 will after this, and the chat and Q&A buttons will never be made public. And if I'm asking a question tonight, we will not use your names. We will not post questions requesting specific medical advice or topics that are not related to the panelists area of expertise. And the views expressed during this community discussion are not necessarily the views of Bedford Playhouse, Periscope Foundation, or the Medicating Normal team, but we certainly welcome dialogue from all points of view. And lastly, this panel discussion is for general educational purposes only. This discussion does not constitute professional medical advice, encouragement, or recommendation that any individual reducer withdraw from their psychiatric medication. And now I'm going to tell you a little bit about everybody on the panel, then they're going to go and tell you a little bit more about themselves and also how they are involved with the film. So first of all, we have Lynn Cunningham. He's fantastic. He's the co-director, co-producer of Medicating Normal. We have Stan Pasek, MD. He is a board-certified psychiatrist and psychoanalyst and associate clinical professor of psychiatry at Yale. Swapnil Gupta, MD, is a Yale alumna, a New York City-based psychiatrist and author of D, Prescribing in Psychiatry. And Angela Peacock, MSW, is a military veteran, mental health advocate and subject of the film, Medicating Normal. Todd Green is a religious studies professor at Luther College in Dekora, Iowa, and he is in the film. And we're delighted to have you all. So please tell us a little bit more about yourselves and let's start with Lynn and how did this film come about? What is your role? Lynn, you're on mute. Thank you so much to Vanessa and Dan and the Bedford Playhouse and to my dear, dear friends, Olivia and John Farr, without whom Bedford Playhouse might not even exist and who have given me so much love and support and friendship over the years. I also wanna thank our fellow panelists tonight, each of whom brings a unique perspective to this very important dialogue. And dialogue is what we want to, is our main mission with the film. And so thank you again for letting us do that tonight. And I just wanted to begin with, I guess giving some, because it's asked in every panel, the film began really as an attempt to help a beloved struggling family member who in her early mid-20s had a mental health crisis. She'd been a stellar athlete scholar at one of our nation's most competitive colleges. And she, something happened, our family, we were confounded, we were scared, we were very, very lucky enough to be able to have access to the very best doctors in New York City. And from there, we didn't know what to do. And she was diagnosed with a serious mental disorder that we were told was due to a chemical imbalance and that she would have it for life. And we felt relieved. And fast forward, 10 years later, one drug had become 10. She was on disability and she was not happy. She was calling me every day, Linny is everything gonna be okay, was the question I got every day. And our family has so much love for her that I would say, of course it's gonna be okay, but answering that question every day began, I began to feel a bit disingenuous because what I realized was she was not asking me about her material wellbeing. She was asking me about her potential as a human being and extraordinary talented young woman. And I realized then and there that I needed to figure out what it was she was, what drug she was taking, what they were doing to her and whether they were helping or not. So that launched me. I joined with my filmmaking partner, Wendy. We interviewed hundreds of patients across the country about their experience on psychiatric medication. We interviewed scores of excellent doctors. We found, we read incredible books, one by Bob Whitaker called Anatomy of Epidemic. We, another one, for instance, Todd's wife, Tabitha Green wrote an amazing book called Her Lost Year about their daughter, Rebecca. And you'll learn a little bit, well, we've learned in the film about that, her story a little bit. And these books and talking to people and learning more and more about the topic made us realize we had to make a film and we had to tell what we thought was an untold story. It's not the only story on this issue. And tonight you're gonna hear many perspectives on it but it's why we made the film and we've learned so much in the process and in this talking about the film now we've learned so much. Every single panel brings up another issue or another insight and we just wanna keep the conversation going. So thank you. And now, Angela. Oh, sure. Would you like to go next? Okay, I'm Angie. You saw part of my story in the film. I'm now five years off of psychiatric drugs. I still have neurological symptoms from that. I'm probably an outlier because I was on so many medications for so many years. I did graduate with my master's in social work from WashU. I decided not to practice in the system. So my social work right now is doing community screenings like this. I do a little bit of outreach for the film. This is our 136th community screening. So we talk about this all over the world with all different people, with doctors, teenagers, parents, you name it. So I just look forward to the dialogue that we have and I just love hearing from the audience and love seeing people open their minds and maybe not, you know, I just love this whole thing. So thanks for having me. And Stan? My name's Stan Pasek and I'm psychiatrist and psychoanalyst in New Haven, Connecticut. Excuse me. Now I spent most of the first half of my career working at a place called the Yale Psychiatric Institute which at the time was primarily an inpatient facility for late adolescents and young adults, many of whom had schizophrenia and who had been felt to be untreatable and we tried to work with them and helped them get better. The last 25 years or so I've been in practice and I've also been teaching and supervising clinical work at the Mental Health Clinic of Yale Health which is a clinic that treats Yale undergraduate and graduate students and their partners. And a particular area of interest for me has been the integration of psychological and pharmacological treatments for severely disturbed patients. Thank you. And Todd? Thank you. So yeah, I'm a liberal arts college professor I teach religious studies at Luther College in the core of Iowa, which may be less relevant to this particular panel but as much as I'm the proud parent also of Rebecca who is featured in the film. Her story is at least a younger version of her. She's now almost 24 years old. It's been over a decade since that nightmare year on psychotropic medications began and probably about one decade since that journey ended. Watching the film in many ways is a journey back into a very dark time for Rebecca and for me as her father. But I'm grateful for the film, incredibly grateful for the film, the stories it highlights because these are not the kinds of stories that get airtime when it comes to discussions about medication and mental health. I see the film as providing a lot of balance to an unbalanced narrative, a narrative that at least in the most prominent narrative being that medicating people who are struggling with depression or anxiety is the obvious thing to do that can only help you. And as you see in this film and the stories that are highlighted there, that stories of medications making things not better but worse are important to tell as well including in the case of Rebecca who back then got to the point where psychotropic medications turned a bright, sassy, sarcastic, engaging charismatic adolescent girl into a really helpless, lost, disconnected psych patient with no prospects for the future until that is my wife and I decided to make a difficult decision to take her off medication ignoring a year's worth of psychiatric advice. I wanna say that now Rebecca is graduated from college. She's working for a nonprofit organization based in Washington DC. She's happy, she's healthy, she's optimistic. In that lost year of hers back a decade ago is not something she likes to think about too much and she doesn't like to go down or stroll down memory lane because it was not just a distant memory, it's sort of a distant nightmare for her. One that she again, doesn't like to revisit too often but she does think that the story is important to tell nonetheless. And let me just finish by saying that normally I'm not the person who should be here. It would be my wife, Tabita, who wrote the book for lost year and who did so much to reach out, engage larger publics on the topic of children's mental health and complicating very simplistic narratives about how we should address children's mental health including raising the question of addressing children's health, mental health and mental health broad days of social justice issue. And Tabita passed away back in July of pancreatic cancer. But this was really her cause, her book, her passion. Of course, it's my lived experience as well but I don't think I can quite do justice to it in the way that she would have done but in many ways I'm here and not only for my daughter, Rebecca and the incredible journey she's made out of that nightmare from a decade ago. I'm also here in memory of my wife, Tabita. Well, thank you so much for being here in so many ways. May I ask Swapnil? I don't know if... Hi, so I'm Swapnil Gupta, I'm a psychiatrist. I work in New York City right now close to Columbia at Mount Sinai Hospital. So my journey to deep prescribing or a sort of slightly more critical approach to psychiatric medication has been somewhat torturous and winding one. So I used to work as a psychiatrist back in India which was my home country. And when I moved to Brooklyn in 2009 I noticed there was a huge difference in the number and the doses of medications that were being prescribed. So I think that sort of introduced me to this idea that people can do very well with lower doses of medication or sometimes even without medication. And as I went through my training mostly in public mental health settings where we were treating people on public health insurance or sometimes on no insurance at all. I noticed very, very huge lists of medications and combinations that sometimes were difficult to make sense of. And I think as I started practicing independently I realized that we needed a systematic intervention to reduce the use of these medications. And if psychiatrists were prescribing them I thought that to an extent it was our responsibility to help people reduce them and stop them if that's what good medicine advised and if that's what the patient chose. So that's how deep prescribing came about. And within two years of sort of developing the topic my colleagues from Yale, John K. Hill, Rebecca Miller and I came up with a book on deep prescribing and psychiatry which is rooted in some of the recovery oriented principles like upholding patient autonomy, shared decision making. And a lot of tolerance of uncertainty like and basing that tolerance and sort of managing that uncertainty by strengthening a therapeutic alliance with the patient. So the book is written from that point of view. I also work with an organization called the International Institute for Psychotropic Drug withdrawal that has several people from several countries in Europe who are all working on the same topic. It includes Dr. Magnus Hald who runs the drug-free schizophrenia unit in Norway and Trumpson, Norway. Dr. Mark Horowitz who's written a lot about how to safely taper SSRIs and he's also proposed like a variety of taper schedules and all these are quite well-based in evidence nicely based in evidence in either a neuroimaging or pharmacokinetic studies. So yeah, I do firmly believe that the uncritical application of medications to psychological distress is a public mental and public health problem. And I'm so glad that panels like these are happening and that you made this wonderful movie that I deeply understand both from the point of view of several friends and a lot of my patients. I wish my patients could watch it. So thank you for doing this and thank you for having me on the panel. I'm delighted to be here. Yeah, the film is so incredible, such an important topic. Can I kind of take two of the questions from the audience and kind of bring them together for Swapniland Standard? Of course, anyone can answer. From a provider's perspective, what do parents need to know before putting their children on medication or trying to think about tapering things down? Is there pushback to this? How do you deal with parents? I'm sure there are a lot of parents in our audience tonight. And how do you handle a parent who may be pushing to get a prescription for their child? Whoever would like to. Do you want to start, or would you like me to? I would defer to you because I don't work with many children at all. So I even worked with children under 16. I think the, first let me say, I thought the film was wonderful and I thought the clinical stories and all of the people were very compelling and it was painful to watch and see what and hear about what people had gone through. I had a slightly different take on what I found most troubling in watching it. And that was, it struck me that that the people who were prescribing the medication, I didn't get a sense that they really knew the people they were prescribing for. It didn't feel like they'd spent the time to sort of figure out who they were as people, what they wanted or for a 13 year old child, what the child's parents wanted. And to really engage the patient and the patient's family when the patient's younger in figuring out what their goals were, what it was they felt they needed, what they were looking for at the same time that you were thinking about what made most sense. So that it didn't feel to me like it was really a collaborative process between the patients and the prescribers. And so I guess what I would say in terms of the question is that if it doesn't feel like one is working in a collaborative way from the person who's gonna prescribe the medication, it probably makes sense to try and have another opinion, to see someone else who may have a different opinion so you can get a sense of whether another point of view might make more sense to you. So for example, with Mr. Greenstone she's a 13 year old child. And there was no sense that in a 13, you're going through profound developmental changes. And my first thought was, well, what is she going through? What's going on developmentally? What's going on in early socially? There's no mention of that. And did someone not look at that? Were they just trying, were they only thinking pharmacologically as opposed to thinking about, well, who is this person as a person? What's going on inside of her psychologically? What's her social situation? It felt like that was missing from the stories or where it was present say in Angie's story. The idea that no one who was responsible for clinical care was really helping her look at what had gone on and how to figure out how one deals with an extraordinarily traumatic situation psychologically, how do you make sense out of it? And how do you help someone who's been through that make sense out of it in a way that's helpful to the person? And the drugs seem to me to be a kind of quick fix that don't really, they may cover over some symptoms and they may do it well for a while, but they don't necessarily cure things for a lot of people. Angie or Todd, would you like to follow up with anything, any comments on that? Todd, you go. Yeah. You know, to sort of develop one of the points Stan was talking about with Rebecca, she spent a year in and out of psychiatric hospitals we probably saw, I may have lost count 10, 12 psychiatrists, we got, we went through a lot. A lot of different psychiatrists, almost all of whom had the same approach when there was the intake, which was what symptoms were Rebecca presenting with. So she got on with some antidepressants and started having hallucinations. So all of those is what got her in the hospital a number of times. And so she would present with hallucinations and the psychiatrist was very focused on that symptom. After two or three hospitalizations, I started to get really pushy about, well, you know what? She wasn't having hallucinations before she went on these antidepressants. In fact, she was a little melancholy here and there, but she was functioning, she was going to school, she had friends, she had a social life, she watched Glee on TV. I mean, you know, she was kind of a normal kid. And she was at an age where she was going through puberty and all the transition into adolescence and into early teenage years. And I raised all those questions and it was like I was talking to a brick wall every single time, not just with one psychiatrist, but almost all of them. They weren't particularly curious about Rebecca's life before her medication. They were curious about what symptoms she was presenting at the time. And that was eventually in the course of the year, what finally triggered was the trigger for my wife and I to say, this is not right. We know our daughter and this is not who she is, except we keep running into people who aren't curious about that with the exception of social workers. The social workers asked those questions. They were really curious about her life circumstances, her family life, what changes in her life, what sort of anxieties that she may have been going through prior to going on medication. And most of the psychiatrists by and large had zero interest in that stuff. They were only interested in prescribing for the symptoms that they had in front of them. And that was one of my big frustrations. And when we kind of turned the corner and said, no, this is not our daughter and made the decision to take her off medication for us at least, that was life changing. We got her daughter back. And we had to hold on. That was the compass for us throughout the year was we knew our daughter. We knew our daughter better than the psychiatrist we were meeting with did. And if they had taken that kind of interest in her that Stan was referring to, I don't think we would have gotten to the situation that we ended up being in. Angie, would you like to add to that? Sure, I'll just add a few things. Yeah, well, I think Stan works from a psychoanalytic approach. Is that true? So you're, you have more time with clients maybe? I don't necessarily psychoanalyze them but I have more time with clients because I make the time. Yeah, that's awesome. I take the time to get to know them. And I don't, you know, I don't willy-nilly put people on medication. Yeah, so like Todd and their family, I saw, I probably saw 25 and 13 years, different psychiatrists. I've been fired by a psychiatrist and told that I was treatment resistant. After they had put me on like a cocktail of 17 like you saw in the film, that was after that, doctor was a civilian psychiatrist, she fired me. I've done all kinds of therapy like you saw. And I think the problem is with the modern psychiatric system is we're seeing through the lens of diagnosis. We're seeing through this list of symptoms. We're not seen as real people with value, with goals, with decisions, with the past. I feel like, you know, like the last 20 years of my life have been robbed for me because I was taken off my healing course and then made into this patient. And, you know, when you take pills every day, three times a day, that tells you something about yourself. When you go to a psychiatrist once a month, that tells you something about yourself. When you go to a therapist once a week to talk about your problems. So when you do that year after year after year, I mean, if we believe in neuroplasticity, that's doing something, you know? So good or bad. So I'll just say that I only had one psychiatrist in all those years that said, and I'll quote him. I'm a psychiatrist who doesn't believe in psychiatry. Who put you on all this? We're taking you off. So, I mean, he took me off 10 overnight, but I was still left on seven. And then I went through a horrible withdrawal. I hallucinated in the hospital. I was in the hospital for 45 days. And, you know, that does something to your life. When you don't pay your bills, when you're away from your family, when you're socially disconnected, when you don't have shoelaces and clothes. I mean, it's a horrible system. It's not a therapeutic place. I know that's kind of harsh to say and controversial, but modern approaches that we have don't feel therapeutic. They feel traumatizing. And to the point, you know, I'm even trained as a social worker. So I read the evidence. I talk to patients. I listen to them. I have my own experience that may color my view, but we need a lot of change to happen. It's just the way we're going. The suicide rate has never been higher. The disability rate has never been higher. We're going the wrong way here, especially with kids, I think. Did you know anything about the whole idea of deep prescribing and not going off something cold turkey at that point? So in other words, you just listened to the person who told you, go off 10 meds. My doctor took me off 10 meds in the hospital overnight. And that was in 2006. Remarkable, remarkable, remarkable. I didn't learn about tapering until probably 2014. I couldn't get off Simbalta. And, you know, the doctor had told me, skip one day, take the next day. And that landed me in the emergency room. I couldn't breathe. I felt like my heart was doing one thing and my breathing was doing something else. And I got to the emergency room and they wanted to give me a volume. And I was like, no, you're not going to give me another pill to get off another pill. So then my friend told me, you know, count the beads out and every day, you know, every week, take like so many beads out. That was the first introduction. It was from a fellow patient, not from a doctor to help me get off. Incredible. That's why one of the reasons this film is so remarkable because people aren't talking about these things. I hadn't heard about deep prescribing. I hadn't heard about any of these things. So important. We have a really very detailed question from the audience. Our daughter has been taking very serious psychiatric medications for years. She has bipolar, schizoaffective disorder. Is it safer to wean off of medication in an inpatient setting? I see benefits to the meds, but it is a trade-off. Her OCD increased with her meds. Additionally, I worry about the long-term effects of her meds. Closapine, long-term. Who would like to take that? Do you want to do this one? So, yeah. Well, I'll address the last part of the question first. I think it's completely reasonable to worry about the long-term effects of clausera. These are medications that are not to be taken lightly and either prescription or deep prescription of these drugs need to be done very, very thoughtfully and carefully. So as far as discontinuing a drug or reducing a drug inpatient versus outpatient, it's hard to say. I think it's a decision that needs to be taken with your daughter, with her doctor, and of course with you as her family. So, and I suspect that if it's going to be a very, very slow process, I mean, you need to take into account how long she's going to be in the hospital for that. So that's going to be one major consideration, at least from what I'm looking at. And it also depends on whether you think you want to taper off the medication and give her something else or do you expect to taper it off and find other ways to ensure her psychological well-being. So, I mean, in short, there are lots and lots of factors that would go into that decision. I think my strongest recommendation is take your time in deciding one way or the other. And like Dr. Pasek had mentioned earlier, if one doctor doesn't feel right, please, Dr. Schaub. Well, if in a way you're all talking about finding the right mix for your family, it's your family, it's finding the right care and it's listening, but being very proactive, correct? There's a lot of parents I know with some of those people in our audience. Now we have a lot of questions. May I, did anyone else want to mention anything? Lynn, do you want to comment? Anyone want to comment more on that question? I guess I wanted to say that one of the interesting things in the making of the film is with relation to deep describing is that across the country, every doctor, all the good, everybody had a different, and this is so interesting that Swapna was putting all this together, but there are different, there's no consistent way to deep prescribe. And we heard things like, we'll skip a pill one day and take two the next. We heard, break your pill, like Angie was talking, count your beads. We've heard so many different strategies for it that brings up a huge thing for a family trying to do the right thing. And I just think, and there's tremendous, huge significant groups of people online who know, and I, with no disrespect for the doctors on this panel who know so much about tapering and what it entails and the symptoms that occur and the language they speak. It's so, they are so familiar with it. And I, it may be scary to go online, but for instance, Dave Cope had a hard time. He went online and his family all said, oh, Dave, you're irresponsible. Who knows who you're meeting online? But he said it was the best advice that he ever got was to go online and learn from your fellow sufferers about there are many different opinions out there. So. You know, I'll second what you're saying, Lynn. I think science or the science of psychiatry has very little to offer in terms of evidence for how to be prescribed. And although not online, but I have learned a lot from people who have actually gone through the process themselves, including some of the patients that I treat on a daily basis. Because I mean, you know, at the outset, what I'm telling them is that I don't know how to do this perfectly. All I can assure you off is that I'm going to be available to you and we'll keep working on finding solutions that work for you. So I'm sure all of you know Laura at the end of campus. I've learned so much from, you know, talking to her. I've learned a lot from the person who runs Surviving Antidepressants, Adele. They've been wonderfully supportive and, you know, they've really educated me about a lot of these issues. Well, again, that's why this film is such a resource. And also you're putting a screen up at the end of this talk that people can refer to everybody. Can I go to another question or were there any other, did anybody else wanna, okay, we have a lot. Can the panelists speak to ADD medication for kids, young teens as a way to control kids rather than helping them learn actual life skills? Is that something that one of you would like to address? I don't have the expertise with young kids or I mean, I really haven't seen them. So I can't really address the question intelligently. I don't know what the swap mail does. Unfortunately, neither do I. I think at the end of my training, I was so mixed about prescribing the children that I decided to steer clear of child psychiatry. So I would leave that, you know, to the experts who do that on a daily basis. Absolutely, now I understand. How do you, another question, how do you recommend tapering off SSRIs? Oh, sorry, again, children. Do you, actually, this is in a way a general question. Do you prescribe kind of getting to a medication-free zone and then trying to add something at a certain point or does anybody wanna talk to that with finding the right medication, whatever right level of medication and whatever correct medication would work? You mean with SSRIs or...? And this came in, it says, do you recommend a drug-free period before you start new medication? In other words, getting back to a... Oh, when you're switching from one to another, it depends on what you're switching from and to what. Okay. Yeah, and, you know, in my, I mean, this doesn't directly address the question, but if people come in with mild or moderate depression, I'm pretty clear about SSRI withdrawal syndromes even before we prescribe, you know, before we move towards prescribing. So we definitely factor that into a decision to actually start a medication that coming off of this might end up being a problem. Right. Can we go to a question for Todd? Knowing what you know now and having seen Rebecca blossom into who she is now, how would you advise parents who are wrestling with the decision to medicate one of their children? You know, every family's situation and every child's situation is unique. So, and again, I'm not a mental health professional, but my, from experience, my general advice is to explore all options, including other options before necessarily resorting to medication. I think my wife and I came to the conclusion, not so much whether to tell people to medicate or not medicate their kids, but as best as you can, given the circumstances, let medication be the last resort and maybe not the first resort as it all too often is. I remember as a father, just the idea, loving the idea or wanting to love the idea, that there was a magic pill that could just make my daughter be happy when she was going through this melancholy period. And that's just, that's not realistic, right? As a parent, I get it. And I emotionally want what I wanted, but it's just not how medication works. And, you know, and that's a temptation to avoid. If you do medicate your child and you notice, as we did, that your child actually gets worse and develops more significant symptoms or problems. I think, again, it's just imperative to remember that no one knows your child better than you do. In most cases, right? No doctor, no psychiatrist or healthcare provider has the experience with your child and particularly your child's unique personality that you have. And so if you suspect that medication is making things worse or that it was the case with us that your child was much better before medication than after being on medication, it's your job to advocate for your child. And to lift up the child you have known, the person they were before going on medication, and that your child is your light in the darkness in that respect. That was the light that guided us in our decision to take Rebecca off medication. And the final thing I'll say that we learned kind of in a haphazard way is be honest with yourself as family, as parents, about whether the circumstances in your family's life or elements in your family's dynamics could be contributing to your child's mental health struggles. One of the big turning points to Rebecca's journey out of psychiatric system was when one of her psychiatrists hit the pause button on the medicating part and just for one afternoon did an impromptu family therapy session with Rebecca and my wife and I. And the session gave Rebecca the opportunity to reflect on elements in her home life that were causing her anxiety, things that my wife and I had not fully recognized or really owned. And it was the beginning of our recognition that there were changes that we had the power to make in our family life that could, and ultimately did make a big difference in Rebecca's mental health. And in the long run, our family grew closer after making those changes. So that's just to say that it's a little bit of family therapy sometimes is not a bad idea. Talk therapy is not popular among a lot of the psychiatrists I talked to that year, but talk therapy for a family in terms of the family dynamics and how that might be affecting a child's mental health is something I would definitely be more inclined to do if I had to do it all over again before ever going on medication and making medication being the last resort. Thank you. Would anybody else like to comment? Nope. There's another question. Justice, there are studies to prove the effectiveness of the drug. Shouldn't there be clinical trials to study effective tapering off of each drug? Thank you to whoever asked that question. That's a fantastic question. And yes, that should be happening. I suspect that that data exists from logical companies when they, sorry pharmaceutical companies when they do these large clinical trials, they're obviously stopping these medications and the patients are experiencing withdrawal to an extent. So all they need to do is just follow these patients for a little longer time and try and figure out and delineate withdrawal symptoms of the same medication. And ideally, like the person who asked the question is saying that they should develop tapering schedules for these drugs, safe tapering schedules. I think some of the data about SSRIs is actually being re-analyzed to remove the effect of withdrawal syndromes. I think there is a social worker at UCLA, Dr. David Cohen. Yeah, he writes, he's written a paper about that where the usefulness of SSRIs in preventing depression, the effect actually went away when the withdrawal syndromes were factored so yes, absolutely we should be having studies where tapering withdrawals and roms are delineated and safe tapering schedules are being developed. Also, can I just add just from my experience of being a patient that came off meds and I had to find the information myself, I think I had medical journals access to it at my college so I was reading like all I could get my hands on like what is going on with me like is this a real thing? Cause I'd never heard of it but I just I've been really immersed in the patient. I guess they'd call it the lay person withdrawal community for five years. I've admin some of the groups. I work with Laura Delano with draw projects sometimes. So I just wanna say that because this is such a new thing that's happening, it's slowly, slowly, you know being talked about people like Swapnil are working on it. It's really a tricky thing because right now this is what I see is patients talk to their doctors and say, hey, I wanna get off the Simbalta. How do I do that? And they will take them off in three weeks. And then the patient ends up in our support groups on Facebook. Oh my God, help. I can't see. I can't shower standing up. What do I do? Mothers of children with autism. That's another, it's happening a lot with they're given anti-psychotics and then they end up in our support groups. So a big part of this is like we want this to be more talked about and more known but even a withdrawal schedule that's like a protocol is not right for everyone. And rarely are these patients on one drug. Most of us are on like five or six or seven where people have been on them for 30 years. And for some reason, everybody has their reasons why and not everybody wants to come all the way off. We would say that's a harm reduction approach. Maybe instead of five you wanna take two but we see this is what I see. People come off, they get new diagnoses. So now that you're experiencing psychosis that could be a withdrawal effect from coming off an anti-psychotic not the original condition then they're put on something stronger. Even me, that happened to me. They wanted to put me on lithium at the end of my taper. And I was like, no, I want off. So it's really tricky as patients are coming off they're being put on other medications. They're being given new diagnoses. Some of them get so severe they're in hospitals they're made homeless because they can't work. They can't get on disability because nobody recognizes this as a problem. So like Swapnil said, this really is a public health problem. And nobody knows really like is this withdrawal? Is this the original condition? Is this a relapse? Like what is this? How do we even know what that is? So I just wanna like throw caution that talking to your doctor about deprescribing can go like horribly wrong. And I've seen it every, I see it every day on Facebook which I can't even believe I'm saying that that people are on Facebook trying to get help. That sounds really crazy even when I say it. But the consequence I heard Mark Horowitz say this the other day in a different panel. He said, because there isn't medical evidence because there isn't a deprescribing in psychiatry the consequence of that is patients need help and they have to find it somewhere. So they find each other. And here's the movie. There's a movie about it. Everybody wants to say it's rare. It's like, no, it's not rare. They made a movie about it. That's how it's not rare. So I just wanted to add that. That's amazing. Lynn, do you wanna talk about, you did such extensive research talk with so many patients. Can you talk a little bit more about this? What you found out, what you learn in making the film? We start, we knew, we discovered that there was that we felt we kept feeling this was, this is an untold story because in our experience as a family we had absolutely no idea about any, anything that might go wrong or any other the questioning of what the standard of care. And we just, we knew there was another story and as we started to meet a lot of people Angie's referring to them who were telling stories that had patterns that were not, they weren't the same story at all but they had essential patterns that were the same. And so many people told us over and over again it's just something's not right. I don't feel good. I don't feel myself anymore. I feel numb to the issues and then, and then once the decision it made to get off the incredible withdrawal and how devastating, I mean, it really life threatening and devastating withdrawal can be, not for everybody. And that's what's really hard to convey in the film is that you'll see someone like Brie who was okay with her withdrawal. I mean, it wasn't comfortable for her but she was not near the situation that her husband was in which was really in a fetal position rocking back and forth in his withdrawal. Or I mean, as Angie said, she literally had a knife in a kitchen and was fighting herself. That was her part of her withdrawal. So the patterns were the things were just not right. So I just think we learn so much from everybody. And then as we show the film we are learning more about it. People, especially right now it's COVID and we can't see people, but at screenings people get up and tell these unbelievable personal stories about their experience. And I think it's just all adding to our collective knowledge and we have a lot to learn from each other. Could you each maybe say what you think is the most difficult or challenging or important thing that you learned through the making of this film and through all these panels because you have, I mean, if you, this is your 136th panel that's a lot of panels. That's a lot of people, that's a lot of questions. So what, I mean, what, like if you could kind of encapsulate your biggest insight I'd love to hear that from, I bet the audience would love to hear that from each of you, if you have one. I guess I'll go first. Cause I've done 75 in person and probably probably 50 of them were by myself like with large groups of counseling students or social work students or therapists. This is what I've learned I think through all those thousands and thousands of people that I've seen. I think that we're not honest about mental health. Like there's no easy answer. There's no pill that fixes it. There's no, you know, if we throw money at mental health that's gonna take it all away and we're just all gonna be okay. I also think where people are very misunderstood their behavior might be eccentric or different or strange or scary even. So we're just uncomfortable I think with feelings with how we're feeling with talking about those feelings with each other. A lot of people don't have a person to tell their problems to and to like talk it out without being like invalidated or so I just think there's a lot of suffering all around but there's no easy answer for that. No matter how easy we wanna make it. We know little about the brain. We know a little about self-regulation about trauma how trauma looks from kids to adults. So that's what I think I've learned. Anyone else? I had one of my biggest moments was existential. It was someone, a really, really good dad who came up to me and said, you know really great film, good film, great storytelling everything like that but I would never let my child see this film. This child had struggled in college and had been medicated and got through a really bad time and he felt was in a very good place because of the medication. And he said, you know, I would never let him see it. I think it's irresponsible. It might convince him to go off of his meds and I'm sorry but that's irresponsible. And it really, it did become an we were finishing up our rough cut we hadn't finished the film but I gathered the team together and I was like, oh my God, you guys, this is huge. This is a huge responsibility. Are we being irresponsible in airing this film which is not your typical balanced pro or anti-medication film. It's really, as I said before the telling of an untold story and something that we haven't talked about. And I really felt this father was being so honest with me and then I just thought about it, thought about it. And what I realized is we are irresponsible if we do not tell the story. And what about all the people who, you know are about to begin medication without taking the pause or without as Stan says, getting to know their doctor and learning about much more about what they're going through. So that moment, I mean, I thank that dad for telling me that but I do feel these are serious issues and we have to take them very seriously but it is our responsibility to talk about this film to show it as much as we can and not be afraid that we're doing something wrong. Bravo, bravo. Anybody else want to say anything? Todd or Stan Swapnil? You know, I haven't been on so many panels but maybe I can reflect just a little bit more on how both the process of making the film and the work that my late wife to be to did on the book that was prior to just prior to that has clarified something for me at least on the place of children's mental health in this larger conversation that there's a quote that my wife liked to use a lot this idea that kids are canaries in the full mind when it comes to the larger mental health epidemic of the United States and what does she kind of mean by that? I think what she meant by this and what has become clear to me as the more I have these conversations about this film and what we learned from Rebecca's experience is that our children here in the United States struggle increasingly with anxiety and depression. We all know that on this panel and we would do well to see our children signaling to us that all is not well in our society as a whole including in the adult world, right? Particularly in the adult world. If our children are struggling they're not doing so necessarily because there's something inherently wrong with them but perhaps because they are responding to the incredibly unhealthy dynamics of what's going on around them whether that's their family, their school, their community, but also the nation. To be to be to often like to say that it is no sign of health to be well adjusted to a sick society. It's no sign of health to be well adjusted to a sick society, right? Many of our kids are struggling because they're resisting adjusting to a society that is failing them. A society that has its priorities backwards. A society that dehumanizes people. Society that treats individuals as means to an end that fails in providing adequate economic and health resources and in terms of the distribution of these at least to the larger population. If we want to know just how sick our society is look at the mental health epidemic among our children. They're trying to tell us something as best as they can that all is not well in this world and in this nation. And if we can only do a better job of listening to them and that's the clarity I've achieved in the past several years working with this film and really try and tap into the stories of others whose children have been struggling with mental health issues. That's great. Beautifully put and you know and your daughter by the way she's helping other people by being part of this film. I mean, that's the whole point. This all goes around. It's great. And would anybody else like to comment? We have a bunch more questions but would anyone else like to say anything about this? Okay, may I read another question from another woman in the audience? I have had my annual checkups and found it interesting that my internist was very eager to prescribe psychiatric drugs readily for sleep and anxiety. How do you feel about this type of prescribing? And how much does it contribute to public health problems of over prescribing? Yeah, I think in the United States primary care doctors surpass psychiatrists in the prescription of antidepressants at least of SSRIs at least. So yes, it is contributing to a part of the problem. And I think, of course, initiation of these medications is an issue especially if a patient just has mild or moderate anxiety or depression. I think the larger problem is also the uncritical continuation of these medications because once they're started, people end up taking them for years on end without any sort of review because pharmacies automatically request refills, primary care doctors refill them without actually reexamining the need for these medications. So I agree, you know, internists and primary care doctors have become sort of more are prescribing psychiatric drugs more freely than before. SSRIs are one group and the other group is benzodiazepines and the Z-drugs like Ambien and Sonata and these drugs. So I do think that the problem needs to be addressed very proactively and through more education. Yeah, I would agree with what Svagnil just said. The other point that I think needs to be made is that psychotropic drugs can be harmful in their own right but psychotropic drugs also interact with other medications that we take. And so I was thinking about Angie's story of being on 17 different drugs. Most of these drugs are broken down in the same system in the liver and often they compete with binding sites and are metabolized either more quickly or less quickly because of their interactions with other drugs. And if you're prescribing these drugs, particularly multiple at the same time or if you're an internist or primary care physician is prescribing these drugs to someone who may be on non-psychotropic medication, you need to be absolutely and completely aware of how the drug is gonna interact with the other drugs and how the patient will experience that and you have to let the patient know beforehand what the potential complications are so earlier for example, one question focused on a person who's child, I think was on close-up and just in passing, it sounded like the questioner mentioned that the person had increased symptoms of OCD. Well, close-up can cause OCD symptoms. It's not common, but it does happen and it may be that that's a good example of where someone who is taking a drug to treat whatever the symptoms are, presumably psychotic symptoms, then one of the complications of that is gonna be the development of a new set of symptoms, in this case, OCD, that can be very, very distressing. And it doesn't sound like, perhaps they were told that would happen, but I doubt it, it's not that commonly something that one thinks about but it's not an uncommon side effect. So just knowing when there's more, when you're having polypharmacy, knowing exactly about the different kinds of interactions and you should have the expectation that whosoever prescribing the drug knows that information is able to impart it and should tell you about it ahead of time. Well, don't you normally, by the way, may I just ask you, you normally have one person prescribing all of the pharmaceuticals, correct? Or is there sometimes, is there a lead doctor and then other doctors who are? Well, generally, there'd be one psychiatrist. For example, if the psychiatrist is prescribing some medications for depression or what have you, to a patient who has thyroid disease or diabetes or what have you, one needs to, that both doctors need to be aware of exactly what drugs the person is getting. And if the person has a psychotherapist, the psychotherapist needs to be aware of it because the psychotherapist is spending time with the patient is able to observe things and the family needs to be aware of it for the same reasons. So normally just one person prescribes, except if you have a person who has medical problems and then other psychiatric problems per se, and you might have a couple of people prescribing. Would anyone else care to comment on this? Okay, we have another question that just came in for Dr. Pasek. The students that you see, do you get the sense that their issues are a response to the unrealistic expectations that are out there at all sorts of pressures that are placed on them? Well, I think that's an excellent question. I would say that right now, the pandemic and the impact of the pandemic on students from elementary school through college has been enormous. That the ability to make social connections with other people, the ability to find support from the usual places is just extraordinarily difficult. And I think that's really stressed people out. In addition to which, for a lot of people, it's not easy to learn via Zoom, for example. It takes a toll on people. On the other hand, I do think certainly in certain academic settings, Angie went to Wash U in St. Louis, a place like that or a place like Yale or what have you, kids are under real pressure. I'm talking about the undergraduates to get into these schools nowadays is so competitive that one has to really be an excellent student. And generally when you're, before you get to college, so much of the support you get as a student comes primarily from your family, friends, of course, but primarily from family. And that shifts often when people get to college. They have to find other sources of support and gratification. And that's when you don't have the opportunity to do it because of the pandemic. That's extremely difficult. But to get back to the original question, yes, I think the pressures that kids are under really has a significant impact on them. It just makes it, it becomes, if you feel that you have to get A's in everything and you're in a place where it's very hard to get A's, it's easy to begin to feel down on yourself and to then question your abilities and also question what your future will be. And I think there's much more pressure on students now than there was 15 years ago, certainly when I was a student. I just didn't, I don't think we felt that kind of pressure. Right, that's very well put. May I just ask each of you to kind of give either a last statement, something that we haven't covered that you want to cover, throwing out a question to the audience to think about or whatever you'd like to do, something about the film, but each of you, if you don't mind, and then we'll wrap everything up. And Lynn, would you like to go first? I just wanna, yeah, thank everyone for being here again. We are trying to have these discussions. So if anybody watching tonight has an idea or a connection or a place where a conversation like this would be helpful, we can be reached at medicatingnormal at gmail.com. We have our film website has upcoming screenings. And we also, if you do go to a university or have connections with a teacher at a university, we are, our educational distributors are excellent. They're called good docs. And we are trying to get the film into as many schools and universities and med schools as possible so that these issues begin to be talked about. So please contact us and thank you for being here. And Stan? Well, I guess part of what I, first of all, I'd like to thank Lynn and Angie and Todd and the other people involved in making film for making it. I think it's really very valuable. I think it also points out something of a crisis really in modern psychiatry. And that is, I think it's a field that's looking for a center and kind of a new center. And I think that medication is very important for people. I don't mean to say it isn't. And for many people it's life-saving. On the other hand, you can't lose sight of the fact that you're dealing with a person and who is trying to sort out his or her life and trying to make sense out of it. And I think in our training programs these days, we're so focused on pharmacological and biological aspects of psychiatry that we lose sight of the more human and humane aspects of the work that we do. And I think that's, I'm just making a pitch for that as something that needs to be a part of this psychiatric here going forward. And I think if you're seeing a psychiatrist, it's important to have someone who's competent pharmacologically, but it's also important to have someone who knows how to listen. And I think that's something that, a very small percentage of psychiatrists these days do any kind of psychological work. At the latest study I'm familiar with despite Mark Olson in Columbia. And I think 11% of psychiatrists across the country did any kind of psychological work with their patients. They were primarily doing evaluations or prescribing meds. And I think when you're selecting a person, you need to select someone who you can tell fairly quickly whether someone's listening to you. And that becomes, I think an important aspect of how one goes about deciding on who's gonna provide their care. That's great. And Todd? You know, one thing I could share here at the end is that it was a scary, incredibly scary decision and my wife and I decided to take our daughter out of medicine and we got no support really from psychiatrists. In fact, I told Rebecca's child psychiatrist the time that we were doing it, I got shamed. I mean, what he didn't just disagree with me. He shamed, condescendingly told me that he'll still be there when we find out that DBT or CBT won't work for her. You know, that we were going in the wrong direction trying to help her develop coping skills as opposed to sticking with a medication. And, you know, part of what I had to learn there is my own assumptions about expertise. You know, I'm a PhD myself, not in mental health and anything. I'm a religious studies professor. I study anti-Muslim racism and bigotry for a living. That's kind of where all my waking hours are spent writing about researching. But I do sort of know what it's like to operate in a field where I, you know, people might look to me for an expert opinion on something and the ego that's involved in that as well. Professors are sometimes known for that. But, you know, the truth is in this process, I was deferring a lot initially as my wife was to the experts. We weren't MDs. We didn't have training in psychiatry or children's psychiatry. And so we kept deferring because, you know, we were both very much socialized as very high achieving academic types ourselves to trust anyone who has expertise. There were claims expertise in something and not to question it. And it took a long time for us to learn to be confident that we were both actually kind of critical thinkers, my wife and I, which I think was to our great benefit in the long run. And it was okay to ask critical questions, you know, that for me actually kind of do my professor thing in my real life world, right? Which is to ask those kind of critical questions this time about the treatment my daughter was giving. And so I guess I passed that along to the audience listening tonight in that, you know, it's scary to buck the system and it's scary to ask critical questions of experts or people who have the mantle of expertise in a field. But when it comes to mental health and particularly in my experience, children's mental health, and there's a lot we don't know about, you know, the long-term effects of psychotropic medications on children, a lot we don't know. We should be asking as parents, as Concerned Citizens has a lot more critical questions and not see that as disrespectful, which is what I was afraid to be for so long with psychiatrists that we were seeing, but to see that as being really faithful to our children and faithful to the process of inquiry that hopefully will make our kids and the rest of us much better when it comes to our own mental health. Thank you. And Swapnil? Yeah, I had three points to make. Two of them are very similar to what Stan and Todd already said. I think medications have their place, but they're not for everybody and they're certainly not forever. So that's something that's really important. The second point, part of which Todd covered it's very, very important to remember that patients would be the best advocates for themselves and it's very important to ask questions. If a psychiatrist is unwilling to answer questions, then it's time to change psychiatrists. And the third point, I think that's very important and often gets left out in the conversations around deep prescribing that it can also be a social justice issue at times because very often medications can, people who are disadvantaged get over-medicated and they have the least access to deep prescribing resources as well. And I think the most striking example for me was a young single mother working at a Burger King who wanted to reduce her Zoloft and SSRI, but she just could not do it because she didn't have the time to stay home or to tend to herself while she was going through withdrawal. So it's something that needs to be approached from, we need to take a rights-based or a human rights approach to it as well. And finally, thank you so much for having me and thank you for making this phone again. Thank you and Angie. Hi, I love what everybody said. I think I would just, the only thing I could add is, sometimes we like to say like, don't believe anything we said, let this be the beginning of your own journey. And in that, I would just say, I've met a lot of people, this was me, I thought like, here's my body, fix me. Here's my emotions, fix me. And I just kind of relinquished my autonomy and you just want this answer or you just want someone to fix you and it doesn't work like that. And it's a hard work and it's painful. And even in the pandemic, the prescribing rates have gone through the roof, 30 to 40% increase. And I just worry about all of those patients. Like, do they have an exit plan? Did anybody tell them to read the pamphlet? Like these simple health literacy things that we don't learn. So I just think that we all have to learn what's right for us, whether that's medication or not, learn the risks, the benefits and the alternatives and have an exit plan. And there's nothing, you're not broken is my biggest message, is don't believe everything you're told, I think. Can I just say from the Bedford Playhouse and the Let's Talk series, we are so happy to have had you here. We are so humbled by the film. It's just an honor to have you here because it's such an important topic and you're such wonderful speakers and wonderful people. And we've learned a lot and we hope that this is just the beginning. And again, after Dan is gonna put a resource page up and you can refer to this on YouTube, correct? YouTube. And so anyway, so we thank you so much. Thank the audience. Thank everyone for being here and Dan's gonna take it over. Really appreciate everybody being here. Thank you. Yeah, thank you very much everybody. So we'll leave this page up for a few minutes for anybody who's tuned in who would like to jot down some of this information. And we also did record tonight's talk and we will send everybody a link to where they can find the recording in a couple of days so that if there's parts that you need to re-watch or if you wanna find certain pieces of it again, you'll be able to do that. So thanks very much again to everybody for participating. And Dan, may I just say one more thing? May I say one more thing? There were a couple of questions we didn't get to because they were very specific and hopefully those people who asked those questions can find good resources here on this page. Yes, indeed. So we'll leave this up for a few minutes for everybody who needs it. But thank you very much for attending again and I hope we can do it again soon. Thank you, Bedford, for having us. Good night, everybody. Good night, thank you. Good night. Good night, Swapnaio. Good night, you all. It's so nice meeting you. Thank you so much. Thank you. Take care. Cause you got it. Good luck.