Is the Proliferation of Antidepressants Good?

Antidepressants are the most prescribed drug in America. 

Almost 20% of adult women, and 10% of men, are currently taking an antidepressant pill.

I can’t get the thought out of my head that we spend inordinate time debating whatever social or political controversy Twitter or cable news tells us to think about, but we spend so little time as a society discussing what is happening in our brains.

Antidepressants have brought positive, sometimes life-saving, benefits to many patients. But the fact that such a large proportion of Americans are taking a dependency-inducing, mood-altering drug daily seems to be a big deal. I actually couldn’t think of something more important because reality and perception itself is nothing more than what our brains perceive.

This proliferation of antidepressants (SSRI’s) represents so much of what is wrong with healthcare today. Antidepressants are a way for the medical system to earn recurring revenue without solving the root causes of what is actually making people depressed. 

Right of Passage?

Mental health is an urgent national priority. Suicide is the second leading cause of death for people under 34, 25% of young adults said they contemplated suicide last year. These suicide stats are the canary in the coal mine of widespread struggles people are having navigating their brains.  88% of Americans said we are on the wrong track – a record. By my own experience, it is clear that far more than 20% of women and 10% of men are struggling with anxiety and their life’s purpose.

Taking an antidepressant is marketed today as almost an American right of passage. Pharmaceutical companies communicate that taking a daily antidepressant pill is a brave act. D2C websites target ads at millennials urging them to “take control of their mental health” by ordering daily antidepressants to their door with a couple clicks.  

Clearly, patients are in need of help and dedicated psychologists are trying to help. And antidepressant pills have helped many people regain control of their lives.

But do these pills help cure the underlying causes of depression? Do they even effectively manage the symptoms on a population scale? Is the fact that such a large percentage of adults take these pills a good thing for those patients?

In recent weeks, I have dug into research on the subject and discovered some fact I found surprising. 

6 Facts About Antidepressants

  1. Antidepressants barely work better than a placebo. 
  1. Drugmakers exert significant financial influence on the psychology profession. 
    • When The New England Journal of Medicine, one of the nation’s leading medical journals, was looking for psychiatrists to write a review of antidepressants, they had trouble finding one who was not conflicted. (Selling Sickness by Ray Moynihan, page 25)
    • Former Harvard psychiatrist Dr. Loren Mosher said “psychiatry has been almost completely bought and paid for by the drug companies.”  (Selling Sickness by Ray Moynihan, page 27)
    • Alan F. Schatzberg, Stanford psychologist and former head of the American Psychological Association, was forced to step down from leading an NIH panel to create guidelines on antidepressants because he failed to report more than $6 million of ownership in an antidepressant drugmaker. (Chronicle of Higher Education
  1. The vast majority of antidepressant advertising it spent targeting women.  
    • Prozac spent more money on advertising than Apple during many of the years its patent was active. (AdWeek)
    • Antidepressant ads feature women about 90% of the time, usually in leisure activities, parenting, or sleeping – almost never in processional settings. (Psychiatric News)
    • Drug companies have launched campaigns on college campuses to “educate” students about depression and prescribe pills. (The Truth About the Drug Companies by Marcia Angell, page 152)
    • The marketing strategy for Valium, one of the earliest drugs to treat depression, instructed doctors to use it as a cure for the “unstable emotional equilibrium” and “panic states” of women. While Valium is a different and more addictive compound than SSRI’s (the primary antidepressants today), these marketing tactics that play on insecurity persist.  (Pharma by Gerald Posner, page 205) 
    • Valium ran advertisements in the 1960’s and 1970’s saying the drug could help women who become “unpredictable grouch[es]” and alleviate the “neurotic sense of failure” for 35-year-old single women. 71 percent of prescriptions for Valium went to women, a trend that extends to SSRI’s today. (Pharma by Gerald Posner, page 207) 
  1. Antidepressants increase suicidal thoughts. 
    • The evidence is so great that antidepressant pills increase the risk of suicidal behavior (especially in young adults), that pill bottles are now required to carry a label. (FDA)
    • In fact, increased prescriptions of antidepressants over the past four decades is correlated with increased rates of suicide. Today, the second leading cause of death for kids and teenagers is suicide. (CDC)
  1. Antidepressants numb symptoms of depression, but don’t address root causes or cure anything. 
    • Antidepressants can reduce feelings of depression by allowing more serotonin to pass between nerve cells, but studies show depression comes back at the same rate once a patient stops using antidepressants. Antidepressants do nothing to help patients identify the root cause of what is making them depressed. 
    • Antidepressants help patients manage depression, and generate recurring (sometimes lifelong) revenue for pharmaceutical companies and hospitals (where patients are required to schedule appointments to re-subscribe). 
    • Pharmaceutical companies have not invested in areas to “cure” depression, because that would turn off revenue. 
  1. Antidepressants can lead to physical dependency and can result in withdrawal symptoms if not tapered properly.
    • Patients who stop taking SSRI’s experience  withdrawal symptoms such as insomnia, headaches, nausea, electric-shock sensation, and return of depression symptoms. (Mayo Clinic)

What is Causing Depression? 

The proliferation of antidepressants represent so much of what is wrong with the medical system. They serve an important purpose at times, but represent an easy way for the medical system to earn recurring revenue without addressing the root causes of what is making people depressed. 

The truth is, there are many underlying things that can lead to depression including thyroid hormone deficiency, vitamin D deficiency, chronic inflammation, underlying illness or infection, omega 3 deficiency, or chronic stress or sleep deprivation and the impact these have on underlying physiology. Antidepressants do nothing to identify or treat these things, many of which can be mitigated with dietary and lifestyle strategies and interpersonal support strategies.

We need to start looking at root causes.


I’m writing these articles to share facts that impacted me on healthcare, stress test my thinking, and connect with people who resonate with these ideas (particularly people building or thinking about building companies to address these issues). Reach out to me on Instagram, Twitter or email (calleymeans@gmail.com)


Processing…
Success! You're on the list.

Our Ovaries and Penises Are Breaking Down. Could This be a Sign of Larger Problems?

I weighed 11 pounds, 9 ounces when I was born. 

My mom’s doctors treated this as an amusing outlier statistic. 

While many parents brag about having large babies, my high birth weight meant that my mom had a baby with fetal macrosomia, a condition where babies are born above the “healthy” weight of 8 pounds, 13 ounces. Fetal macrosomia (literally meaning “big body”) can lead to increased risk of many complications for the baby, including childhood obesity and metabolic syndrome. Studies show that having babies who far exceed the criteria for large birthweight is a clear sign of insulin resistance (i.e., poor glucose management). While she wasn’t diagnosed at the time, I suspect she may have had gestational diabetes, where higher than normal blood sugar and insulin levels during pregnancy often results in babies gaining excess weight in utero.

It is perplexing to me why my mom’s physicians didn’t explain to her that fetal macrosomia is related to impaired glucose management for the mother, particularly since she went on to die prematurely from a disease directly linked to blood sugar dysregulation that was preventable with early intervention. When glucose (sugar) enters in the blood, insulin is released to let the sugar into cells where they are powered for energy. High-sugar diets overwhelm the body with glucose, leading cells to become insulin resistant and causing excess glucose to build up in the bloodstream.

My extreme birthweight could have been one of the first signs in her life that she needed to control her insulin, but nobody told her.  As cells become resistant to insulin, they do not behave properly. This metabolic dysfunction is what causes disease. 

My mother’s metabolic dysfunction showed up in my excess birthweight, her difficulty losing weight after her pregnancy, her rising weight throughout her 40s, and blood sugar problems and prediabetes that started in her 50s. 

Her metabolic dysfunction was also a link to the pancreatic cancer that ended her life – more than 80% of people who contract pancreatic cancer have some degree of insulin insensitivity. This could have been prevented if my high birthweight was seen as a warning sign instead of an amusing, isolated health situation. 

Canary in the Coal Mine

My mom’s experience is just the tip of the iceberg in the relationship between fertility and larger root causes of our health issues. Is there anything more evolutionarily vital than our reproductive organs? How could skyrocketing fertility issues, for both men and women, not be related to wider health problems?

Polycystic ovary syndrome (PCOS), which is interconnected to gestational diabetes, is the most common form of female infertility. Friends I have spoken to who have struggled with PCOS have also said the condition is treated as an isolated incident, with them leaving the OBGYN with a pile of prescriptions but little understanding of the underlying causes.  A woman diagnosed with PCOS today will most likely be prescribed an assortment of pills to artificially induce egg production, lower cholesterol, and/or regulate insulin levels. If fertility issues persist, procedures like IVF are often recommended. 

But insulin resistance is a causal link to PCOS: excess insulin stimulates the ovaries to produce “masculine” hormones, including testosterone – causing fertility issues. And insulin resistance is preventable and reversible.

Ignoring the root causes isn’t working. Today, up to 26% of women have PCOS and gestational diabetes rates have doubled between 2006 and 2016. This is directly tied to our diet, which has seen a 150x increase in sugar intake in the past 100 years. Often, these fertility issues are the first visible signs of metabolic dysfunction that will severely limit the quality and duration of life. 

Between 1973 and 2011, male sperm count has reduced more than 50%. In the past 10 years, the case of miscarriages has gone up 10%.

What about erectile dysfunction? We all know about Viagra. There is certainly a place for it. But have you ever heard a medical professional ask why an exponentially growing number of penises aren’t working? Could this possibly be related to wider health issues? 

The penis is not a siloed part of the body. Viagra might reduce inflammation in the arteries leading the penis, but shouldn’t we be asking why those blood vessels are inflamed in the first place? 

It turns out erectile dysfunction is one of the best indicators we have of metabolic dysfunction. In fact, 79% of men with ED are overweight, up to 75% of men with diabetes will experience ED, and there is almost no relation between the aging process and ED – it is all about lifestyle and diet factors.

Most importantly, ED is one of the strongest warning signs of larger health issues. In fact, ED is highly correlated with diseases such as diabetes, heart disease, and hypertension. This shouldn’t be a surprise – ED is constrained blood flow between capillaries which is the same thing as hypertension. Having ED also increases the risk of depression by 192%.

ED should be a big flashing warning light that you have other health problems. But you will rarely hear this. 

It is hard to turn on the television without seeing advertisements for online services like Hims or Ro that offer Viagra mailed to you in a few clicks. My venture capitalist friends tell me these companies are “innovative,” but I increasingly see them as part of a dysfunctional system that generates recurring revenue by selling pills and procedures that ameliorate symptoms of disease – while ignoring the root causes of why we are sick.

I think patients want to know why they are infertile, why their penises are not working, why they are unable to lose weight when they are desperately trying, why 25% of adult women are on an antidepressant, why 30% of adults over 40 are on a statin, and why 12% of adults in the United States need to carry an insulin pen. 

What we are currently doing isn’t working. 

For the first time in American history, life expectancy is in consistent decline. We are experiencing record rates of diabetes, obesity, heart disease, chronic liver disease, stroke, and Alzheimer’s. These preventable chronic diseases kill 70 percent of Americans and make up 80% of healthcare costs. 

Millions of lives are being shortened by not seeing early signs of metabolic dysfunction for the warning signs they are. 

We need to start demanding explanations for the root causes of diseases. 


I’m publishing ideas on healthcare to hopefully spark ideas among friends, stress-test my thinking, and engage with other people who are passionate about these issues. You can contact me via EmailInstagram, or Twitter.


To stay in touch on future writings and interesting links, sign up here:

Processing…
Success! You're on the list.

Skeptical About Psychedelics? Read This.

NOTE: Psychedelics are extremely powerful compounds, and should only be used in professionally-supervised and legal settings.


This essay outlines information I wish I’d known earlier about psychedelics and the impact these compounds can have on humanity. It is written particularly for people who are skeptical about these compounds (psilocybin, MDMA, LSD).

One year ago, I thought psychedelics were only of use to hippies and Burning Man attendees. I’m a conservative person who owns many more Brooks Brothers button-downs than tie-dye shirts. But today, I am convinced that the encouragement of medically-guided psychedelic usage should be an important public policy priority for the United States.

Because of the stigmatization around psychedelics, studies coming out of research institutions such as MAPS, Johns Hopkins, NYU, Harvard, and UCSF (and private companies like Atai and Compass Pathways) haven’t received the attention they should.

Participants in these studies report remarkably consistent experiences: a sense of awe, a feeling of connectedness with the world, and an event that “produces persisting positive changes in attitudes, moods, and behavior.” What could be more important in today’s world?

Reflecting the general optimism of these researchers, a leading Johns Hopkins neuroscientist recently said “This is about as excited as I can get about a clinical trial.

I’m writing this because the research has profound implications for society, and I think there is a lot of misinformation and misunderstanding about these compounds. It is important for more accurate and up-to-date information to get out and be discussed among lawmakers, investors, educators and business leaders.

Below is the information that opened my mind on psychedelics:

Why Psychedelics Matter

Many of the major issues America faces (domestic violence, social injustice, school shootings) originate in our brains and perspective. And our brains are in crisis:

These trends will only be solved on the individual brain level, because reality is nothing more than what our brains perceive.

If there were a non-harmful treatment that caused a life-defining, self-actualizing experience for nearly everyone who takes it, shouldn’t leaders pay urgent attention?

And it’s not just for “sick” people. Consider:

  • Are you and your friends doing the most fearless and valuable work possible?
  • Do you see people around you who are engaged in actions or careers to please their parents or society instead of to fulfill their passions?
  • Do you or your friends feel resentment, anxiety and unhappiness?
  • Do you or your children struggle with questions of meaning or mental health issues that aren’t cured by the existing system?
  • Do you feel ominous about the future?
  • Do you fear division and resentment threatens to tear the fabric of society apart?  

Many of these issues can be traced to perception and the brain. A lot can be gained if society can address the root causes of these questions. This happens by enabling individuals to examine their broader perspective and perception.

My Story

In early 2021, the market for the startup I’ve devoted my life to (which sells wedding dresses) froze, forcing tough decisions and layoffs. I run the startup with my wife who I met at business school, and our marriage was under similar stress. 

In the midst of these challenges, my mother (my best friend and hero) visited the doctor after feeling a stomach ache on a hike. She was diagnosed with pancreatic cancer and died 13 days later – the worst possible event I could imagine in life. 

During this time, I was encouraged by a Harvard-trained scientist to try psilocybin (magic mushrooms) in the same way it is conducted in the Johns Hopkins studies: 3.5 grams, listening to music, sitting in bed, meditating. 

I had never considered taking psychedelics. The drugs had a big stigma in my mind. But given the challenging circumstances in my life, I tried the substance in a legal, supervised setting.

It was the single most meaningful experience of my life – personally, professionally, and spiritually. 

I saw the thousands of people my mom had impacted in her life, and how she changed them and their lives. This image is now inseparable from other memories of my mother, and as real to me as anything in my life. 

My Family, 1991

The four hours on psilocybin reframed major moments in my life in a cohesive, beautiful way. It hard-wired ideas about marriage, family, management, and citizenship – and how these are all connected. 

I thought how fragile the world was and how little I myself, and I expect others, know what they are doing. I thought about what the impact would be if every student at Harvard Business School took psilocybin and thought about their career choices. Would the school continue to funnel graduates to established companies in traditional industries that are seen as part of the problem – leading to significant rates of depression for graduates? Or would students be encouraged to take bolder steps and fulfill the school’s mission to “educate leaders who make a difference in the world?”

Since my experience, I’ve spoken to a range of people who have taken a high dose of psilocybin: billionaires, CEOs, nonprofit leaders, Republicans, Democrats, doctors, anti-poverty activists, and social justice adovcates. 

They all agreed their experience was one of the most impactful and positive experiences of their lives, because it reframed their lives’ purpose in an enduring way. Self-actualizing, self-empowering experiences. Their experience with mushrooms directly led them to quit a job, start a billion-dollar company, end an abusive marriage, or reconcile with a parent.

I decided to study these compounds more, and the academic research and history of psychedelics shocked me.

What Do Recent Research Findings on Psychedelic Compounds (psilocybin, LSD, MDMA) Show?

Neuroscientists studying psychedelics have claimed their use led to some of the most positive findings of their careers, and have produced an increasing number of notable studies:

  • A 2016 NYU study found that “cancer patients receiving just a single dose of psilocybin experienced immediate and dramatic reductions in anxiety and depression, improvements that were sustained for at least six months.” The study’s lead, Dr. Stephen Ross, said “The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.
  • A 2016 John Hopkins study showed that “67% of the volunteers rated the experience with psilocybin to be either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life… similar, for example, to the birth of a first child or death of a parent.”
  • A recent study from the Imperial College, London, showed psilocybin was “as effective” as antidepressants (again, the most widely prescribed drug in America), for the reduction in depression. And, it occurred “more quickly in the psilocybin group … and, greater in magnitude.” 
  • This month, a UCSF study showed a group with severe PTSD who “received MDMA during therapy experienced a significantly greater reduction in the severity of their symptoms compared with those who received therapy.” Gul Dolen, a neuroscientist at Johns Hopkins said: “There is nothing like this in clinical trial results for a neuropsychiatric disease.

For a more in-depth overview of psychedelic research, click here.

What Do Research Participants Experience On Psychedelics?

The takeaway from the existing psychedelic research is that among people dealing with life’s most existential challenges (imminent death, PTSD), the psychedelic experience put them face-to-face with their greatest fears and resulted in life-changing insights and takeaways:

  • Scott Ostrom, a participant in the UCSF study who faced crippling PTSD from his time in Iraq said the experience “stimulated my own consciousness’s ability for self-healing… You understand why it’s OK to experience unconditional love for yourself.
  • Nathan McGee, who suffered childhood trauma and also participated in the UCSF study, said: “This allowed me to accept myself and recognize who I am. It’s made me really understand what the feeling of joy is.
  • Reviewing research from Johns Hopkins, New Yorker reporter Michael Pollan noted the patients  “don’t regard these narratives as ‘just a dream’… [but had] the unmistakable sense that whatever has been learned or witnessed has the authority and the durability of objective truth.” In other words, this was not a “drug experience.” 

Whereas antidepressants help numb and manage the symptoms of depression, psychedelics helped these patients confront and address the root cause of what was holding their lives back. 

The next question is what would happen to society if more people engaged in medically-supervised psilocybin therapy.

Dr. Roland R. Griffiths, a Professor of neuroscience at Johns Hopkins, concluded: “We are all terminal. We’re all dealing with death. This will be far too valuable to limit to sick people.” 

Are Psychedelics Dangerous?

The Global Commission on Drug Policy, a group of world leaders from the Americas and Europe, recently ranked the harm of the 20 most well known drugs based on factors such as health damage, loss of relationships, crime and injury, and community costs. 

Alcohol, Heroin, and crack cocaine ranked as the most dangerous drugs. 

MDMA, LSD, and mushrooms (the three main psychedelic compounds) ranked as the least harmful. 

Source: The Economist

How are Psychedelics Different from Other Drugs?

In June 2021, the Police Officer’s Union in California came out against a state bill that would legalize psychedelics. The statement read as if psilocybin was crack cocaine, arguing legalization of magic mushrooms would lead to more drug dealing, addiction and crime. 

This trend of looping all “drugs” together is common – and unfounded. It is also tragic given the context of how much these treatments can help people – particularly the people experiencing the most suffering around us. The research so far has been conducted on terminally ill patients (NYU), child abuse victims (UCSF), and those with treatment-resistant depression (Imperial College London).

It is not accurate to loop psychedelics with other “drugs.” For starters, psychedelic compounds aren’t addictive and do not impact dopamine receptors. Typical drugs from alcohol to heroin to sugar release a dopamine rush, which can lead to addictive behavior.

It also isn’t accurate to say psychedelics “distort” your perception. In fact, the compounds bind to serotonin receptors in the brain and take your brain to a different wavelength (that is no less real). In fact, imaging research from the Imperial College London indicated the brain on psychedelics “resembles the state our brains were in when we were infants: free and unconstrained.”

Why Are Psychedelics So Stigmatized?

If psychedelics are safe, how did they become so stigmatized? 

One answer: Nixon. 

When psychedelic compounds entered America in the 1950’s, leading psychologists at Harvard thought it was one of the most promising developments in the history of psychology. The U.S. Government subsidized hundreds of experiments.

As Michael Pollan notes in his book How to Change Your Mind, President Nixon and the Vietnam-era generals bemoaned the fact that psychedelic drugs were making too many Americans think for themselves – which would hurt the ability to draft willing soldiers for the Vietnam war in the late 1960’s. He labeled Timothy Leary, a Harvard psychologist studying psychedelics, “the most dangerous man in America.” In 1970, President Nixon introduced a ban on all use and research on psychedelics. President Nixon also directed a PR effort to associate psychedelics with hippies and bad behavior, stigmas that still exist to this day.

During the height of the Vietnam War, President Nixon banned psychedelic compounds because he felt they promoted too much independent thought and worried it would hurt the government’s ability to draft soldiers.

What Has the FDA Said About Psychedelics?

After a freeze on research following President Nixon’s ban, the FDA has recently note of the positive psychedelic research. In recent years, the agency has issued Breakthrough Therapy Designation to MAPS for the study of MDMA on PTSD and Compass Pathways for the study of psilocybin on depression.

According to the FDA:

A breakthrough therapy designation is for a drug that treats a serious or life-threatening condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement on a clinically significant endpoint(s) over available therapies.

Is More Research on Psychedelics Needed Before Legalization?

Opponents of psychedelic legalization also claim we need more time “to research psychedelic substances in greater depth.”

Let’s not forget: psilocybin and LSD have been studied over a span of 70 years.

Since LSD’s discovery in 1951 and Nixon’s banning of psychedelic compounds in the 1970’s, “40,000 patients were prescribed LSD therapy… research into the potential therapeutic effects of LSD and other hallucinogens had produced over 1,000 scientific papers and six international conferences.” These studies showed the psychedelic could have positive outcomes on mental health and treating alcoholism. In fact, the founder of Alcoholics Anonymous (AA) credited LSD with spurring his recovery – and argued for the compound to be a part of the AA program.

Time to Wake Up?

Before he died, Steve Jobs bravely spoke about his experience with psychedelics being “one of the two or three most important things he had done in his life.” He wasn’t joking, and his experience wasn’t unique. 

If psychedelics are safe, and research from Johns Hopkins is validating that they produce life-changing experiences routinely, we should be having a more urgent national conversation about fast-tracking legalization.

COVID-19 was a crisis that we marshalled resources for, and approved a vaccine for, within a year of the outbreak. 

We have a similar crisis occurring in our brains. And it is time to take psychedelic research very seriously. 

If you have questions or comments, you can reach out to me at calleymeans@gmail.com


If you want to be notified of future essays, sign up here:

Processing…
Success! You're on the list.