gosh if it does work for you it completely changes your life I mean it's not just less side effects I mean like with Trudy it was like I'm going to a group home and now it's like I'm going to medical school I mean it it can just be um it just gives someone it can give people a completely new lease on life it's it's just remarkable Dr ysf is a board certified psychiatrist who specializes in tapering and de prescribing and specializing in psychiatric drug adverse reactions and he has such the perfect background for this as a clinical psychiatrist having worked for trial design and safety monitoring in the pharmaceutical industry and having worked for the FDA for drug approval and and safety and he brings all that experience to his Clinic of helping people get off psychiatric medications safely and appropriately and now relatively recently has has started to learn more about metabolic therapies and ketogenic therapies and how that can help the process so this is a a really insightful discussion with Dr y about his approach to anti-depressants psychiatric medications welcome to metabolic mind a nonprofit initiative of bazooki group transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health thank you for joining us on this journey before we get into the interview with Dr ysf please remember none of this is medical advice this is a discussion between two clinicians to maybe help educate you help you bring this to your CL clinician and hopefully educate other clinicians but any medication adjustment any Lifestyle Changes has to be done under the guidance of a prescribing physici because it can be very dangerous even life-threatening to do this too quickly on your own but as you'll hear from this interview when done appropriately and with clinical guidance it certainly is something that can be done safely but the key is with clinical guidance thank you all right Dr ysep thank you so much for joining me today at metabolic mind Brett it's so good to be here yeah and I'm I'm really interested to talk to you because you have I guess you could say unique perspective about the field of Psychiatry about the field about the the medications use in the field of Psychiatry one that's not always so popular I guess you could say with with mainstream psychiatrist so I definitely want to get into that but also you have a very unique background both as a clinician and having worked in the pharmaceutical industry and the FDA so give us a little bit about your background and how you got to the point where you are today yeah yeah so I guess for context the point where I am today is uh I'm a psychiatrist who only works in De prescribing so I help people come off psychiatric medications um and that's that's all I do um and so how did I get here because I did come from a very I I think conventional background I you know I trained as a physician then I went into Psychiatry residency at a at an academic institution I was at bayor College of Medicine down in Houston and I'd say uh I you know the reason I help people come off medications is is I actually have a lot of questions about how helpful they are for people and and and the risks of being them long term and that's been an an ongoing concern for quite some time so when I uh you know I went into Psychiatry because I love understanding what makes people do well emotionally what makes people thrive what makes people sick you know that was what I've always been interested in uh from being a teen and the things I used to read and so when I went into a medical school I um thought wow you know Psychiatry what what a blessing I could combine my love of medicine and my love of uh psychology into one field Psychiatry and I can help people um in in that in that way but uh quickly I think after leaving medical school and going into residency gosh it was not what I expected at all um I I quickly learned that um the way we were treating people in Psychiatry was just not what felt intuitive to me at all you know I think intuitively I felt that when when someone had a mental health problem um let's just stay with depression uh I mean you would be looking at why they're unhappy you know like what are what are the stresses going on in their life uh how can we help how can we help these people address them what are the reasons you know that they're upset and I didn't see a lot of that in conventional Psychiatry and I'm sure this isn't a shock to people listening to this because if you've just seen a family medicine doctor or a psychiatrist maybe you've had this experience as well where you you essentially um get asked a couple of questions about your symptoms or maybe you even fill out a questionnaire and then um they offer a medication and implicit within that is that there's something genetically wrong with your brain and that this um medication is the solution and so um that intuitively felt wrong to me I think from the beginning I was just like you know this doesn't really make sense why are we just helping why are we just using these medications why aren't we spending the time to get to know people and figure out what's you know what's the root cause of what's going on with them and and it bothered me for a long time and I think I suppressed it and I think I went fully over to the biological model and for a while I I was able to kind of convinc myself yeah you know depression bipolar schizophrenia all of these things these These are mostly just gentic conditions and we just we really just have to manage them with medications but it just kept nagging away at me and I just said you know there there's got to be something better than this um and because I was very curious about that I came across a lot of other critical psychiatrist in the space who were saying well actually you know there's a lot of problems with the way we think about mental illness as being genetic and also with the treatments and it threw me sort of into a dark place where I was like well now I don't don't know what to believe you know there's a group of people saying that we're completely overmedicating people and we're actually doing them harm and there's other things that we could be doing and then all of my professors are saying you know these are evidence-based safe treatments and so I'm in my residency and I don't know what to believe and um and so I I became really interested in psychiatric research because I I figured I had to get to the bottom of this myself and so I started doing a lot of uh drug Safety Research because that that was the other because the question I had was you know is there is there really that much harm to just giving these medications out so liberally you know in these short visits like like I was saying and the way I wanted to answer that question is by understanding risk really well and so I I started to publish on drug side effects drug risks um and and through that work I ended up going to the pharmaceutical industry as a a drug safety officer so um get getting to learn how the uh drug companies characterize the risks of the drugs and then I also went to the FDA as a medical officer in the division of Psychiatry to sort of be at the epicenter and look at all of the drug safety issues coming in and see what the evidence basis is behind getting psychiatric drugs onto the market and that was kind of an odyssey for me and I and I was that chapter of my life lasted about 3 years but I came out of it uh actually siding with the psych sists who were saying that these these medications really are overprescribed they're not as safe as people seem to think they are and um and I was able to make up my own mind having seen the inside of the drug companies and the FDA and understanding what went into the clinical trials yeah that's what I think is so unique about your story that you you have that so many different touch points and different being able to see it from different perspectives from the pharmaceutical perspective from the far pharmaceutical industry perspective from the governmental regulation perspective and from the clinical perspective which is very unique I mean I'm I'm sure you understand how unique it is to be able to see things from such detail from those perspectives and in the end you came out saying I want to help people get off these medications but but it's very sort of easy to say black and white we'll take anti-depressants anti-depressants work or anti-depressants don't work right like very black and white and I don't know my take is it's not so black and white so I'm curious for you too like they do something they have a role but maybe their role has just been way overblown I mean would you agree with that statement or how would you characterize it so I mean there's nothing really wrong with any of the psychiatric medications the the problem really comes down to uh what we tell patients about them and what we teach the other Physicians about how they help people um and so I mean for a long time staying with the anti-depressant the The Narrative was that they're correcting a chemical imbalance um and that's how how um I mean originally I was taught you know they they're correcting um serotonin imbalances or or some doctors say you know they're they're helping with bdnf you know brain derived neurotrophic factors and we'd always be ex the way these drugs would be described as helping people would be through um these these biological ways and there is a significance to that and I'm and I'm going to lay that out the significance to to explaining an anti-depressant works at a biological level is is that it can make people feel like it's it's correcting something wrong in in the brain and and I want to contrast that against what I think is the only logical position uh to understand these drugs and and that is that they just work through drug effects um that they they're not they're not like uh a diabetes drug that's correcting ins like it's not like insulin in in diabetes where there's a clear def mind problem that it's that it's fixing and because you're fixing that clear unique problem all of the problems stemming from that illness are going to go away that's that's not how any of the psychiatric drugs work we've never identified any unifying pathology or chemical imbalance or deficit in any of these conditions um and so but the drugs work and by work I mean they have a clear effect I mean I've taken multiple psychiatric medications I've been on benzos I've taken antidepressants and I've used them for 10 years so I know I know um I used them with patience for 10 years so I know what it feels like to be on these drugs and I also know um what my P what my patients feel on the drugs and they have drug effects they have clear drug effects I mean and and they vary but in general um if you're taking serotonergic anti-depressants it's somewhat some somewhat of a calming effect and and an emotionally blunting effect and that can be really therapeutic for some people especially if someone is highly anxious um and you know and so to take a drug and to experience that calming that can result in a reduction in you know suicidal ideation it can result in an improvement in functioning uh for some people but when you when you acknowledge that you actually have to acknowledge that these drugs you know unlike the diabet the diabetes drug that just fixes the biological problem at its core and everything's fine if you acknowledge that it's working through drug effects you have to start acknowledging that there's collateral damage for instance there is collateral damage to blunting someone's emotions it can make them emotionally distant in their relationships with people it can it can mute their Drive um and it can cause some personality changes and we and we never talk about that and they can be experienced as quite negative for some people a lot of people come to my practice now and they just say I feel like I'm faking my emotions I feel like I'm inauthentic you know things are happening around me and I and I'm putting on this face but I'm not really feeling anything um and so you have to acknowledge that side of things that you are in fact drugging someone um and you were trying to use the drug in a therapeutic way to help them but there is collateral damage to that the other issue is that we start dealing with issues of Tolerance and now this is the thing that no one really talks about which I think is the biggest issue when it comes to psychiatric medications is that these drugs wear off in a large number of people clinically any any where from 6 to 24 months after I start someone on an SSRI a good proportion of people are not going to be feeling that drug effect anymore it's going to wear off they they're going to need a and and and when that happens you're stuck in a situation where you have to either increase the dose to get the same effect and so on and so forth or you leave it alone but the drugs not working and they just have a drug on board that's causing side effects or you have to withdraw them and then you're pulling them off the drug they're having withdrawal withdrawal effects and then they're dealing with the problems that got them on the drug in the first place and that's a really bad ter that's a bad outcome for a lot of people I don't think a lot of people would really want to sign up for that and sure it doesn't happen to everyone there are stories out there with lots of people who've been on these medications for decades and it's just hit the right spot for them they they they're not fully adapted to it and it's working but oh man are there a lot of people out there and I would say more than half by far these drugs they wear off they need higher and higher Doses and you end up in a situation where people accumulate drugs and before you know it they're on five or six different medications the types of side effects that they're having become more comp more complicated some people will even have manic episodes sometimes because they're on a cocktail of medications it gets misdiagnosed and before you know it the person is is is really sick and and it's it's completely drug related yeah yeah I I I I want to go back to your analogy about the diabetes medication because I think it's so interesting because on the one hand you could say how it's different but the other hand is very similar because if you're giving insulin to someone with diabetes you're trying to you know mask the symptom of of high blood sugar just like if you're giving an anti-depressant maybe you're trying to to mask some symptom but neither one gets to the sort of the ideology the root cause of what why the blood sugar is high or why someone is feeling symptoms of depression so I think that's such an interesting analogy because it does kind of work both ways but like you're saying each one has a role right you don't want to walk around with a blood sugar of 300 that's really dangerous so the insulin has a role in bringing it down at least in the short term or temporizing it and the same for anti-depressant if someone's suicidal or or just very seriously depressed then maybe that anti-depressant has a role but it shouldn't be sort of the end of treatment if if I can sort of put words in your mouth there that you know there's treating to be safe to get the blood sugar down in a safe level to get get it so you're out of the hospital and you're no longer having suicidal thoughts but that's different from thriving and living your life to the most and that's where other treatments need to come in so when you see that in your clinic that someone isn't optimally treated that someone is probably having side effects from the medication and it multi emotionally blunted but hasn't really gotten to the root cause I mean it's such a huge question but like how do you think about okay now we need to Target this and find a way to get this person back on track to what I think is the best treatment for them to live their life fully uh yeah I I think that in some ways mental health can be simple but treating it can be incredibly hard um you know it's simple in the way that it is actually very intuitive uh what makes a lot of people unhappy you know not you know struggling at work not not doing work that that you like you know being in a dangerous abusive environment having relational stresses um being physically you know unhealthy and so so that's where I start uh looking at I start looking at life hardship and I start looking at physical health and then really once you've you know because for each person um and for each person it could be something different I mean you could have someone who has sleep apnea and they have terrible you know their Sleep Quality is terrible and they have anxiety and depression that's a very specific treatment uh you could have someone who's um really shy and they're struggling to form relationships with people and they're lonely they don't even need like a traditional mental health professional they just they might need like a coach who could teach them some social skills You' you've got someone who who may be struggling to connect with a partner um because of some interpersonal Dynamics they learned when they were growing up seeing an interpersonal therapist to to learn about empathy and to learn how to put yourself in someone else's shoes that could be the treatment for them and then also you know I know we're on the metabolic mind podcast I mean you could I mean you could have someone who is having dietary problems I mean they look physically unwell you know they're they're overweight the food that's going into their body isn't nourishing them and and I think that's especially relevant uh when you come across people who say I don't know where this came from because you get two stories in mental health you get well you know I went through a divorce and I got put on this drug or I moved town and was lonely and I got put on this drug but then you have some people who just say it just it just slowly crept in and I just started feeling lethargic and terrible and then I was just sick and and and none of the treatments worked when I when I hear that I used to think oh genetic illness you know severe genetic underlying illness time time to bring out the gun the big guns and we'll use the meds now when I hear that I say you know what's going on with their diet because I think until you address diet with those people you cannot I think in good conscience say that there's something wrong with that person's brain or the genetics because I've seen many people now um come off Decades of psychiatric medications with dietary interventions and it hasn't been keto the whole time I mean I've seen people go gluten-free who didn't even have GI symptoms um you know come back from bipolar disorder diagnosis and completely come off meds after two decades I mean it's just remarkable some of the dietary interventions and the impact it can have on Mental Health yeah yeah I mean it is impressive what you can see and I actually want to Circle back on that so we'll talk a lot more about about nutrition and ketosis or other dietary interventions but first I want to say you know we we we've talked mostly about anti-depressants at this point but I'm curious to get your viewpoint on how you see anti-depressants antipsychotics mood stabilizers right the whole the whole breath of psychiatric medications do you see them similarly in terms of their you know effect or lack of addressing the root cause um high potential for side effects that isn't discussed enough you know long-term effects do you see them all in the same bucket or do you see them differently based on their class of medication no I I see them all in the same bucket um um and in that uh they they all work they all clearly have drug effects which which can feel therapeutic for people when they're having these crisis but with all of them you're still dealing with the issue of Tolerance I mean we're we're we're dealing with the problem of of putting a drug into our body that disrupts our neurochemistry which controls you know our neurochemistry isn't controlling just our emotions it's controlling the physiology of our entire body it's involved in our cardiovascular system and our immune system and our GI system and our body hates that and so it pushes against it and people adapt to the drugs and eventually they they wear off and so you end up in that same POS some so many people end up in that same state where they where the drug effect is wearing off and they need more more of it over time the other issue is um there's so many different stories out there with these medications I mean and and they're all valid I mean you have some people who this drug saved my life I've been on it for three decades I'm not coming off it's the greatest thing ever and you have people people whose lives are just destroyed by them um and part of the issue with the evidence base behind psychiatric medications is we have you know because our studies are about 12 weeks long at at least the double blind portion of them we don't really know how they affect uh people over the long run I mean we're talking about safe and effective for three months and so the rest of it just ends up being this kind of Black Box this question mark I you going to be a lucky one where where it's going to work indefinitely for you and it and'll be a good fit or are you someone who's going to slowly start to feel worse and run out of options it's true for the drugs yeah yeah that's a really interesting perspective um so so now getting back to what you were talking about about nutrition though which can play such a powerful part in many ways um you know I've seen on your your Twitter your XV that lately you have been posting a little bit more about ketogenic therapy about ketogenic diet so um I'm curious what was sort of your first experience of using ketosis to help either you know de prescribe and I want to get also more into the tapering and the Deep prescription specifics but first what was your sort of exper your first experience with ketosis as a treatment for mental illness or as a an aid to help people deprescribe uh it it s it actually found me is is what happened so I because I because I work in psychiatric de prescribing I have staff I have staff that help me um just support the patients there uh you know with counseling as as they come off the medications and one of my coaches Trudy um her story was that when she had you know when she was I think 17 years old and she had a trauma history and we've talk and it's okay to talk about this we've talked about this on my YouTube channel you know multiple times but she she had a trauma history and she was put on anti-depressants and and um she was on an anti depressant for a while then she got diagnosed with bipolar disorder and then she you know I think there was some psychotic symptoms in there she got put on antis psychotics and then eventually she had multiple rounds of ECT and um she was completely disabled you know almost placed in a group home and she was sick for I think 20 years until she tried to come off sha which is an ADHD Med it's it's kind of like an like an snri an depressant and she came off and she had a what she had something called a protracted withdrawal injury which is kind of a specialty of what I work on people who have a really hard time coming off these drugs and when that happened to her when she came off the drug and had this severe withdrawal reaction she became acutely aware of drug side effects and it kind of cracked open a door for her and she said well how could something that's meant to be helping me have hurt me so so badly and so she started questioning the medications that she had been taking and um she discovered dietary interventions and she stopped gluten was what she uh was what she did I think she was 37 at that time she'd been on it for about two decades and her symptoms completely went away when she stopped gluten um and over the course of three years she was able to come off all of her psychiatric medications and um she was able to return to work um and it never came back I mean this depression and the and this this depression that needed ECT you know multiple rounds of ECT in the past multiple psychiatric hospitals had just vanished completely and and we I mean we're working together now she's been off medications for five years and she's returning to medical school I mean she's back in college she's doing prerequisites it's crazy but this was someone's life who was completely derailed for 20 years because of a Mis A Mis dietary thing and um and so that was the first thing that happened and and then another coach joined actually uh nesset and maybe she's even you've even spoken to her uh because I think she won one of your research Awards and she had uh yeah yeah and so her story is she had bipolar bipolar diagnosis was on medications for 10 years used the ketogenic diet and came off and so for me I was just having these because I was in the space of trying to get people off these medications I'm like well who can help me you know I need to find these other people who have come off and that I'm going to have them support my patients and I just kept on saying oh I came off after a decade because of the dietary change you know here and then I started having people come to the clinic I started having people say Hey you know there was this young girl that recently joined earlier on this earlier on this year and um she again kind of like Trudy was on psychiatric medications as a as a teen and then it just spiraled out of control and she was diagnosed with sko effective disorder alsoo multiple psychiatric hospitalizations ECT and she was on clopine or cleril which is essentially the apex predator of anti psychotics it's it's the kind of the biggest hitter most sedating you know it's the you know if you're on if you're on claar real that that's you know people have pretty much run out of ideas in terms of how to help you and she so she was on this medication and she was in her mid-20s um and she came off using uh paleo diet um and so gluten-free dairy free and she did that and it disappeared and so people just kept on coming to me and just saying hey i' I've I'm coming off Decades of medications changing my diet and at that point it was impossible for me to ignore and so I went and I started talking to Georgia Eid I went and did her course and now it's just a routine thing that we do in our practice everybody especially the people with um metabolic problems and uh and the people who say Hey you know I have depression and it comes out of nowhere or I've got psychotic symptoms or bipolar everyone is everyone is getting these dietary interventions now because I I mean and and they may not work for everyone I don't think I have enough experience to say you know this is the fraction of people it will work for but gosh if it does work for you it completely changes your life I mean it's not just less side effects I mean like with Trudy it was like I'm going to a group home and now it's like I'm going to Medical school I mean it it can just be um it just gives someone it can give people a completely new lease on life it's it's just remarkable yeah I mean th those stories are incredible and like you said just how lifechanging they are but also you know frustrating that you had to learn about it from someone you were working with or you know from a patient or you know you didn't learn about it from your training or from your CME courses so all that the landscape seems to be changing but so wonderful that this was brought to you and you were able to embrace it now the downside though is you know people like you were saying you don't doesn't work for everybody um and it's not going to be as easy as it is for some people but do you find in general that using ketogenic therapy helps with the tapering and the Deep prescription process um because it it can be a very difficult process especially for the patients you see right do they have drug potentiation do they have you know withdrawal effects or do they have a recurrence of their of their symptoms it's it's a it can be a complicated sort of mix to try and figure out and some people find that ketogenic therapy can help with that um so I'm curious just to to get your experience with that yeah I I think I think it depends I mean for some for some people I think just cutting out gluten just just seems to have a remarkable effect on them so we kind of bring them up from this this kind of paleo Whole Foods diet and sometimes that helps a lot um and then when you get to the the ketogenic diet listen I think the ketogenic diet just in general makes people feel better uh well I mean not everyone but a lot of people I mean I I've done the ketogenic diet myself but what I do notice from my patients and what I notice for me as well is you actually have a lot more stable mood on it I mean you don't have like food cravings as well I feel like you eat less um and I just and so I think PE people they I I know it's not meant to be a weight loss diet but all I see is people tend to lose weight on it and um and they they they seem to like that a lot and then I feel like their mood is a lot more stable and and these are just people without mental health problems as well it's just it's just an interesting intervention um to just um I think just bring you off that Sugar roller coaster where your insulin is like spiking and then your adrenaline is spiking as the blood sugar crashes um and so yeah I do think most people um just feel good especially if you're coming from a diet where you're eating a lot of refined carbohydrates and sugars and um you're kind of riding that roller coaster yeah and that's what's so interesting as we're learning more with research is it just the the eating better approach right the getting rid of the junk food stabilizing your insulin a little bit and it's clear that can help but then what about going that next step and actually adding ketones to the brain and and does that add even further so that's what a lot of the upcoming research is looking at so I'm curious for you as a clinician you know the the clinical impact you can have versus what the research shows like some people say I'll try it when there's a randomized control trial or I'll try it when it's in the guidelines versus here's a patient in front of me maybe I should try it anyway to see if it can help how do you frame that in your clinical and research and scientific mind right all these Minds coming together to try and help this patient in front of you I mean I don't need randomized controlled trials to to do things but I think I'm kind of diff different because I'm so disenchanted with um just what passes as highquality research just in mainstream Psychiatry because I I do think a lot of the anti-depressant clinical trials I think they're honestly I think they're like um marketing a a lot of it I don't think it's really helpful so um I'm pretty cynical in that respect so I don't need randomized control trials like for something to have if I if I can see something in front of my face and I see it enough and then I also there's a really solid scientific rationale behind it and I mean a lot of these things I try for myself as well like I've done a ketogenic diet and so I've kind of experienced those benefits um and so for me uh I don't I don't need the the I I don't need the clinical trials to do it I I I'm just confident just having seen it in so many people at this point and just knowing that there's theoretical benefit and knowing that it's not just me I mean it's people all over the world who are noticing this you know different researchers of different walks of life I mean maybe people like me who weren't even interested in in dietary therapies until it kind of hit them in the face um and so to me that's enough yeah yeah that's a that's a great perspective well and and it's also fantastic the setup that you have in your clinic that you have the coaches who can work with the patients on a regular basis um and you as as a psychiatrist who can manage the medications but getting off medications is not always so easy you know you hear stories online that people get off their medications and do great and then you hear stories that some people can never really get off their medications and really and struggle to do so so I'm curious how you advise people when they come to see you and they say I'm having these side effects I want to get off my medications like how do you counsel them about how to go about doing it and what the success might be and what to look for kind of yeah what's that what's that meeting like sure so I mean the first thing that comes to mind is like why do you want to get off the medication so that that's the first question I ask and usually it's because I don't feel well you know so the person is suspecting that there's something about being on the medication that's just you know they're they're sedated they don't feel like themselves they feel dissociated or they feel irritable and on edge and so the first thing that you do is you look at all the medications and you have to identify you know is is there a drug here that's potentially causing this effect that's making you feel unwell and and then the next part is you have to pick a speed right so depending on the seriousness of the side effect now some side effects can be so severe you're going to pull them off the drug you know within a couple of weeks because it's so risky you know I think about something like uh athesia where someone is pacing a lot that can be a life-threatening side effect but sometimes it's really benign you know it could just be like well you know I'm I'm just not feeling that great now for that person I I would do a I would start with a slower taper for them because you're always kind of balancing these two things on a seesaw it's like on here it's like the risk of the drug effect and here it's like the risk of withdrawal and so you know if there's not a lot of risk from the drug effect then the risk of withdrawal is therefore higher and so you're going to be moving slower now if there's more kind of risk of the drug effect and you're going to be moving faster so you really have to decide um you have to kind of make that assessment um the way I taper after that is patient Le and so what that means is well I typically will let's let's say that we have a non-serious side effect going on uh I would start someone at a taper in 5 to 10% reduction uh per month and then I would just check in with them every two to to 3 weeks hey how are you doing if they're doing fine I increase the rate by 5% and then check in with them in two to three weeks how are you doing fine I increase the rate again and eventually we might get someone up to say you know 10 to 15% a month and they the my my goal is that when someone tapers with me is that they have no loss in function it's okay to experience mild withdrawal symptoms but if they get to the point where you're not able to work or they're impacting your ability to care for your family you're moving too quickly and so that's the the kind of barometer that I have and so when I start to have someone say Hey you know I'm at 15% and I you know I had to take a day off work this week or two days off work this week because I couldn't sleep you know my insomnia was getting really bad that's a sign to me to say okay we are going to go back to the previous dose we going to let you sit there for a couple of weeks and then our next reduction is going to be smaller and it's that's that's the way I taper them so we're always moving at the fastest rate that's safe for them and still allows them to be functional um and all of my adjustments are just based off withdrawal symptoms and for me that seems to have worked really well and most people tend to be able to come off between one to two years if they've been on these medications for several years now from a practical standpoint though decreasing by 10% 15% is challenging to do if you have a big pill that you have to cut in half or cut in quarter so do you make use of compounding pharmacies or liquid medications or what are some of the like the Practical things that you can do to help with that yeah so I um I use a lot of liquid medications especially to finish off a taper now um I think you can only really safely uh um cut a tablet into about quarters if you're using a pill cutter um and so what that means is let's say someone is on like 50 of Valium for those in the audience 50 of Valium is a pretty big dose of Valium um and so with 50 of Valium it might be really easy to just lower by one milligram of Valium every two weeks and that's like you could just do that with tablets and you might be fine tapering down with tablets until you get to around maybe five milligrams of Valium in at which point you know if you were to drop by a milligram oh my God that's a 20% reduction you know that might that might hit and so what I tend to do is at the higher doses I will taper people down on tablets and as they start to get to the lower dose range where um this this there's a quirk about the pharmacology of the psychiatric medications where at the lower dose range they they it's almost like they become less sticky and so as you make reductions at that lower range the drug disengages from the receptor at a much uh at a much higher rate and so like let's say you could have you know going from you know 50 of Valium to 49 of Valium that that may feel like nothing but going from five of Valium to four of Valium that may cause a huge shift in receptor occupancy uh at that lower dose range and so um the bottom half of the drug taper is much trickier people run the risk of tapering too quickly by mistake and having withdrawal syp symptoms then and so what I do in my practice is at that lower range is I'll convert people onto a liquid medication now the great thing about psychiatric drugs is you can practically convert them all to liquids with a few quirks um one being prestique and sybol which you would have to uh those are special uh psychiatric medications that have a capsule around them that you can't tamper with because it sort of shut the drug through the um acid Rich stomach environment into the small intestines and and you need a special capsule so it doesn't affect the drug um and so those those ones don't come in liquid formulations because the drug would hurt them because the um the the stomach acid would destroy the drug but with those ones you can put people on a effector which can be compounded into a liquid and so there are some quirks where if someone on prestique or some Bolter you could put them on AER and you could still use Liquid so essentially all of these medications can be liquefied and so when you get to that bottom dose range you can grab a liquid version from your CVS or Walgreens most of them come in manufactured liquid versions or you could get one compounded um and the benefits of liquefying it is you could then draw your dose up with a syringe and there's lots of like great 1 ml syringes uh that just give you so much Precision of your reductions um at at that level and so I think that tends to be the best way to finish a drug typa is with a compounded liquid yeah that is that's fantastic practical advice on how to do this and and interestingly I mean in a way you could say like why do we it's going to sound wrong but like why do we need you right like a a physician a psychiatrist who is trained to start a medication should be trained to taper that medication if it's not working or having side effects but it seems like that's not the common practice that like you're saying it tends to be add another medication or or increase the dose or you know not so much the the the tapering or the de prescription that seems to be very foreign to a lot of clinicians and it doesn't always make sense that it should be so we need someone who specializes in it like you so why is that why is the you know the medical and pharmaceutical World structured this way where where it is a rarity to find someone who is comfort able helping people get off their their psychiatric medications so I think I think what happened was and you know this is one of the problems I think with the pharmaceutical industry is they have a agenda I mean surpris surprise to anyone they have an agenda to make um to make people see their drugs in the best possible light especially doctors and so when it came to things like the anti-depressants when they came out there a lot of these consensus panels um which were published and the conclusions of those was that um and this is what I was taught that was that anti-depressant withdrawal is mild and self-limiting and can usually be done in a couple of months and so that was you know these these were all doctors on this panel who were involved in the clinical trials they were already pretty Pharma friendly uh because they they helped them get the drugs on onto the market and so when they put them together and they came up with this conclusion the drug companies took this report and they pretty much gave it to every single Medical School talked about it at conferences brought it out to dinners and so they really um spread this message that psychiatric drug withdrawal you know it's it's mild and self-limiting you can do it quite quickly it's not a problem and the truth is uh for some people it can be like that um because uh coming off these medications is is not not challenging for everyone for reasons I don't understand some people can stop them quite quickly and their brains are very elastic and they just kind of snap back into place sometimes even within a month or two and they just go on with their life even after being on the drug for 5 to 10 years so so a lot of doctors they do see these patients but that's not everyone and so there there are a fraction of people and their brains for whatever reasons they just need a lot more time to readjust to the drug but um because all the doctors have been told that um you know it's it's it's easy they they end up just kind of reducing it by like what the tablets come in okay we've got like a 20 a 10 a five and then uh you know half the five and stop and there's just a big group of people where that doesn't work yeah yeah so then they would say at that point well it's not working you need the drug clearly so we can't come off it as opposed to sort of reassessing the the method of which they're deprescribing so I think that's a good point when when the message is it's easy and it's not so easy you tend to not want to do it and you give up because it say it's not it's not working yeah that's that's a really good perspective yeah and that's a terrible thing because there's lots of people out there who are stuck on a drug that they don't want to be on and they've been kind of G I mean gas lit you could say or just given the wrong information you know told that they have a brain problem but they're just experiencing withdrawal um and I mean the other thing you kind of asked me before you know why does someone like me need to be around saying these things it's because um it's just an unpopular message you know if you're if you're someone who's trying to make doctors see these drugs in the best possible light that's like a scary thing to think about like oh my God you know some people it takes them a year or two to come off these things that's that will make people think twice that'll make doctors think twice that'll make the patients think twice and they don't they don't want that message out there and then also to get back to the analogy of the the diabetes medication like taper to what right like okay we want to stop your insulin well if you haven't made any other changes to control the blood sugar you can stop the insulin and so sort same sort of thing I guess could be said for psychiatric medications I had a great interview with Dr Lori calibra and she said she used to either taper to another medication or taper to good luck but now she can taper to ketogenic therapy and more metabolic and lifestyle interventions and more sort of holistic intervention that tends to be successful so I guess that's the same thing from the from the physician standpoint if you think tapering is going to be easy but tap or to what what's going to take that place and that's where metabolic therapy lifestyle intervention can be one one potential realm again maybe not for everybody but for some people who it works for could be life-changing and help taper as well you see it that way too yeah I I I do um I mean for some people yeah it's clearcut I got on this drug during a divorce and my life is better now taper to nothing you're probably G to be okay but for the person who's who's just like you know I just don't I don't know why I feel this way um you can't you know someone who has a psychotic illness someone who has some schizophrenia or some bipolar going on that's pretty serious um you have to tape it to something and and that's and that's where metabolic therapies are the rock that you must turn over uh I think before you just park a patient on this drug for for decades yeah yeah well this has been a a very enlightening conversation I I really appreciate your perspective um and I'm sure people are going to want to know more about you and about your clinic and so I know you're on YouTube you're on X you've got a website so where would you direct people to go to to learn more about you yeah sure so um I guess I'd say probably YouTube is our biggest platform and so that would just be Dr ysep and that's belt in the German Way so it's j o f not pH um and so we're putting out a lot of content and interviews there like you said we're also on X Tik Tok um Instagram and our and our practice website is taper clinic.com and that's T AER Clinic um and we're all over the place so if if you're in the US and you are looking for a specialty practice for drug tapering that's um has a holistic a view of getting to the root cause I mean we we do functional medicine we do metabolic therapies and we combine that with drug tapering um and so if that is of interest to you uh you can go to the taper Clinic website and you can see our coverage areas and we're all over the US wonderful well thank you so much again for joining me and for sharing your wisdom with us it was it was wonderful it's a pleasure to be here Brett thank you for having me