Anna Sale: Hey, it’s Anna, and this is a special Saturday drop of the show. For three weeks this month, we’re dropping new episodes on Wednesdays and Saturdays, to share the national call-in series about mental health we’ve been hosting with our colleagues at WNYC during this Mental Health Awareness Month. 

We’re calling the series “Hold On,” and we’re taking calls from public radio stations across the country to talk together about our mental health, share your stories, your questions, and your frustrations with the mental health care system, and also what's worked for you. 

In this hour, we talked about our relationship to prescription psychiatric medication.

According to a 2021 study, 1 in 5 American adults are taking medication to treat their mental health, that’s more than the number of people in any sort of talk therapy or counseling, which is about 1 in 10. In this episode, you’ll hear from listeners about the drugs that are helping and about the relationships, or lack thereof, that they have with their prescribers…and how that can be tricky to navigate when trying to change or taper off their current meds.  

If you want to take a look at the whole series, plus a list of mental health resources, go to wnyc.org/holdon. We’ll have our final two episodes in your feed next week. 

Please share the series with anyone you think might find it helpful. Again, you can find it at wnyc.org/holdon. Here’s the episode.

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Anna Sale: This is Hold On, a national call-in special about our mental health, from WNYC and the Death, Sex & Money podcast. I'm Anna Sale, thank you for joining us for this series. 

We are on public radio stations around the country this month of May, which is Mental Health Awareness Month, to talk together about the state of our collective mental health… where you've gotten help, and where the systems let you down. 

On each of these call-ins, I'm joined by guests with expertise in our mental healthcare system, but really the focus of our conversations together is sharing our own experiences more than getting advice.

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Anna Sale: Because unfortunately, a lot of our mental health frustrations don't have easy fixes that an expert can deliver, but we are all experts in our own lived experience. And what we can fix together with these call-ins is lifting the stigma of needing and seeking out mental health treatment. 

We are focusing this hour on prescription medication and your mental health. Today, one in five people take medication for their mental health. Three decades ago, less than one in 50 people did. And with that rise has come a shift in the relationship between the doctors that can prescribe that medication, and the people who take it. 

I have two guests joining me to take your calls about this. Daniel Tadmon is here, currently getting his doctorate in sociology at Columbia University — and is finishing in mere weeks — where he has researched how psychiatric drugs are administered, and how it differs for patients depending on how much money they have and other factors. Before he was an academic researcher, Daniel was working to become a clinical psychologist. Welcome, Daniel. Thanks for being with us.

Daniel Tadmon: Thanks for having me, Anna.

Anna Sale: Also with us is Dr. Kali Cyrus, back from the first hour of our Hold On series. Dr. Kali is a practicing community psychiatrist and assistant professor at Johns Hopkins Medicine. Thanks for being with us again, Dr. Kali.

Dr. Kali Cyrus: Excited to be here. Thanks for having me again.

Anna Sale: I want to start with Daniel to understand your path into this work. You started out wanting to be a psychologist in a clinical setting, and then decided you wanted to pull back to study as a sociologist who was getting what kind of care, based of what you'd seen in your clinical psychology training. What did you notice about how different kinds of care people got along with their psychiatric drugs?

Daniel Tadmon: So, I would say that the thing I noticed while I was practicing and while I was in training was more than the question of who's getting what. I was kind of becoming cognizant of the fact that the different mental health care treatments that we get, basically tell us very deep things about ourselves. When we go to see a mental healthcare specialist who tells us that if we take this drug, if we take this medication, we'll be better, we learn something different about ourselves than if we see a therapist, for instance, who tells us that to be better, we need to understand something about our past. We need to understand something about the way we think about our life. And, it really interested me to study who gets exposed to these different ways of thinking about our own mental health, about our own lives, about our own problems, about what should we do to be better. And the fact is that different people do get exposed to these different frames of thought.

Anna Sale: In your research, you've found that way fewer psychiatrists are administering any kind of talk therapy when they prescribe medication. Put some numbers on that for us. What have you found?

Daniel Tadmon: That is true. So, this trend of psychiatrists basically veering away from therapy and concentrating on medication management started probably in the 80s. Um, specifically I looked at 21 years, since the mid-90s till the mid 2010s. And in that period, I saw that the number of psychiatrists who were not providing medication but providing therapy to their patients basically halved.

Anna Sale: Mm-hmm.

Daniel Tadmon: Um, so the majority of psychiatrists nowadays don't do therapy at all. They just see patients for medication management. And, psychiatry has become kind of a two-tiered system. You have some psychiatrists who are usually seeing patients in private practice. They see them more often, they see them for longer appointments, they see them in urban areas, um, they get paid differently. And these psychiatrists will provide therapy. They will sit for longer with their patients. They will hear more about them, um, and that's the type of treatment they will provide. 

And the other part of psychiatry are psychiatrists who almost solely do medication management. They see patients more rarely. They see them for very short appointments, and at the end of that appointment, they will prescribe medication, which is very good because medications generally work, and there's a lot of the stress out there that's being relieved thanks to medications. Um, but basically the type of treatment patients will receive from their psychiatrist, so my study, um, shows is dependent, not exactly on their clinical characteristics, on their diagnoses, on what they're suffering, but on who they are. What's their race? Where do they live? How do they pay for treatment?

Anna Sale: The kind of care they can have access to.

Daniel Tadmon: Exactly.

Anna Sale: Dr. Kali, you're a psychiatrist, you do sessions of talk therapy with clients. Does this analysis of a two-tiered system about who gets talk therapy along with their medication, uh, does that resonate with you and what you've seen in your practice with patients?

Dr. Kali Cyrus: It not only resonates with what I've seen in my practice, but I think it even resonates with me and my own experience and those of my colleagues. Most of my colleagues when they graduate are going into research, and they may see some patients on the side, or they may see folks in the community.

Um, and then there's probably a few who will decide to go into who will do psychotherapy, which is an interest of mine. And you usually, even though you have a rotation that trained you to do this, you have to seek out that additional training if you want it. So for me, as a psychiatrist whose personality is interested in this, um, I sought this out and I have a private practice where I do psychotherapy with clients for 45 minutes to an hour.

I also have clients I only see for meds for 30 minutes. I've also worked in a community psychiatry clinic where folks come in for 15 minutes with schizophrenia and bipolar disorder who just so you know, also need therapy, um, can benefit from it, but you just give 'em meds. Um, and also hospitals and you can see, depending on what color they are, depending on their diagnoses, um, depending on where they live and which setting I see them in, and insurance and education, um, it, it looks different.

Anna Sale: Hmm. And when you're in a session that you know is gonna be 45 minutes, um, where, where there is prescription medication as part of the treatment, but you have more time to talk. Do you talk about the medication in a different way than you're able to in a 15 minute appointment where you are describing, this is what I'm prescribing, this is what I want to hear from you about your experience with this… how do you, how do you sort of like pull out, like an accordion, how you talk about how someone should think about the medication they're receiving?

Dr. Kali Cyrus: Well, I’ll say the first thing that's important is what's the setting in which I'm seeing the client? So right now, we're talking about my private practice. That means I set it up the way that I want, schedule appointments, the time that I want. I do not do 15 minute appointments.

Anna Sale: And these are private pay primarily, correct?

Dr. Kali Cyrus: So these are patients who pay me first–

Anna Sale: Uh-huh.

Dr. Kali Cyrus: And then I give them a superbill that they get reimbursed from insurance, which is really complicated, because you have to spend a deductible to then get maybe 60% covered. And for comparison, let's say I see my psychoanalyst three days a week. I have to spend up to $15,000 out-of-pocket before I start to get reimbursement of 60%. So with my clients, my 30 minutes appointment, my 30 minute appointments are generally billed at a specific rate, unless someone has a sliding scale. And when we talk about medications, well, when we jump into a 30 minute appointment, I usually catch up, and then specifically ask about the meds. And then, um, even if there's time left over, um, I try not to be the teacher who doesn't let you outta class, but-- [Anna laughs]

I also like to say, what's going on with your mom? What happened to that person you were dating? And usually other details come out that, that help me with the prescribing, because I need to know what makes them anxious in order to adjust the meds. So with my, those are my 30 minute appointments. 

With my 45 minute appointments, um, kind of jump in like therapy does. Where do you start? Where do you begin? And they start talking. And then if I hear that they've had a terrible week at work, not getting much done, I might say, well, um, were you taking your stimulant every day? What was the timing of that? Or at the end of the session, I might say, just so you know, it sounds like you could benefit from an increase. You don't have to do it right now, you can keep it in your back pocket. Let's keep an eye on it. But a lot of psychiatrists, and, and I hear this from my patients, don't fully explain how these medications work, don't explain the differences. And again, because I'm in my private practice, my first appointments are all 75 minutes.

Anna Sale: Hmm.

Dr. Kali Cyrus: So that I can, yeah–

Anna Sale: I wanna know about that 15 minute appointment though, Dr. Kali, what can you–

Dr. Kali Cyrus: Okay–

Anna Sale: Get done in that 15 minute appointment?

Dr. Kali Cyrus: Okay. Okay. That 15 minute appointment is, um, how are you doing? How was your way in? You ask a kind of perfunctory question, and then, um, how's your mood? Which is, you depress sad, whatever. And then you ask, how are your thoughts? Have you been worried about the same things you were? Is it, are they every day, most days? Have you had any hallucinations? Have you still seen that shadow that you usually see? Um, what are your side effects? How much, what hours are you sleeping, going to bed, waking up? How's your appetite? Are you eating more? Have you noticed you've gained weight since you've been on this? Um, have you had, have your thoughts of suicide decreased or increased? Have you thought about a plan or not? And then refills, do you wanna make any changes?

Anna Sale: Mm-hmm.

Dr. Kali Cyrus: If so, then we'll make them, and then we're done.

Anna Sale: A real focus on what the, the patient has experienced, what they connect to, their response to this particular treatment, and less about the universe of their emotional health.

Dr. Kali Cyrus:  Right.

Anna Sale: I wanna go straight to a caller, Felice in Chicago.

Felice: Yes,

Anna Sale: What’s been your experience with medication?

Felice: Oh, I've been on medication for many years. I'm 64, probably started in my early 30s, maybe my late 20s. I started on Prozac, and then I switched to this and that, and this and that. Um, I’ve mostly been on anti, I mean, antidepressants for all those years. I went off a few times, but found that I had to, uh, go back on. I've switched around on them. I've only been to psychiatrists twice.

Anna Sale: Uh-huh.

Felice:  Um, I didn't find that, I didn't, I didn't enjoy either experience. And so mostly the people that have been, um, prescribing is my GP–

Anna Sale: Your general practitioner? 

Felice: And I've had different GPs along the way. Mm-hmm. And I've had different GPs along the time too.

Anna Sale: And Felice, while you've been taking this medication that you get from your primary care doc, have there been long stretches where you've just been taking it and not really talking to a medical provider regularly about what's going on? It's just been something you’ve set and forget?

Felice: Um, I don't… yeah. Yeah, I don't really talk to him. I do see a, I have a therapist that I talk to pretty regularly. I go off and on with her, but most, you know, on a lot. So she's sort of the one that tells me, you know, I think you should try this or try that. And then I go to my GP and we talk about it. But that's only when I'm in a slump or I need to make a change.

Anna Sale: And just generally, if you could characterize these many years where you've had antidepressants as a tool to help take care of yourself, how's it worked for you?

Felice: Mostly positively. I still have depression. And, um, even today, even now I have depression, but I sort of know my pattern now, and I can come out of it easier. And I think that that's, um, the antidepressants working for me. So I just sort of only last a day or two instead of a month or two.

Anna Sale: Yeah. Felice, thanks so much. Daniel, is Felice’s experience something that you would say is commonplace that you sort of find your prescription initially maybe through a primary care doc? A psychiatrist is someone you maybe see, but seek, get therapy in another kind of setting?

Daniel Tadmon: I think it is. So recent data shows that at least half, if not more of psychiatric medications are being prescribed by family physicians, by primary care physicians. Um, and, and that's okay… because, um, these physicians are trained to treat mild to moderate anxiety and depression. Um, I'm curious to know about Felice… why has she seen a psychiatrist only twice, um, in these many years?

Anna Sale: Felice, you're still on the line. Can you tell Daniel?

Felice: Yeah. Yeah! I didn't enjoy, well, the first one that was so many years ago, probably like 30 years ago. And I just didn't really jive with her. And I only, and my, and then my insurance only lasted, I could only see her for, you know, five visits or, or whatever at the time. And then, um, some years later, I tried another psychiatrist. And the first time I went to his office, I waited for two hours and never got to see him. So that was a bad taste in my mouth.

Anna Sale: I would say so.

Felice: And then I finally did get to, yeah, and then I finally did get to see him, and I just did not like him. I just did not like his demeanor, anything. So I was just like, forget it. I just can't deal with this. I'm not going to another psychiatrist. And so, I haven't.

Anna Sale: And you haven't. Dr. Kali, anything you wanna add about your profession? About, I imagine the variety of experiences one can have in a psychiatrist's office?

Dr. Kali Cyrus: Yeah, I, I think shopping for a psychiatrist can sometimes be like walking into an ortho doctor, or a neurologist's office, and I think some of us get anxiety. We don't know how they're gonna, their personality. Unfortunately, yes, we are psychiatrists who talk to people about their psyches, but some of us have different personalities, or maybe we not be, we are not the best at talking about people's problems. And so I, again, I can, I feel really bad for Felice that those are the kind of experiences that she's had with psychiatrists because then you don't wanna go back again! You're telling your deepest, darkest secrets to someone who's being, you know, a little short with you. 

But I think we need to remember, psychiatrists are trained as medical doctors and specialists of the brain and the body. And some of them are, you know, scientists focused on that. Others are more focused on the other part of the conversation, but we all try to do the job holistically, because you have to meet all those needs.

Anna Sale: Jennifer in Byron, Michigan, I wanna bring you into the conversation. Your experience with prescription medication from your mental health is more recent. What's been your experience?

Jennifer: Um, so yeah, I, I was diagnosed with cancer last year. Um, and so I was in fight mode for that with surgeries and chemo and everything. And, um, you know, everybody around me was like, wow, you're dealing with this so well. And I internally didn't feel like that, but I guess, you know, that was front and foremost. 

So, I had my last chemo in March and I fell apart. Like, I was crying all the time… I, and it just shocked me. I thought I would be happy and relieved and, you know, I had, um, nurses saying that that's not uncommon or whatever, but so when I saw my oncologist, I was fighting back tears and trying to say, you know, how I felt and his first thing was like, well, I'll just get you on Zoloft. And I, it was so abrupt. I was like, okay, that kind of shut me down. You know, like, okay, I'll take this, whatever. 

And I took it for a while, and then he passed it off to my GP. And when I saw her next, she was like, is this working? And I said, no, I'm still crying all the time. And she's like, well, let's just up it. So they upped the dosage and, um, it just started to occur to me, like, maybe they need to talk and not just keep upping this medicine because it's all just, you know, staying inside. 

So I talked with our insurance about, um, you know, paying for therapy, and although they were happy to cover the, the, uh, antidepressant, all of a sudden the brakes went on. And they were like, well, we have to pre-approve this and there's limited provider, you know? And so I was getting all this insurance kickback, and I've heard that from a lot of people with mental health issues. Um, but they're like, well, we'll pay for Zoloft. And I'm like, but if that's not fixing it. 

So it's… after a year of, of medical bills that are just, you know, outrageous, it, it just makes you feel defeated and like, I can't go to this without accruing more bills. I already feel guilty about that for the financial issues my family's having because of my illness, and do I wanna take up more? And, and then that plays right back into my mental health. So, that's been my year.

Anna Sale: Oh, that's a big year, Jennifer. And Daniel, uh, it sounds to me like Jennifer's experience confirms what some of your research has found about, um, what can be difficult about getting accompanying talk therapy along with prescription medication.

Daniel Tadmon: Yeah, I think so. So it's, it's kind of shocking and, and it's very sad to see just the role that money plays in the provision of care. And the fact is that these insurance companies, other funders of, of mental health treatment are of course driven by economic pressures, and they're incentivized to have patients receive the cheapest treatment possible. And oftentimes that's medications. Therapy's expensive. It's a person sitting with you for 45 minutes, for 50 minutes, week after week, for hours. Some therapies are, you know, not short-term. Um, and these economic pressures really dictate what kind of treatment different people get based on their insurance, based on their abilities to pay out of pocket. And they also kind of shape the type of treatment that psychiatrists provide too.

Anna Sale: Tricia in Crown Heights, Brooklyn, what’s been your experience with prescription medication, and the person who provided it for you?

Tricia: Hi. Um, well, I only first reached out for an antidepressant, like whenever I got my eviction notice during COVID.

Anna Sale: Hmm.

Tricia: And like, I'm even feeling myself tear up right now because of all of the anxiety that comes with that, you know? 

Anna Sale: Yeah.

Tricia: Um, and it, I appreciate everyone that said what they had about the difficulty with the insurance providers. So, to find someone who could immediately see me, I mean the insurance provider put me on, on the phone with a clinician right away. Because my… anxiety experience just trying to get information, I was having a breakdown. 

Anna Sale: Yeah.

Tricia: Now, I mean it was just like a panic attack. But she had to kind of talk me down and say, alright, we're gonna get you a few providers. But the only providers that they could provide near me, and that would take patients soon… and this was, you know, halfway through COVID, so people are seeing each other, people are actually going into offices. Um, you know, he specializes in bipolar. And I said, you know, I definitely have these ups and downs. He's like, look, these are not manic episodes. You're not bipolar. I'm gonna give you some Zoloft, and I'm gonna give you, what's the other one? Um, hold on. I pulled it out so I could remember… Seroquel.

Anna Sale: Mm-hmm.

Tricia: I think Quetiapine is the generic brand. And you know, he's like, let's see how that works. And I'm like, well, I mean, I'm not breaking into like crying fits anymore, but it's not really working. I'm having a hard time being in settings with people, et cetera, et cetera. So he upped the Zoloft from 25, to 50, and then to a hundred. And with the Seroquel, he, um, added that up to a hundred milligrams.

Anna Sale: You know, Tricia–

Tricia: And he didn't give me instructions on how to take it. So I was taking two of them at night. I couldn't get up in the morning!

Anna Sale: Oh.

Tricia: I didn't know the sedative effects of the mood stabilizer that was supposed to help me sleep.

Anna Sale: And, and Tricia–

Tricia: Yeah, so–

Anna Sale: You, you described this journey starting because of a crisis, um, that was related to material conditions, which was related to an eviction notice and the fear of losing your housing.

Tricia: Absolutely! And I have seen a therapist before, a talk therapist before, but that was never in combination with medication.

Anna Sale: Uh-huh. And, and Dr. Kali, I wanna bring you in because when you hear Tricia talking about the various medications and the dosages that she's been on, when it's related to something terrifying in life, which is the, the, the terrifying fact of, am I gonna have stable, secure housing? Um, how does one think about that as a prescriber of like, this is an acute crisis, it is upsetting, and also there are these tools that can help you while you're going through something difficult. Like, how do you, how do you think about that as a physician?

Dr. Kali Cyrus: Yeah. So first of all, Tricia, I'm really sorry to hear this. It's, it's, it's terrible how, it's terrible how often it's social issues that really can tank us. I mean, it makes sense, but there's, we need more investment in social services as well. When I encounter a client who's in a crisis that has to do with relationship, housing, um, something else like that that's kind of out of our control. First thing you wanna do is stabilize. Um, and sometimes meds are the quickest thing. And it might be something like a Seroquel to get you sleeping, although I have some differences in opinions with starting that one. And um, but it might sometimes be the best thing to do just to kind of get you through not having panic attacks every day.

But the goal is long term, um, how do we get you to a place where you can operate at a baseline? Where you're not in tears, not functioning every day. So I try to describe to my patients right now, you're under that baseline. Meds will help you get to an amount, like, to a place where you can, you can access the coping strategies that usually help you. Um, I also tell my clients is that sometimes you don't necessarily need or want a med, which is why seeing a therapist can often be useful, and that therapist will say, this might be too much for me, you need a psychiatrist. But sometimes you just need someone to check in with you weekly, and provide that ear of support that might help you get through the crisis. 

Um, so a lot of it depends on the timing that you're coming in for, but I think if you know you're not functioning, uh, most days of the week for weeks at a time, medication can get you to a place that will help you function, um, and deal with the way the world is terrible. It can't solve the terrible problems out there, but it can help, when it helps. 

Anna Sale: And Daniel, quickly, in about 30 seconds, when you hear that story from Tricia in Crown Heights, Brooklyn, how do you hear it as a sociologist?

Daniel Tadmon: I hear it as, so I'm thinking of it in, in the context of the pandemic. And, and so many people have gone through very serious crises in that period. And we see that prescription medication, psychiatric medication has went, has gone way up. Um, there are some states right now that over 33% of adults are on prescription medication.

Anna Sale: You said 33%.

Daniel Tadmon: Yes. More than one.

Anna Sale: You said a third of us.

Daniel Tadmon: Yes.

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Anna Sale: And that is both a signifier of what we have been through, and also as Dr. Kali has said, what some of us have needed to get back over that baseline into normal functioning. But that is an enormous number, um, of people on prescription medication. And we are taking your calls this hour about your experiences with psychiatric medication, and your relationship with the provider who prescribed it to you. 

This is Hold On, a live national call-in special from WNYC about our mental health. Please join us after the break. 

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Anna Sale: This is Hold On, a series of live, national call-in conversations about mental health, from WNYC and Death, Sex & Money. I’m Anna Sale, and I host the podcast Death, Sex & Money. I’m joined by sociology researcher Daniel Tadmon, and psychiatrist Dr. Kali… I wanna bring Marcy in Grand Rapids, Michigan into the conversation. Marcy, I understand you are one of those people who's thought about maybe being, thinking about changing the prescription medication you've been on. What was your experience with that?

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Marcy: Yeah, well, I've been seeing my psychiatrist, well, my whole family has really since the early 90s, and he always has me on something. I've been on Celexa for a good 12 years.

Anna Sale: What's that to treat?

Marcy: But I recently wanted to get off of it just to see if I can function without it. But it seems like when I attempt to do it, it, it's almost difficult just to get out of bed. So… I don't know if I'm doomed for life and I have to take it forever, or if there's an alternative. I, I'm not really sure. But it's like once you get on, it's really hard to get off.

Anna Sale: And for Celexa, was that originally prescribed for what? For what symptoms were you trying to manage?

Marcy: Um, for depression.

Anna Sale: Mm-hmm. And when you say you've tried to kind of get off of it, why was that important to you? What was the, the, the question you had about yourself? About why, why maybe try changing it up?

Marcy: Well, ultimately, I, it's kind of embarrassing to have to rely on a pill every day to function. So I thought, I'm, I can do this, I can do this without it, I won't need it. But in reality, I can't even get out of bed–

Anna Sale: Hmmm.

Marcy: if I don't take it. So, yeah, it's kind of a difficult place to be in.

Anna Sale: And when you tried–

Marcy: Especially when that's all you know.

Anna Sale: Yeah. When you've tried not taking it, was it in conversation with a mental health provider or something you experimented with on your own?

Marcy: It might be something I did on my own. I mean, I did research it, um, extensively, like how to slowly wean. Um, but it wasn't successful at all. It was quite difficult, so… 

Anna Sale: And what's your sense about your medication now, knowing that it does help you get out of bed in the morning and does help you function? Do you feel less embarrassed?

Marcy: No. I'm, I'm still, I still struggle with it a bit, but I'm sorta, I'm accepting that perhaps this is something I might have to take forever. Um, and I guess I'm okay with that, ultimately.

Anna Sale: Dr. Kali, I wanna bring you into this conversation when you have someone who has been on a medication for a long time, and is interested in what happens when they, when they go off of it. Um, what's the conversation you wanna have with the patient about how to approach that?

Dr. Kali Cyrus: The first conversation I have is, um, you know, I ask why, what are some of the reasons? And we talk those through just to see if there are, there's information that I can, I don't wanna say correct, but I can confirm as a misconception, um, that they might be worried about and look at the data and talk them through it so they understand.

But it's, if someone wants to go down or off of a medication, the first thing you need to do is go slowly. A lot of people will self-discontinue. Um, they'll say, I think I'm doing fine, or I don't need this anymore. Or I'm just, I can't reach the psychiatrist, so, and I ran out. But that's when we have the worst types of withdrawal, and Celexa tends to be one of the, have some of the worst syndromes. 

Um, but the more important thing I say to my clients, because I do believe you can discontinue these medications safely without the withdrawal, is I say, what are your next three months look like? What do your next, um, six months look like? Which is a tough question ‘cause the world is chaotic. But if you know your finances, what's going on at home, maybe it's the summer you have less workload that you have, uh, the time and the space to wean off of these medications slowly without, um, your social life drawing you too many, um, curveballs, that's the best time to go off with the help of a psychiatrist.

It's not like we're miracle workers or anything. It's mostly that we'll say, go down by 10 this week, go down by another 10 that week. But it's better than just stopping it, because what happened to, um, Marcy, commonly happens. 

And I might just say this really quickly, Anna. I think fear of what they're gonna do to us forever is another reason people don't like to start meds. And I think Marcy's touching on stigma, which is, I, am I gonna be someone who's on meds forever? I tell my clients, some of us, and Marcy, it sounds like, I don't know you, but your family has a strong history. S, some of us, because of our genetics and also environment, are maybe we're just gonna be anxious for a lot of our life.

I'm one of those people, I'm a very neurotic person. I'm probably, I'm just… dealt with the fact that I'm probably gonna be on something for anxiety for the rest of my life. Not everybody is. And regardless, everyone deserves an opportunity to try to go off of the meds, and to see how you do. So you know, it doesn't mean you're a weak person, just means that your unique combination of who you are, from your family and the environment, makes it such that you're acutely aware, you know of how you feel, and it impacts you a little more, just like someone who has high blood pressure genetically, that worsens at times.

Anna Sale: And Daniel, do you wanna add something to, to Marcy's experience?

Daniel Tadmon: Yeah. So, I think I'm gonna speak from my experience as a former therapist right now and not as a sociologist, that I think the relationships we have with our problems, with our depression, with our anxiety… are complicated. And also, the relationships we have with the things that help us. So it's kind of interesting that this medication does help, but it's not easy for us. It comes with a whole world of meanings. What does it say about us that we're dependent on it? Will we ever be off it? What… and I think that in therapy, for instance, that's one of the things that people can really process and work through.

Anna Sale: Marcy, thank you so much for your call. Leah in Chicago, where are you in your experience with prescription medication for your mental health?

Leah: Hi. Yeah, I, um, I've been taking Effexor for the past four years, and, uh, this conversation is very prescient. I just this week started to, um, well, I, I finished the transition from Effexor to Zoloft and, um, I, I think the, the thing that hit me hardest was I was very unprepared for how bad the side effects of that transition could be. 

Anna Sale: Huh.

Leah: Um, and I basically, I, I, I knew that there would be some, but it, they were much worse than, than I anticipated. And, um, when I shared those with my psychiatrist, who I don't really have the best relationship with, um, but I'm seeing him now, I'd rather not switch to someone else. Um, I felt like he was sort of, um, I don't know, just not very, uh, sympathetic.

Um, he, you know, I had almost flu-like symptoms and he kind of was like, well, did you take your temperature? Maybe you're just sick. And I was like, no, they're, they're very concurrent with, you know, the, the last day of me taking my last pill. So I, I think they're connected. And I, I just feel like… he very casually mentioned the possibility of side effects, but I, I really felt caught off guard by it and it was a very, like, terrible, unpleasant five days.

Anna Sale: And Leah, did you find yourself like, Googling by yourself, or looking at Reddit forums to understand what was happening in your body to get more information? Since it sounds like you didn't have a great conversation with your provider?

Leah: Yeah, I was just trying to, you know, see if this was normal and sure enough, yeah, there's, there are articles about it out there, but, um, about, you know, the po, the possibility of the side effects I was feeling. So I felt a little bit better that what I was feeling was tracking with some of those descriptions.

But, um, I just felt it, it kind of walloped me. Um, and uh, you know, it was just, it was just so sort of casually tossed out there. It was like, oh, you might have indigestion, but I actually felt like I had the flu. Like I had nausea, my head hurt, I had chills, and I had very volatile, um, emotions. Crying, um, and sort of a spike in anxiety.

Anna Sale: Yeah. And now that you have made that transition, what, what prompted that transition for you? Why did you wanna try a different medication?

Leah: Um, some of the sort of well known side effects of taking, um, antidepressants. Um, uh, I, I basically wanted to, without getting into too many details, uh, I wanted to try a different drug that might have less of, um, the side effect I was seeking to avoid.

Anna Sale: Yeah. And then you were surprised by the side effects of that transition. Um, Dr. Kali, is there– 

Leah: Of the transition.

Anna Sale: what do you have to say to Leah about her experience with that transition?

Dr. Kali Cyrus: I just wanna say that, first of all, good for you for looking that up on Reddit. I mean, I, you know, hope, I, I hope it's someone on Reddit who, you know, has some clinical background, but I think the internet can be a great source of information when you don't have access. Um, just careful who you get it from, but I think withdrawal is very common.

And we, and I think also the thing is, is that we're psychiatrists, we're not surgeons or primary care doctors. It doesn't mean that we don't know how to diagnose other medical conditions, but folks come to us with all kinds of like, weird side effects or like very, very d- um, descriptions of when they're going off of medications, what they're experiencing.

We can't always say what it is, but it's pretty common. We have plenty of, like, textbooks that teach us about Effexor is one of, like, the biggest culprits of withdrawal. So I, I think that we know these medications have these kind of effect when you go off of them, especially if you've been on them for longer than a year.

Um, what I try to tell clients is that, again, there's a way to go off safely, slowly. Um, and the withdrawal symptoms usually don't kill you. That's not the most reassuring advice, but you can go off of them. You're just really uncomfortable, you might be really uncomfortable for a while, and that's not everybody. Um, so I, you know, I, I'm sorry that you had to go through that and, and maybe felt like you were going through it on your own.

Anna Sale: And, and… Daniel, I wonder, do you think psychiatrists should be more upfront about withdrawal when first prescribing the process, the li, the life cycle of what it can look like when you are deciding to take a medication for the first time?

Daniel Tadmon: I think so. Um, I think I'm, I'm sure Dr. Kali would agree with me that you want to be upfront, you want to be open. There are no secrets. These are medications that people are taking that are gonna have, hopefully, very positive effects on them. But, these effects can also be complicated. I think it's very important that people can trust that their mental healthcare providers are, you know, upfront and clear with them.

Anna Sale: Um, Josh in Toms River, New Jersey, what's been your experience with prescription medication taking care of your mental health?

Josh: Hi, thank you for taking my call. Um, so I want to share, uhm, I suffered from anxiety and depression for quite a while. And I cut off taking medication, uh, really working very hard in therapy, trying to really get on top of it. Eventually, it was too difficult for me, and I said, okay, I'm just gonna take the pill, and I'm imagining this pill is just going to, you know, bring me the healing that I'm waiting for.

Anna Sale: Mm-hmm.

Josh: I’ve come to learn that the pill itself was a, was a journey in and of itself, and the side effects, uh, caught me by surprise. And, after much time I really began to think, you know, side effects also is something that's difficult to live with, especially sometimes when people feel not so attached to life, a little bit unemotional. Besides for other things, and I've, I've, I've grown a lot from being on the pill, but I've made the decision to come off of it, and put a lot of self-care in place. Exercise, meditation, friends and all different things. And I could say, now that, you know, I'm doing very well, I'm happy, and I'm happy I went on the pill, but I'm happy I'm off of it. And I've, I've learned that, you know, the experience may be different for everyone, and it's not always just a magical, uh, pill experience like we may, uh, seem to believe it is.

Anna Sale: Yeah. Josh, thank you so much for sharing your experience with medication. Daniel, is there anything you wanna add to what Josh had to say there in about the last 30 seconds?

Daniel Tadmon: Hmm. Um, yeah, so first, I'm very happy to hear that Josh is having a positive experience. And, there is research that shows that many, many patients actually prefer therapy to medication. And this also has to do with the previous call. I think that our culture vests mental healthcare experts, psychiatrists and therapists, with so much authority and with so much cultural power. 

When people go to get therapy, when people go to see their psychiatrists, they come with great hope. And, they kind of tend to accept, um, what, what the person tells them or doesn't tell them as, as kind of a type of truth. And I think that when psychiatrists decide to provide medications or not to provide medications, many patients might be kind of influenced to just accept it, um, because of this authority. And I think it's really important that mental healthcare providers listen and ask their clients really what they feel and what they think.

[“A Path Unwinding" by Blue Dot Sessions starts]

Anna Sale: Daniel Tadmon is currently getting his doctorate in sociology at Columbia University and was a clinical psychologist before that, and Dr. Kali Cyrus was back with us again on this series, a community psychiatrist and assistant professor at Johns Hopkins Medicine. I wanna thank you both for taking calls with us this hour. It was a joy to be with you. Thank you so much.

Daniel Tadmon: Thank you, Anna. 

Dr. Kali Cyrus: Thanks.

Anna Sale: This was the fourth of six episodes of Hold On, we'll have two more in the feed for you next week. Please share this series with anyone in your life who you think might find it useful, and be in touch with any feedback or stories you want to share. Our email is deathsexmoney@wnyc.org. 

And you can find a list of mental health resources we’ve compiled and listen to every episode in the whole series, go to wnyc.org/holdon.

Death, Sex & Money is a listener-supported production of WNYC Studios. This series is produced by Zoe Azulay and LIliana Maria Percy Ruiz, along with Megan Ryan and Zach Gotterher-Cohen. The rest of the Death, Sex & Money team also helped out: Afi Yellow-Duke, Lindsay Foster Thomas, and Andrew Dunn… as well as our intern Baiz Hoen. 

Matt Marando, Raymond Chan, Wayne Schulmeister, Rob Christiansen, and Aaron Cohen supported us with engineering and technical support in New York, and Topher Routh engineered for me in the studios of the UC Berkeley School of Journalism. 

Thanks also to Alicia Allen, Jaqueline Cincotta, Robin Bilinkoff, Mike Barry, Tara Sonin, Kim Nowacki, and Rachel Lieberman. 

I’m Anna Sale, and this is Death, Sex & Money from WNYC.

[“A Path Unwinding" by Blue Dot Sessions ends]

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