our moods, our illnesses and that medications are, you know, because it’s a medical condition with a chemical cause that a chemical solution makes sense. And so we we are we are living in a, you know, vastly over medicalized world. And that message was delivered as you, as you’ve indicated by the medical profession, because in many ways it expands their power as well, because, of course, you know, the key, the key, the USP, the unique selling point of a of, of psychiatry is that it offers medication for, for, you know, for emotions.

Dr Ron Ehrlich [00:08:47] For a diagnosable.

Dr Mark Horowitz [00:08:48] Illness, for diagnosable. Who knows? Exactly.

Dr Ron Ehrlich [00:08:50] Yeah. Well, I had the pleasure of interviewing, Doctor Martin Whiteley, who’s written a wonderful book called Overprescribing Madness. And I will actually release rereleased that episode in the same week that this has come out. So for our listeners, they can listen to that in the coming week. But but Martin pointed out, and I might say that to read his book online, the last 60 pages, have got references hyperlinked to the reference. So you want to read evidence? There it is. He shared with me that 95% of antidepressants are prescribed by GP’s and that, they are. And considering the average appointment time for a GP consultation is 10 to 15 minutes. Now, Mark, you’re a psychiatrist. I’m fairly certain that your appointments to get into the mental health of your patients wouldn’t get very far in 10 to 15 minutes. Am I right in saying that? I mean.

Dr Mark Horowitz [00:09:46] You’re want I think I don’t know if it’s 95% or 85%, but you’re definitely right. It’s definitely the vast majority of medications is prescribed by GP’s. That’s true. You’re right. The GP appointments are short. I mean what what has been you know, I don’t blame GP. Sometimes people think that I’m blaming GP’s. I don’t at all. They’re just doing what the system is forcing them to do. You know, I think GP’s are incredibly difficult position because all of the, all the problems with modern society are washing into their waiting room. So they are being they are being forced to deal with a product of poverty, of inequality, of, you know, job problems, relationship issues. It’s all on their on their desks. So they’re in a very tough position. And given given that, you know, I think a lot of them reach for a prescribing pad because there’s not a lot else you can do in ten, 15 minutes. I do think those are you know, they’re going to be superficial assessments. You’re right. I guess one of the one of the advantages of being in psychiatry is you have more time to assess people, to understand what. What you know, what the context of their lives are. You know, I do think that because we have medicalized these conditions, people think it’s the same as treating blood pressure. You know, because you can treat blood pressure in 10 to 15 minutes. You know, someone has high blood pressure. There’s a medication for it. There’s a there’s a guideline. You follow the guideline. I don’t think I don’t think depression or anxiety really fits into the same box as as as as as that. It’s not as neat. It’s much more connected to people’s lives. And I think that putting it in this kind of medical machinery has created this overprescribing, culture that we live in at the moment.

Dr Ron Ehrlich [00:11:14] I mean, it is interesting that you draw the distinction, and I hadn’t really thought about it, that the DSM three was a reaction to psychiatry versus psychologists. But at the end of the day, the majority would I be fair to say the majority of psychiatrists, even with, an hour long appointment, ends in a prescription?

Dr Mark Horowitz [00:11:34] So I think I read somewhere that 97% of interactions with the psychiatrist involve medication. I don’t know if that’s in American psychiatry, but I think, you know, more and more these days, you know, medication is the main tool being used. You know, I know there are lots of psychologists of focus on psychotherapy. It’s still a part of psychiatry training, but I do think it’s generally the main tool used. And that’s that’s definitely fair to say.

Dr Ron Ehrlich [00:11:58] And given we are living in a world where we’re constantly reminded in medical profession that it’s evidence based. And considering that these medications are designed, supposedly to correct biochemical imbalances in the brain, how is that measured?

Dr Mark Horowitz [00:12:16] It’s a very it’s a very good question from, a colleague of mine called Michael Gartner, wrote a book called Evidence Biased Medicine, put in one letter to evidence based. And I think that’s very useful because, you know, one of the thing about, you know, I’m, I’m a I’m a scientist. I’ve done I’ve done a PhD, I’ve got several degrees. I can’t stop doing degrees. So I’m into the evidence. But but the the issue is that the evidence base is socially constructed. It’s the evidence base. It’s conducted by people that pay for the evidence. So for example, when it comes to medication, you know, to anti-depressants, 97% of studies are funded by drug companies, and they design in a way to make their products look good, because companies do not produce studies that make the their studies that make their products look bad, that is commercially not a viable strategy. And so they do all sorts of things to dress up medications. You’ve pointed to to one aspect of that, which is the story behind medications. So yes, I do have chemical imbalances. So the first question you’ve asked is, well what is a chemical balance. If there’s a chemical imbalance what’s a chemical balance? And of course, the honest answer is we don’t know because, you know, the chemistry in the brain is changing all the time. It’s very hard to measure. That’s not, you know, so it’s very hard to say what is a chemical balance or what does a chemical imbalance mean? Really what this comes from is chemical balance is the colloquial description of a hypothesis, the low serotonin hypothesis that’s been around for several decades, that came up in the 1960s by psychologists in America, where they basically work through the following syllogism. If medications that increase serotonin improve people’s moods, then maybe low moods are caused by a lack of serotonin. It was a legitimate hypothesis. And there has been six decades of study to look at. Is that the case? And we wrote it. We wrote a paper on this last year, a couple of years ago now, where essentially none of these studies found any differences between healthy volunteers and depressed people. So it’s not true to say that depressed people have low serotonin. It’s not true to say I have a chemical imbalance. Why has it become so prevalent? It’s because drug companies push that out everywhere. You know, in in Australia we don’t have direct to consumer advertising, but in America they do. And in America there was ads on TV saying, you know, they had, sad little blobs walking along, no friends, grey sky. Why? They said because they’d have enough serotonin in their in their brains. If you give them Zoloft, a very popular antidepressant in Australia, still, certainly it will increase their serotonin and will fix up their chemical imbalance. And so that message has been pumped out by, by advertisers. It’s also been put out by professional bodies. So the Royal College of Psychiatrists, the American College of Psychiatry, the Royal Australian College of Psychiatry has said for many years, I think maybe recently they might have updated it, but for many years they said depression is caused by chemical imbalance. And that these drugs can rectify the imbalance. You know, and I think that the talk about the evidence, the evidence is that that is not true. You know, that is not that is not an accurate statement. And I think it’s misleading to say to patients, many, many people have been told that if you survey the public in Australia, 90% of people believe that depression is caused by chemical imbalance similar in American. So that that messaging has come out very effectively. We also know that if you if. People believe that if people believe that their depression is caused by chemical imbalance, they’re more likely to take medication because of course, chemical problem, chemical solution makes sense. They’re more likely to be pessimistic about their chances for recovery because they’ve been told there’s something fundamentally wrong with your brain. There are also lots just like you, to take control themselves because, you know, if you’ve got a broken, if you’ve got some sort of chemical problem, it’s very hard to fix it yourself. You need to go to an expert with a chemical solution. So it tends to make people more pessimistic, people who believe that their depression is caused by life circumstances or rough patch difficulties. A more likely to be optimistic about recovery are less likely to take medication, and are more likely to think that they have it within themselves to make changes to their lives, to get better. So I think this narrative of a chemical imbalance is both not supported by evidence and also a demoralising, you know, unnecessarily negative explanation to give to people. And the last thing I would say is referring back to what I said before, if 70% of people have depression or anxiety in their in their lives for the age of 45 would be pretty strange. Of 70% of people had abnormal brains. You know, it’s it’s what’s normal if 70 people have something. So I think that, you know, the chemical imbalance idea is misleading in many, many, many different ways.

Dr Ron Ehrlich [00:16:52] But it’s an idea. Well, it’s a it’s a great economic model. A market’s just not a very good health model, which goes a long way to explain our health care system. Yeah. But it’s perpetuated continuously in an almost tsunami. Like I mean, voices like Martin Whiteley’s or your own. And I know Martin said to me, this is great. The podcast comes out, the book comes out, it’s reviewed for a week, and it may change a couple of minds, but then the tsunami of information takes over, doesn’t it? And it and with ABC and I agree with you, I do feel for general practitioners they put in a very, very difficult position where they have to do something and they’re overwhelmed. And this is an acceptable and actually acceptable and expected response. So it’s a perfect system, isn’t it? It’s it’s not a very good health system, great economic model, not a very good health model. I mean, the the other one that I found really interesting, before we dive into this whole discussion about anti-depressants is the influence of I know there was a great article in the Australian, the British Medical Journal in April 2022, is an opinion piece on key opinion leaders and product champions. And when it comes to antidepressants, I think the same can be said for statins. And one could even argue vaccinations. But I don’t want to go down that path. But but certainly, statins would fall into this category. The product champions, the key opinion leaders sit in positions of enormous authority and power. They do that.

Dr Mark Horowitz [00:18:23] Your observation it is I don’t I don’t I can’t speak to Statens or vaccines, but I can talk about antidepressants, certainly. So, look, we don’t have direct consumer advertising in Australia. The most important, but being the most important market to advertise to is to doctors, because they’re the ones who prescribed medications. Drug companies cannot give medications to patients. So that is an important constituency to to market to. Doctors think, well, people maybe think that the way that drug companies sort of influence doctors by giving them pens or expensive trips to Hawaii, I think that’s less that happens less likely. That happens less often now. But that was never the main way that people, marketed to doctors. The main way to market to doctors is to publish papers in the New England Journal of Medicine, and to have professors from Harvard and Oxford and Stanford and NSW and Sydney University give lectures about how effective, safe and easy to stop these medications are. And so what drug companies spend a lot of time doing is, as you say, they cultivate relationships with key opinion leaders in the same way as a perfume company may pay Kim Kardashian to put their put their product next to her. Her dancing, drug companies will pay professors at the, the big universities in Australia to become the spokespeople for their for their, for their drugs. And these people will be in the media putting up positive stories. They’ll be giving lectures at medical conferences, and there’ll be a tiny little asterix at the bottom of their lecture saying, sponsored by Janssen, AstraZeneca. But but that’s become so common in the lecture circuit. People don’t even notice. It’s just, people make jokes about it, and, some, some visit. There’s a, a lecturer in England who we used to have a long list. So he would say, when it comes to taking money from drug companies, people are either promiscuous or they’re completely abstinent. And I fall into the, into the former. And he would show a long list of drug companies he took money from, with a bit of a giggle from the audience, because he’s made a bit of a joke of it. So it’s become incredibly normalised. And these people often, you know, that the people that are recruited are the people that, you know, are in good positions. So they’re they’re leveraging their authority. And of course, the support from drug companies helps these people’s. Careers, you know, go forward because what happens when you associated with drug companies is they send you papers, they send you studies that are going to the Lancet, the New England Journal of Medicine, to put your name on it. It makes life very easy for such people to have excellent publication records. They get promotions. And so their careers, you know, ascend along with the, the messaging from drug companies. And they are embedded in the, in the, in the landscape of, of medical education. And that means that doctors are walking around. And I remember this when I, when I was a student and when I was, when I was a young doctor thinking, you know, I’m a very critically minded, very clever person. You know, I can I can spot a, a weasel from a rabbit. And I, I had no idea, you know, how stage managed what I was being taught was, you know, even what we were criticising, even that, you know, even that was within the bounds. And I really didn’t see that until I hit, you know, right in my face, information that contradicted what I was being taught, you know, which was me coming off my own medication and seeing that it didn’t match the textbooks at all. But up until that point, I was, you know, as, hypnotised by, by this educational machine rather than than anybody or anyone else. And I think these capabilities play a very big role, you know, the patriotic, these myths.

Dr Ron Ehrlich [00:22:01] Yes. Well, I think it’s a story that is very easy to miss. But once you hear it, very difficult to ignore. The, the overwhelm, the doctor’s face, not only in their patient load, but in the research that they are meant to keep up with. I. I always laugh when I hear a doctor say there’s no evidence to support this, which suggests that they’ve read all the evidence. And I and I think it takes about 600 hours a week to stay up to date with all the evidence. But there’s also about to curiosity, that I that I find most intriguing in the medical profession, because the curiosity for health seems to kick in only after a doctor studies pathology and pharmacology, because they go so well hand in hand. And they really do go to the heart of what you believe the doctor is all about. Whereas if we bothered to remember our biochemistry and physiology, we may have a different view of that.

Dr Mark Horowitz [00:23:00] My takeaway is the education that that you go through in medical school, in psychiatry, you know, makes you think about things in a machine like way. And I think it’s more appropriate to physical health, although I think there’s a big limitations to that as well. You know, because I, you know, I, I think but I won’t, I won’t I’ll, I’ll stick to, I’ll stick to my, to my field. I think, you know, doctors like everyone likes a simple model I think. So I remember when I sat in a lecture and the professor, at uni showed us that, you know, mild to moderate depression was caused by low serotonin and severe depression was caused by serotonin. Noradrenaline problems, and psychotic depression was caused by serotonin, noradrenaline and dopamine. You know, with these sort of neat diagrams, different overlapping, circles. You know, I thought, this is brilliant. I mean, you know, I was reading Nietzsche and and Kafka and Dostoyevsky and, you know, trying to work out, you know, I was a young man, you know, why am I so screwed up? What is the meaning of life? And suddenly, you know, on a diagram, on on a lecture, all of this stuff becomes resolved into three chemicals. I thought, you know, I’ve. I’ve lucked out. This is that this is the greatest lecture I’ve ever been in. Suddenly it all makes sense. And of course, you know, we have medications that match each of those neurochemicals. So I thought, you know, I have seen into the heart of what it is to be, you know, human and ill. It was so compelling. And I think that’s the sort of thing that, you know, sticks in doctors minds, that kind of simple mechanistic model and the idea of dealing with the messiness of life, you know, stressors and human interactions and diet and exercise and mindset is all too, somehow, especially for a GP, you know, ten minute consult is all to diffuse and complicated. And so I think that kind of mechanistic model is really what sticks out for people. And, you know, they like doctors, like, you know, neat solutions. I think, I mean, I mean, everyone does. Who does, who doesn’t want much, I mean, I who doesn’t want to walk into a doctor’s office, take a complicated problem and solve with with it with a tablet or, or a procedure. So I think that’s, that’s the seductive aspect of, of medical education that, that, that simple explanations like chemical imbalances play into.

Dr Ron Ehrlich [00:25:10] And I and I can understand that. I mean, we all love certainty, but if you’re a doctor and patients are queuing up to come in with their life’s problems, you don’t want an awful lot of uncertainty there. You want certainty, particularly if you want to sleep at night. So I can understand the allure of that. Back on anti-depressants, Mark, because 1 in 6 Australians are now taking it. And interestingly, I know there was a research article about 20 years ago that stood out for me. That showed, that they took the six major, anti-depressants and compared them to a placebo for mild to moderate depression and found the placebo was just as effective. So that was about 15 or 20 years ago. But it’s sobering to realise that in the last 15 years since that article was published, there’s been a 95% increase in antidepressant prescription or thereabouts. I don’t know exactly.

Dr Mark Horowitz [00:26:03] How that sounds. That sounds about right to me. Yeah, that sounds about right to me.

Dr Ron Ehrlich [00:26:07] That’s quite I mean, that is quite extraordinary, isn’t it?

Dr Mark Horowitz [00:26:11] I think it is extraordinary. I think it’s I think it’s the triumph of marketing over science. I mean, since if you’ve looked at the literature 20 years ago, not much has changed. There’s more. There’s more antidepressants. Is a few more, maybe two drugs. It is still the best studies in the field show that the difference between a sugar tablet and an antidepressant is two points on a 52 point scale. But there’s a lot of problem with that, with that, with those studies. They’re very short term. So no one knows if those effects will last. In those studies, patients on antidepressants will know that they’re on antidepressants because of side effects. We know that people that know they’re on a medication will respond better. That’s called unblinding and expectation effects. We also, and I think this is another central point which speaks to chemical imbalances, is how to if drugs do have this very small effect over placebo, how do they do this? Because if they do it by fixing the chemical problem underlying depression. Well, that sounds pretty good to me. You know, if I had a thyroid problem with too few thyroid hormones and I was offered extra thyroid hormones, I would take it. That seems to me a pretty neat solution to a problem, and I think people think that then any person must fix the underlying chemical problem. But there’s a different way of understanding how antidepressants work, which is, rather than solve the underlying problem. If you ask people in surveys, how do you feel on anti-depressants, the most common response is numbs. They mean that their emotional range from positive to negative has been squashed. And you can see if you’re in the middle of huge uproar, panic, anxiety, depression that having your emotions turned from a ten to a three might be quite relieving. And you can also imagine how in the long term, it may be a problem in itself, because you don’t just, you know, if antidepressants are sometimes portrayed as, a targeted missile just going for negative thoughts or negative feelings, but of course, we’re not so clever. You know, no one is that clever. What the drugs seem to probably do is to numb global thinking and feeling. And so people, the number one reason people come to my clinic where I help people come off anti-depressants is because they have lost, the feeling of life. They’ve lost their enthusiasm, they’ve lost their interest. It’s often affected their relationships, and they don’t want to be a bit numbed anymore. That numbing, that numbing feeling is often correlated with sexual numbing, because, of course, sexual side effects are very common with antidepressants, and there are studies showing that the degree of genital numbing people experience on anti-depressants correlates with emotional numbing. And in fact, the drugs. Because I’m writing always about how to come off them. If you crunch up most antidepressants and swish it around your mouth with water, it will anaesthetise your mouth lightly. And so I think that these these drugs have mild anaesthetic effects that affect both your bodily sensation, particularly your genitals, and also your emotions. And I think that that is a much more convincing way that these drugs work, which is a very different story. You can imagine the difference between being told by your doctor. This is a drug that will fix the underlying chemical problem in your mood versus this is a drug that will numb you. You know, those two things are very different explanations for why they’re working. You might say yes to a numbing emotion, but you probably wouldn’t be thinking, I won’t take this long term. If you think you wanna get off this as soon as possible, which is very different to what you might think about if you were told that this was caused by, this is going to fix a chemical problem.

Dr Ron Ehrlich [00:29:39] That is so interesting to hear you pull that up, because we have done quite a lot of interviews and we’re doing one, following yours, Mark, with Doctor Eli Cutler and this psychedelic, psychedelic assisted therapy, which does exactly the opposite. It opens up, it works on what I believe is the default mode network and opens up those connections. Quite the opposite to the numbing, right. Do you have any do you have any thoughts on on that, on that therapy? I’m sure you do. I mean.

Dr Mark Horowitz [00:30:11] It’s not it’s not my area of expertise. No. I guess we’ll.

Dr Ron Ehrlich [00:30:14] Stick with some authority. Mark.

Dr Mark Horowitz [00:30:17] What I have is I have a slight, inherent concern and apprehension about any chemicals that affect the affect of delicate neurological system. Because what I feel is there’s been a recurring story in psychiatry, which is we have a great new drug. It’s going to solve a lot of. You mean emotional problems? It doesn’t have many side effects, and it’s easy to stop. That was the first round. Was barbiturates that was given to housewives in the 1950s. It was said it was safe, effective, easy to stop. It turned out to be not so safe. Not so effective, not too easy to stop. It was replaced by benzodiazepines that was said to be safe and effective and easy to stop that were given out. That was, you know, Mother’s Little Helper or the Rolling Stones is given out to housewives in the 60s turned out to be not so effective, not so safe, not so easy to stop. That was replaced by antidepressants in the 1980s and 1990s, which was said to be safe, effective, easy to stop. It turns out they’re not so safe. They’re not so effective, not so easy to stop. And it happens that as those drugs are coming off patents, a bunch of new drugs come back, which, yes, are old drugs. And there is something appealing about that story, about opening things up and about access to, you know, emotional problems. But I worry these drugs are certain. Magic drugs act on similar receptors, to to antidepressants, to some mild variations. It looks to me like very heavy uses of psychedelics. Looks like they have brain damage. You know, they don’t have such good memories. And so with it. So I have concerns, although it’s intriguing on one level to have these drugs, it can that it can encourage inside. I spent a lot of time dealing with people that have had serious problems from these medications, like antidepressants, benzodiazepines. So I have this inherent concern that with all the hype around this, that underneath it, there’s still the worry that these drugs affect a delicate brain and may cause some people trouble. And of course, people do become psychotic. Some people, you know, sometimes the and the effects are more short lived than people would like. So I, I don’t wanna be the ghost at the feast because there’s always a very big feast going on around these drugs. But I would I would urge everyone to be cautious, you know, cautious and not to, to dive, not to dive into the deep end of the Kool-Aid.

Dr Ron Ehrlich [00:32:29] Yeah. I look, I don’t want to get into that too much, but I would say from my reading of it that, firstly, these aren’t new drugs. They’ve been with us through our entire human experience that we’re not talking about recreational use. We’re talking about very careful administration and supervision. And it’s really unusual to find a therapy where 80% of the people who take it describe it as the greatest experience of their lives or most meaningful. But let’s put that aside for a moment. Because I know the antidepressants are a big issue. And, I think that the one that I really have thought about too was because there is and Martin pointed this out in his book very eloquently, the the black box warnings on on medications, antidepressants for those under 21 or 25, and the suicidal ideation, which is one of the major side effects. And yet in Australia now, not only has the number gone up by 95% in 15 years, but one inch 30 children in some as young as four, are being prescribed anti-depressants. I mean, what’s your reaction to I mean, it’s must be the same, even worse than your reaction would normally be.

Dr Mark Horowitz [00:33:41] I mean. You’re right. Basically all the issues for adults, you know, are more and more and more worrying for children. The effectiveness of antidepressants, which I’ve just said is pretty minimal. It exists and for adults is even smaller for children. The effects are even smaller. You know, in studies, you know, the if this is from a big FDA study, they did a big analysis and they found that people on medications in their studies, were more likely to be suicidal than people given placebo, which is very worrying when you’re talking about a group of of vulnerable children who are already, you know, depressed. There’s a story that so you write it’s on the 25 is a black box warning. There’s a story that was put out and explanation by drug companies and and the story goes like this. The reason why people are more suicidal is because they feel better. They have more energy. And the energy comes first, before their mood improves. And that’s why they they’ve got the ability now to act on that. They’re suicidal ideas. But if you wait longer, it’ll get better. Now, that is total nonsense. There’s no evidence for that. There’s no study that shows that energy improves before mood. That’s completely manufactured. What the studies show is that people that children under the age of 25 who are given antidepressants are more likely to be suicidal than the people that are not given antidepressants. Full stop. There’s no energy, preceding mood stuff. That is a complete line to cover this up. So I think it is very worrying that, these drugs are given to children with very poor evidence and very big risks in America. Just just this in the last year, they approved an antidepressant for people over the age of seven for anxiety. In the study, the studies showed that the that that more kids were lucky. So the drug was more likely to make kids suicidal than less depressed. So about 10% became suicidal, but only 9% improved in the depression. And the FDA approved it. And the FDA judgements are very influential around the world. And so it’s likely that that will affect what the TGA does. So we have written furious letters about this, study because it’s completely nonsensical to approve a drug that is more likely to make your child suicidal than less depressed. I mean, that is completely, in my mind, madness. So I, I’m, I’m very worried about prescribing medications to children. We don’t know how to fix the developing brains. We know it affects the we know in animals that that giving antidepressants affects the development of their sexual organs. But we don’t know what it does in children because no one’s ever looked. So I think we we are we are running an experiment that we do not understand. And we’re running in our children.

Dr Ron Ehrlich [00:36:19] Gosh, Mark, that is so sobering and even more sobering when I have done an interview with a professor of paediatrics where I asked him about use of novel, medication on children, how can you justify it? And he said, and I quote, how will we know it works if we don’t try it? It’s quite, quite frightening. But listen, you are more focussed on some of the myths, some of the misconceptions. One of them is withdrawal effects are only mild and last for 2 or 3 weeks with any severe symptoms. Interpret interpreted as a relapse in depression. So what’s your response to that.

Dr Mark Horowitz [00:36:55] So you know in I’ve just rewatched Dopesick, about this crisis in America, which is a brilliant I mean, I’m a big fan of Michael Keaton. It’s really it’s a brilliant, you know, it’s a brilliant, capturing what happened. And, you know, at the heart of that was, was misinformation put out by drug companies that were excellent marketing loads. And the opioids is a very extreme example because they’re obviously a very deadly medication and antidepressants are not so deadly, but the themes are the same. It’s about misinformation planted by drug companies. And they did a few very clever things that, you know, that, you know, become a $1.5 trillion business without being very clever. So what they did was, what happened was the edited prisoners were released in the 1980s. 1997 was the first was Prozac. But in the early 1990s, there were stories about withdrawal effects from antidepressants. People were writing into medical journals about the issues that were being had, and the the drug companies got very nervous because Valium, benzodiazepines had been a huge market that had been badly impacted by withdrawal effects, dependence on withdrawal. It was happening again, and it was a nightmare for the drug companies. So what they did was they convened a consensus panel, the 1990s, where they got the big shots in America and England, the cols, the key opinion leaders, the the Kim Kardashian’s from Harvard and Stanford and Oxford. And they wrote a series of papers describing withdrawal effects as discontinuation effects, a euphemism, you know, sort of like a sort of like describing a, a car crash into a wall as a discontinuation, events involving a wall. It sort of makes it sound much less worrying. And they described it as brief and mild in all these scientific papers, which they distributed to doctors around the world. And those studies were based on people who’d been on added resonance for eight weeks. So if you don’t added business for eight weeks and you stop them. It’s true to say that most of the symptoms are brief and mild. Not everybody. Some people have severe effects, but mostly it’s brief and mild. So it’s a true statement. It’s just completely irrelevant to most people because out there in Australia, the average period of time people are on anti-depressants is four years. And so it’s a little bit like doing a crash test with a car and showing that at five kilometres an hour it’s extremely safe and hits a wall. But, but, but people out there driving an 80km an hour. And so that’s exactly what’s happened. The longer you’re on this medication, the harder it is to stop, the more severe the withdrawal effects, the longer they last. And so in in real life, people have months and even years of withdrawal effects that can be very severe and they’re very common. But the guidelines for many years said that the symptoms were mild and brief, based on eight week studies. That’s only the last few years in England that the guidelines have changed, and in Australia they haven’t changed. They still say brief and mild. And because of that, that makes doctors very misinformed. That means when a patient walks into your office and they’re saying, I’m having severe, long lasting effects, you look at your textbook, it says brief and mild discolouration symptoms. This can’t be that. It must be a mental illness of some sort. It must be their anxiety or depression. And so this leads to a cycle of misdiagnosis, where withdrawal effects are misdiagnosed as a relapse or return to people’s condition, which leads to their being put back on the drug. So it becomes a revolving door with trouble coming off. The drug leads to being put back on the drug, and that’s a very big issue in medicine.

Dr Ron Ehrlich [00:40:18] What about, antidepressants work by growing new brain cells. I mean, that’s that’s another one, right?

Dr Mark Horowitz [00:40:24] So so that’s the so for a long time, the main explanation of how Americans work was they correct a chemical imbalance to some degree. Academic psychiatry has retreated from that. They say, look, that was a that needed to say that was a simplification. It was a metaphor. We don’t think that anymore. And the full back explanation is antidepressants grow new brain cells in the brain. And I did my PhD on that topic as well. I spent three and a half years working on in England. Now what? I didn’t so, some of the studies come from animal studies. It hasn’t been shown in humans. But what I didn’t understand until I left, my PhD was lots of things, cause the growth of new brain cells that involved damage to the brain. So, for example, strokes cause the growth in your brain cells. Blunt trauma to the head causes the growth in your brain cells in the same way as if you cut your skin. You get the growth of new your skin cells. So what I had what had not occurred to me in four years of research was that if you damaged the brain, perhaps by a toxic chemical, you can get the growth in your brain cells, which might not be a good thing. And the other thing is, you know, because everyone thinks, well, you know, new brain cells. That sounds fantastic. You know, that sounds great growing in your brain, but, you know, is a house better with more bricks? Is that better for a house? It could be, if they’re arranged in a loft that increases the house of your the price of your house. But if you just have more bricks, you know, in the middle of your living room, is that a good thing? So I think that we have to ask, what are these drugs actually doing? Is it because of damage? Is it repair? Is it useful? And I don’t think there’s any very good evidence that it happens in humans with, with with medications. It all comes from animal studies. And if it does happen, is it useful or not. So I don’t I think we should be a bit more, we should interrogate idea a little bit more before we say this is a fantastic result.

Dr Ron Ehrlich [00:42:13] So you did you actually did your PhD on this very subject.

Dr Mark Horowitz [00:42:16] I did, I did, I did.

Dr Ron Ehrlich [00:42:18] And you were setting out to show that it in fact did. Was that the point that what were you hoping to show when you started, and how did that change when you finished? I mean, you’ve shared with us so that so.

Dr Mark Horowitz [00:42:29] So the so my, my laboratory that I worked in looked at the effect of antidepressants on brain cells in a dish. And one of the big findings by a senior colleague of mine was that antidepressants increased, increased neurogenesis, the growth in your brain cells in a dish. I was looking at does inflammation affect that? It does. It makes it it makes brain cells die. My findings were I was looking at our antidepressant. Does it does it does it decrease inflammation. And essentially in my PhD I found nothing I didn’t I found it didn’t really affect inflammation. I found there wasn’t reliable effects on neurogenesis and new growth in new brain cells. I walked out of it thinking that I was not a very good scientist, because I couldn’t find what well, people were finding. But now that I reflect on things, I think there are very few positive findings in this field of psychiatry. And I think it’s I think it’s more about looking in the wrong place than about my inadequacies as a, as a pipette holder. So I, you know, to some degree, I think the entire basis of biological psychiatry is based on a category error of mistaking the mind for the brain. You know, I, I think that a quick analogy is, you know, if you had a problem with your Microsoft Word. And you called in a software engineer to help you out. And I started opening up the back of your computer to look at the circuitry to work out. You know, we got out of soldering machines. You’d fire him in a second because you think this guy doesn’t understand what’s going on. But we are doing exactly that when it comes to things like depression and anxiety. You know, all the studies show an incredibly strong correlation between what is happening in your life and your risk of depression. If you add up the number of stressful life events you have divorce, job loss, poverty. Yeah. The more you have, the more likely you are to be depressed. You know, it’s about the responses to life. But we are obsessed with looking for the chemical equation of depression. You know, looking at what’s the amygdala doing, what’s the the campus doing? And I think we are missing the point in the same way as the software engineer opening up the back of the computer. The issues are, you know, our emotional lives, what makes us feel secure. What meets our emotional needs. You know, what are degree of security in life? And I think that looking in the in the hardware to try to find what is wrong in the brain, he’s looking in the wrong place. I think it’s a category error. And I think that’s why we have gone down such a a, a mistaken road when we come to treating anxiety. Depression.

Dr Ron Ehrlich [00:44:55] I love that metaphor. It’s lovely. But listen, I, it is. I mean, you are making the point that it is life events, which is the main driver. But of course, you mentioned also inflammation there. And I know you were looking at inflammation in terms of its effect on brain cells, but in a broader sense, do you feel that inflammation has a role to play in? How will we deal with life events?

Dr Mark Horowitz [00:45:20] I don’t think so. I mean, I mean, not the answer you were looking for.

Dr Ron Ehrlich [00:45:26] I it’s that your answer was what I was looking for.

Dr Mark Horowitz [00:45:29] I’ve sort of gone through, you know, I’ve been very immersed in all this biological psychiatry, neuro endocrinology. Look, when I think about it, when I think about why my friends, when they’re happy, why are they happy? When they’re depressed, while they’re depressed, I feel it’s mostly about their lives. If people are if people have their emotional needs, generally miss the generally pretty happy. If people have their emotional needs not very much met, they’re probably they’re generally pretty miserable. So I think about mood and anxiety has been a readout of the degree to which your emotional needs are being met to be a very give it in 30s. Yes, there are different set points. Some people are more sensitive to than things than others. Does it come down to level inflammation? I does recognise that, yes, exercise and diet does does influence people’s emotional resilience. So I think that’s I’m not you know I think that’s but plays a role is inflammation epi phenomenal. Is it caused by that. Is it is it is is it a result of emotions? I’m not sure. All I know is that is that there’s, there’s a, a part of more of my field that tries to treat unhappy childhood with anti-inflammatory drugs. And I think that’s manage to be perfectly honest. You know, there’s a there’s a very big groups of, of researchers that try to give ibuprofen and other anti-inflammatories to depressed people to try to improve their mood. And I think that, you know, that’s pressing the wrong button. You know, maybe unhappy childhoods does make your immune system a bit dysfunctional, but I don’t think you can raise it on a happy childhood with, with a, with an anti-inflammatory drug. So I think there’s something something is being mixed. The wrong the wrong level is being pressed there. So I’m interested in it. But I don’t think that’s where the money’s. If I had to put, we might decide where I think it is.

Dr Ron Ehrlich [00:47:13] Well, I think when it comes to inflammation, the money is definitely not in giving anti-inflammatories to treatment, mental illness, but perhaps to explore why person what what are the causes of the inflammation that a person is experiencing. Which leads me into another area that you are interested. I know you helping people come off, these medications, and I know you also have not just a professional interest, but you’ve had a personal experience. I wondered if you might share with us that.

Dr Mark Horowitz [00:47:45] So I guess I have, you know, people describe people like me as critically, critically minded, a psychiatrist critical of a biomedical model. And a lot of people around me are very clever people who have worked out the issues with these, with with the current model through reading and research. I’m not so clever. I only works it out by being smacked in the face with the with the limitations of the biomedical model. Because to cut a long story short, when I was 33, thereabouts, I had been on an antidepressant for 15 years. You know, I’m, talking about slightly miserable people. I’m I’m one of them. I’m, if you’ve seen a Woody Allen film, you’ll see. What what sort of, family I come from, and neurotic, messed up loss. And as a 21 year old, I was a bit, unsure about my my, my, my medical degree. And I went into a camp, and in about 2.5 minutes, I was given an antidepressant, and I took Lexapro. I still about for 15 years when I was finishing up my PhD on antidepressants, which, of course I did, to try to, in the cliche, solve my own problems. So everyone goes into psychiatry. I, I tried to come off my antidepressant. I’ve been on it for many years. I had a lot of health problems. I had a lot of trouble with fatigue, with memory, concentration, memory issues and concentration issues. And a part of me thought it was because of the antidepressant, and I decided to try to come off it, and I, I came off it in a few months, a lot slower than guidelines recommended. But I ended up in a in a world of pain, the most, unpleasant period of my life. Unpleasant. An understatement from being in England too long. I, I had trouble sleeping. I would wake up in the morning in a state of utter terror, feeling like I was being chased by a world and my heart beating, you know, covered in sweat. And I would stay in that state for ten, 11, 12 hours a day. Utter terror. I took up running to, to try to get a bit of relief. I ran onto my feet, bled, I, I felt dizzy, the world around me appeared unreal. It went on day after day, week after week. And at some point I thought, I cannot keep living like this when I compare what I went on the drugs for, I went on I was pessimistic, I was miserable, I was existentially lost in life. That was a three out of ten compared to the ten out of ten I had when I came off the drugs. It was a completely different quality of of experience, you know, the worst, the worst excuse of my life. And I and I soon realised, mostly by reading about other people’s experience, that what I was, what I was, if it was withdrawal effects from antidepressant. And I really hadn’t been taught about that very much in my training. As I said, I was reading guidelines that said discontinuation symptoms from anti-depressants are mild and brief for 2 or 3 weeks. You know, my experience was completely different from that. I might have walked away thinking I was a very unlucky chap from that, except. On the internet. I found a dozen people with similar stories. Then I found hundreds, and eventually I found tens of thousands of people with similar stories. And I thought, this isn’t just me being unlucky. And that really opened my eyes up to, you know what? What coming off these drugs looks like. And, and that’s that’s what’s led me really to, to, you know, right hand change in my career that that these drugs that I had been giving out, prescribing quite widely that I had been taught were safe and effective, easy to stop. It’s been for years studying in, in, in, you know, in laboratory, actually, you know, I came face to face with reality of these drugs and realise it was quite different to what I’ve been taught.

Dr Ron Ehrlich [00:51:13] Wow. What a story. And which you are now focussed on helping people come off. That and one of your initiatives I noticed is Outro Health. Can you tell us a little bit about that?

Dr Mark Horowitz [00:51:26] So I’ve done so since, since I had that experience of a few different things to try because what I, what I, what I understood from this is I had a very bizarre experience. I was at that time, finishing of my PhD at the Institute of Psychiatry at King’s College London. While I was there, it passed Harvard as the most cited research institute for psychiatry in the world. So I was working with the top professors in the world. I had just finished a PhD in how I did business work. So I was I, in the scheme of things, pretty highly qualified. When it came to early prisons, I learned how to come off an antidepressant from a retired software engineer on a peer support site. In other words, I was being I was being taught, you know, how to look after my own health with these drugs, you know, bought by by people that were not medically qualified on peer support. So that’s I thought this is the most bizarre thing that has ever occurred to me. You know, I’m a very I’m a very institutionalised person. I’ve got six academic degrees. I am used to listening to professors. I’ve sat in lecture theatres my entire life and I thought, you know, what is happening? And the response, you know, a couple of things happen from that one, I actually worked out people online were saying things that were more accurate and more helpful to me than what I was reading in academic articles, and I took their advice, and I’ve managed to come off that drug because of the advice that I was given. I came off a lot slower, you know, over many years, going down in very small amounts using a liquid version of the drug, you know, technical ID from them. And I wanted and I thought, you know, I have to how can this be happening? I need to tell all the doctors what, how to do with these issues. And so I wrote an academic article about what I’d learned on those websites. And that article was published in The Lancet Psychiatry, which is a good journal, good European journal. And that led to, guideline change in England, where the guidelines now recommend what I had put forward coming off much more slowly, often using liquids, being much more careful about where you come down. It has led to I it started to lead to a culture change in England, where there is more awareness of these issues. The government has asked for clinics to be set up to help people come off the drugs. I run the first such clinic in the National Health Service in England to help sort of stop antidepressants. What happened after I wrote that article was I began to get hundreds of emails, and I got thousands of emails. Before that, I read 15 articles. I got one email, but also wrote the article about anti-depressants. I got I got 7500 emails in the first year of that up. That article, and a lot of them were from Americans and Canadians and people around the world asking me, can I help them to come off their medication because their doctors didn’t know how? I thought, this is utterly bizarre. I’m a research fellow in London and people in America writing to me to help me come off the drugs, and I thought, you know, there’s something deeply wrong with what’s going on. We’ve we’ve since surveyed these people and we find, you know, doctors don’t recognise withdrawal. They do it. They do it too quickly. They misdiagnosed relapse. And basically a couple of years ago, some people involved in medical clinics in America approached me to say, you know, can we set up a clinic where we will stop any business in America? And I said, you know, please, it’ll it’ll empty my inbox. And so we set up, a company called Altro Health, which is aiming to open in California, a clinic to help people safely stop antidepressants in the second half of this year, doing the kind of thing that I do in my clinic in London, which is taking people off much more slowly than other clinics to, do in a much more individualised way, and giving people a bit of support because it can be quite an unpleasant experience. And that’s what we’re trying to do. I’d love for Australian medical culture to follow that, just to take on some of the improvements in English, medical guidance. But so far I’ve seen not much evidence of that. There’s a few there’s a few bright spots and some fantastic research being done in Queensland by, a professor called Katherine Wallace, who is doing a great study on this technique. I think she’s a real trailblazer. She’s, very, very effective researcher, great clinical leader. And I think people like her, are paving the way for the future in Australia, and I. I hope more people will pay that sort of work attention.

Dr Ron Ehrlich [00:55:40] You mentioned, it’s quite that’s that’s an astounding story. Mark, given your academic background, not only in terms of qualifications, but where you achieved them, to have received this advice online from a software engineer was the key, the time it took to come off it. And if so, what’s the difference between what your doctor said and what the software engineer informed you?

Dr Mark Horowitz [00:56:06] So there’s there’s basically there’s three principles to coming off these drugs. And you’re right. Number one is the is the speed. The guidelines say come off over weeks. But what what we found from research and my own experience is you can take people months, more than a year and even several years because, you know, people are on these. If you’re on the drugs for a few weeks, you can come up in a few weeks. But most people are on the drugs for years, and your brain becomes incredibly accustomed to the drug, and it needs time to adapt to the being less drug about. And that can mean that it takes months or years of slowly reducing the drug. The second principle is it’s got to be at the right people can tolerate everyone’s a bit different. We don’t have enough research to say who’s going to take six months, who’s going to take 18 months. So you need to take an approach that’s adjusted to the individual. If they can handle it, go a bit quicker. If it’s too much, go a bit slower. And the last point, which is really what my research is focussed on, is very small doses of antidepressants have outsized effects on the brain. You know, there’s this for for people who are looking at this, this video, there’s this it’s a curve called a hyperbola. Very small doses have large effects. So for example, a very common antidepressant, citalopram celexa two milligrams of celexa has about half the effect of 20mg. It sounds like a tiny dose, but actually these tiny doses have big effects. The smallest available tablet is 20mg. It means that to come off these drugs, it’s almost impossible to do it with the tablets. Even if you have them or quarter them, it’s still very hard to get down to these tiny little doses at the end, which is why a liquid version of a drug or specially compounded tablet to make these smaller doses is so important because what happens is people fall off. It’s like a cliff. It starts off, you’re walking down a quite, a quite a nice path, like a country walk. It becomes steeper and steeper and right at the end it becomes like a vertical cliff. People fall off this cliff. This last bit of the drug, these last few milligrams are the hardest to come off. And what people need to do is to come down very slowly at the end of a tiny percentage of a milligram at a time to come off the drug. And that’s what I learned. I fell off that cliff to start off with, and I’ve come off it a lot more slowly. And what we find in our clinic is people that have tried several times to come off without success with this technique, slower over months and years and right. They can tolerate and very carefully the end are able to come off. It takes a lot longer, but they get off. And that’s been very gratifying to be to, to, to to to be part of.

Dr Ron Ehrlich [00:58:33] And I notice on on the outro health site it makes some reference to holistic wellness practices. What does that mean to outro health to you. What does that mean? Yes.

Dr Mark Horowitz [00:58:44] So so look, you know, one question people people ask is so if if antidepressants are not the answer, what is the answer? And I thought I’ve got two answers to this. My number one answer is there’s not a one size fits all because you know, that’s that’s what chemical imbalances. And it turns everybody’s problem to the same problem wherever you are. It’s a chemical in your brain. So I’m I’m very those kind of prescription people depressed for a reason. I would go back to the DSM one and two. It’s a reaction to things in life. You know, people are upset because of relationship problems. People are upset because of job issues. People are upset because of illness. So everyone’s problems. I think understanding why people are depressed is the best way to help them. You know, if it’s relationship, they might need relationship advice. If it’s financial issues, they might need financial assistance. So I think the first thing is meet the person where they are, understand what their issues are. That’s the best way to help them. And then in general, I think there are things that are helpful for everybody. And you know, those are the, you know, non medication lifestyle things. And and I don’t just take my my word for it in the nice guidelines. So nice is a government department in England that determines what is effective treatment for all sorts of conditions, from diabetes to depression and the Nice guidelines. There are 21 equally effective treatments for depression for both mild and severe depression. Three of them involve antidepressants, and 18 of them don’t. Those 18 treatments involve exercise, group exercise, various forms of therapy, mindfulness. But the single most cost effective treatment out of all of them for depression, for severe depression is problem solving therapy. And problem solving therapy means writing down your top three problems. What is the first step you’re going to take for each of them? And come back in two weeks and tell me what you’ve done about the first step, which I think really speaks to, you know, being the issues in people’s lives that drives depression. But, you know, it’s also you’ve talked about the holistic pillars of health. So I think there’s a lot of things that people can do with diet and exercise and social contact and, and finding ways to, you know, to relax oneself. But it’s mindfulness, whatever people do that can make people, you know, more able to deal with the ups and downs of life. And I think that those are the people in medical training. You know, it’s real stuff. Real stuff involves chemicals and scalpels. But I think in the long term, those sort of approaches have profound effects on people’s lives. Whereas things like drugs wear off because I think that’s another big limitation with studies. So they often go for six weeks now at six weeks, a lot of things are equally effective. Exercise, depression, therapy, medication. The trick is medications wear off. You know, all medications cause tolerance become used to them. So the effects of drugs wear on. But skills like therapy, therapies, learning you know how to think about your life, how to manage your emotions, exercise. You know how to be healthy. Those are things that can improve you. You can improve skills over time. And so in the long term, that is there are not long term studies that I know of about exercise. But for therapy, for example, after a year of therapy is vastly more effective than anti-depressants. And I think that those sort of holistic pillars probably fit into the same, category of things that you can improve over time. That probably benefits the long term.

Dr Ron Ehrlich [01:01:59] Now I just want to finish up with one last question mark, because taking a step back from your background in, in academia or in study as a psychiatrist, we were all on a health journey in this modern world as individuals. What do you think the biggest challenge is for us as individuals on that journey?

Dr Mark Horowitz [01:02:20] Okay. It’s a big it’s a big question. I think about my life if I can use the prism of my life to understand things. I think me learning to take care of my own health has been a very central part of things. So I think of myself as a distressed 21 year old that I no longer am, and I think that I was very poorly equipped back then, to, to manage my own health. And I think the things that I’ve done since then probably do fit into these holistic pillars. I think understanding myself better has been very helpful. I think, you know, becoming getting into exercise and mindfulness along the way. I learned a lot about diet. I think all those things, had I known them at 21, it may have put me in a different position to to to where I have now. I think that’s maybe as a part of maturity is learning and sort of things that you need to do to keep yourself healthy. So I guess what’s the message for other people, I guess, is like, there’s a lot we can do for our own health that involves us being, you know, empowered and having agency in looking after ourselves that makes us less less reliant on external help, like, like medications. And I think that’s it always makes me think about my grandmother. Yeah. My grandmother was an old school Russian, you know, tough guy. And I think that, you know, her response to things was good to do an hour of exercise in the morning. You’ve got to be disciplined. You got to get things done. And I always thought, you know what? I had us. And I think there’s a lot of I think it’s a lot of wisdom in that. I think, again, I don’t want to be. I’m not saying the people to pull themselves up by their bootstraps because that’s not I don’t I don’t subscribe to that. But I do think there’s a lot we can do for ourselves that can make us more, more resilient, against the troubles that are inevitably I got to experience in life. And I think that’s that maybe that that speaks to both physical and mental health in general.

Dr Ron Ehrlich [01:04:01] Mark, thank you so much for joining us today. I’ve been so looking forward to this conversation. Thank you for sharing your knowledge, wisdom and sharing your personal story as well.

Dr Mark Horowitz [01:04:11] Thanks everyone. Ron, it’s been good to talk to you.

Dr Ron Ehrlich [01:04:13] Well, as I mentioned, this is a big topic and a topic while we were discussing mental health. Really, when we talk about the influence of key opinion leaders and product champions who actually occupy very, very senior roles in our healthcare system, from bureaucrats to academics, from editors to, professors of health, that key opinion leaders and product champions play an extraordinarily important role. And that role is, well, let’s put it this way. If the evidence is anything to go by and we’re told it is, then we have an epidemic of preventable chronic degenerative diseases. And that evidence would suggest that perhaps our approach to not just mental health, but health in general is not all that it should be. If we were really focussed on the evidence now, I should have mentioned that Mark also co-wrote a clinical handbook called the Maudsley Deep Prescribing Guidelines, which outlines how to safely stop antidepressants, benzodiazepines, which are things like Valium and sleeping tablets. It is aimed at GP’s psychiatrist, pharmacists and anyone involved in the care of people taking these medications. And I’m assuming that includes people, actually. Be taking these medications. And we also are aware that patients are buying it. To give to their prescribers and to better inform themselves. Absolutely. Inform yourself. It’s available on Amazon. We will have links to that book in our show notes. So I hope you enjoyed that conversation. Very stimulating. Some very important concepts that we discuss there. I encourage you to go in to join the unstressed health community, which is independent of industry, be a chemical, food or pharmaceutical industry. And if, if I had to, say anything, the clear opinion leaders who are involved in this platform, I in myself and and the advisory panel which supports me in that. Well, I can assure you there are no links to industry. Your health is all that is important to us. I hope this finds you well. Until next time. This is Doctor Ron Erlich. B1 this podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice, or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.