Depression – SSRI's or Nutrition and Exercise??



wow that's that's really intense stuff the other question that I wanted to have to talk to you about was when you're saying schizophrenia and how sophiar Fame can prevent or somehow or mitigate the fact the effects of schizophrenia do you think that there's a possible correlation between a lot of these mental health diseases and a lack of proper nutrition oh absolutely I think that a lack of proper nutrition is a huge component of a lot of mental diseases and psychological diseases in general in fact inflammation is now it's really been identified as I caused playing a causal role in depression and that's something that you know so with the depression thing it's here's here's kind of a funny story and it's not that funny it's actually kind of eye-opening but back in these so the CDC has like estimated that about 11% of Americans or on it some sort of antidepressant 11% it's a lot so here's the story behind that it is and I know several people that are on them or have taken them or you know you know whatever but the story behind that is kind of interesting because back in like the early 70s a lot of these clinical trials were being done on antidepressants with people that had depression and at that time people that had depression that were involved in these trials were people that were severely depressed and hospitalized so they were so depressed that they had been hospitalized for depression I don't know many people that have been hospitalized for depression nowadays but so they were hospitalized for depression and then they were given either a placebo or an depressing and in multiple trials you know FDA had reviewed these trials 70% of the time the antidepressant so the antidepressant worked in 70% of the patients compared to 30% of the patients core policy but worked right 70 percents pretty good if you're comparing that to 30% placebo it's like well that's efficacious that seems to work right what then happened after those trials were done starting in the 70s and like 80s is that the clinical diagnostic manual it's called the DSM at that time it was the DSM – they changed all their their diagnosis you know markers and and symptoms for depression and they expanded it a great great deal and they then called depression major depressive disorder so it became this sort of like broader you know disease quote-unquote where it was like it's not just these people that are severely hospitalized it's people that are feeling depressed and anxious and sad or what you know it's basically you're you're getting a bigger group of people which is probably a great opportunity for for a pharmaceutical company but then when clinical trials were repeated on this new population of people so these these are clinical trials that were done from like the 80s all the way up until like the 2000 year 2000 when those were reviewed by the FDA what was found was quite shocking and that was that only 40% of people were now responding to like and depressants SSRIs other you know norepinephrine reuptake inhibitors less whatever the standard of care is compared to 30% placebo so now you're talking about only 10 performing only 10th this antidepressants performing only 10% better than placebo it's like okay something so clearly it's not that the antidepressants don't ever work it's just that we are now over prescribing them to people that you know or have this major depressive disorder and they're not working on people that weren't you know the the the initial group of people that were like severely depressed and hospitalized you know so it's like okay that's that's a big problem because they're I mean they are prescribed like I mean I just like I can't even believe it you know I just have so many personal stories people I know you know that have gone you know going through some crisis and personal break at forest whatever and all sudden they're giving you some crazy give me some crazy drug and they changed the personality the person and I'm just like please get off of this like you know it's not like and like I said it's not like they don't ever work it's just that you know I think once the clinical diagnostic you know book changed the whole like I mean a procedure for diagnosing depression it became major depressive order disorder all of a sudden you're getting people that are now like having just you know whatever stressful event in their life that's making them a little depress the time which everyone's probably experienced are now being you know given this antidepressant when they don't really need it and there are effects that are not good with taking some of these you know antidepressants so we know there's a big effect on libido yeah libido yeah I know a lot of people that have taken it where their sex drive just goes away yeah there's actually a gene that a gene polymorphism a variation in a gene that that is linked to that so people that have it have even more severe effect where they really don't they really have like sexual dysfunction and in response to us yeah it just shuts down yeah yeah it doesn't happen to everyone quite as much but there there's a percentage of people that it really really affects and there's lots of other you know things I mean it's just it's changing your brain chemistry right and it's not exact it's not an exact science no there's a lot of experimentation going on with it I had a friend of mine who had gone to several doctors and they had prescribed a bunch of different things to him and he was severely depressed and eventually they gave up and he had to find a much better doctor that his care his whatever his insurance package would not pay for and once he found that doctor then the doctor was just more knowledgeable about what would you know potentially different ones I mean I don't know how many different ones there are but they got him on something that actually worked he's off it now it took him a while and then you know eventually got happy and then oddly enough mm-hmm which is an interesting thing people always want to connect depression they want to say depression is a disease and they want to say it almost like oh you got herpes like you know I mean it's like well you've got depression oh well you need medicine and for him the one of the big factors in fixing everything was his own success his own personal success and then he became more happy and then his the medication helped he became more successful and then as he became eventually really successful he started to experience like a better quality of life he was happier he was more confident and then he slowly weaned himself off and now he has no need for them to mean that is so fascinating because so we're not talking about necessarily a disease like he does not have cancer it's not like they cured him of a disease it's it was a blanket that was keeping him warm you know it was something that was it was allowing him to bridge the gap between an unhealthy mental state and a healthy mental state but a lot of that health had to do with his own life he still eats like shit I mean he's not like the healthiest guy he's not fucking candy but he's really healthy now as far as like his mind he's very happy yeah he's not lying you know he's not faking it so to me it's always I mean when when you know I've talked to friends that have had really good results with antidepressants so I think there are some dark moments in people's lives where that can kind of get them out of that but then part of me doesn't buy that that's the way to go because part of me is like okay well did you exercise no did you take like really healthy foods no did you clean your life up no did you you know like how what happened here and one of the things that a lot of these antidepressants do is they make you not feel bad about stuff like about anything like I had a friend was on Zoloft and she said like she took it for a year and she's like I kind of lost a year of my life like I didn't give a fuck about anything during that year like anything can happen okay scary yeah it's but that not giving a fuck not not feeling bad you also you don't feel great either you don't feel great like you don't feel like God it's a good time to be alive look leave me I'm healthy I can move you're like all those thoughts don't sort of come into play it's like it dulls everything it dulls the highs and it dulls the lows and it keeps the pain away I that's kind of interesting because believe it or not that's actually a symptom of depression I think it's called like head down ears something where someone's not like really responsive to anything it's like you can't like you just can't like you know you know you can't like excite them or or like make them super anxious either there's kind of like you know so that's actually kind of interesting that she was experiencing that while on an antidepressant well the results vary pretty widely yeah I mean with the same drugs right yeah yeah now is that because of biodiversity like what what's causing that that like you could take something and you would have a totally different reaction and I could take something and you know it would just be perfect yeah I you know I honestly I don't think we actually know really why that is but what we do know is that there are I mean there are different you know we are different people and I've got different genes that are regulating how much serotonin I'm making how much dopamine I'm making how much I'm metabolizing how quickly I metabolizing it than you and other people and so when you like and pipa and this is this absolutely does affect how some of these drugs are you know when they're taken how how their what their biological effect is now you know why why I don't know you know so it's there's definitely like a genetic variation that affects just the way our neurotransmitters are being fired away and the way they're being metabolized and so if you're if you're adding a drug that's changing the way something's being metabolized already then it's you know it's going to affect people differently I think I think that's one reason but honestly I don't know who knows there's maybe like other you know life situations as well other dietary situations all these things probably play a role you know with the inflammation I was talking about it actually playing a causal role I mean there have actually been studies where normal healthy people are injected with either a placebo which is saline water you know salt water or they're injected with something that our gut produces called endotoxin our gut produces it when our immune cells in our gut attack the bacteria in our gut because endotoxin is actually a component of the bacterial cell membrane and that is released upon inflammation so when you're eating a terrible diet lots of refined sugar and that's and it's actually been shown you release endotoxin and it causes inflammatory response so when people are injected with endotoxin or they're injected with pro-inflammatory cytokines like interferon gamma which we also make in our body when we're inflamed people start to normal healthy people start to experience feelings of depression they start to feel depressed anxious social withdrawal people with the placebo did not experience that also they had elevated levels of other inflammatory by tomorrow markers in their blood so it really like and this is just this is causal and when we're talking about injecting information information all of us and they're experiencing these like depressive symptoms it was actually people that were then given one of the omega-3 fatty acids EPA there have been actually a pretty high dose of it I think it was close to like two grams or something completely alleviated any of those symptoms so that so those people that were getting the inflammatory cytokine or the a neurotoxin and the EPA did not experience those symptoms so it was really like inflammation you know driven these symptoms that were not experienced in the placebo so that's kind of and there's been multiple studies showing this not you know it's not just one study there's multiple studies multiple studies again this is kind of like a new method people are using to explore how inflammation affects depression it also has been shown the same sort of scenario where there's a placebo and they're injecting an inflammatory cytokine dopamine levels lower in the brains of people that were injected with the pro-inflammatory cytokine but not the saline water and also the reward pathway in the brain is also decreased so you know again like I was mentioning you're not not that excitable or you know you know it's just kind of like and that and that was not that did not happen in the placebo group so this was not just an effect of being shot up with something you know so when when scientists have looked at some some of the mechanisms and explored well how is it that inflammation is affecting dopamine in the brain how is it that it's you know affecting people's mood it's thought now there's a variety of mechanisms one is that you know these inflammatory cytokines they actually cross the blood-brain barrier they get into the brain and they disrupt dopamine release they disrupt sera release that disrupt norepinephrine release you know they're disrupting nurten these neurotransmitters being released the other way thing is that there's been recently discovered that the lymphatic system is actually directly connected to the brain through the meninges I mean it was previously thought that that was like cut off the brain was protected from the lymphatic system but it turns out we were wrong you know everything that we learned in textbooks for years and years in our science classes was not accurate actually we are lymphatic system is connected and what that means is that our immune system the chemicals the inflammatory cytokines were producing you know from our immune cells are getting into the brain and disrupting you know neurotransmitter release and other things so there's obviously a really strong connection to inflammation and depression that's shown to be causal but when you think about it it's like well what causes inflammation okay well we can talk about the sugar stuff because that's that's been shown eating a terrible diet does but the other thing that causes it and it's what you you mentioned that is a stressful event in someone's life an emotional event you know a breakup a tragedy work-related stress social anxiety whatever it is anything that causes you to release cortisol stress hormones believe it or not those things actually affect inflammation in your gut so it's like a two-way street here I think that previously you and I have talked about in other podcasts like how gut microbiome and bacteria you know you can take microbiome and bacteria from an anxious Mouse and Transplant it into a non anxious Mouse and make it anxious and vice versa alright so there's like some sort of gut brain access through with something called the vagal nerve well it goes both ways you can go from the brain down to the gut so it's been shown that like cortical releasing hormone which is a stress hormone you know it get you know through the vagal nerve when you release it goes into the gut it activates immune cells which then activate other proteins in the gut that chew up they're called proteases they chew up the gut barrier and then you start to release more influent you know inflammatory cells which then like get in contact with bacteria more inflammation and then it goes back it's like this feedback loop so I think that's how stress also part of the mechanism how a stressful event and any sort of breakup or tragedy those sorts of things also cause inflammation they cause inflammation in fact it's a totally off topic but that's one reason why people should never go and like get like blood work done like like a day or two after some kind of like traumatic event so if you get fired don't get your blood work don't ya do not get your blood or break up or whatever yeah cuz they will like it will skew everything Wow everything well that's that's so amazing and when you discuss this and when you lay all these facts out it makes it seem so irresponsible that 10% of the people are on let's draw 11% excuse me are on this drug or a you know whatever a pet category of these drugs instead of dealing with it I mean it seems like it's it's we're in a weird place when it comes to the holistic treatment of the human body we're in a very weird place where we have all this information now but it doesn't seem like it's being applied when it comes to the average person who is suffering the average person who's dealing with the disease or depression which I guess you could call a disease and it just seems so insane that with all we know that we're treating it only with this chemical pathway we're only treating with a pill this pharmacy you know this Pharma collage achill solution to this which just seems so limited upsetting it's so upsetting it's very upsetting I am like it's like a mission of mine you know I think you know I think that the problem is multifold and you know one is that you have you know psychiatrists and and they're trained a certain way and people when their patients come in they expect that they're gonna come they come in because they want a pill most of the time they do they come in because they don't want to deal with it and they want a pill and so you know it's that's kind of a problem because they need you know people need to understand that these pills are not the magic bullet I mean I just told you only 40 percent of people are responding to these antidepressants that our standard of care compared to 30 percent that respond to placebo a sugar pill Brian like that is ridiculous you know so I think I would love if there was some way you know to to get a physician of usually their psychiatrist that people go to for these sorts of problems to like push someone to say you have to go run you know you're gonna run six miles a week you're gonna run you're gonna do that that is going to help you like you know it's in fact it's been shown it's been shown in multiple studies that exercise helps improve depression and one of the ways it does it very interestingly is that aerobic exercise specifically has been shown that whole serotonin pathway we're talking about inflammation inhibiting release of serotonin well guess what an inflammation affects serotonin and another way Sarat the precursor to serotonin serotonin tryptophan when you have inflammation so like I said an emotional event causes inflammation doesn't have to be your sugar diet okay what out you know inflammation can be caused by your your cortisol release when you have that inflammation it your body thinks that it needs to fight off something but that's what it thinks it's like okay this I'm sick I've got a foreign invader I need to kill it and so the tryptophan which usually is being transported in the brain to make serotonin which plays a role in how you feel it plays their role in lots of brain functions then gets diverted into another pathway because your body's like wait a minute I don't need to feel good I need to LA I need to survive I need to live so it the tryptophan gets converted into this whole other pathway called kynurenine which helps with it basically immune cells need it too the different immune cells needed to make different types of immune cells so your body's like okay the tryptophan is going to this other pathway I need more means selebobo but the problem is that the Kahn yearning then gets converted into so now what you have is you're depleting your brain of serotonin boom right there right that's the first thing so if you're not sick if you have chronic inflammation you're chronically stressed you're chronically eating a terrible diet then you are going to constantly be diverting the serotonin you know the tryptophan into the other pathway you're gonna be depleting your premium serotonin right so that's one thing this is a two-fold problem then that whole kind yearning thing gets converted into something called quina lytic acid which actually crosses over the brain barrier becomes a neurotoxin and also has been shown to cause depression so not only you're not getting serotonin you're getting this gnarly shit and you're praying that's not supposed to be there and exercise it's been shown specifically aerobic exercise causes your muscle to soak up the conure anine actually another precursor to it so that it can't form Quinn Olynyk acid so it doesn't form the the neurotoxin Park part but you know exercise also causes you to make – it makes tryptophan go into your brain you know alleviates some of the competition with branch chain amino acid it's like leucine and isoleucine so that's another way it's doing a million things brain derived neurotrophic factor we talked about the beginning of the podcast that also plays a role in the depression helping prevent depression yeah so neurogenesis all that stuff that helps growing new brain cells making new connections helps helps you deal with stress that's why you make it when you stress your body it seems like there could be some sort of a whole holistic approach like a clinic that looks at all of these factors looks at all these factors and prescribes instead of just prescribing a pill prescribes a very specific diet and exercise routine and maybe even meditation maybe even something that practices or enhances mindfulness or promotes mindfulness something that allows you to manage the way you are viewing and taking in scenarios and and scenes and and events in your life and then processing them in a more healthy manner it seems like all these things would be as effective or maybe more effective than just a pill I agree with you and I'm hopeful for the future I think that the more there's a lot of scientists just that are studying this now I mean it's becoming very common to look in the scientific literature and see you know scientists researching inflammation and the role of inflammation and depression and the role of exercise in helping treat it and the role of other you know dietary lifestyle factors in causing and treating depression so I think that you know I I really am hopeful that in in the near future that it like you said it's it's gonna be a multi-pronged approach where it's not just a magic pill and I'm not saying that's not also going to be included in some you know I'm just saying you know it's I think I think the diet lifestyle meditation exercise if we could just get that into like you know the the clinical world and if people were motivated enough to realize this will really help them like it really will people will be so much happier I really I really think so

43 Comments

  1. I’m sorry but if you have gone through true clinical depression and or anxiety you would know it’s physically impossible for most people to get out of bed and shower let alone exercise! I myself was sooooo judge mental Towards antidepressants until I found myself in such a dark place I could literally not function in any form of the sense. I lost 35 pounds in 2 months and was on the brink on loosing my job and my life. I never ever ever thought I would go through depression. It was the worst experience of my life and I would not wish it on my worst enemy. I’m so thankful for antidepressants now. I can honestly say they saved my life. I went from having panic attacks everyday feeling like death was right around the corner to not having a panic attack in a year. I fought like hell to not be on them!!!!! I went to counseling I took every natural vitamin and tincture under the sun!!!!!! In the end nothing helped me except this. I don’t plan on being on them forever but now I can get out and exercise when before I was afraid I would go into cardiac arrest if my heart rate rose. Now I can get out and socialize without thinking My throat is closing up meeting new people. Now I don’t have panic attacks at work. Now I can get out of bed and live my life. ♥️

  2. Belief and confidence first and the things come with them. Exercise and self care and success in all aspects of life comes from an outpouring of a healthy mind. Romans 12:2 New International Version (NIV)

    2 Do not conform to the pattern of this world,but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.
    Once you're mind is aligned with success, fitness, money, relationships etc, follow your mindset. One translation says be transformed, bt the renewing of your mind and the things will be added.

  3. Mild depression, for the most part, occurs when your expectations don't meet reality. When they do, your happier. Depression is a normal part of life, so knowing how to power through it is vital. Now some people who are profoundly depressed may need treatment, such as those who do have imbalances going on in the brain. A breakup, for example, is fleeting. I have had people I know commit suicide for such petty things. Life gets better in time if you give it a shot. Much of depression comes from the food we eat or exercise we get, or lake thereof. Always find ways to better yourself through natural means, and if that's not working, or you have a mental disconnect, then medicine may be right for you. We need to stop letting doctors push drugs on us for a 'buck.' See a doctor who listens to 'your' situation.

  4. she rambles

  5. I don’t think there’s anything wrong with either side of the discussion just do what works for you.. if pills don’t work for me I’m not going to tell you not to Try them.

  6. Extremely interesting

  7. What did people do before this Prozac Planet? And don't say they drank, because people still drink.
    A small percentage of people should be on these meds. Less than 1%.
    Instead, it's 11%…as per this lady's citation of the CDC stats.
    I've heard larger figures. I'm curious how the CDC collates it's data.
    Prozac and the other drugs like this are probably a big reason why there are so many NPCs and Soyboys walking around.

  8. The lymphatic system is not directly pass the blood brain barrier. There is an internal brain system called the glymphatic system that clears out the brain itself

  9. I love Dr. Patrick and Joe Rogan!

  10. i have been on ssris for a long time. just got off of em month ago. nutrition and exercise is the way to go!

  11. I took xoloft for two years. It made me asexual

  12. Sometimes demanding a depressed person to have radical changes in their life style can be very difficult for someone who can't even get out of bed in the morning. I say using the SSRI's as a stepping stone to achieving those good habbits would be a better/ more effective way of treating someones depression. To a point that their life is stable enough that they do not need the SSRI's anymore. To me, anti-depressents should be used to assist in a persons life, not to carry them through it.

  13. If you prescribe exercise and diet though, how do you get a depressed person to actually do it?

  14. On Celexa SSRI for 13 years. I want to get off but the doctor tells me that I need to expect to be on this medicine the rest of my life.

  15. I workout and meditate and eat pretty healthy and still have agoraphobia

  16. IF you want to get rid of depression apply the Win Hof method ( "the iceman") His interview with Russell Brand is great he explains it all in a nutshell !

  17. I exercise, i eat healthy food for the most part. And believe me. When shit it the fan, there's nothing you can do to prevent depression to absolutely ruin your life. I

  18. These two should start these clinics

  19. Ya and then people were being called exaggerated vampires, werewolves, or witches with powers and were being hunted by a whole village. Some things you have to keep to secret or just tell a few. Most regular humans can't understand or handle how this planet or world really works. My kind for example are real but metaphors were exaggerated into myths but some legends are based on science and evolution /adaptation and not magic or whatever. I am a super predator and superior to humans and see them as potential food or slaves and are lesser creatures but its part of the food chain order. Humans get frustrated and scared realizing they are overall weaker and less intelligent than real vampires for example. The possible irony for humans though is they created my kind by genetics and severe abuse early on. We evolve or die, its simple. We have a lack of feeling truly alive in our opinion but stay alive because pleasures and fun moments exist and many things. Humans just are less evolved for understanding really how we the super predators really control everything. We will kill whoever or whatever if it stands in our way with real intent and doesn't back off. We usually stick to ourselves though and few humans ever need to worry. Human cattle is so rampant that even if a few go missing it shouldn't matter. Also humans teach lies like religion and gods to abuse their own childrens minds and much more. Humans mostly don't have true ability to care for people in their lives and are not truly concious beings. If humans had real self-awareness the world would be much different little ones :).

  20. Zoloft is the devil

  21. there are certain mental disorders that can be cured. But some cannot.

  22. SSRI's can not cure depression or any disease. Similar to the drug dealer on the corner praying on depressed people, these SSRI pushing companies are praying on depressed people. None of it will work! Only changing your life habits can cure your depression. Depression is your body telling you to change something YOU are doing, that no drug can remedy, only mask!

  23. SSRI's work 33% better, if efficacy is 40% vs a 30% placebo. Not 10% better. Could say 10% more people felt benefits from the SSRI. Either way SSRIs are a dangerous snake oil.

  24. How about both?

    Trintellix has helped me a lot. No, I'm not a drug rep. I had a lot of anxiety and depression, and suicidal ideation before. Been taking it for about 2 years now. However, I am trying to eat better and exercise as well. Maybe I can faze the medication out over time.

  25. the relationship btwn nutrition and exercise vs pharmaceuticals. Joe is speaking on his friend Ari I believe. I exercise mainly for stress relief.. looking good is just a plus 8) I feel so much better when I intermittent fast bc I eat a buncha junk all at once and sleep, wake up, and poop, them fast again all day with some caffeine.

  26. She's hot

  27. hedonia is what i got

  28. what i hate is this approach. some of us are very sick. instead of showing empathy or trying to help all you say is did u exercise or did u try to change your life. no one says this to someone going through a bowel disorder or got measles

  29. i feel kind of attacked because i’ve been feeling the way i’ve been feeling depressed since the age of 12 it’s been 5 years . id like to think it is a disorder or state and not just ‘a phase or stressful events’ and before you asked i have tried, i have eaten healthy for the past year so far and exercise as much as i can and taken up new hobbies but nothing has helped

  30. Then they tell u you can’t just quit you have to taper off

  31. What you eat has a massive impact on your Mental state so change your diet. Vegetarian diet helped me a lot and add coconut to your diet. Also nuts and raw sugar.

  32. The serotonin is so damn addictive. It’s really hard to get off from as it can kill you if stop taking it. Reducing it slowly is the key but it’s hard. I was at 20mg and now got down to 10mg but it’s been a challenge to get it this low and it took so long and I plan to lower it more after my body adjusts for a year and keep cutting slowly. Doing it every 3 months doesn’t work for me. Also diet is another major factor. I eat coconut and no meat and added nuts and avoid sugar and use jaggry which is raw unprocessed sugar. Also I avoid using garlic and onion. These things have helped me a lot

  33. So my depression phase was caused by poor diet and lack of exercise.

  34. Going to your family.doctor for temporary depression is like asking a painter to upgrade your electric service.
    Family doctors should not be allowed to prescribe drugs that affect your personality or empathy.
    Next thing you know. Youre shooting up a school or a rock concert and have NO feelings whats so ever about it.
    Start holding unqualified doctors responsible, and youll stop over prescription of psychotropic drugs

  35. It fried my libido 25 years ago. But it was a better life on ssri's than without it. Lonely sometimes, but still better….

  36. And do they realize it's nearly impossible to exercise when severely depressed?

  37. I'm pretty sure most people try therapy for a while before wanting to go on antidepressants… it's kind of a last resort

  38. If stress affects our health so much, then why is it unreasonable to take a drug to prevent unreasonable stress during a particular time that could seriously impact your health?

  39. I work out regularly AND eat clean including Dr. Patrick’s smoothie recipes 4-5 days a week. I also take SSRIs (Prozac) for anxiety. Wish I didn’t need it but the meds have helped tremendously. Two cents.

  40. I've been exercising regularly and eating right, and it's been two months – it hasn't helped.

  41. He is talking about Ari

  42. My kid is 16 and pushing for these SSRI's and his therapist is pushing this . Try saying No and then having CPS show up and say you are a bad parent for refusing , No ONE would give me a placebo for him . THey basically laughed at me !!! CPS was at my house ! I had to defend myself and hew has suicide in his immediate family . It's insane , mention exercise and diet ! Ugh ! I have to lawyer up to fight this off ! Fuck ~ YOU SAID IT I asked the very same thing , put him in a program that works from the ground up but no meds ! AND i told the CPS lady to look up my Blog to see how I formed my " uneducated opinion ! " and this is at the top of the listed videos . lets hope they look !! Robert Whitaker MAd in AMerica ! HAve him on with you !!!

  43. Recently stopped taking Pristiq/Effexor after being on it for over two decades.

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