Dr. Josef
@DrJosefWD • 21,963 subscribers
Board-Certified Psychiatrist | Former FDA Medical Officer | Founder of the World’s Largest Psychiatric Drug Tapering Clinic - TaperClinic
Videos
In February 2025, Tranyelle Harshman, a Wyoming mother of four with no history of violence, shot her four daughters and then took her own life. Her family describes an event completely out of character for a loving mother. In this video I examine what her medical care looked like in the months before, because according to the wrongful death lawsuit her mother has now filed, that care centered on take-home ketamine for postpartum depression. If you followed my coverage of the Lindsay Clancy case, the pattern here will be painfully familiar. According to the lawsuit and public reporting, Tranyelle sought help for postpartum depression in late 2024 and was prescribed ketamine lozenges to take at home. I want to explain why that detail matters. Ketamine is a dissociative anesthetic. In most settings it is administered under clinical supervision precisely because it can cause psychiatric disturbances, dissociation, hallucinations, and dangerous blood pressure spikes. Tranyelle reportedly experienced heart palpitations, trouble focusing, and a sense of disconnection from reality, and reported this to her provider. The response, according to the complaint, was that these reactions were common, and her dose was increased. On February 10, after taking that increased dose, the unthinkable happened. Toxicology reportedly showed a blood ketamine level four times the threshold associated with mind-altering effects and physical impairment. The clinic and provider deny wrongdoing and say the treatment followed the standard of care. A court will decide that question, and I am careful in this video to separate what is alleged from what is established. But the clinical lesson does not need to wait for a verdict, because it is the same lesson from the Clancy case: when a patient reports getting worse on a psychiatric drug, the answer is never to double down. An adverse reaction is information. Raising the dose into it is how tragedies are built. I also talk about what should surround any mother struggling after childbirth: family involved in her care, providers who listen when she says something feels wrong, and real attention to the fundamentals before and alongside any medication, not medication alone at home with no one watching. Four little girls deserved a system that treated their mother's warning signs as warnings.
Dr. Josef114,370 Aufrufe • vor 28 Tagen
Matt Walsh says temporary insanity is a myth, something from the movies. Millions of people heard him say it about the Lindsay Clancy case. In this video I respond as a psychiatrist, because I think he is asking a fair question and arriving at the wrong answer, and the difference matters enormously for how we understand this tragedy. His argument is intuitive: a functional, coherent person cannot suddenly lose all agency, commit an act like this, and then get it back. I take that seriously, and he is right that there is no lab test that can prove what was happening in someone's mind at a specific moment in the past. But that is not how the question actually gets decided. Juries integrate evidence, and in this case the evidence is unusual: months of medical records documenting a woman deteriorating on psychiatric medications while she and her husband told doctors she was getting worse, a rapid benzodiazepine taper, an antidepressant dose doubled the day before the tragedy, no motive, no history of violence, and a husband who lost his three children still standing by her. I walk through why I believe the medications drove what happened, and why I think Massachusetts' legal threshold points toward a verdict of not guilty by reason of insanity. I also respond to his framing of postpartum depression as largely an adjustment problem, hardest for the most selfish among us. The transition to motherhood is genuinely jarring, and he is not wrong that it demands the surrender of your own desires. But I have sat with too many struggling new mothers to accept selfishness as the explanation. What I see is isolation: mothers raising children far from family, without community, sleep deprived, and too often handed a prescription instead of support. I believe the enormous public interest in this case exists because so many women recognize a version of their own experience in it. And on the GoFundMe controversy, I explain why I think a grieving family seeking help through the worst circumstances imaginable deserves something better than our contempt. Whatever you conclude, this case deserves more than a culture war take. These children deserve to have the whole truth told about how this happened.
Dr. Josef85,680 Aufrufe • vor 29 Tagen
Hayden Panettiere died on August 16, five days before her 37th birthday. She was 36. This video is about what she told us about her own life while she was alive, because she was remarkably open about it, and because her story contains warnings that may save someone else. In her memoir and interviews, Hayden described being pressured to take Adderall for press events as a teenager. She described roughly a decade of addiction, the public scrutiny of her body that fed dysmorphia, and using substances to manage her mood. During Nashville she went through postpartum depression, isolation, and alcoholism while watching those same struggles get written into her character, which she described as traumatic. And she was prescribed Klonopin, a benzodiazepine, to help her cope with postpartum depression and alcohol withdrawal, alongside a reported history of opiates for chronic back pain. As a psychiatrist, that combination is what I want you to understand. Long-term benzodiazepine use is associated with worsening depression and anxiety over time, the very symptoms it gets prescribed for. And the combination of benzodiazepines and opiates carries the strongest boxed warning a drug can hold, because together they can suppress breathing during sleep. Prescribing that combination to someone with a known history of addiction and alcohol dependence is a decision that deserves scrutiny every single time it happens, for any patient, anywhere. In this video I walk through her story in her own words, what these medications do with long-term use, and the questions every patient and family should ask when these drugs are prescribed together. My condolences go to her daughter, her family, and everyone who loved her.
Dr. Josef23,435 Aufrufe • vor 1 Monat
What happens when one of psychiatry’s biggest critics meets one of its most respected defenders? I recently sat down with Awais Aftab—hailed by The Lancet as “one of psychiatry’s foremost public intellectuals" to discuss the CURRENT STATE OF PSYCHIATRY IN THE UNITED STATES He’s thoughtful, articulate, and willing to engage—something many in the field won’t do. For that, he has my respect. But… I couldn’t help but feel he was defending a sinking ship. Where I see institutional failure, he sees good intentions. Where I call for accountability, he offers grace. Was he dodging the core issues? Or offering a realistic defense? You decide. CONVERSATION REALLY STARTS AT 24 Minutes and 40 Seconds Watch me—one of psychiatry’s most outspoken critics—go head to head with one of its most respected defenders. Drop your thoughts below—respectfully. And thank you Awais Aftab for showing up. That matters.
Dr. Josef25,149 Aufrufe • vor 1 Jahr
