Prevention Over Prescription with Dr. K
Aug 18, 2026 · 52 min · 21 segments
In this episode of Prevention Over Prescription with Dr. K, we revist a great episode with psychiatrist and neuroscientist Dr. Dave Rabin to explore how mental health care is evolving beyond a purely…
Kwadwo KyeremantengHostAnd I, I think that, you know, where we're going has a lot to do with w- where we came from, right? And I think we often lose tr- lose sight of the history, but history's really important.
And, and over time, actually in large part thanks to the discovery of, uh, psychedelic substances like LSD, we were able to start to elucidate the, what was, like, how important the serotonin system is, and for regulating our mood and also g- all the way going down to our gut.
And that's when we started to actually, in large part thanks to the discovery of LSD, we were able to the s- then inadvertently allow, uh, enable big pharmaceutical companies to launch a serotonergic w- approach to now what we called for the last 40 or 50 years biological psychiatry, right?
Where the entire field of medicine was focused on how do we treat psychiatry like a physical illness, where you just give somebody, rather than thinking about it like a chronic long-term issue that might be stemming from past trauma, which is what it actually is, the f- the, our field went into, well, maybe there's a mo- a molecular origin for these issues people are having, and if there is, then maybe that's why m- MAOI inhibitors and tricyclic antidepressants and these early antidepressant medicines are working because they're acting on that system, so maybe it's a serotonin deficiency.
And so that kind of started this era of biological psychiatry that resulted in everybody thinking and, and in large part, [clears throat] you know, big corporate entities convincing us that there is a quick fix silver bullet to mental illness like you are treating an infection with antibiotics.
And so m- m- family medicine doctors who are on the front lines, and pediatricians and, um, and of course psychiatrists, but 50% of mental health patients are seen by non-psychiatrists in primary care in the US.
And people are just handing out prescriptions for SSRIs, SNRIs, antidepressants of all kinds, benzodiazepines, which are very dangerous and addictive, opiate narcotics for, for pain, oftentimes treating chronic physical pain that i- is perceived as physical pain, but it's actually, uh, u- un- unprocessed emotional pain that's manifesting physically, right?
So we don't wanna treat that with opiates, as one example, because that, those people have a very high degree of likelihood of addiction and overdose ultimately.
So there, so, so looking at where now where we, we are, we're in an opioid epidemic, right? And today we're in a, uh, the substance use r- substance abuse rates, including opiates, in large part now mostly started by doctors, are on the rise across all domains in the recreational drug space.
O- opioid overdoses are higher than they've ever been, and we have higher rates of mental illness than we ever have had.
And that's after 30 to 50 years of having new biological approaches that we've been giving to everybody.
Right? If everything's getting worse [laughs] right, we as the doctors, the researchers, we have to, like, maybe take a look and be a- at ourselves and what we're doing and be like, "Okay, wait.
Is this working? If 50% of people are not getting better, is this working? If 70% of people are not getting better, is, is our, maybe our basis for how we treat mental illness is off, and let's go back and reevaluate." So that's kind of where we are right now is we're in the process of updating psychology and psychiatry with the latest neuroscience on understanding how mental ill- what the evidence really shows about how mental illness, what's at the root of it, which is usually, in almost all cases, unprocessed s- uh, trauma that's stored in the body, and it's the processing of that that gets it out in all, like, and, and helps people heal in all different kinds of ways.
And d- do you feel like people are drinking the Kool-Aid, like, uh, like in terms of folks in the mental health space, in terms of, "Hey, we have been treating this from a, a biological perspective for years now," and as you mentioned, we're seeing numbers on the rise for multiple reasons.
B- but, but I'm, I'm wondering, are you on an island? Are you, do you feel like you're riding this, this wave solo?
And I, I think that, you know, where we're going has a lot to do with w- where we came from, right? And I think we often lose tr- lose sight of the history, but history's really important.
And, and over time, actually in large part thanks to the discovery of, uh, psychedelic substances like LSD, we were able to start to elucidate the, what was, like, how important the serotonin system is, and for regulating our mood and also g- all the way going down to our gut.
And that's when we started to actually, in large part thanks to the discovery of LSD, we were able to the s- then inadvertently allow, uh, enable big pharmaceutical companies to launch a serotonergic w- approach to now what we called for the last 40 or 50 years biological psychiatry, right?
Where the entire field of medicine was focused on how do we treat psychiatry like a physical illness, where you just give somebody, rather than thinking about it like a chronic long-term issue that might be stemming from past trauma, which is what it actually is, the f- the, our field went into, well, maybe there's a mo- a molecular origin for these issues people are having, and if there is, then maybe that's why m- MAOI inhibitors and tricyclic antidepressants and these early antidepressant medicines are working because they're acting on that system, so maybe it's a serotonin deficiency.
And so that kind of started this era of biological psychiatry that resulted in everybody thinking and, and in large part, [clears throat] you know, big corporate entities convincing us that there is a quick fix silver bullet to mental illness like you are treating an infection with antibiotics.
And so m- m- family medicine doctors who are on the front lines, and pediatricians and, um, and of course psychiatrists, but 50% of mental health patients are seen by non-psychiatrists in primary care in the US.
And people are just handing out prescriptions for SSRIs, SNRIs, antidepressants of all kinds, benzodiazepines, which are very dangerous and addictive, opiate narcotics for, for pain, oftentimes treating chronic physical pain that i- is perceived as physical pain, but it's actually, uh, u- un- unprocessed emotional pain that's manifesting physically, right?
So we don't wanna treat that with opiates, as one example, because that, those people have a very high degree of likelihood of addiction and overdose ultimately.
So there, so, so looking at where now where we, we are, we're in an opioid epidemic, right? And today we're in a, uh, the substance use r- substance abuse rates, including opiates, in large part now mostly started by doctors, are on the rise across all domains in the recreational drug space.
O- opioid overdoses are higher than they've ever been, and we have higher rates of mental illness than we ever have had.
And that's after 30 to 50 years of having new biological approaches that we've been giving to everybody.
Right? If everything's getting worse [laughs] right, we as the doctors, the researchers, we have to, like, maybe take a look and be a- at ourselves and what we're doing and be like, "Okay, wait.
Is this working? If 50% of people are not getting better, is this working? If 70% of people are not getting better, is, is our, maybe our basis for how we treat mental illness is off, and let's go back and reevaluate." So that's kind of where we are right now is we're in the process of updating psychology and psychiatry with the latest neuroscience on understanding how mental ill- what the evidence really shows about how mental illness, what's at the root of it, which is usually, in almost all cases, unprocessed s- uh, trauma that's stored in the body, and it's the processing of that that gets it out in all, like, and, and helps people heal in all different kinds of ways.
And d- do you feel like people are drinking the Kool-Aid, like, uh, like in terms of folks in the mental health space, in terms of, "Hey, we have been treating this from a, a biological perspective for years now," and as you mentioned, we're seeing numbers on the rise for multiple reasons.
B- but, but I'm, I'm wondering, are you on an island? Are you, do you feel like you're riding this, this wave solo?
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