Medicating Normal, The Movie: Why Are Psych Meds Prescribed So Frequently?

Dr. Mark Leeds [00:00] Nicole, you are part of, no, is Medicating Normal, is that like an organization beyond just the film or like is it, that’s the film supported by various organizations?

Lynn Cunningham [00:11] Lynn, you can answer that. Medicating Normal is the film. And after the film was made, we added what’s called an outreach team because we felt like the film has its life and it’s a production. But there are so many other stories, themes, experts in the field of mental health that we needed to hear from. So we sort of used the film for about a little more than a year. It started with our festivals and our outreach team really, to be very broad about it, is about getting the film talked about. So medicating normal outreach is sort of the phase we’re in right now. The umbrella organization is called Periscope Foundation, and that’s the nonprofit that we created to raise money for the film, but also to raise money for outreach. So Medicating Normal is the name of the film, and that’s what we feel. It’s almost a brand now. […] But it’s really under the umbrella of Periscope Foundation.

Dr. Mark Leeds [01:29] Okay. Today on the podcast, we have Nicole and Lynn from the film Medicating Normal. And if the two of you, Lynn, first, if you could introduce yourself, your full name, and tell me about what you do and how this came about, Medicating Normal.

Lynn Cunningham [01:46] Hi, Mark. Thank you so much for having us. I am Lynn Cunningham, a co-director, co-producer of the film Medicating Normal. It’s a documentary film about the overprescribing of psychiatric drugs and the harms caused by taking them in particular in the long term and yeah so my role was it primarily in product directing and producing but after the film began its festival foray we started we launched into a phase of outreach where Nicole joined our team and we’ve had almost 190 community screenings organized with panel discussions afterwards. And this part of the film really is exciting because it’s creating a dialogue that we want experts from all aspects of the mental health experience to take part from people with lived experience, doctors, not just psychiatrists, but all kinds of doctors, all kinds of mental health professionals, alternative practitioners, all take place in these panels following the film to talk about it. So, yeah, that’s, and I’m very engaged, as engaged in the outreach phase as I was in the production of the film.

Dr. Mark Leeds [03:18] And Nicole Lamberson, how are you involved in the film and in the movement?

Nicole Lamberson [03:24] Yeah, so thanks, Mark, for having us. My name is Nicole Lamberson. I actually trained as a physician assistant, although I’m not currently practicing. And that is because I took psychiatric medications, specifically benzodiazepines, sleeping pills. I took Adderall, Remeron, Seroquel. I was basically a classic polypharmacy case. And I got sick from taking them and even sicker from coming off of them. So I’m part of the, you know, lived experience community of taking these medications. And then I got involved doing marketing, outreach, and distribution for the film Medicating Normal and, you know, work alongside Lynn and the other filmmaker to help get the film out to the public.

Dr. Mark Leeds [04:22] Okay. And I watched the film and I really loved it. I think it was a really great film and, you know, something that will definitely affect my practice going forward of how I inform patients about medications that I’m prescribing and, you know, thinking more about with prescribing medications about risk versus benefit and going into the long-term risk, which I don’t, you know, now listening to, watching the film, you can see that the pharmaceutical companies are not looking at the long-term effects of these medications. They’re picking the data that looks good for them for the short term. And I think it would be great if every person who is going to a doctor who might get prescribed medication or is prescribed medication watches this. But I also think doctors shouldn’t be afraid to recommend this film to their patients. In fact, it maybe should even be required viewing. You know, a doctor may say, you know, I think you might benefit from this medication. But before you take this medication, you should know about psychiatric medication in general and how it might affect you in the short term and long term. Watch this film and come back and let me know what you think about it, and then we’ll talk further.

Lynn Cunningham [05:40] I think that is such a sound takeaway, Mark. And I think that’s what we, when we were making the film, we kept coming up with the term informed consent. And we realized that it’s for a film that’s a really hard, not very interesting to put those words in a film. But it is essentially what the film is about. It is about weighing the pros and cons of taking any medication before. And Nicole can talk about it more in detail. But we opened the film with a scene from a hearing up in Boston that one of our characters, Dave Cope, is taking is testifying in. And this hearing is about really about whether or not informed consent is being given properly for the class of drugs known as benzodiazepines. And it was really interesting to us that the pushback on it on that labeling a drug and making sure that doctors give informed consent the pushback was that doctors were afraid that these drugs would would not be available anymore or that people would be worried about taking them and so but that just doesn’t make sense to us the I if I if I were being presented with whether or not to take a drug, I would want to know before, you know, even if it made me a little bit hesitant, I would want to know. So Nicole can give you a follow-up on what’s been happening up there.

Nicole Lamberson [07:11] Yeah. I mean, I’ll just add that being part of the, there’s a whole community of people who are injured by psychiatric medications and benzodiazepines online. It’s sort of an underground community and it exists because people feel like they have to go there for help because their doctors don’t really know enough about these medications or how to get them off of the medication safely. So they turn to each other for information and support. And we’ve done surveys of people in the community asking them, you know, about this issue of informed consent, how many of them felt like they were prepared by their prescriber at the time of prescription for, you know, all of the potential outcomes of taking the drugs long-term and overwhelmingly patients report that they feel like they were not given informed consent and had they known more information about the true, you know, risks and potential harms of the medications, they would have never taken them or they would have looked for viable alternatives first. I can include myself in that. I mean, I don’t feel like my psychiatrist fully informed me and I trained as a PA. So people will say to me sometimes, you know, well, like you had medical training, didn’t you know? And my response to that is, well, I was brand new as a PA when I first started the medication. So I didn’t know. And also we didn’t have the training in school. We weren’t taught about the physical dependence causing properties or the potential for severe withdrawal, how to get people off of medications in general like that. So no, I think we need more training in medical schools. And I think patients are deserving of more information at the time of prescription. But then also on the topic of informed consent, a lot of patients say, I don’t know that you could give informed consent because or fully informed consent, because what happened to me when I tried getting off of these medications was so far beyond the realm of like normal human experience or it was so torturous. I don’t know that a doctor could have ever told me that was possible and had me truly understand what was going to happen to my body. So

Lynn Cunningham [09:38] Yeah and the words the warning words are intentionally simple so as not to scare people away from taking the drug I think but then they do not convey like simply another member of our team often talks about the word dizzy and you know you read the word dizzy on a warning label and you think okay all right well if it’s really going to help with this other problem I can handle dizziness, but the extent to which she describes the word dizzy when it, as it actually happened to her, it was so not able to stand up in a shower or being on a tightrope with high heel shoes, such extreme dizziness that’s another thing. The words themselves, as Nicole pointed out, do not convey actually what can be experienced.

Dr. Mark Leeds [10:33] Yeah, informed consent also, when you go to a surgeon, surgeons have to give informed consent before a procedure. It’s required by law. And it’s usually in the form of a written form and you read over it and you really want to get the surgery done and it’s going to help you in some way. And then you read infection, scarring, death, disability, and all these horrible things that can happen. And then most people will just say, well, it’s routine. They might sign the form or they might even ask the doctor, what about all these horrible things that can happen? And the doctor will say, well, I’ve never really seen any of that happen, but we have to put it on the form. So even informed consent can turn into like a routine thing that people kind of gloss over and it’s fine print on a form. And, you know, I mean, doctors, you know, I mean, it’s important to actually talk about it openly to say, you know, these are real things that can really happen to you. Also, these drugs are not designed, I don’t think, with the idea of tapering. You know, it’s almost like an airplane with landing gear that doesn’t come out at the end. You know, it’s like we didn’t really give you all the dosage levels and any kind of a mechanism for how to come off of them. You know, maybe you have like in the film, it comes up, how do you get off of Vyvanse? Well, maybe pour a little bit out of the capsule, but you can’t do that very precisely. I mean, it’s just not designed for a person to come off of it ever.

Lynn Cunningham [11:53] Yeah and also nicole the also many people report back who after having seen the film or beginning to be aware of these issues and the actual as you say the medication doses on how to withdraw vary if you go across the country from doctor to doctor to doctor they do know generally about the concept of withdrawal but some say oh you know cut it a third, cut it a third. Others are more aware that it needs to be less, cutting a less amount. But how to do that when the actual pill or capsule is a given size, it doesn’t exist in liquid form. At one point, we did not put this into the film, but our character Angie was literally counting the beads inside the capsule to be able to taper by taking three, four, five beads out every time she dropped a dose. I mean, that’s just not only, I mean, I guess it is precise, but it’s absurd that it doesn’t exist in smaller amounts for people to taper.

Dr. Mark Leeds [13:04] Yeah. And one thing, another thing is compound pharmacies can help out with this, where they can create customized dosing and even help with the tapering process by creating liquid forms that can be measured out very precisely. So, you know, people interested in tapering are coming off of medication very gradually, may want to become familiar with their local compounding pharmacist.

Nicole Lamberson [13:27] Yeah, totally agree. We, in the support communities, refer people to compounders quite a bit. But, you know, they tend to have good information, like which doctors are actually even using them for compounding. So you may be able to even find a physician who’s open to the idea of compounding and going more slowly. Just sort of in response to what Lynn said, you know, the dosages not being available and prescribers saying, you know, just reduce by whatever available dosages there are. There are people in the withdrawal communities who are, I couldn’t believe this. When I showed up, I was like, oh, my goodness, I can’t believe people are making mixtures, you know, they’re dissolving their pills in whole milk and water and, you know, making these solutions at home, basically becoming like kitchen chemists to try to come off of this stuff. So it’s really shocking what people have to go through. And some physicians we found when patients go back and say, you know, I need to go much slower than the doses allow for some of the doctors, like they just don’t believe or they don’t understand that how slowly some people actually have to go. They think it’s sort of like extreme or excess or, you know, maybe like an indication that the patient is, quote unquote, addicted to the drug because they’re saying, you know, no, my body will only let me remove 5% of my current dose per month, as opposed to these bigger, you know, sort of arbitrary percentages that we think people should be able to go at.

Dr. Mark Leeds [15:16] Yeah, and just to be clear, like what we’re talking about with cutting back and this is physical dependence. It’s not addiction at all, completely outside the realm of addiction. Although there are people who do use benzodiazepines addictively, it’s probably a very small number of people. But that’s something I was wondering about. You know, like there’s this, the Ashton manual that tells people, here’s a way of tapering very gradually off of a benzodiazepine. But if a patient comes in and says, well, I’m addicted and I, if you give me a bottle of pills, I’m just going to take them all in one day. I mean, how do we deal with a patient like that? Like they need to be tapered safely. Maybe that needs to be done in an inpatient facility or something.

Nicole Lamberson [15:57] Yeah mark thank you for pointing out the language that’s something like is one of the things that I have spent a lot of energy advocating for is people making the distinction between physical dependence and addiction because I think it’s so important I think one of the reasons I was able to fall into this trap especially with benzodiazepines is because you know it says on the label addict could become addicted or addictive properties But when you’re just the average person taking the medication as prescribed by your doctor, you hear the word addictive and you think that doesn’t apply to me. I’m safe because I’m not abusing them. I’m taking them as prescribed. My doctor told me I need to take these. And there’s a whole group of people who become physically or physiologically dependent on these, which means basically just that your body neuro adapts to their chronic presence and you have the potential for severe withdrawal syndrome from them. So we need to find a way to let the public know that, you know, if you are taking these medications chronically, antidepressants too, you can become physically dependent and has nothing to do with being addicted, abusing them, or having a substance use disorder. Now, on to your point about people who abuse them, I can’t really speak to that because most of the people in the withdrawal support community that I’m a part of are physically dependent. We don’t have a lot of people who have substance use disorders from benzodiazepines, but I will say that I made the mistake as someone who was physically dependent on benzodiazepines of going to a detox center myself to get off of them. I had no idea that you had to taper. I didn’t find the Ashton manual myself until it was much too late. And because the physician that I went to and told I’m having all these horrible adverse reactions to benzodiazepines and this other psychiatric polypharmacy, because that doctor thought I was quote unquote addicted because they didn’t make the distinction between physical dependence and addiction. They referred me to a detox center and I went and the results were catastrophic. I mean, I had severe, severe withdrawal. I almost took my life because the symptoms were so intense that I wasn’t sure I could bear them. I actually had to find after the fact a physician who knew the difference between dependence and addiction who reinstated me on a benzodiazepine and allowed me to taper. And that is what sort of saved my life. So I think the language in this space is so important that we know the difference and make the distinction and also understand that the treatment of both is completely different.

Dr. Mark Leeds [18:58] Yeah, yeah. These benzodiazepines are really not very addicting. The DEA knows this. They put it at Schedule 4, which is low abuse potential. So it really is overwhelmingly an issue of physical dependence and not addiction.

Nicole Lamberson [19:14] Yeah, correct. There’s actually a study I found. It was from 2015, 2016, where they looked at, it was national surveys on drug use and health. And they looked at how many people in the U.S. Were using benzodiazepines and it was 12.5%. But then they found that only 2% of U.S. Adults misused them at least once and only 0.2% met the criteria for having a benzodiazepine use disorder. So it’s rare. Yeah.

Lynn Cunningham [19:54] That said, I just want to point out that it is currently quite common for these pills to be available in at the high school level in boarding schools, in colleges. My sons are both in college and their friends have reported that, you know, there’s the phenomenon of the big bowl of pills that people just dip into and you take your choice, not even knowing what it is. So it, they are available to a very young recreationally, because as Dave Cope points out in the film, they really work immediately. They work immediately and they calm you down immediately. It’s just these kids unknowingly are taking them, not knowing what the consequence might be if they start taking it regularly.

Dr. Mark Leeds [20:52] Yeah, yeah, I mean, going away to college is like a stressful thing to begin with, and then a kid gets there, and they’re in parties and extreme stressful situations, and then someone says, well, here’s some Xanax, and it works, and it doesn’t mean they got addicted to it. They found that it solved a problem very effectively, and then they may very likely become dependent on it.

Nicole Lamberson [21:13] Yeah, that’s a good point. There’s a physician by the name of Sami Timimi. He’s a psychiatrist out of the UK. And he even warns about, you know, we raise so much attention about long term use being so dangerous, but he raises the point of even short term use can be dangerous because it can open the door sometimes to a long term prescription.

Dr. Mark Leeds [21:38] Yeah, yeah. And now the film I was trying to keep track of all the drugs that were that were mentioned, and I might have, I was making a list I may have missed some and I think some of these were all mentioned by one person early in the film but I got Effexor, Cymbalta, Geodon, Abilify, Prozac, Zoloft, Vyvanse, Adderall, Ativan, Xanax. And there may have been more and I started looking through the product information for each of these every one of them gives you a you know mechanism of action how they think it works but they all start with mechanism of action as unknown like they don’t really know how any of these really work in the brain

Lynn Cunningham [22:15] Yeah and also Klonopin was in there too but yeah but there are if you look up. Yeah, nobody knows that. And also what we found was interesting is that if you go online, they all warn about the properties of these drugs. So in many ways that the warnings are out there, they’re just downplayed and not available to the actual patient during the time of prescription. So if people or their doctors would actually really dig into this information out there are warning signs. But you’re right. There’s no knowledge about how they really work.

Dr. Mark Leeds [22:59] Yeah. And the antidepressants, a lot of these medications have what they call the black box warning, which is literally a black box in the package insert or the page, the PDF or printout you get. And it says it may cause suicidal ideations. And I think it’s children, teenagers, is young adults. And I don’t know what a young adult is. I’m 52, almost 53. I don’t know if I would still be a young adult, but it is, that part’s kind of vague, but yeah, these things can cause people to become suicidal things like Prozac and the other antidepressants.

Nicole Lamberson [23:33] Yeah. And sometimes Mark, you know, the information we have is constantly evolving. You mentioned the black box warning. I mean, benzodiazepines back in the seventies, people raising, you know, flags about them. And we only just got a black box warning on benzodiazepines here in the last couple of years. And then you mentioned too, about how, you know, we don’t know the true mechanism of action of the, of the drugs. And even more, we don’t know what happens when you start taking them in combination with other drugs. And there’s so many people in the withdrawal support communities that I meet who are polypharmacy patients. I mean, they start out with one and they have an adverse effect. The adverse effect is sometimes misdiagnosed as, you know, quote unquote, mental illness. There are more medications are added. And so you have people who wind up on these combinations of medications, which we know even less about what happens when you take this one with this one.

Dr. Mark Leeds [24:37] Yeah, yeah, that’s a good point. And when you look at drug interaction checkers, you know, these online things where they check the database and, you know, I don’t know how they know that these things, you know, they’ll often say, and you can put together a combination of stuff that looks toxic together and it’ll say no known interaction. Yeah.

Lynn Cunningham [24:57] And then, and then the, well, this drug you’re taking is making you feel this way, and I’m speaking from personal experience with my family member who actually inspired the film, but this drug is unveiling another disorder that was there all the time, but you didn’t know about it. So therefore let’s take this drug in addition, which is just, it just defies logic. And the fact that, well, case in point, if you now look on TV, you see a plethora of ads about tardive dyskinesia. And, you know, we know, and Nicole can tell you more about it, and I know you know, Mark, but this is a side effect of antipsychotic, and yet it’s being portrayed as a disorder on its own that needs to be treated with yet another drug. And that kind of thing is happening all the time.

Dr. Mark Leeds [25:58] Yeah, and that brings up something else I was thinking about calling a lifestyle a disorder. And I was thinking specifically of, I think, shift work sleep disorder, which is apparently a disease, which is really that you’re working a bad job, a job that makes you work irregular shifts. You know, I first thing I think about as a nurse, you know, a nurse being told you’re going to work the night shift now and then two days later, you’re going to work the day shift and a 12 hour shift. And so their circadian rhythm gets gets thrown off and they drive home and they’re tired and they can’t spend time with the family. And maybe the husband or wife or children expect them to be awake during the day when they just work all night. And so what’s the solution? Well, here’s Provigil. That’ll make you feel like you get a full night’s sleep. It’ll promote wakefulness. And as to treat this condition, shift work, sleep disorder, where probably the better solution would be to quit the job. And that may not be practical for everybody, but now we’re calling a lifestyle a disease.

Nicole Lamberson [26:58] Yeah. Yeah. I think that’s why the title of the film is so perfect, because it’s we’re medicating normal. It’s your body. When you stay up all night, you’re going to have, you know, symptoms and repercussions from doing that. You know, I look at, at back at why I first started my first medication, which was Xanax that got the whole ball rolling into this, you know, mess that I found myself in. And it was because I had stress at work. You know, I was fresh out of PA school. I was nervous about, you know, caring for patients for the first time. And so instead of, you know, just, doing other things that would have helped me cope with that. I took these medications, it all backfired, I became so ill that I couldn’t work anymore. So in one sense, I guess it caused or it solved the problem of work related stress, because I became so ill, I couldn’t work. But in the end, I had to do all the things, the coping mechanisms like yoga and meditation and eating healthy and exercise to cope with the severity of the withdrawal that I had from the psychiatric medications. When, if I would have just done those things in the beginning, I would have dealt with this normal life work stress that I had, and I would have been fine.

Dr. Mark Leeds [28:22] Yeah. And there’s a lot of things that people can do. And it’s not sometimes not easy just to push yourself to do it, like walking outside, or if you live near a beach, you know, walking to the ocean, waking up and going outside in the morning, sunrise, sunset. I mean, there’s therapy. That was something I was also thinking about. Doctors, psychiatrists don’t really do therapy. And I actually had another guest on the podcast, Dr. Lloyd Sederer, who’s in public health for like 20 years in New York and did a lot of great things for New York and helped improving psychiatric care. But we talked about that, about how psychiatrists really can’t even afford to, you know, with their loans and their lifestyle, that they could see one patient an hour and see eight to 10 patients a day or whatever, but they can see four times as many. They can see one every 15 minutes if they use medication instead of therapy, which sounds terrible, but, you know, where do people turn for therapy? I was thinking now you have these coaching people, although it doesn’t have the same protection of like when you see a psychologist, you know, they can’t, your privacy is protected, but you know, now maybe not everybody has the time or the money to see a psychologist or the ability to, but you can, there’s all these people now you can do coaching online. And if you just want someone to talk to, like probably for $20, you can get someone on the phone for an hour and just talk. I mean, I don’t know if that’s a solution of any kind, but yeah, people need therapy. They need talk therapy or even just someone to talk to. And it just doesn’t seem to be available now.

Nicole Lamberson [29:58] Yeah. I mean, it’s really the system is, you know, set up, to where, you know, a lot of people, if you don’t have money for something, like you need to pay a coach or something like that, they use their insurance, you know, because they have a $10 copay and that’s what they can afford. And they wind up, you know, in the psychiatrist’s office where they’re not getting the therapy. But when I became injured by the medications, I even found just reading out to support groups. I mean, finding somebody who’s in a similar situation as you don’t have to obviously be in psychiatric drug withdrawal. It can just be like a divorce support group online. Finding other people in the same situation is, in my opinion, I had so much more support there than I would have even paying a therapist.

Lynn Cunningham [30:52] And Nicole, talk about, because I think it’s so interesting to learn about these support groups, because a lot of doctors are leery of them. They think that there’s misinformation out there in the support groups that I’m talking about, you know, on a particular drug support group, trying to get off or taper. And I think it would be interesting to know, like, how do you know that you trust these people? What actually happens in a support group online?

Nicole Lamberson [31:21] Well, I mean, of course, there’s bad information everywhere on the internet. So you have to be discerning and be your own best health advocate for sure and do your own research. And like we talked about earlier, you know, Mark suggested having connections with compounding pharmacists and professionals that you trust as well. But yeah, I mean, for the most part, there are really great people in the withdrawal support communities. Some of them have been around for 10, 15, 20 years supporting people going through psychiatric drug withdrawal. Some of them are subject matter experts, in my opinion. I mean, they’ve spent years studying one particular drug, For example, if it’s the Cymbalta support group, for example, they’ve read everything there is to read about Cymbalta and they know all the different ways to tell people to taper and what has anecdotally worked and not worked over the 10 years they’ve been adminning the group. There’s physicians in the groups. I’m a PA. I’m in the groups. There’s a cardiologist I know who’s in the benzodiazepine support groups. So it’s not all just, you know, lay people either.

Dr. Mark Leeds [32:39] Yeah, the groups, those groups, and I follow a lot of these groups like on Facebook and different places, and some of them are very good. There’s a suboxone type support group that I love following, but it’s very well moderated. They keep people out that they give bad advice, you know, people saying you use the herbal kratom to get off of opioids or suboxone. And, you know, people that are going to put things that are dangerous or illegal or promoting themselves, you know, they there’s moderators that will protect the group from that. And I think a lot of the groups have that. They have moderators just making sure that nothing bad gets into the group. Although sometimes, you know, one thing that I think can be harmful that might be harmful to a person is to see someone else’s experience. Someone may go through something extreme and you know it scares them you know like like you know someone says well when I tapered off of benzodiazepines it was horrible and it may have been horrible for that person it might not be as bad for the next person so I wouldn’t want somebody to get scared to even approach it because now they’ve been scared by the group so I mean everybody’s experience may be different and it may not be as bad for one person as it was for another person.

Lynn Cunningham [33:48] Yeah, that’s a good point. Well, and I just wanted to let you guys know that when in the screening of this film, all around the country, you know, very good friends who are psychiatrists, you know, I would present the film, its thesis, its premise, the purpose for it. And they’d say, no, that drug is a great drug. I’ve never had any patient ever respond negatively or have, or have had trouble coming off of it. And there, I don’t, I don’t disbelieve this psychiatrist. I feel like it is their reality that the patient group that they see could possibly be responding well and not have issues coming off. I just, it’s almost like a self-actualizing truth for a given someone’s experience, like that doctor has people who come to him and continue coming to him because they are doing well, whereas those who may not be doing well go to a different doctor. So when you talk about the variation of response, I think it is very real because when we’ve screened the film, people react so differently given their own personal experiences. And that’s the challenge to say, okay, you had this one experience, but other people have this, and we need to understand that’s a part of the truth.

Dr. Mark Leeds [35:16] Yeah. There was someone on the film that right away I recognized her and Dr. Anna Lembke from Stanford. And because I remember seeing her on another podcast, the Huberman lab or Huberman report with Dr. Andrew Huberman, also from Stanford. And so when I saw her, I thought, oh, I caught someone because I’m pretty sure, you know, Dr. Huberman is all about enhancing human experience with supplements and medications, although he does also talk about non-medication and non-supplement type things. But so I ran over and watched that one again. I watched some of it. And then I saw she wasn’t, she was completely consistent with her message on your film and in his podcast, because he was pressuring her towards the end about psychedelics of, you know, what do you think of this psychedelic study or that one? And she was very clear that they’re very small, short-term studies. And, you know, there may be some benefit, but, you know, let’s take it all with a grain of salt. I don’t remember her exact words, but she was very consistent, you know, of not being all in favor of it and saying that people have unrealistic expectations. But some of the psychedelics, I mean, these are like the up and coming drugs that they’re trying to get approved. And, you know, they also have unknown effects and effects on neurotransmitters. You know, MDMA apparently causes a large release of serotonin and what is it serotonin and dopamine at the same time, which is unusual. But that could be a whole new thing coming. Everybody thinks these psychedelics are going to be the, you know, the thing that’s going to fix everybody. And maybe if you can just take one dose and it works and that’s it, maybe it’s safer than taking something long-term. But I mean, like, do you have an opinion on like these other kinds of drugs, like things coming up for psychiatric treatment?

Lynn Cunningham [37:07] Well, I think, yes, if someone can have relief on a very short-term basis and not be prescribed the drugs on a daily basis, maybe, but I think you’re absolutely right. So much more research needs to be done on the health implication. And I do know for a fact that it is the next big thing in venture capital. A lot of money is being put into the psychedelics and lots of good press about it. And it’s very easy. And I know people who swear that it is mine. It’s just the wave of the future, et cetera. But I, given our whole experience with medicating normal, I would just pause, pause, pause on that and be very leery and take it slowly and do more research, demand more research and regulation and regulation.

Dr. Mark Leeds [38:07] Oh yeah. As soon as money starts going and things like marijuana is suddenly now it’s not a gateway drug. It used to be a gateway drug. And now you can’t even find anybody calling it a gateway drug anymore, where clearly it is. Anytime these things become big business, everything changes, and you have to be careful. I mean, if psychedelics are so great, why is it that every patient I treat for addiction tried them when they were younger? Why were they not cured back then when they were taking tons of them? And I know that they’re now saying it’s got to be regulated, taken with therapy, and done in a certain way. But yeah, there is no magic bullet. None of these are going to solve all of a person’s problems overnight.

Nicole Lamberson [38:46] Yeah. I mean, I think if you look back at the history of medications, we’ve just sort of repeated the same mistake over and over and over again, you know, it was like the bar the barbiturates and then they were bad and then the benzodiazepines and then they were bad and then, Oh, but the antidepressants, we’re going to market those as safe and non-addictive. And now we find that they cause physiologic dependence and withdrawal. And maybe the psychedelics is going to be the next thing, you know, down the pipe. I just feel like after my experience of taking these medications and, you know, looking for the bandaid fix that wound up actually being the thing that destroyed me and caused me so much suffering, you know, learning about my body and how to take care of myself and, actually getting out there and exercising and realizing how good you can feel when you do that eating right. I mean, when I changed my diet and cleaned it up and read all I could about the best ways to eat, I stopped biting my fingernails for the first time in my entire life because I started taking care of myself. So for me, I just feel like I know lives are busy and we want something fast, but there’s, it’s not free, you know there’s a cost

Lynn Cunningham [40:05] Yeah

Dr. Mark Leeds [40:07] Taking a long walk I mean it’s very therapeutic and we should all be walking more that’s definitely a good thing so I one thing I felt with the film I kind of felt it in some ways maybe it was a little unfair to doctors but probably because I’m a doctor yeah two doctors were kind of attacked for you know I mean not attacked but like shown as being you know not really understanding one was shown as being very uncaring towards the patient. Although I could see his point of view, but I think the way he presented it was wrong and really no empathy or caring of what the patient is going through. But doctors are not that far removed from patients. I mean, we don’t know all that much more. Some of our patients know a lot more than we do about certain topics. And, you know, I’ve kind of felt like maybe the real villain here is the pharmaceutical companies. And he did talk about that, about how they cherry pick the data, they push away the data that doesn’t support them. And in some ways, it’s criminal what they do with the data. And they, you know, really control the message and to some degree control all of medical education. And doctors and healthcare providers in general, there’s a lot of gaslighting going on in medical education. You know, we’ll go to a convention one year. I mean, just for example, there was a time when we went to conventions and they would yell at us about how it’s criminal to not treat pain with opioids. Then 10, 20 years later, it’s criminal to treat pain with opioids. And I think we’re going to come back around to the opposite again soon. And, you know, we’re sitting there thinking, wait, didn’t just, I know 10 years ago, there was a guy up on that same stage telling me the opposite. And now he’s threatening me that I’m going to lose my license if I do the opposite of what he told me 10 years ago. And if you bring it up, you know, you’re not, we’re not supposed to question authority. You know, we’re supposed to, you know, just listen to the experts, listen to the authorities, and the authorities are controlled by these billion-dollar companies.

Lynn Cunningham [42:09] Yeah, what’s so interesting about that is that we did have, in one of the early screenings of the film, we had a bunch of top psychiatric professionals. There were some psychiatrists, there were some regular doctors in to take a peek at one of the rough cuts. And needless to say, they did not like the film because I do think that it maybe is not, it’s not that it’s unfair. It’s just that to tell this part of the story, we needed our patients to convey their experiences. And so their doctors played a role. But this group of about 10 mental healthcare professional doctor looking at the rough cut, I turned it off. There was a long silence. And I said, what did you guys think? And someone said that was terrible. And I said I was my heart was pounding because I didn’t want them to hate the film. I wanted it to open their minds. And I said, OK, why did you think it was terrible? And their immediate response was you can make you could you could have made 20 different films on this very topic. And this very broad film doesn’t, you know, it doesn’t get it at the truths that these 20 films could. And that is true. But you’re talking about introducing something to the general public, you kind of have to do a basic 101 overview of this perspective. But I did say to the group well okay of those 20 films which film would you guys do and they all and almost in unison said oh the pharmaceutical corruption for sure and so it is doctors are aware of it and but then I you know I didn’t want to get on and argue I wanted these this group to feel part of the solution but my question then was if everybody in that room was aware of the pharmaceutical corruption, and they are the professionals using the product of this corruption, then why can’t they, you know, and that’s where it ends for me, is that if everyone is aware of it, then why aren’t we doing something about it?

Dr. Mark Leeds [44:20] Yeah, yeah, I saw an interview with this doctor, his name was Dr. John Abramson, the author of Overdosed America, The Broken Promise of American Medicine. In the interview, he talked about the extreme corruption of the pharmaceutical company. And he was mostly talking about things that are not psychiatric medications. Like he talked a lot about cases with Vioxx and I think Lipitor, you know, cholesterol medication, pain medicine, probably, you know, but it was the same issue. The fact that no one really has access to the real data is completely controlled by these billion-dollar companies. And we don’t really know anything until there’s a disaster that the drug gets released. And then the real study is when the public takes it and we find out that they’re dangerous. And even then, you know, apparently it’s hard to get to the heart of what really happened.

Lynn Cunningham [45:10] Yeah. And I think why can’t, and this is what, it’s so super simple, but why can’t the people testing or the organizations actually funding the trials that are testing for safety and efficacy be removed from those who are actually profiting? That to me is where the conflict of interest inherently takes place. And you can’t blame a company that is wanting to put a drug to market. You can’t blame them for wanting that trial or trying to get the trial to make their drug look favorable. I mean, they’re in business, but if we could somehow separate the funding of the trials from those who are actually profiting from the sales.

Dr. Mark Leeds [45:55] Yeah. It’s a conflict of interest the way it’s set up right now. Yeah.

Nicole Lamberson [46:03] I just wanted to add a sort of like someone who had my foot in both doors, you know, a PA who saw patients and also a patient who took these medications. I think, you know, like you guys are talking about doctors and prescribers are certainly victims, you know, of the system. I remember when I was working, I would get notices like your average time, you know, spent with the patients this month was 12 minutes and we’d like you to get it down to eight. So they’re under immense pressure, you know, to work fast and prescribing a drug happens in eight minutes easily. But when I was on the patient side, the thing for me that was sort of unforgivable was, and what I see in the support groups to patients reporting that when we come to the doctor and we say, I’m having this horrific withdrawal syndrome. It’s the being disbelieved even times where I would print out the Ashton manual or I would take papers about how benzodiazepines or antidepressants could cause withdrawal I would be turned away or disbelieved or told that doesn’t happen so you know yes it’s unfair to vilify the doctors for the state of affairs but I think when it comes to not being open-minded about what can happen when you try to come off of these drugs, you know, all you have to do is listen to the patients. They’ll tell you what’s happening to them.

Dr. Mark Leeds [47:34] Yeah. Yeah. That’s, that’s a good point. I mean, there’s a huge issue with doctors, not trusting patients, you know, especially in addiction treatment. And even though lying can be part of addiction, it’s not always. And often the patients are being completely honest. I mean, there’s a huge issue with also with patients who go to the hospital and their medications are messed with very quickly. They’re taken away and patient goes into withdrawal and it’s seen as a psychiatric issue. And the patient then gets, they may have gone in the hospital for something completely unrelated to anything psychiatric. And so now they suddenly find themselves being transferred to the psych ward. Maybe a patient went in for, they had chest pain and so they’re being evaluated for that. But then someone took them off their benzodiazepine or their pain medication, they go into withdraw. And it’s like, oh, look, we have an addiction problem, or we have a psychiatric problem, let’s transfer them to the psych ward. And it becomes a disaster, almost like a circus of misunderstanding. And all because, you know, the patient tried to tell the doctor, well, I need this medication, you can’t just take it away. And the doctor saying, well, you’re, you’re addicted, you know, there’s just a, so yeah, doctors should listen to patients very carefully. That’s an important thing. And it doesn’t take that long to listen and to not always distrust everything you hear and to think things over and think, you know, maybe there’s something to this. Maybe I need to go do a little research and look into what they’re talking about. Yeah, absolutely.

Lynn Cunningham [49:06] Yeah, and I think, and we’ve come across many, many great doctors, psychiatrists who do listen And it’s really important to note that our film is not trying to villainize the doctor, because I feel like we’ve come up there in our film, Anna Lembke, you know, just the humbleness or the humility of being able to say, I realized I was harming my patients takes a huge it’s it just takes a lot. And those doctors are all over and open to this, to the ideas in the film. And so really important that, Mark, you point out that there it’s and it does cause defensiveness. And we try to allay that by bringing in people with divergent viewpoints into the discussion along so that people can hear from people with lived experience on the panel. And we want that dialogue to happen more because I just think it takes, as you say, listening.

Dr. Mark Leeds [50:13] Yeah, I was wondering specifically like those two doctors I was thinking about. There was the doctor with the Vyvanse where he talked about cutting by a third. And that looked like a camera person went in with fancy equipment. And I imagine the doctor was agreeable to being filmed. And I don’t know if he felt bad about it later. I mean, and then the other doctor, it was like an undercover camera and his voice was altered and it was blurred out. So I would imagine he didn’t agree to be in the film. What are the details of that? How did that work out?

Lynn Cunningham [50:45] Yeah. So the second one, when the doctor was blurred out, that was a hidden camera that Shalimar wore when she went back to ask him about her situation. She was afraid and felt he would not take her if he knew the extent for questioning. What happened after that is when we saw that, when we reviewed that footage, we thought to ourselves, this guy is actually, I mean, as you noted, his delivery was not very sensitive to her. But in many ways, he was more honest to her than many of the other psychiatrists who deny that there’s any kind of a problem. At least he compared to what she was going through with, you know, withdrawal from crack and cocaine. You know, at least he used them in the same sentence. And we thought, well, maybe, you know, maybe we and we did. We took our footage and went and made an appointment to see him and explain the whole film, explain the scene, showed him the scene. And he was you know not happy I wouldn’t say the word happy but he did not get mad and he said yeah and it shocked me when I came from russia actually he was from russia and he came over in the 1970s it shocked me how easy it is to actually be prescribing these drugs over here because where I come from you can’t and then we said we know you are very sort of honest in a weird way Maybe you should have warned her, but would you be willing to talk about this if we came back and interviewed you and, you know, talk about how you prescribe these drugs? And he said, let me think about it. And then a day later, he called me, said, no, I don’t think it would make me look very good. Please disguise the footage to the extent that no one knows it’s me. So that’s the story behind that doctor. And, you know, I think doctors, I think that this is what happened to Shalamar, who had, as you described earlier, the shift sleep disorder. I think that’s happening all over the country. So we thought it was really important to include and it would have been better had he had he then come on and allowed us to show it in its full non blurred state. But that was him. And the other yeah oh sorry go ahead no and the other doctor we have not reached back to him and that’s bad on us but we didn’t feel that scene was necessarily that unfair because brie who is married to dave who’s one of the characters in the film she is not horrifically harmed by having taken her vivence you know she wanted to get off it’s difficult to get off but And did that doctor cause her huge harm? Did she actually feel that those drugs helped her through a phase of her life? Yes. So I think that, again, is just a typical scene with someone. Now, we wanted to put that scene in because his assumptions and directions on how to taper were so different than what other people recommend. So that scene shows how varied the knowledge is out there about how to taper.

Dr. Mark Leeds [54:15] Yes. He presented, he was saying instead of Vyvanse, maybe we could switch to Adderall because it’s more potent to overcome the tolerance. But he also could have said maybe Adderall was the right decision, but for another reason, because it is short acting and comes in multiple, more dosage options. So maybe it just like, you know, similar to the Ashton manual method, maybe that would be a way of tapering, switch over to something that has more options to cut down to smaller tablets. Or, you know, I’m not sure if it would work that way. But yeah, I mean, there may have been ways to explore that of finding better ways rather than, you know, counting beads out of a capsule.

Nicole Lamberson [54:56] Yeah, Mark, they do that for antidepressants a lot, what you’re describing called bridging. And a lot of times they’ll bridge people over to Prozac because it comes in different forms and better doses and that kind of thing. But sometimes people report that and maybe it’s because they’re, you know, the drugs are not exactly identical. They’re similar. And some people, when they switch, they’ll go into withdrawal anyways, because they’re taking a new drug and not the same old one that their body is adjusted to. But other people switch and they do fine.

Dr. Mark Leeds [55:33] Yeah, that’s a good point. That’s interesting. The idea that doctors should consider, maybe if we try it this way, maybe even look for other… I mean, that would be great if there was a community of doctors discussing these things of like, how are you doing it? Maybe I can try it this way or that way, or having that discussion amongst professionals of different ways to help patients taper. When you have an antidepressant that only comes in a few different strains and you don’t know exactly how can I help the patient do this gradually. And maybe there’s other doctors that have that information. Yeah, it’s such a great idea.

Nicole Lamberson [56:08] We, I also do some work at a nonprofit called Inner Compass Initiative, and we have a grassroots project called the Withdrawal Project. And we’re actually developing something right now like that, where we’re going to open it up and invite professionals to come and have those discussions with each other.

Dr. Mark Leeds [56:30] Okay, that sounds great. I mean, just for example, I have a patient that wants to come off of Lyrica, and Lyrica comes in, I think, 25, 15, 75 milligrams. And so there’s not a lot of, you know, what do you, I mean, just as an example, what might you hypothetically tell someone, because now you have these, I think they’re capsules, I don’t think they’re, you can’t break them. So basically, the lowest dosage option you have is a 25 milligram.

Nicole Lamberson [56:59] Yeah. I mean, in the withdrawal support communities, there are people who I know with gabapentin, they’ll open the capsule, which has powder inside of it. I’m not sure I’d have to go look about Lyrica, you know, what form it comes in or whatever, but they make their own liquid mixture with water. I know that makes a lot of, you know, practicing physicians nervous. They don’t like the patients, you know, making these things at home. But anecdotally, it’s successful for lots of people, and it’s a means to an end, and they get off the medication. I mean, compounding pharmacies always, I think, safer and better, and doctors feel better about it. But there are people making their own mixtures at home and having success with it.

Dr. Mark Leeds [57:50] Yeah, it’s true that compound pharmacies are often not covered by insurance and they can be expensive.

Lynn Cunningham [57:56] But I could also see where Mark could not tell a patient to do that. You know, I could see that doctors. Well, I don’t know. Could you could not? I don’t think given.

Dr. Mark Leeds [58:10] Yeah, I mean, it’s a it’s a difficult topic because it’s not if it’s not in the literature. Now we’re, you know, we’re going into off-label territory and things that, yeah, I don’t know that you absolutely can’t because we do have, you know, a lot of leeway in what we’re allowed to do of doing things off-label. But, yeah, I mean, you need to be careful. I would have to think, like, is that really going to work? I mean, I’ve never tried it. Would it really distribute evenly? You know, I wouldn’t want someone to mix it with water. And then, you know, I mean, we have to assume also that everybody doing this is as clear thinking as we are and that they’re going to properly shake it up every time. Same could be an issue with the compound. So there’s there’s that danger of that. They’re measuring out the liquid, but not shaking it and letting it settle. And how do I know that it’s going to mix properly with water? What if it settles and now they get a toxic dose at the end because they at the end, they have that concentrated amount at the bottom. So yeah, it could be risky. I mean, we’d have to be very careful in what patient we talk to and have some confidence that there’s not, not too much risk with it.

Nicole Lamberson [59:15] I mean, even, you know, that’s some of the things that we spend time in the group supporting one another with is a lot of people, they don’t know how to do the math of figuring tapers out. They don’t know how to read a syringe. So even if you’re using a compounded liquid, for example, you have to use a syringe and you have to know how to read it, what the markings mean and how to keep track of what you’re doing and calculate, you know, milligrams per milliliter. That’s not like common knowledge for most people. So there is some handholding that is involved.

Dr. Mark Leeds [59:50] Yeah. Oh, sorry. Go ahead.

Lynn Cunningham [59:53] I was just going to say, case in point, Dave Cope, a subject in the film, trying to describe to his wife how he would have her come off her Vyvanse. It takes an MIT brilliant math student to be able to arc that, you know, the change, the incremental change that needs to occur if proper tapering. You know, it’s not just tapering 10%, it’s tapering 10% of the existing dose. So, yeah, that would be difficult for me to figure out.

Dr. Mark Leeds [1:00:26] I was thinking of that. I was remembering his graph and how it dropped quickly and then leveled off. And you could see the dosages were all like to three decimal points or whatever. But you could potentially hand that over to a compound pharmacist. And then they don’t have to make it a liquid where you measure with a syringe. They could make capsules. And maybe the compound pharmacist could even say, you know, this is what you get this week and this is what you get next week. And they could handle the complex math for patient and all the patient has to think about is like, here’s my capsule for this week. And next week he’ll make me the right one at the next level down. So there are other, other possibilities like that.

Nicole Lamberson [1:01:06] Yeah, that’s true, Mark. And I know you do a lot of benzodiazepine tapering. There’s also some drugs that come in a liquid and they’re pretty concentrated. But if you read in the, you know, patient information pamphlet that comes with it says in there, you can mix this liquid, you can further dilute it with water, juice, you know, it tells you the substances you can use. And so people can adjust the milligram per milliliter ratio of the manufacturer liquid even further to make it more dilute and easier to taper as well.

Dr. Mark Leeds [1:01:43] Oh, that’s, that’s good. That’s definitely good to know that, you know, especially if the manufacturer supports it. One issue that we have with tapering people off of suboxone, you know, suboxone typically comes in a film, like a little rectangular strip. And it actually says in the FDA approved literature, do not cut it at all. And I think the reason behind that is that when people start manipulating the thing, cutting it with scissors, that they’re engaging in addictive behavior. Now they’re obsessing over the drug. And they even actually say it should be a single once a day dose. And that doesn’t seem to work for people. It works more effectively if it’s split into morning and night. But the thing about cutting it, and I don’t know where I read this, but, you know,

Lynn Cunningham [1:02:30] Sorry, sorry. Sorry about that.

Dr. Mark Leeds [1:02:33] But no problem. So apparently the suboxone film, if you cut it in half, say you have like an eight milligram film and you cut it in half, that you’ll reliably get four milligrams on each side. But if you start cutting it in smaller pieces, then the medication may not be evenly distributed throughout it. So now, and I had one patient that was at one point, he was tapering and he was measuring with a ruler to measuring millimeters on the film. And I told him that, I warned him that once you start cutting it in smaller pieces, and I did offer a compound pharmacy, he wanted to use the prescribed medication for his tapering. And that medication is really not designed for people to ever come off of because even the lower dose the two milligram is way too much to stop taking it at but yeah I mean there’s these issues that these things are again back to that they haven’t really designed these things to for people to taper yeah

Nicole Lamberson [1:03:29] And you don’t know even how evenly distributed the medication is in a pill. You know, they say, I guess there is some literature, if the drug is scored, you know, it’s safe to split, or you can research the drug itself and find out if it’s safe to split, but anything beyond the score, you don’t even know if you’re cutting it into four pieces, if the drug is evenly distributed in, into those four or eight, or however many you’re trying to get it into. And what about extended release?

Lynn Cunningham [1:03:58] Is that a weird, is that an imperfect, what happens in a pill that has extended release?

Dr. Mark Leeds [1:04:08] Yeah, that’s interesting because you have different types of extended release. You have, you know, some of these, I think like Adderall XR, and I think there’s other medications, and they may use the same patent delivery system, that there are little beads inside the capsule. And they can actually be poured out on like applesauce. You know, if you have a patient who’s older and they can’t, I don’t know why an older patient who can only eat applesauce would need Adderall, but the actual little tiny beads, maybe they’re called spansules, I don’t remember, but those little tiny beads that you pour out, and Vyvanse might be the same way, but it’s a time-release bead. So the beads themselves are the time-release mechanism. So you can distribute it and count out those beads and not take all of them at once. But then you have some things that are in a shell you know it’s like a time-release shell and it might even be designed not to be I mean this isn’t really a great example but that’s how OxyContin worked it was like a laser drilled tablet that was not meant to ever be broken and all the medication was inside and then later they made an abuse deterrent where they made it very difficult like if you broke it was like in a gel matrix inside but there are some non-opioid non-controlled medications that use those kind of things where it’s a tablet that’s not meant to ever be broken and it has like drilled holes in it that release the medication gradually so there’s all different you know you’d have to know which medication to know how to overcome if it’s even safe to overcome the time release or like in those capsules with the little beads and they’re actually made to break open like like I said to pour an applesauce or whatever

Nicole Lamberson [1:05:40] Yeah but it that I mean even that comes back to where we started talking about informed consent. Like if somebody would have told me in the beginning, this is what you’re going to be facing when you decide to come off of this stuff. Like this drug doesn’t even come in a form that’s taperable. You know, it’s something to think about.

Dr. Mark Leeds [1:06:01] Yeah. Oh yeah. That’s definitely important. I wanted to just bring up also the fact that if anybody’s listening to this and they go to my website, they’re like, well, you know, you’re an addiction doctor. You’re surprised you’re prescribing Suboxone to all these people. And Suboxone, which the medication is buprenorphine, is the active ingredient. And it definitely has these issues that there’s a very strong element of physical dependence. And it can be difficult to taper, much more difficult for some people. Some people will get what they call post-acute withdrawal syndrome after they stop taking it, where they may have reoccurring withdrawal symptoms coming back over sometimes even like up to a year, depending on the patient. But it is a matter of balancing the risk versus benefit. You know, like when you have a person who is at high risk for overdosing on heroin or fentanyl on the streets, or living and surviving and having a higher quality of life, I mean, and probably with all these medications, you have to take that into consideration that some people will benefit from short term, and in some cases, maybe even long term use. And it may be life-saving for some people. But it is important also for me to tell people that. And I do tell people that now that if you start this medication, it is going to be hard to come off of. And it’s not really designed to come off of. But maybe it will be life-saving right now. And it does have the highest chance of success over just talk therapy or not taking the medication.

Lynn Cunningham [1:07:33] Right. Yeah. Well, you’re giving them informed consent. Yeah.

Dr. Mark Leeds [1:07:38] Yeah, but it’s definitely an issue. It’s a different issue because opioid withdrawal is not the same as benzodiazepine withdrawal. People have said it’s worse than coming off of heroin, and it is definitely more dangerous than coming off of heroin.

Nicole Lamberson [1:07:52] Right because of the seizure element and all of that what about duration I mean I’ve I am having protracted withdrawal symptoms from benzodiazepines well I can’t say that specifically but I suspect you know I was polypharmacy so it could have been the combination but I detoxed in 2010 and, you know, I said I reinstated and had to taper. So really my last exposure was 2012 and you can do the math. We’re in 2022 now, and I still have protracted symptoms. Do you see that with opioids much?

Dr. Mark Leeds [1:08:33] It’s hard to say, like when a person is addicted and say that a person take there’s actually an interesting thing there’s a guest I had on recently david poses and we don’t know what happened with him it’s a tragic case this all happened very recently he was tweeting that he went into a psychiatric ward and they treated him poorly they took him off of his buprenorphine which he had on my podcast had reported he’s been on 16 years and has had great success with it and doing very well in his career. He wrote a best-selling book. He’s very happy with it, was very happy with his wife and three children, and they really messed with his medication in the psych ward and then transferred him to an addiction facility where he said he didn’t belong, and then shortly after that passed away, and we don’t really know what happened to him, but, and not to mention bring him up specifically because we really don’t know what happened. That’s still an evolving story. But we don’t really know the long-term effects of any of these things. You know, is it the addiction? If a person relapses 10 years later, is it because the addiction or is it because something that the medication changed over time? I mean, even, you know, people who abuse stimulants on the streets, you know, they say that there’s studies, I think, that show that there’s damage to the microscopic little sacks that hold, I think maybe norepinephrine, one of the neurotransmitters, and they become leaky. And if it gets to a certain point that the person will never be exactly the same as they were originally. So I don’t know that we really know all the stuff that happens on a microscopic level in neurons, you know, long-term for many of these things. And probably anything’s possible. I mean, someone could be prescribed, you know, a low dose of Xanax and 20 years later, maybe they have OCD symptoms and who knows if it was related to that. It’s really hard to tell.

Nicole Lamberson [1:10:27] Yeah. I guess I didn’t mean like a re-emergence of like anxiety 20 years later. I mean like chronic daily withdrawal symptoms that persist for years and years after cessation.

Dr. Mark Leeds [1:10:41] Yeah. I mean, anything is possible with these things because, you know, like we said, we don’t even know how they work. And we don’t know what changes that they’re causing at a microscopic level. And everybody’s different. Everyone has a different makeup and genetics and you know what it does to one person may be completely different with what it does to another. So I would say anything is possible and making it almost impossible to give proper informed consent because we really just don’t know everything.

Lynn Cunningham [1:11:09] Right. Yeah. And the exit plan, We often say, just have that conversation with your doctor. I may, after informed consent, decide that this is the route I want to take with this prescription, but how long and what is your plan for helping me get off of this medication? That’s a fair question, don’t you think?

Dr. Mark Leeds [1:11:34] Oh yeah, definitely. Definitely. And it may be variable. It may not be, you know someone gives a person a prescription for a psychiatric medication they you may not know you may say well you may benefit from this for a month or maybe a year you know we’ll have to kind of reevaluate along the way but yeah I mean definitely and definitely the alternatives when you say risk benefits and alternatives the alternative shouldn’t just be you have the option to not take it I mean there should be clear alternatives of non-medication things you can do. You can do yoga, exercise, meditation, hypnosis. It should be a long list of things not involving medication as the alternatives. Great. So anyway, so thank you for joining me on the podcast today. Sorry about that. Yeah, thank you for joining me today.

Lynn Cunningham [1:12:34] Thank you for having us it’s again inspiring to know that you’re out there and that you know this and that you’re compassionate and you know you’d be my doctor if I lived near you

Dr. Mark Leeds [1:12:46] Thank you I think I think people need to know this I’m going to put this podcast on the top of my the home page of my website because I think people need to see this film and they need to hear this message and have this information

Nicole Lamberson [1:12:59] Thanks Mark and we do interviews at Medicating Normal on our Facebook and YouTube. And we’d love to have you as well, because I’d like to, I’d like to have you and feature you as a doctor who does this in real time. You have benzo patients that you’re tapering and that kind of thing. Maybe you could come on our interview series and talk about that.

Dr. Mark Leeds [1:13:22] Oh, that would be great. Thank you. Yeah, sure. Sure.

Lynn Cunningham [1:13:26] You know, one question I didn’t ask you, which I wanted to, but was what, and I know this is hard to answer, but in the world of addiction and recovery, mostly for, you know, illicit drug use, how, what percentage of that group of people are actually taken off of, or weaned off of the illicit drug and then put on psychiatric drugs? Like just, just general, what would your ballpark percentage, not, not you, but in general.

Dr. Mark Leeds [1:13:56] Oh, you’re saying someone addicted to street drugs and then they get put on psychiatric drugs after.

Lynn Cunningham [1:14:01] Yeah. How common is that?

Dr. Mark Leeds [1:14:03] Well, I think there’s an assumption that a lot of people who are using street drugs are very likely self-medicating a psychiatric issue. And, you know, and then the idea is like, okay, we’ll send them to a psychiatrist after they get off the illegal drugs and put them on, you know, something legal to treat them, you know, maybe they were self-treating bipolar disorder or something. That’s something I was thinking about, you know, when that woman at the beginning mentioned all those different drugs, including Abilify, which seems to be a pretty good drug for bipolar, but you have people with bipolar disorder committing suicide and are having really difficult lives because of their manic episodes, and it seems like medications really help them, and, you know, but I guess, you know, you’re always going to have people that are helped a lot by them or not. But the addiction issue, that’s something, you know, people go into these institutions where they call them dual diagnosis. And they have, you know, they have two, you know, they say they have addiction and they have whatever other psychiatric disorders. And I know part of that’s for billing. But yeah, it’s probably a lot. I don’t know the exact percentage, but it’s probably a lot. And I do have a lot of patients that they come to me for the opiate addiction or alcohol, and they go to a psychiatrist also for whatever else that they get.

Lynn Cunningham [1:15:26] Right, right, right, right. Yeah, it’s interesting. Yeah.

Dr. Mark Leeds [1:15:31] Yeah, it’s not unusual for one of my patients to be on an antidepressant prescribed by another doctor. And even some of them are on, I don’t prescribe any Adderall. I don’t do any schedule two drugs at all, but some of them are on Adderall and even benzos. And so, yeah, it’s not my place to take them off of it, but I have recently because of my awareness of this, I’ve been talking to people about it that you might want to start considering tapering, even if it’s over a very long period of time, but just to introduce the subject to them.

Nicole Lamberson [1:16:02] Yeah. Lynn, when I went to that detox center that, I mean, that was my whole, I said, I went off of all of this stuff, but they remove the ones they deemed quote unquote addictive or the scheduled drugs. And then they kept me on the ones they deemed non-addictive and even added more. So I got off the stuff myself when I got out of that place, you know?

Dr. Mark Leeds [1:16:27] Yeah. Yeah. I mean, we’re taught to think these things are like a completely safe and easy. Like, in fact, the SSRIs are the ones that like they, you know, they make them seem like these are the primary care drugs. You know, if you’re going to treat depression, if a patient needs like a more complex mix of like older things like tricyclic antidepressants, send them to the psychiatrist that understands how to prescribe them. But we can always start out with Paxil or whatever, Lexapro, Prozac, Zoloft. You know, those are supposed to be like the easy ones that the primary care doctors and practitioners can handle.

Lynn Cunningham [1:17:03] Wow. So interesting. I hope you guys talk about that in the Facebook live interview.

Nicole Lamberson [1:17:09] Yeah, Mark, I’ll shoot you an email and maybe we can pick a day and time or something to do that.

Dr. Mark Leeds [1:17:16] Okay. Yeah, that sounds good. Thank you. Okay, great. Okay. Yeah, thanks again. And I’ll let you know when I have this all ready to go.

Nicole Lamberson [1:17:24] Yeah, sure. Send a link over and we’ll advertise it on our end.

Dr. Mark Leeds [1:17:28] Okay. Okay, great. Thank you.

Nicole Lamberson [1:17:29] Okay it was great meeting you and thanks for being one of the good guys out there anyways we have somebody we can refer patients to you in florida anyways

Dr. Mark Leeds [1:17:38] Oh yeah oh you know there’s another one I was thinking even of mentioning this at the podcast there’s this psychiatrist called free range psychiatry and I think she’s in florida I don’t know much about her but she seems like a good person in that area

Nicole Lamberson [1:17:51] Yeah kendra campbell I think she’s been on our q a we had her as a guest already.

Dr. Mark Leeds [1:17:57] Yeah. I don’t know where I met her, but I follow her on Instagram. So yeah, but she posts all kinds of stuff about, she doesn’t believe in medication and helping people get off the medication.

Nicole Lamberson [1:18:06] She’s wonderful. She’s wonderful. I think she’s actually RV traveling in an RV with her family now. I’m not sure she’s in Florida anymore, but I’d have to check.

Dr. Mark Leeds [1:18:14] Oh, well, there’s another one who was on my podcast early on, in, Manhattan. She’s, Anna, Anna Yusim, Dr. Anna Yusim. And she says she barely prescribes any medication, but mostly does talk therapy and spiritual therapy. And she wrote a book called The Science of Spirituality that’s full of exercises that patients can do, spiritual exercises. And she said she wrote the book for doctors to read to have things that they can do with their patients that are non-medical, no medications.

Lynn Cunningham [1:18:46] That’s great. I think that idea, Mark, that you came up with, of getting, getting a group of doctors together to talk about this, to share. I think it’s an incredible idea. I mean, inner compass to Nicole, you guys are doing that, but I think that is

Nicole Lamberson [1:19:01] No, no, no. We’re developing the platform to allow the doctors to communicate with each other.

Lynn Cunningham [1:19:06] I think that’s such a great idea and it’s exciting. And, yeah, just because doctors need support from one another in this. And they, I think, don’t have it. Clearly, they don’t have it through the medical school experience or even the ongoing education experience. Yeah. So,

Nicole Lamberson [1:19:26] Yeah. If you’d like to join that, Mark, when we get it up, it’s in the final phases. So probably another month or so. And then you can, I’ll shoot you an email how to join.

Dr. Mark Leeds [1:19:38] Oh, that’d be great. Yeah, I definitely want to join.

Nicole Lamberson [1:19:40] Yeah, we’re going to have like the key players in there that we have good relationships with. So like Mark Horowitz, I don’t know if you’re familiar with him, but he does tons of research on tapering and withdrawal from all kinds of different psych meds. I mean, we’ll probably even invite, you know, Anna Lembke and all the big names in the community. So at least we’ll have doctors who are super knowledgeable in there to get it started.

Lynn Cunningham [1:20:05] Is it a one-time event, Nicole, or is it supposed to be sort of a… No, it’s a platform for communication. So most of them have email or…

Nicole Lamberson [1:20:14] Well, it’ll be sort of like Facebook only it’s private. So it’s like a room post and say like, here’s a case study. I have this patient, blah, blah, blah. And then everyone in there is only the people who will see your post. They’re members and they can respond to you. That’s fantastic. Yeah.

Dr. Mark Leeds [1:20:37] Yeah, that sounds good. I just joined this one community of doctors and might even be good to bring this up and share this interview with them. And the topic. It’s called, I think it’s called, it’s called NewScript. And in fact, one of the doctors, Dr. Tom, he was on my podcast also. And it’s mainly just to help doctors get out of the abusive careers that they’re in and find side jobs and work on developing their own practices. And that’s, I mean, this is like an opportunity for doctors that want to do that, to create a practice built around educating patients properly and treating them properly without just doing the quick, easy fix. So I’ll definitely bring it up in that group also.

Nicole Lamberson [1:21:17] Yeah, awesome. Thank you so much.

Dr. Mark Leeds [1:21:20] So, okay. All right.

Nicole Lamberson [1:21:23] Thanks. All right. Well, have a great rest of the weekend, weekend, everybody. Yeah.

Dr. Mark Leeds [1:21:28] Oh, yeah, you too. Thank you.

Nicole Lamberson [1:21:29] Okay. Bye-bye. Thanks. Take care. Bye.