Dr. Josef Witt-Doerring
speaker
129 appearances
1 recordings
1 series
first heard May 2025
last heard May 2025
Dr. Josef Witt-Doerring’s voice in public audio — every appearance, attributed to the second.
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Appearances
Well, thank you so much for having me. You didn't miss – I think you got the biggest parts. Yep. So I'm a board-certified psychiatrist, and I've been doing this for over 10 years now. And a big thing that makes me a little bit different from other people is I'm an expert in drug side effects. And that's what I was doing in the pharmaceutical industry and at the FDA.
And in my day-to-day job now is I run a private practice with my wife. We're in 10 different states across the U.S. And we help people safely come off medications when they've started to have side effects. And so... That's likely where Ivan has kind of found me. I talk a lot on Twitter and on YouTube about the problems that I'm seeing in my patients.
And I also use my research background from being at the FDA and in the pharmaceutical industry to try and break down complicated things like drug studies and research and make them accessible for people. Yeah.
For a long time, the use of antidepressants was justified. I mean, I'll say it like this, was almost sold to the public in a way where the medications were thought to be fixing an underlying chemical imbalance. And the reason it was able to be sold in this way was because throughout the 60s and 70s, we started to learn more about what these drugs were doing.
And at the beginning, we would just give them to people and we would notice, you know, there'd be some mood elevating effect. We didn't know what caused it, but eventually, as science improved, we found out that these drugs were actually boosting chemicals like serotonin, norepinephrine, adrenaline, you know, these very core neurotransmitters that help regulate our mood and cognition.
And so this idea took place that maybe these drugs are actually working in depressed people because we're boosting these neurotransmitters. These people, they have a deficiency in the neurotransmitters and we're boosting them. Well, it's a reasonable hypothesis. But the issue with that is that
There's also a competing hypothesis, and that is that there's no actual problems in the brains of the people, but the drug effect is simply masking the symptoms that the person is having. Now, that's a much less sexy idea, and it's actually a lot harder to sell because intuitively, people...
People don't like the idea of taking a drug to paper over a problem, to mask a problem because it feels wrong. It feels like we're not really getting to the root cause. It's also sort of linked in with ideas about maybe taking non-prescription drugs, things like alcohol. You worry about, well, I don't want to do this to escape problems.
I also know that if people use this a lot, they can develop a dependence and they need to use more and more. So when you think about the drugs out of this drug-centered model, people are a lot more concerned about taking them.
But if you tell someone, well, there's probably a genetic problem wrong with you and this drug is going to go into your mind like a magic bullet and fix the issue, it can seem a lot more justifiable. It's like, well, I'm not papering over my symptoms. I'm not hiding them or masking them. I'm fixing a medical problem. Now, Ivan, you mentioned Joanna's paper just a moment ago.
yeah yeah and so this was a really big deal at the time you know a group of researchers led by joanna mong brief and out at university king's college london they essentially did a review of every single study out there that had looked at serotonin in depression and so looking for correlations you know in these depressed patients when we bring them in if we if we draw the central spinal fluid
you know out and we look at the metabolites of serotonin you know are they are they lower you know they never found it you know they would do autopsies of the brains of people who had a lot of depression and they would look for the concentration of you know serotonin receptors on the neurons absolutely no difference and then they also touched on
really high-tech brain imaging studies, things called functional MRIs, where you can look at structures in the brain, and you can also look at the way the physiology of the brain changes. And they got all these people with depression, and they got normal people, and they could not find any reliable differences between them. So what this means is that
There is no underlying chemical problem that we're seeing with people who have depression, at least not one that we can test for. Maybe we haven't found it yet. But the idea that we are fixing well-known problems with these drugs is false. This doesn't mean that there can't be things out there like temperament. We know that temperament is kind of genetic.
But it's not this easily understood thing where it derives from this one thing in the brain. It's likely polygenic, meaning it's made up of multiple different genes. But that's not a disease. This is just normal human variation that you get some people who are more nervous and some people who are more extroverted.
Yeah, yeah, yeah. And that's just normal human variation. I mean, some people are taller, some people are shorter, some people are more athletic and less. And all of these different things have survival advantages, and they're completely normal. And so what this paper by Joanna Moncrief
It really brought to the fore, at least for humans, that when we are using these drugs, we are not fixing broken brains. We are papering over anxiety and depression with a drug. And that made a lot of people very uncomfortable to hear that, but it's the truth. And that's why that paper was such a big deal.
Well, see, a lot of this comes down to commercial forces, right? And so I mean, most doctors have known for a long time, essentially, depression. Why do people get depressed? Well, it could be due to life circumstances or it could be due to maybe things we don't understand.
And so I think we've always had this idea that there was this interface between maybe your temperament and just the natural variations between people and then also stresses in one's life. What the drug companies wanted to do was they wanted to downplay the life hardship. When life hardship leads to depression and anxiety, they want to downplay that because that's not what their product fixes.
They wanted to paint depression and anxiety as more biological than it was because that's what they had the solution to do. And when you have a group of powerful companies who have billions of dollars of marketing spend, And in the US, they used it on television. You know, there are old ads from, you know, the 2000s, where there's this bouncing Zoloft blob.
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