First published on Mad in America on 27/2/25
Taking psychiatric medications long-term is like playing Russian roulette. It’s a harsh reality, but one that most patients are never informed about. The truth is, these medications can substantially worsen your life over time.
When I was a psychiatric trainee, I was told these drugs were safe and effective. I assumed that meant long-term safety and effectiveness as well—after all, I watched my professors and colleagues prescribe them to patients for decades.
They were presented as helpful tools but with modest effects. Sometimes they worked, and sometimes the patient’s “underlying mental illness” would overpower the drugs. In those cases, we were taught to increase the dose, add more medications, and, if that didn’t work, escalate to ketamine, transcranial magnetic stimulation (TMS), or even electroconvulsive therapy (ECT). The conditions we treated seemed mysterious—constantly changing, worsening, and leaving patients increasingly disabled.
That was the paradigm I was trained in.
But over time, I realized that many of these so-called “treatment-resistant” conditions weren’t underlying illnesses—they were caused by the drugs themselves.
This idea may not be new to the Mad in America community. After all, Robert Whitaker’s Anatomy of an Epidemic laid out the case that psychiatric medications often make people worse over time. But I want to offer a different perspective—one from someone who exclusively treats patients suffering from severe drug side effects and helps them safely taper off these medications.
Let me share how I went from believing these drugs were safe to realizing that taking them long-term is gambling with your brain’s future.
The Devastation of Protracted Withdrawal
In 2017, I authored an article highlighting the hundreds of thousands of people reporting severe withdrawal side effects on forums like BenzoBuddies and Surviving Antidepressants. These were people who, upon stopping their medications—either through a planned taper or by abruptly deciding they didn’t want to take them anymore—suffered devastating consequences.
What most people don’t understand about those harmed by psychiatric drug withdrawal is that they’ve sustained brain damage—also known as protracted withdrawal. The defining feature of brain damage is that it doesn’t resolve, even if the person reinstates the drug.
This is what makes protracted withdrawal so devastating. Many patients assume that if they develop severe symptoms after stopping a medication, they can simply restart it and their suffering will disappear. But that’s not the case. The damage has already been done, and reinstatement doesn’t always reverse it.
Neurotoxicity From Psychiatric Drugs—Even Without Withdrawal
After I became known in this community as a doctor who recognized this condition, patients started booking appointments at my clinic for help.
Initially, I assumed these toxic reactions only occurred in people who were rapidly withdrawn from medications. But soon, I noticed something alarming:
Many patients were developing the same constellation of symptoms seen in protracted withdrawal—except they hadn’t even started tapering yet.
This was especially common among benzodiazepine users. I’ve now treated multiple women who were prescribed benzodiazepines for perimenopausal insomnia—only to develop full-blown neurotoxicity after 6–12 months of use. These patients never tried to taper; the drugs alone caused severe, enduring neurological damage.
Since that time, I’ve been investigating long-term neurotoxicity from psychiatric drugs taken as prescribed. And what I’ve found is deeply troubling.
Toxicity That Psychiatry Refuses to Acknowledge
Mainstream psychiatry acknowledges that antipsychotics can cause neurotoxicity—tardive dyskinesia is a well-documented condition. But the field refuses to extend that acknowledgment to other psychiatric drugs.
Yet, in my experience, long-term antidepressant use can cause its own form of neurotoxicity, leading to:
- Apathy
- Dissociation
- Chronic low energy
- Agitation
This condition is recognized in the medical literature as tardive dysphoria. But despite its existence in research, I was never taught about it in my psychiatric training. I’ve never heard it mentioned at a conference.
What happens to these patients? Instead of recognizing their condition as antidepressant-induced neurotoxicity, they get diagnosed with treatment-resistant depression. This leads to:
- Higher doses of medication
- More drug combinations
- Escalation to ketamine, TMS, or ECT
- In some cases, being placed on heavy antipsychotics like clozapine
All because mainstream psychiatry refuses to acknowledge that these patients aren’t treatment-resistant—they’re suffering from brain damage caused by the drugs themselves.
Unfortunately, this is how many patients show up at my clinic—suffering immensely, on ungodly cocktails of psychiatric medications that are making them worse.
Reframing the Problem: From “Treatment-Resistant” to Drug-Induced Toxicity
If we correctly identify these cases as drug toxicity, the treatment approach changes completely. Instead of piling on more medications, these patients need:
- A slow, careful taper off the offending drug
- Nervous system support for healing
- A recognition that additional psychiatric medications often make them worse
A damaged brain does not respond predictably to more drugs. That’s why adding medications in these cases typically exacerbates symptoms rather than alleviating them.
How Widespread Is Psychiatric Drug-Induced Brain Damage?
The medical community is comfortable acknowledging persistent brain injury from recreational drugs, yet remains silent when it comes to pharmaceuticals.
We already acknowledge that:
- LSD can cause hallucinogen-persisting perception disorder (HPPD), a form of lasting brain damage.
- High-potency cannabis can cause neurotoxicity and cognitive impairment, especially in young people—and it can look like schizophrenia.
- Methamphetamine use leads to clear brain changes, often mimicking schizophrenia.
- Chronic alcohol use can cause Wernicke-Korsakoff syndrome, a severe neurological disorder.
Yet, when it comes to pharmaceutical drugs, we assume they are somehow “cleaner” simply because they’re prescribed. But to your brain, a drug is a drug. And psychiatric medications—especially when used long-term—can have profoundly neurotoxic effects.
Why This Conversation Is Avoided
This issue is almost never discussed in mainstream psychiatry because:
- It’s a direct threat to the pharmaceutical industry. If it became widely known that these drugs can cause irreversible neurological damage, prescriptions would plummet.
- It’s uncomfortable for doctors to acknowledge. Imagine telling a patient:
“If you take this medication long-term, there’s a small but real chance it could make you worse and cause lasting neurological damage that may never go away.” - It disrupts the 15-minute medication-management model. If doctors admitted these risks, prescribing in quick visits would become far more complicated.
Why Patients Deserve the Truth
We now have 17% of the U.S. population on psychiatric medications—millions of whom may be at risk for drug-induced neurotoxicity. Many of these individuals, upon failing medication after medication, will be labeled “treatment-resistant” and given even more drugs that will likely worsen their condition.
There is no way to predict how long a psychiatric medication will work before it turns on you. That’s why taking these drugs long-term is like playing Russian roulette with your brain.
We need to start informing patients about these risks—before they become another needless casualty in the growing crisis of psychiatric drug-induced harm.