I can’t wait for the next one, so let’s get that in the calendar right away:
I’ll be hosting a live Q&A again on Sunday, July 19th, at the usual time (11:00 AM PT / 2:00 PM ET / 7:00 PM BST / 8:00 PM CEST).

The link will be in the chat.

Bring your questions :)!

I hope to see you there.

Full recording (video):

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I hope to see you there :)!

A recording will be released afterwards in the chat for those who cannot attend.

Zoom Invitation below.

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When you’re in withdrawal, there are often two things happening at the same time.

The first is withdrawal itself:
The inner restlessness, insomnia, nausea, inability to focus.
The heart palpitations, waves of terror and anxiety, dizziness, brain zaps.
The low mood, crying spells, emotional numbness, fatigue.
The strange sensations that make you wonder whether you’re losing your mind.

Those symptoms are real.

And then there is something else. Something that often goes unnoticed because it feels so reasonable.

The constant monitoring.
The checking.
The analysing.
The resisting.
The Googling.
The endless search for patterns.
The attempts to predict tomorrow based on today.
The calculations, the planning, the ”what ifs.”

And before long, you may find yourself carrying both:
Withdrawal plus the effort to control withdrawal.

Because while we cannot choose to stop experiencing withdrawal symptoms,
we often have way more influence over our relationship with them than we realise.

Why withdrawal pulls us into control mode

The desire to understand and control withdrawal is completely understandable.

Psychiatric drug withdrawal is inherently unpredictable.
Symptoms fluctuate. Good days are followed by bad days. Some days you wake up feeling almost normal. The next day, it can feel as though you’ve gone backwards for no reason. New symptoms can emerge months into the process, and existing ones can disappear and then return.

Faced with such uncertainty, most people naturally start looking for patterns and things to do.

When the ground keeps shifting beneath our feet, the mind naturally tries to regain some sense of stability.

It starts asking questions:

What’s happening?

Why today?

Am I going crazy, or is this normal?

Will this pass?

Did I do something wrong? Was it the coffee I had yesterday? The poor sleep? Stress?

Should I change something?

Am I healing? Am I getting worse?!

Is this withdrawal or relapse?

Is this me without meds then?

The mind invites us to monitor ourselves. To constantly "check in" and compare today with yesterday. Many people know the feeling of waking up and immediately starting to assess: How do I feel? Better? Worse? What's today going to be like?

Its intentions are good: It’s trying to prepare and stay safe.

The problem is that these strategies rarely provide the certainty you are hoping for.

Instead, they often become another source of distress, even though they feel helpful in the moment.

The control agenda survives because it occasionally produces relief. Not because it solves withdrawal, but because doing something often feels better than sitting with uncertainty.

The trap

Most of the mental habits that emerge during withdrawal present themselves as solutions to the very distress they end up amplifying. When symptoms roar inside, it feels sensible to think harder and search for the missing piece that will finally explain and resolve everything. And when symptoms are unpleasant, our instinct is to turn towards them and try to fix them. To make them go away. To do something.

Here’s the thing.

The more attention goes into monitoring symptoms, the larger they appear.

The more time spent checking how you’re doing and feeling, the harder it becomes to focus on anything else, and with that, for symptoms to step into the background and self-regulate.

The more energy invested in predicting the future, the more frightening the future starts to feel.

Left unchecked, withdrawal can begin occupying not only your nervous system but your entire field of attention. And that’s exhausting on a whole other level.

I’ve seen people become trapped in a cycle where symptoms generate monitoring, monitoring increases awareness of symptoms, increased awareness makes symptoms feel more prominent, and the increased prominence generates even more monitoring.

And I've helped people out of this cycle by gradually loosening the control agenda. At first, this can feel frightening - almost like deliberately putting down a shield you've come to rely on for protection. After all, monitoring, analysing, checking, and preparing can create a sense that you're staying ahead of things.

But much of that control is an illusion.

Withdrawal remains unpredictable whether you spend six hours thinking about it or six minutes. The shield feels protective because it gives you something to do, but it rarely changes what the nervous system is actually doing. What it does change is how much of your day becomes consumed by withdrawal.

I do this by helping people understand their role in the process.

Your body's job and your job

One of the most helpful shifts people can make during withdrawal is recognising which aspects of the process belong to them and which do not.

Healing is not your job.
Healing is your body’s job.

Your nervous system is already attempting to restore equilibrium. It is adapting, recalibrating receptors, and reorganising brain chemistry in ways that occur largely outside conscious awareness.

No amount of analysis can force receptor systems to adapt faster. No amount of monitoring can accelerate neurological recovery.

Your role is different.
Your role is to create the conditions that allow healing to occur.

Part of that means tapering the dose slowly enough that symptoms remain within a tolerable range. Beyond a certain threshold of intensity, no psychological strategy will compensate for severe withdrawal. If symptoms are overwhelming, the taper itself needs adjustment according to hyperbolic principles.

But once symptoms have been reduced to a manageable level - often meaning they can step into the background, at least partly, when attention is directed elsewhere - a different challenge emerges: learning how to stop interfering with the process.

In other words, a more productive goal is learning how to live alongside symptoms.

The paradox of allowance

As sure as night is dark and day is light, people eventually discover the paradoxical effect of allowing symptoms vs. fighting them:

Symptoms given space take up less space.
Symptoms resisted tend to take up more space.

Many people initially hear this as resigning themselves to suffering and giving up control. Or that it means pretending symptoms are not real.

That’s the mind talking again.

What allowance really means is recognising that resistance tends to magnify the experience we are trying to escape.

And of course you're trying to escape it. For one thing, because it's so painful and chaotic. For another, because many people feel understandably angry about finding themselves in a situation they were never warned about.

Yet, the resistance doesn’t work.

Consider what happens when you spend several hours or an entire day checking whether a symptom is present and what it means, monitoring whether anxiety is increasing, and/or assessing whether you feel better or worse than yesterday.

The symptom becomes the centre of attention.

Then, perhaps on another day, you become absorbed in a conversation, a television programme, work, gardening, a walk, or time with friends and suddenly realise that the symptom faded from awareness for a while.

Technically, the symptom may still have been present - just as the sensation of the chair you're sitting on, the sounds around you, or the feeling inside your mouth are still present, even though you rarely pay attention to them. It simply wasn't occupying the entire room when attention was directed elsewhere. It had become background noise. And just like real background noise, the closer we listen to it, the louder it seems.

Ironically, allowing symptoms some space frequently reduces the amount of space they occupy.

Again, this does not mean symptoms are imaginary. It means attention matters. Once symptoms have been reduced to a tolerable level through proper tapering, you often gain some influence over where your attention goes, even if you don’t have much influence over the symptoms themselves.

This is very different from the mind’s control agenda. One is about choosing where to place attention. The other is about trying to eliminate, predict, or figure out symptoms. The two are often pulling in opposite directions.

Letting go of the control agenda does not mean becoming passive. It means directing energy towards the things you can influence rather than the things you can't.

Moving from prediction to navigation

Many people approach withdrawal as a prediction problem. They want to know what tomorrow will look like and what today will bring. To understand every fluctuation, weird thought and sensation. They want certainty in something that is inherently uncertain.

One reason we spend so much time trying to predict withdrawal is when we don’t trust ourselves to handle a bad day.

If tomorrow becomes terrible, what will I do?

If symptoms return, what then?

If a wave hits, how will I cope?

How am I supposed to plan a life around something this unpredictable?

These questions - however understandable they may be - are what keep people trapped in endless forecasting.

A more useful question is often: How do I navigate difficult days when they arrive?

This shift may seem subtle, but it can change everything.

Here’s a simple exercise. Instead of asking why today is bad (or rather, instead of answering your mind’s questions about why today is bad), try asking what helps when today is bad.

Instead of trying to eliminate uncertainty, we develop confidence in our ability to respond to it. Instead of trying to eliminate symptoms, we develop a roadmap of what helps when they happen. What matters is discovering your own toolkit.

Over time, most people discover practical strategies that make difficult days more manageable. They learn when to rest, when to seek support, when to do more, when to distract themselves, when to lower expectations, and when simply getting through the day is enough.

What matters is developing trust that difficult days can be navigated. And once people know how to handle bad days, they become far less preoccupied with predicting them.

A wound that knows how to heal

Withdrawal is like a wound.

Imagine constantly poking at a cut to see whether it’s healing. Analysing it, comparing it to yesterday, trying to force it to close faster.

None of those actions contributes to healing. The wound already knows what to do.

Withdrawal is obviously more complex than a cut on the skin, but the principle is similar. Your nervous system already knows how to recover.

The challenge is allowing the process to unfold while continuing to engage with life as best as you can, while recovery unfolds in the background.

Of course it’s hard!

I know it’s hard.

That’s what symptoms - and catastrophic thoughts about symptoms - do:
they pull your attention towards them.

Dropping the control agenda may therefore feel like putting down that shield you’ve come to rely on. But the shield is heavier than it is protective.

If anything, the process becomes considerably lighter once we stop carrying the additional burden of trying to control every part of it.

The two versions of withdrawal

So yes, there are really two ways of being in withdrawal.

One is withdrawal itself.
The other is withdrawal plus the endless struggle to control it.

Both are understandable. Both are deeply human. Every instinct in your body will tell you to figure it out, get ahead of it, prepare for it, and gain control over it.

I’ve done the same thing in difficult periods of my own life.
Most people do.

But over the years, I’ve watched thousands of people move through withdrawal, and one pattern keeps appearing.

The people who suffer least are rarely the people who become best at predicting and controlling withdrawal.

They’re usually the people who become best at living alongside uncertainty.
The people who learn to let symptoms be present without making them the center of every day.
The people who know what to do when bad days arrive.
The people who gradually return their attention to the parts of life that withdrawal tried to take away.
The people who manage to stop spending quite so much time fighting the healing process itself.

To be clear, I don't mean "the people" as though this describes a particular type of person. I mean the people who gradually learn these skills. In my experience, these are habits that can be developed over time, not traits that some people simply have and others don't.

There were so many great questions in last week’s Q&A, and not nearly enough time to get through them all.

So rather than wait until the next scheduled session, let’s do another one sooner.

I’ll be hosting a live Q&A again on Sunday, June 21, at the usual time. This time I’ve set aside two full hours, which should give us a better chance of getting through everyone’s questions.

You’ll find the link in the chat. If you have a question you’d like me to address, feel free to bring it along.

I hope to see you there.

Sunday, June 21
11:00 AM PT / 2:00 PM ET / 7:00 PM BST / 8:00 PM CEST

If you missed it, you'll find the recording of the last Q&A below.

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Ten years ago, if you had told me that American doctors would one day be able to earn continuing medical education credits for learning how to safely taper antidepressants based on our research here in Denmark, I probably wouldn’t have believed you.

Yet here we are.

I’m excited to share that our course - developed together with psychiatrist Georgia Ede - has now been approved for Continuing Medical Education (CME) in the United States.

That means physicians can take the course as part of their official continuing education and receive CME credits for completing it.

For me, this represents a milestone: the growing recognition that withdrawal from antidepressants (and all psychiatric drugs, really) is a real clinical issue that deserves proper attention and education.

For decades, patients have been told that withdrawal symptoms are typically mild, short-lived, and resolved within a few weeks. That they’re no biggie, really, and that tapering is no problem. Yet over the last several years, a growing body of research has painted a more complicated picture.

Many experience severe and prolonged withdrawal symptoms that can closely resemble relapse, creating confusion for both patients and clinicians.

The challenge is that most healthcare professionals have never received formal training in this area.

That gap between research and clinical practice is one of the reasons so many people struggle when trying to come off psychiatric medications. Simple as that.

The goal of this course is simple: to help close that gap.

We cover the principles of hyperbolic tapering, withdrawal symptoms, distinguishing withdrawal from relapse, psychological strategies to get through periods of withdrawal, and practical strategies for reducing medication safely and as comfortably as possible.

Most importantly, we try to translate research findings into something clinicians can actually use in everyday practice.

Another thing I’m particularly happy about is that the course is completely free.

The team behind the project - Metabolic Mind - made a deliberate decision that cost should not be a barrier to accessing this information. Anyone interested can take the course.

This Course Isn’t Just for Clinicians

Although the course was designed for healthcare professionals, patients, family members, and advocates are very welcome to take it as well.

In fact, many people who have struggled with antidepressant withdrawal tell me they wish they had access to this kind of information years earlier.

The topics are covered in a way that is accessible even if you don’t have a medical background.

So whether you’re a clinician, someone currently tapering, or simply trying to better understand these issues, I hope you’ll find it useful.

How You Can Help

If you are a healthcare professional, I encourage you to take a look.

If you are a patient, consider sharing it with your doctor, psychiatrist, nurse practitioner, therapist, or anyone involved in your care.

Many clinicians genuinely want to help their patients taper safely. Often, they simply haven’t had access to the latest evidence or practical training.

Education changes that.

One clinician learning about withdrawal can improve the care of hundreds of patients over the course of a career.

The course is available here:

https://www.mycme.com/courses/stopping-antidepressants-with-hyperbolic-tapering-10792

Feel free to share it widely.

Join me live on Substack for an in-depth Q&A

This is your opportunity to ask questions directly and be part of a thoughtful conversation about psychiatric drugs, withdrawal, tapering, trauma, emotions, overthinking, and life after medication.

I’ll share insights from my clinical work, research, and personal experience supporting people around the world through this process.

Whether you’re a patient, family member, or clinician, you’re warmly invited.

I’d love to see you there.

Join here:

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When the MAHA Commission ordered a federal reassessment of SSRI safety,
The American Psychiatric Association (APA) was quick to respond with a warning: questioning antidepressants could have “serious deleterious consequences.”

The message was clear. Don’t criticize, don’t doubt, and certainly don’t suggest our drugs might be overprescribed or overrated.

Under the “safe and effective” evergreen, the APA pointed to “decades of rigorous research” supporting the current use of antidepressants. Yet it cited no actual evidence; it simply asserted that the commission’s safety concerns cast doubt on
“this research”.

This defense deserves scrutiny.
So what does the evidence actually show?

There are three main types of studies used to evaluate antidepressants:

1. The randomized placebo-controlled trial (RCTs)

2. The long-term observational study

3. The discontinuation trial

1) Placebo-controlled trials
- 28 years of insignificant outcomes

RCTs are considered the gold standard of medical evidence. They are designed to isolate the drug effect by comparing an active medication to an inert placebo. If the drug works, the difference between the two groups should be large. If it doesn’t work, the difference will be small.

Since the first meta-analysis by Kirsch et al. in 1998, hundreds of antidepressant trials have been pooled into meta-analyses, looking at all the available evidence combined (Table 7).

Across meta-analyses, antidepressants outperform placebo by, on average, about two points on a 52-point depression scale.

Two points.

For context, the threshold for a ‘minimal improvement’ is 7 points, while the threshold for ‘much improvement’ is 14 points.

In other words, no meta-analysis to date has shown a clinically significant average effect of antidepressants over placebo. The effects are the same.

And for anyone who needs proof, here it is:

A plain language summary:

This does not mean antidepressants have no benefit. It means that much of the benefit people experience stems from factors other than the drug itself – placebo effects, expectancy, hope, time passing, crises resolving naturally, and the meaning attached to treatment – given that nearly the same improvement occurs regardless of what is in the tablet.

This is the essence of a therapeutic illusion: improvement occurs after treatment and is therefore attributed to the treatment.

And even that tiny effect has been challenged by research methodologists. Known problems of these trials include:

Placebo run-in bias – removing early placebo responders before the trial even begins.
Drug washout effects – stopping participants’ prior medication before entering the study, which can produce withdrawal effects that contaminate baseline or early trial outcomes.
Publication bias – negative trials are less likely to see daylight.
Patients breaking blind, because side effects can reveal who is on the active drug.

All of these biases inflate the drug-placebo difference, meaning the true drug effect could be even lower than the two points.

2) Long-term studies
- paradoxical outcomes, every time

Most RCTs last just 6 to 12 weeks. Yet most people take antidepressants for years.
So what do long-term studies show?

Here, the picture becomes uncomfortable for mainstream psychiatry.

Long-term observational studies and naturalistic follow-ups have generally not shown better outcomes with continued antidepressant use and, in some cases, have reported higher relapse rates, greater chronicity, and poorer functional outcomes among patients who remain on antidepressants long-term compared to those who do not – even after adjustment for baseline severity. (Fava 2003; Pigott et al. 2010; Hengartner 2020; Coryell et al. 1995, Goldberg et al. 1998, Patten 2004).

(Graphs from www.madinamerica.com)

Importantly, these are the only studies that tell us what happens to people over the many years that antidepressants are actually prescribed in routine clinical practice.

If antidepressants are long-term treatments for depression, why do the best long-term studies show such poor outcomes?

Psychologically, this is not surprising. Dampening painful emotions and distress may provide short-term relief, but it does not necessarily help people process loss, resolve conflicts, adapt to difficult life circumstances, eat cleaner, get out of their heads and into their lives, or address whatever stressor caused the depression in the first place. Over time, the drug may become a substitute for the emotional work that lasting recovery often requires.

While observational studies cannot prove causation, the fact that these findings often persist after adjustment for baseline severity – and in some studies worsen with greater cumulative exposure – makes them difficult to dismiss as confounding alone.

That may help explain why, paradoxically, many long-term studies find higher relapse rates and poorer functional outcomes among people who remain on antidepressants for years.

3) Discontinuation “relapse prevention” trials
- flawed by design

Discontinuation trials are often cited as proof that antidepressants prevent relapse. But these studies are built on a fundamental design flaw.

Here’s how they work:

1. Select people who are stable or in remission while taking an antidepressant.

2. Randomly assign half to continue the drug.

3. Abruptly or rapidly discontinue the drug in the other half and switch them to placebo.

4. Measure which group deteriorates.

Unsurprisingly, the discontinued group fares substantially worse.

In the three major meta-analyses of these trials, stopping antidepressants was associated with a 65-70% higher risk of “relapse” compared with continuing treatment (Kaymaz et al. 2008, Glue et al. 2010, Geddes et al. 2003).

Here’s the bias. Withdrawal symptoms and relapse symptoms overlap extensively, including insomnia, anxiety, agitation, fatigue, depressed mood, panic, intrusive thoughts, and suicidal ideation.

As a result, these studies cannot tell us whether patients are relapsing or experiencing withdrawal.

Not a single discontinuation trial to date has adequately controlled for this by tapering gradually (hyperbolically) and allowing withdrawal symptoms time to resolve before concluding a relapse had occurred.

In the major meta-analyses, antidepressants were stopped in “fewer than 11 days”, “on average 17 days”, and “less than a week” (Kaymaz et al. 2008, Glue et al. 2010, Geddes et al. 2003). Any subsequent deterioration was then counted as a relapse, making the drugs appear highly protective.

So, these are indeed discontinuation trials, not relapse prevention trials.
They show what happens when you stop antidepressants -
not what happens when you taper antidepressants.

(NB: This is how antidepressants can come to seem indispensable: people stop, feel markedly worse, interpret this as the return of their illness, and restart the drug, reinforcing a “chronic mentally ill” self-story.)

Conclusion

If the APA has robust evidence that antidepressants produce clinically meaningful benefits, improve long-term outcomes, and prevent relapse independent of withdrawal effects – as they claim – I urge them to share it with the public.

If such evidence exists, let’s see it.

We’ve seen this pattern before with benzodiazepines and opioids. I believe we’re seeing it again with so-called antidepressants, antipsychotics, and mood stabilizers.

The talk touches on short-term trials versus long-term use, physical dependence, tapering, relapse-prevention trials, and the historical tendency to recognize withdrawal problems decades too late.

This was my talk at the Mental Health & Overmedicalization Summit.

I hope you like it - and feel like helping spread the word.

Full video and the full speech below.

The new ‘Goldberg paper’ on psychotropic deprescribing - formally a consensus statement from the American Society of Clinical Psychopharmacology - is already being circulated as if psychiatry has finally produced tapering guidelines for psychiatric drugs.

It hasn’t.

This is not a paper about how to safely taper psychiatric drugs.
It is a paper about when clinicians should consider deprescribing.

An important difference, because many people reading headlines or social media reactions will likely assume this paper represents a major breakthrough in withdrawal science or safe tapering practice.

It doesn’t.

The fluoxetine auto-taper myth

If anything, the paper unintentionally reveals just how underdeveloped mainstream psychopharmacology still is when it comes to understanding withdrawal and tapering.

In fact, the only concrete statement the paper makes about tapering… is wrong.

The paper - written by 45 MDs - states that drugs with long half-lives like fluoxetine, vortioxetine, and aripiprazole:

That’s simply not true. And that should concern more people, including the journalists presenting this paper as a breakthrough.

Yes, these three drugs leave the body more slowly because of their longer half-life. But slower elimination does not mean no withdrawal; often, it just means delayed withdrawal reactions, not absent withdrawal reactions. The nervous system still has to adapt to the absence of the drug, causing withdrawal symptoms if the dose is reduced too quickly.

When we systematically reviewed receptor occupancy studies for SSRIs and SNRIs back in 2021, these drugs were included. The same principle still applies: receptor occupancy follows a hyperbolic relationship to dose, meaning reductions become biologically larger and larger toward the lower end.

Following Goldberg et al.’s logic would mean massive occupancy changes at the “lower” dose range. That is not safe tapering.

These drugs may leave the bloodstream more slowly. But they still require careful tapering following long-term use for most people, just like other psychiatric drugs.

For context, below are nine real-life examples - not schemas or recommendations to follow - of how the dose reductions ultimately ended up looking in some of the people I’ve worked with. I always ask my clients to note all their dose reductions, resulting in quite a lot of data on how a succesful, hyperbolic taper can look like.

Reference: Sørensen 2025.

The deeper problem

Here’s my worry. If a large international task force of psychopharmacologists gets something this central wrong - despite decades of patient reports, research, and basic pharmacology principles - then what else are they getting wrong?

Do they understand protracted withdrawal? BIND? Kindling? Nervous system destabilization? The frequent misdiagnosis of withdrawal as relapse?

From what I’ve read, I would be very cautious about entrusting mainstream psychopharmacology, in its current form, with the massive task ahead of us helping large numbers of people safely off psychiatric drugs.

I hope the field will start listening to people who have actually been through withdrawal, clinicians working with this every day, and the emerging withdrawal literature itself.

What would Thomas Kuhn say?

That said, I still welcome this paper and I think you should too. Because it represents an acknowledgement of a problem long ignored by psychiatry.

For years, mainstream psychiatry largely minimized, psychologized, or simply ignored psychiatric drug withdrawal altogether. That denial is part of what created the problem in the first place, which is why this paper is interesting historically.

What we are seeing now looks very much like what Thomas Kuhn described in the 1962 classic The Structure of Scientific Revolutions: the early stages of a paradigm shift.

At first, anomalies are ignored.

Then they become harder to dismiss.

Eventually, the dominant framework begins adapting - as its only defense. Slowly, reluctantly, defensively.

The old narrative is beginning to crack. But according to Kuhn, the real paradigm shift does not happen when the dominant framework merely acknowledges anomalies. It happens when the anomalies accumulate to a point where the old framework can no longer adequately explain or manage them.

Recognizing that psych drugs can cause dependence and severe withdrawal is one thing. Actually dealing with the implications of that realization in practice is something entirely different.

It means confronting the fact that millions of people have been told withdrawal was relapse.

It means confronting the fact that many clinicians were never trained in safe tapering despite prescribing these drugs daily.

It means recognizing that the people who understood much of this earliest were the very people dismissed as “anti-psychiatry,” “noncompliant,” or anecdotal.

Historically, that tension is what starts breaking paradigms apart: When the pressure becomes too large to contain within the existing framework.

Also…

The paper also contains an almost astonishing amount of pharmaceutical conflicts of interest. Out of the roughly 15 pages excluding references, nearly 4 pages are devoted to disclosures.

Finally, the authors explicitly discuss concerns about the term “deprescribing” because of its association with “the antipsychiatry community.”

So, even in a paper acknowledging deprescribing and inappropriate prescribing, there is still anxiety about proximity to criticism of psychiatry itself. In other words, the system is beginning to incorporate anomalies while simultaneously distancing itself from the people who raised them.

Textbook Kuhn!

In conclusion, the paper reveals an interesting asymmetry between the confidence with which antidepressants are prescribed vs the remarkable lack of knowledge about how to stop them safely.

But welcome to the conversation :)!

There’s a kind of chaos that comes from the inside. It’s harder to spot.

From the outside, life can look fine. You go to work, answer your messages, meet friends; you keep things going.

But inside, something is off. You overthink small decisions. You feel strangely flat or restless. You move through your days – but without a clear sense of direction.

You don’t really know what you’re aiming for.

So the mind kicks in, doing its thing. It starts trying to fix and solve.

It starts comparing options, running through scenarios, replaying things, projecting endless what-ifs, turning things over again and again.

It tries to organize. Tries. But the mind can’t organize your life without something to organize it around.

And that “something” is our values.

Values - necessity or luxury?

Values are often treated like something optional; something you figure out later. Something “luxury” for when life is already stable.

But together with goals and needs, values are a fundamental source of the positive emotion and sense of wellbeing we all seek.

When you lose touch with your values, life becomes reactive.
Decisions take more effort, and emotions become louder and harder to understand.

Because emotions, in many ways, are signals of what you value. And no matter what psychiatry may have led you to believe, they are not random and they are not “symptoms”. They are attempts to point you toward something that matters.

As I write in my book, page 248:

When values go missing

Now, the mind is fantastic at solving problems. But it is terrible at choosing direction. It will generate almost endless options, pros and cons, risks, and what-ifs. It will try to think its way into the “right” life.

And if you’re not careful, it may convince you that this is what you’re supposed to do.

But without values to navigate by, there is no “right” to land on. So you keep thinking.

Think*think*think

Ruminate*ruminate*ruminate

Analyze*analyze*analyze

From the inside, it feels like you’re really trying. But actually, you’re just thinking; attempting to solve a directional problem with thought alone. And that creates a kind of classic human standstill that doesn’t look like a standstill.

And when you can’t make sense of what you feel, you can’t act on it.

So the signal gets louder. It can’t not.

Something important is trying to come through, and we experience that as tension, frustration. Despair even.

You can still go about your day, doing what you have to do. But the sense of aliveness - of “this actually matters!” starts to fade. And without that, life becomes something you manage.

:(!

Value or goal?

A common confusion is that values and goals are the same thing. They’re not.
A goal is something you can complete. A value is something you can live.

“Get a promotion” is a goal.
“Be someone who contributes in a meaningful way” is a value.

“Find a partner” is a goal.
“Be loving and present” is a value.

“Earn more money” is a goal.
“Be someone who creates freedom and security” is a value.

“Avoid conflict” is a goal.
“Be fair and stand up for what matters” is a value.

“Lose 10 kilos” is a goal.
“Be someone who takes care of their body” is a value.

“Finish a degree” is a goal.
“Be someone who grows and develops” is a value.

“Travel more” is a goal.
“Be someone who explores and stays open to life” is a value.

“Be more productive” is a goal.
“Be someone who uses their time well” is a value.

Goals can be achieved - and then they’re done. Values are ongoing. They organize how you act across situations. And when you’re clear on your values, decisions get easier - because you have something to orient by.

The question, then, is not whether you’re the kind of person who has values or not. You are.
The question is whether you’re in contact with them.

How to find your values (without overthinking it)

Values are not something you think your way into. They show up more clearly in experience. And they don’t respond well to pressure.

So instead of asking and ruminating, “What are my values?”, try looking at where they are already showing up. You want to look for moments that carry some emotional weight.

Here are a few ways in:

1. Turn pain into direction

Think of a moment that really hurt.

Something that stayed with you, not something just mildly uncomfortable.

Then turn it around:

What would have needed to be there for this not to hurt in the same way?

If betrayal hurt, loyalty matters.
If being dismissed hurt, being seen matters.
If isolation hurt, connection matters.
If being overlooked at work hurt, recognition matters.
If feeling stuck in your job hurt, growth matters.
If feeling micromanaged hurt, autonomy matters.
If feeling replaceable hurt, being valued matters.
If burnout hurt, balance matters.
If your work felt meaningless, purpose matters.
If always saying yes hurt, boundaries matter.
If feeling disconnected from yourself hurt, authenticity matters.
If pretending hurt, being real matters.

Remember: Pain Points.
… to what matters.

2. Look at who you admire

Think of someone you respect. A person making you feel there’s something about how they move through the world.

Then get specific. What do they actually do that you admire?

Do they speak honestly?
Hold their ground?
Stay calm under pressure?
Care for others?
Take responsibility?

Those patterns reflect your values.

3. Revisit moments that felt right

Now think of moments where things clicked. Where you felt more like yourself. It may show up as feeling more present, more aligned, or more engaged.

Then ask:

What was I doing?
How was I being?

And also:

What wasn’t I doing?
What wasn’t I trying to be?

A final note

If life feels chaotic and you think it’s because there’s too much going on, try turning it around.

Sometimes, it’s because there’s no clear direction organizing what you’re doing. And or humans, that hurts.

And ask not “How do I get rid of this feeling?” but “What does this say about what matters to me?” and then “How do I follow that direction, even with this feeling here?”

The magic happens when you’re no longer waiting to feel right before you act. You’re acting in the direction of what matters – to you – and letting feelings and thoughts and memories come along for the ride.

I hope I’ve been helpful. If you feel like it, share some of your values in the comment section. You don’t need to explain why.

This Saturday, we’ll meet for our next live Q&A.

I’ve been missing this!

And I’m really looking forward to seeing you all again :)

This time, we’ll do a good old open Q&A - no predetermined topic.

Bring your questions, thoughts, and reflections, whatever stage of the process you’re in. This space is for all of us to learn from each other and share what’s working (and what’s not).

The session will be recorded, so anyone who can’t attend live can watch the replay afterward.

This is part of the paid-subscriber community, where we meet monthly to share experiences, discuss challenges, and support each other throughout the process.

If you’ve been thinking of upgrading, this is a great time. Your support makes it possible for me to keep creating these sessions and writing the in-depth articles you see here (which I’ll resume writing next week, as I’ve been away for some time due to the Danish election, but now I’m back!).

When: Saturday, April 25th, 11:00 AM PT / 2:00 PM ET / 7:00 PM BST / 8:00 PM CEST

Join here:

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Lauren made it through eight months of severe psychiatric drug withdrawal.

And this week, she joined our live Q&A to talk about how -
from the other side of something that, at times, didn’t feel like it would end.

Lauren talks very concretely about that period, and we reflect together on what helps and what doesn’t when making it through such tough times.

What it actually felt like to live through it, what helped her endure it, what others can learn, and what made things worse.

I hope this conversation can help counter at least some of the frustration and hopelessness that often come with protracted withdrawal, making that phase more understandable, predictable, and hopefully more bearable.

Watch the full live Q&A below.

(More conversations like this coming.)

And now that I have your attention:

The next live Q&A will be on Saturday, April 25th at 11:00 AM PT / 2:00 PM ET / 7:00 PM UK / 8:00 PM CET.

This will be a good old open Q&A — no predetermined topic.

Bring your questions, whatever stage of the process you’re in.

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I’ve been quiet for some time.
Here’s why - and I’m back.

You may have noticed that I’ve been silent here on Substack for the past month.

The reason is that I’ve been part of the Danish election, which was called unexpectedly last month.

Therefore, my focus has been almost entirely on Denmark; speaking, writing, debating, and trying to bring mental health and psychiatry back into a political space where it’s too often missing.

Last week, the election took place.
And now that it’s over, I’m back with you guys :)!

New podcast episode

I’m returning with a brand new podcast episode with Oliver - a powerful, honest conversation about living with a bipolar diagnosis, being on lithium for over 30 years, how the ketogenic diet became part of the turning point, and what it actually takes to come off.

We explore:
• The early life stress and context behind his first manic episode
• His time in psychiatric care and the real effects of medication
• Lithium over decades — both what it gave and what it took
• What withdrawal actually feels like (and how it’s often mistaken for relapse)
• Failed tapering attempts — and what they taught him
• The role of meditation, keto, and lifestyle changes in the process
• Navigating fear, uncertainty, and instability while tapering
• Life now — four years into coming off

Please welcome Oliver to our community.

You can watch/listen below. More to come soon.

Live Q&A

Also: I hope to see you on Tuesday for our next live Q&A.
This time, Lauren Ottley will be joining us to share her journey—and answer your questions live.

🗓 Tuesday, March 31
⏰ 11:00 AM PT / 2:00 PM ET / 7:00 PM GMT / 8:00 PM CET

The link will be available in the paid subscriber community chat.

- Anders

Live Q&A with Lauren Ottley – March 31

I’m really happy to share that Lauren Ottley will be joining us for our next live Q&A in the paid subscriber community:

🗓 Tuesday, March 31
⏰ 11:00 AM PT / 2:00 PM ET / 7:00 PM GMT / 8:00 PM CET

Many of you already know Lauren from the podcast and from the piece we published about her story back in November. Her journey has resonated with a lot of people in this community - probably because it’s honest.

In this session, Lauren will be answering your questions about:

• what life was like before medication
• the experience of being on medication
• the process of coming off
• and what it has been like afterwards - practically, emotionally, and relationally.

Lauren is ready to share anything that might help you in your journeys, regardless of where you are in the process

As always, this is not about telling anyone what they “should” do. It’s about learning from lived experience and creating a space where we can talk about the things most people don’t understand because they haven’t been through it.

You’re very welcome to bring questions for both Lauren and me.
We’ll aim for a thoughtful conversation rather than a rapid-fire webinar, so come as you are and stay for the full session if you can.

If you haven’t already, you can read Lauren’s original story and listen to the full podcast episode below.

Looking forward to spending a meaningful couple of hours together.

Zoom link will be available in the Paid Subscriber Community Chat.

— Anders

In this talk, I share five key things I’ve learned from helping people come off antidepressants, antipsychotics, benzodiazepines, and other psychiatric drugs:

1) It’s not just about the taper.
2) Sometimes, it is just about the taper.
3) Tapering is both highly predictable and unpredictable at the same time.
4) People look for things to add or take – but healing often comes from what we remove.
5) Deprescribing is dangerous work – because it challenges a paradigm.

When the German philosopher Hans-Georg Gadamer wrote that “understanding is always interpretation,” he was not thinking about psychiatry. Yet his point applies uncomfortably well: how we name human experience alters how we experience it. The label becomes the lens.

In psychiatry, that lens often arrives in the form of a diagnosis. So, does the language of diagnosis shape the reality of the distress it seeks to describe?

And if so, what happens when the diagnostic language is wrong?

The concept cage

In psychiatry, categories like depression, schizophrenia, or generalized anxiety disorder appear as if they capture something objective - an underlying disease entity you can either have or not have, revealed through a defined number of symptoms that professionals are trained to diagnose.

And to bring in another philosopher, as Nietzsche warned, “every concept arises from the equation of unequal things.” The concept of depression, for example, gathers an enormous range of human experiences – grief, exhaustion, trauma, malnutrition, loneliness, loss of joy, hopelessness – into one label and then treats that label as a disease entity.

Concepts flatten reality. We smooth over differences in lived experience, in biological context, in trauma history, and in social environment, and then reify the smoothing into an illness.

Then, the concept becomes the explanation – but that was never its intention. Its intention was to describe. Intentions matter, but effect matters more, and a diagnosis often becomes far more than a description.

If our third and I promise final philosopher, Wittgenstein, was right that “the limits of my language mean the limits of my world,” then maybe the limits of diagnostic language can become the limits of our emotional imagination.

A diagnosis becomes a filter. It creates a narrative people inhabit; a story we tell ourselves about our inner life and our reactions to the world. Obviously, telling someone their symptoms are permanent increases the probability that they will feel them as permanent.

As a clinician, three questions follow:

• Does the label change how a person understands their emotions and sensations and their reactions to those emotions and sensations?

• Does it change how clinicians respond?

• Does it change the meaning of withdrawal symptoms, turning them into signs of “relapse” when viewed through the lens of the diagnosis?

  Reading and not subscribing? Stop reading then! Or start subscribing - it’s the least you can do to support my work. And it doesn’t have to cost you anything.

The neuroscience of expectation

Across psychological and neuroscientific research, a consistent pattern emerges. Expectations profoundly interact with physiology. Here are three common ways.

1) Belief changes symptom perception

Pain studies show that expectations can modulate activity in the anterior cingulate cortex and insula, key brain regions for processing the emotional and sensory aspects of pain. Positive expectations (placebo) can decrease activity, reducing perceived pain, and negative expectations (nocebo) can enhance activity, increasing perceived pain.

Now, I’m not into neurobabble explanations, so here’s a plain language one: If symptoms are framed as illness, this increases fear, which increases arousal, which increases threat monitoring, which increases symptom intensity (… which increases fear, which increases…).

If symptoms are framed as meaningful reactions, emotional signals, or a nervous system adjusting, intensity drops, and we can maybe even begin to work with what’s happening rather than against it.

2) Belief changes drug effects

In antidepressant trials, the placebo response accounts for around 82-85% of the total active drug response. As I argue in Chapter 6 of Crossing Zero, this does not mean medication doesn’t work. It means meaning amplifies effect.

The brain responds to:

• what we think a pill does

• what we fear will happen without it

• what the clinician communicates, verbally and non-verbally.

To some extent, this makes antidepressants active placebos. And did you know that the same brain changes observed in antidepressant responders are also seen in placebo responders - suggesting that these changes reflect expectation rather than pharmacology, since they occur regardless of what’s in the tablet?

3) Fear of relapse increases actual relapse

Predictive processing models (a brain theory suggesting the brain constantly generates internal models to predict incoming information), show that fear-driven arousal can destabilize mood regulation.

Thus, telling patients they will relapse increases the probability that they do. Because the nervous system is responding to the fear signals themselves. Again, what was intended as information ends up being a prediction. A self-fulfilling prophecy.

In predictive processing terms fear creates hyper-precise threat priors: strong expectations that something bad is about to happen. Once those priors are in place, the brain becomes highly sensitive to any internal or external fluctuations that could confirm them.

Fear also turns up the brain’s gain on prediction errors. Small deviations – a bad night’s sleep, rising anxiety, emotional intensity, intrusive thoughts – may now generate disproportionately large error signals. These are experienced as urgent, meaningful, and dangerous.

At the same time, fear destabilizes interoception, the felt sense of what’s happening inside the body. Heightened arousal produces intense bodily sensations, which are then interpreted as threat, increasing arousal further. The body begins to generate sensations that feel like relapse - especially when interpreted through a diagnostic lens disease narrative.

High arousal also overwhelms top-down control. The system loses flexibility. Emotional responses become rigid and reactive rather than adaptive and helpful. Panic instead of reflection, avoidance instead of regulation.

And so the loop closes: threat expectations amplify sensations, sensations confirm the threat, and the system struggles to update its beliefs.

A quick note on withdrawal and diagnosis

Let’s return to withdrawal for a moment - the process of coming off medications prescribed for these diagnoses.

One of the most destructive linguistic errors in modern psychiatry is the conflation of withdrawal with relapse. Two fundamentally different processes – one pharmacological, one psychological – are described using the same language. And when language collapses categories, the mind follows.

When symptoms following dose reduction or discontinuation are interpreted through the diagnostic lens, the same dynamic unfolds. Withdrawal is read as illness returning.

When withdrawal is mislabeled as relapse, clinicians increase medication, patients lose confidence, and unnecessary long-term use follows.

But when withdrawal is understood as a temporary neuroadaptation, outcomes change. People taper more slowly. Symptoms reduce. Emotions return. And the nervous system stabilizes (eventually).

Again, the lens shapes the trajectory.

The diagnostic lens and its consequences

A diagnosis is a double-edged sword. It can be stabilizing - at least temporarily - because it gives language to difficult experiences. It can reduce shame, offer recognition, and create a sense of being understood.

It can also constrain.

Once a label is internalized, new experiences are filtered through it. Sadness becomes “my depression.” Stress becomes “my anxiety.” Weird thoughts and beliefs become “my psychosis”.

What has changed? The interpretation, not the experience itself. The person is no longer interpreting the world. Left unchecked, the diagnosis is doing the interpreting for them. Automatically. Invisibly. Because language has a way of disappearing once it becomes a habit.

Gadamer’s point returns with full force. Understanding is always interpretation. There is no raw, unmediated experience. There is always a framework, and diagnostic language is one such framework.

Like a fish in water, we don’t notice the lens we’re looking through – including those instilled by modern Western diagnostic language. Not until something interrupts it. Not until the lens itself becomes visible.

And once it does, new possibilities appear.

I want to try something a little different with the paid community.
I have an idea I’d love to invite you all into - if it feels right for you.

Many people begin tapering feeling frightened and alone. …

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Anger is one of the most common - least talked about - parts of coming off psychiatric drugs.

For some, it arrives like a wave; overwhelming, like a punch to the chest. For others, it sits in the background like a silent tension, waiting for permission to be acknowledged - or it is actively suppressed, because anger was never an emotion they were taught they were allowed to feel.

Still, it shows up. And like all emotions, it shows up for a reason.

My intention with this article is simple. I hope to normalize and validate the anger that often arises during or after psychiatric drug withdrawal. Too many people mistake it for “relapse” or “losing control,” when in reality, anger is one of the most understandable human reactions you can have in this situation.

So, let’s make sense of anger.

Let’s name what so many of you in withdrawal have lived through

You were told a story about a chemical imbalance that was never grounded in evidence. You were told that the medications were “non-addictive”, and that withdrawal symptoms – if any – would be “mild,” “temporary,” and “self-limiting.” You trusted that information, because why wouldn’t you? It came from people in positions of authority.

And then, when you tried to come off the medication years later, you discovered – too late – that none of this was true for you. That no one had prepared you. That you were stepping into something far more intense and destabilizing than anyone had mentioned.

You ended up trapped in symptoms you didn’t cause, and certainly didn’t consent to.

And then comes the second shock: You go online. You find thousands upon thousands of stories just like yours. You realize this is systemic. You start to educate yourself and discover an entire field of research confirming exactly what you are living, and an ongoing academic fight to get this evidence formally acknowledged in mainstream medicine. You begin to understand this didn’t happen to you because we don’t know better, but because mainstream psychiatry is actively ignoring both data and the lived experiences of patients.

You find yourself tapering alone, cutting pills into crumbs or dissolving them in water to create small enough doses for your hyperbolic taper, which you also had to teach yourself because no clinician was trained to guide you.

But I want to protest.

Of course, people are angry.

Anger is the body’s way of saying, “A boundary was crossed. Something wasn’t right. I deserved better. I must stand up for myself!”

What is anger?

Let’s zoom out for a moment. Anger is an emotion. And like all emotions, it has a job.

It exists in us to detect injustice, signal when a boundary has been crossed, mobilize energy, restore integrity, and move us back toward safety. I wrote about this in my book, and honestly, I can’t say it any better now than I did there. Here’s the excerpt:

Because it feels unpleasant – and because many cultures tell us anger is unattractive and inappropriate – most people try to suppress it. Good luck with that. That almost never works. When anger is pushed down, it tends to leak out sideways or return stronger.

The way I see it, anger is one of the emotions that gives people their agency back. It wakes up the part of you that says, “No. Not this. Not anymore.”

Why anger shows up so strongly here

It’s one thing to be misled about the nature of your distress; to be told it came from a defective brain, rather than from your life, your circumstances, your trauma, your poor diet, your stress. That alone can derail a life for years.

But then to be misled again about withdrawal – told it would be no biggie – only to experience the opposite?

That compounds the professional betrayal. And some degree of anger becomes the only sane emotional response.

What anger is trying to tell you

I often see people interpret their anger as proof they are unstable or “getting worse.”

I understand why. Psychiatry trains people to mistrust their own emotional signals. Coming off psychiatric drugs requires unlearning that reflex.

In this context, anger is a signal about your lived reality. Your anger has a context. And emotions with context are not pathological. Neither are they disorders. If anything, the anger is the order.

Example time:

• You were not given true informed consent, leaving you unprepared for what was coming and without the information you needed to protect yourself.

• Your vulnerability was met with oversimplified explanations, making you feel unseen or reduced to chemistry instead of understood as a human being responding to life.

• Your suffering was pathologized instead of understood, which turned your real-life pain into a diagnosis and made you doubt your own experience.

• Your withdrawal symptoms were dismissed as relapse or “just in your head”, causing you to question your sanity when you were actually describing withdrawal accurately.

• You were made to believe the problem was you, not the model, leaving you with a sense of personal defectiveness for something that was never your fault. In reality, it was the framework that failed you.

• You had to become your own expert to survive, forcing you into an exhausting, lonely search for answers the system should have provided.
  

If this is not the perfect breeding ground for anger, I don’t know what is.

What to do with the anger

Anger becomes toxic only when it has nowhere to go. When it’s trapped inside, it hardens into bitterness – and bitterness has no value. Zero. Not for healing. Not for growth. Not for recovery. Not for the past. Not for the future. Not for the world.

The way forward is not to suppress the anger, or become aggressive, but to move it. To give it form, direction. To use it and give it somewhere to land.

Sharing can be difficult, I know, because most people outside the withdrawal community simply don’t understand what you’re describing. That’s why communities like this matter. This is where your story makes sense.

As for using the anger, what works is personal. What I do is simple: I go to work.

I channel my anger – because I’ve got it too – into writing, advocacy, education, research, training, Substack articles.

That’s my way. Yours might look different. It might be quieter. More private. More internal. Louder. Less private. Less internal. All of that is valid.

Here are some possibilities if you need inspiration:

• Name your anger without shaming yourself for having it

• Write your story (even privately)

• Share your experience with someone who truly listens

• Join a community where you’re understood

• Advocate at whatever level feels safe

• Set boundaries with clinicians or systems that harmed you

• … and really any boundaries you were once too afraid to set

• Reframe your story: “This was not my fault.”

To summarise. If you’ve felt anger during or after withdrawal, it means there is still a part of you that knows you deserved better. And you did.

Exercises

For my paid subscribers, there will be a live session dedicated to exploring anger, with guided exercises on working with, not against, it, understanding it, listening to it, and preventing it from overwhelming your system. As always, there’ll be plenty of room for your questions.

This will take place on February 24th at:
9:00 PM CET
8:00 PM GMT
3:00 PM ET
12:00 PM PT
7:00 AM AEDT (NB: Feb 25 in Australia)

The link will be shared in the paid subscriber chat.

The workshop will be recorded and released to paid subscribers the following day.

One of the hardest things for people to grasp emotionally – not intellectually – is that the problem is not that a strategy exists, but when and where it is still being used.

The nervous system does not operate with a calendar. It does not notice that ten years have passed, that the house is different now, that the people around you are no longer dangerous, or that you are no longer small. It operates through pattern recognition, asking one question, over and over again:

Does this situation resemble something that once required protection?

If the answer is even vaguely “yes,” the body responds accordingly. It has to.

This is why my clients so often say things like:
“I know I’m safe, but my body doesn’t.”
“I understand it rationally, but it doesn’t help.”
“I can see it’s not logical, yet I still freeze.”

That gap between cognitive insight and bodily response is simply how learning under threat works. Strategies that emerge under threat and trauma are encoded procedurally, that is, as automatic patterns of perception, sensation, and action. They are not stored as beliefs you can reason your way out of. That would ask the nervous system to be more rational than it was ever built to be. They are stored as readiness and preparedness. Just in case!

So, when someone asks me, “Why doesn’t my nervous system update automatically when my life improves?” I almost always answer: “Because it was never designed to.”

And here’s another one-liner I often hear myself saying: “Safety is learned through repeated, embodied experiences of approaching something new and surviving it. It is rarely proven by words (including those you say or think to yourself).

These strategies are not “choices” in the moral sense. But they do become places where we can practice a little more choice over time. The point of everything below is not to fight your defenses, but to build enough safety that your system no longer needs them in the same way.

When gratitude and grief collide

There is a characteristic emotional crossroads many people hit in therapy when they begin doing trauma work.

It is the moment where you can see, with absolute clarity, that a strategy saved you and it is now costing you something precious. By definition, this moment brings mixed emotions that feel contradictory.

Gratitude toward the part of you that found a way to survive; grief for the life that strategy now prevents you from living.

Compassion toward your younger self; anger that it was ever necessary.

Fear of letting go of something that once meant safety.

Many people try to rush through this moment. They want to “drop” the strategy as soon as they understand it and categorize it as a problem. That rarely works. You cannot evict a protector that still believes it has a job. You can only retire it by

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