SSRI Dangers & Tapering Off Safely with Dr. Josef Witt-Doerring

Hosts: Dr. Paul Marik, Dr. Joseph Varon Guest: Dr. Josef Witt-Doerring

In loving memory of our friend Charlie Kirk. May he rest in peace.

“SSRIs may have a role. But they shouldn’t be first-line therapy.” — Dr. Paul Marik

SSRIs are one of the most prescribed drug classes in the world, yet few patients are ever told what it takes to stop. Withdrawal is rarely discussed. Long-term use is often assumed. And the story most people are told—that depression is caused by a chemical imbalance and SSRIs fix it—doesn’t match what the science shows.

In this conversation, IMA Co-Founders Dr. Paul Marik and Dr. Joseph Varon speak with Dr. Josef Witt-Doerring, a psychiatrist and former FDA medical officer who now runs one of the few clinics focused exclusively on safe tapering. Together, they walk through what the profession gets wrong, what patients are rarely told, and what needs to change in how we think about depression, treatment, and recovery.

Introducing Dr. Josef Witt-Doerring

Dr. Josef Witt-Doerring, MD, is a psychiatrist renowned for his expertise in the field of drug tapering and withdrawal management. With years of experience in clinical psychiatry, he has developed a particular interest and specialization in assisting patients with the safe and effective tapering of psychiatric medications. His approach is patient-centered, focusing on individualized plans that prioritize the patient’s well-being and functioning.

• YouTube: @taperclinic
• Website: Taper Clinic
• Free Taper Training

“We are robbing people of the opportunity of addressing these issues at the root cause.” — Dr. Josef Witt-Doerring

The Chemical Myth and the Real Nature of Depression

Despite decades of public messaging, many people will be surprised to learn that there actually is no biological marker for depression and no scientific evidence that it stems from a serotonin imbalance. Dr. Witt-Doerring described that many experiments have been done comparing the serotonin levels in depressed and the general individuals; and in all of these experiments, there is a stunning throughline:

“Every time they’ve done this, they have not found that there is any difference between depressed and non-depressed people.” — Dr. Witt-Doerring

As Dr. Marik said, “That’s not a white lie then. That’s like a massive whopper.”

Instead of being caused directly by a chemical imbalance, Dr. Witt-Doerring emphasizes that depression is often a deeply human response to relationship strain, isolation, lack of purpose, or chronic stress.

“Depression is the logical cause of relationship breakdowns, social isolation, lack of purpose and meaning in one’s life, medical problems, particularly dietary issues, and also drug use. When you look peoples’ problems in that way, that really encapsulates a lot of what we call ‘depression’ and anxiety as well.” — Dr. Witt-Doerring

Short-Term Trials, Lifelong Use: The Problem With Default Prescribing

Since the COVID era, much more attention has been paid to drug safety. SSRIs are just another example of drugs that were not observed long enough to understand the true long term impacts. SSRIs were studied in clinical trials that lasted just 8 to 12 weeks. Yet many patients remain on them for years, even decades, without long-term safety data.

“They were tested for up to 12 weeks, but there are patients… who are on these drugs for decades. And that’s not what they were meant to be.” — Dr. Varon

Patients often cycle through multiple medications as tolerance builds, while the original causes of distress remain unaddressed.

“Eventually… you’re maxed out on the drug, and you go back and see the doctor and they say, ‘You’re treatment-resistant now.’” — Dr. Witt-Doerring

The prescribing pipeline is driven more by time constraints than personalized care.

“80% of the prescriptions are coming from… the family medicine doctor who is tasked with looking after your cardiovascular health, annual depression and anxiety — with like 5 to 10 minutes… Our healthcare system is really not designed to help people with anxiety and depression.” — Dr. Witt-Doerring

The Reality of Withdrawal

Many patients are never warned about withdrawal or how difficult it can be to stop. For some, a standard two-month taper leads to debilitating symptoms that persist for years. Though SSRIs are not chemically addictive in the traditional sense, withdrawal can be severe—and even the very best doctors may not be aware.

“Somebody started me on duloxetine. And oh, they forgot to tell me, Don’t you dare to stop this medication suddenly because you’re going to feel like hell.” — Dr. Varon

For some patients, withdrawal symptoms begin after just a few missed doses. And for many, they mimic or exceed the severity of the original depression—making it difficult to distinguish relapse from drug discontinuation.

“They get back on the drug expecting the symptoms to go away and they don’t. And it is extremely frightening.” — Dr. Witt-Doerring

Patients can get hit by a series of symptoms, as Dr. Witt-Doerring explains:

“They have ear ringing. They have light sensitivity. They have severe anxiety. They have brain fog. They develop digestion problems. They get tingling in their hands and feet. And it can drive people to suicide.”

Proper tapering can take months—or years. But most patients are given little to no guidance.

“In general, for people who are sensitive to withdrawal… they’re coming off between 12 months and 24 months.” — Dr. Witt-Doerring

Lasting Damage After the Drug

One of the most underreported concerns around SSRIs is the persistence of side effects even after discontinuation. Post-SSRI sexual dysfunction (PSSD), for example, has now been acknowledged in multiple countries’ drug labels.

“Up to 70% of people will have sexual dysfunction on these drugs… and for a growing number of people, they find it does not resolve.” — Dr. Witt-Doerring

Other long-term issues—such as increased impulsivity, mania, or aggression—are also acknowledged risks, yet rarely discussed during the prescribing process.

“These drugs can make people unexpectedly suicidal. They can make people violent and hostile. They can cause mania. They can cause a condition called Akathisia where you are very restless and uncomfortable and can sometimes do very unpredictable things.” — Dr. Witt-Doerring

Dr. Witt-Doerring explained at length that the connection from SSRI use to unpredictable violence is not debatable, but rather a clear causal link.

Learn more: Antidepressants and Violence: Problems at the Interface of Medicine and Law

A Different Way Forward

Rather than doubling down on a flawed model, Witt-Doerring argues for a more honest, patient-centered approach: acknowledge the limitations of the current drugs, support those who want to taper, and prioritize upstream factors, like sleep, purpose, connection, nutrition, and trauma healing.

It’s an approach echoed in Managing Depression, a monograph by Dr. Paul Marik, which outlines practical steps patients can take to reclaim agency and improve mental health. Like this conversation, the monograph challenges the idea that medication is the only—or even the best—tool. It’s not an anti-drug message. It’s a pro-truth, pro-recovery message.

Related Resources

• 🧠 The Dark Side of SSRIs
• 📘 Managing Depression – Free Monograph
• 💪 Stress Management Guide
• 🧘 Yoga, Pilates, and Qi Gong for Stress Relief
• 🧬 Brain and Mental Health Guide

Bonus Q&A with Dr. Witt-Doerring

We asked Dr. Witt-Doerring if he would be interested in answering some additional questions from our audience, and not only did he say yes, but he delivered incredibly thoughtful responses. We’ve listed the questions below, and included an audio file to listen, as well as the full transcript below.

• Q: I am being weaned from an SSRI, Lexapro. It is very difficult. I had no idea it could be this bad. Muscle aches, cold sweats, headache and more — is this normal?
• Q: Can you talk about cannabis and SSRIs? What about interactions of these two with Long Covid and/or Long Vax sequelae?
• Q: Does Dr. Josef see the importance of testing for MTHFR gene mutations?
• Q: How soon in SSRI use can someone develop these issues?
• Q: Do you evaluate patients’ mitochondrial health when determining root causes of depression?

Q: I am being weaned from an SSRI, Lexapro. It is very difficult. I had no idea it could be this bad. Muscle aches, cold sweats, headache and more — is this normal?

A: Yes, that is normal, especially if you are being weaned really quickly. What I would recommend is to go back up to the last dose where you didn’t have uncomfortable withdrawal symptoms and then do another reduction that is smaller. Mild to moderate withdrawal symptoms are natural when you’re coming off these medications – it’s what your brain does as it’s readjusting to being off the medications. But if those symptoms are severe and getting in the way of your ability to function, I would do a slower taper.

Q: Can you talk about cannabis and SSRIs? What about interactions of these two with Long Covid and/or Long Vax sequelae?

A: Long COVID or vax sequelae – I think about these as neurological insults for many patients with brain fog and different symptoms. I don’t think SSRIs are that useful for this condition because they’re just masking the symptoms. They can potentially help symptomatically with some of the anxiety, but you have to wonder how long this will be effective, and generally long-term with SSRIs I do see them waning over time with issues afterwards.

Moving on to cannabis – I see it functionally similar to SSRIs in that it’s palliative, something to mask symptoms that can cause dependence over time. Is this less harmful than SSRIs? Honestly, I think it probably is less harmful in some ways. I think it’s easier to come off cannabis than SSRIs, and I’m not seeing as many long-term neurological issues with cannabis. But it depends on what type of cannabis you’re using, as some high-potency cannabis can cause issues as well.
Finding non-drug methods to deal with neurological injuries is better if possible – lifestyle interventions like dietary changes, moving your body, and spiritual/psychological approaches like spending time with family. A big part of suffering with chronic illness can be resisting it. The resistance and anxiety about a state can make it much worse. I’d recommend the book “How to be Sick” which talks about the mental state needed to endure chronic illness, because long COVID and vax sequelae can get better for many people.

Q: Does Dr. Josef see the importance of testing for MTHFR gene mutations?

A: Yes, for some people I think it’s important to look at that mutation for depression and anxiety. Certain alleles are linked with reduced amounts of folate in the nervous system. What I want to caution people against is getting nitpicky about this and going straight for MTHFR while ignoring what I call “the core five”:

• Are your relationships in order? Are you socially isolated?
• Do you have purpose and meaning in your life? Do you like what you do?
• Are you physically healthy? Are you nourishing your body well?
• Are you moving your body? Are you avoiding drugs, alcohol, and excessive caffeine/stimulants?
• Do you have direction in life? Do you have a moral code and good values that guide you?

I often see people jump to supplements or testing without working on these really big boulders first. Yes, by all means do MTHFR testing, but first get the rest of the house in order. I only look for these sort of zebras after addressing those major things.

Q: How soon in SSRI use can someone develop these issues?

A: Generally, it’s after several years, sometimes decades, but there are always exceptions. I’ve seen some people who were on them for a very short period and developed problems like PSSD, or tried to come off after six months and were really sensitive to withdrawal. That’s extremely uncommon though – generally we’re talking about people who have been on these medications for years.

Q: Do you evaluate patients’ mitochondrial health when determining root causes of depression?

A: Mitochondrial health, at least the way I see it, is a downstream effect of pretty much everything. Social isolation leads to stress that can overwhelm the body and cause poor mitochondrial health. Same with lack of purpose and meaning, medical problems, poor diet, not moving your body, exposure to drugs – all of these will damage the mitochondria. When you live in alignment with essentially how we’re meant to be functioning, how we evolved to function, and spiritually how we’re meant to function, I believe your mitochondrial health will come into order.