While he’s in the prison’s custody, it’s their responsibility to provide him with his prescribed medication, and the judge knows that they haven’t been doing so. The judge has been presented with a statement from the defendant’s HCP stating that he “will be severely negatively impacted in his ability to assist in his own defense,” but the judge is ignoring this because he thinks Bankman-Fried “seems fine.” That doesn’t piss you off? You’re lucky if you’ve never had to experience someone in a position of authority over you saying that you’re obviously fine when you know you’re not.

He has a prescription for 3-4x 10mg tablets per day. He has not been receiving that.

He also has a prescription for Ensam that he has not been consistently receiving. Ensam interacts with Adderall, and getting both of them inconsistently could have even more dramatic effects. I’m not sure how going off Ensam compares to other anti-depressants but many of them can have pretty rough side effects.

Per the CNBC article, he did get an updated prescription for XR Adderall, but - presumably because that has to go through the prison system - the judge indicated that won’t be available until Thursday. The judge refused to delay proceedings because he hadn’t gotten an updated medical opinion on the matter:

After the jury exited Monday, Kaplan addressed the issue, saying that he got notice that the extended-release Adderall that was requested would not be available until Thursday. The judge added that he had not observed a problem with Bankman-Fried in court and was inclined to proceed as planned. He did acknowledge that he was not a medical professional but noted that he had not received any updated medical opinions on the matter. “I can’t have lawyers giving drugs to people on trial,” he said.

I get the impression that he’s saying “I don’t care what your psychiatrist thinks. You’re not fidgeting or sobbing, so obviously your ADHD and depression aren’t big enough issues to delay the trial.”

Given that the medical opinion that Kaplan already received stated that it was important that Bankman-Fried receive his medication as prescribed, why does Kaplan need an update? Nothing has changed. This is the letter he received back in mid-August:

Dear Judge Kaplan:

Mr. Sam Bankman-Fried has been under my psychiatric care since February of 2019. Mr. Bankman-Fried has a history of Major Depressive Disorder and Attention Deficit Hyperactivity Disorder (ADHD).

For over 5 years, Mr. Bankman-Fried has been prescribed Emsam 9mg/24hrs transdermal patch.

The Emsam patch is FDA-approved for treatment of Major Depression. The oral version of this medication, is not FDA-approved for treatment of Major Depression. The transdermal patch allows 73% of the medication to enter the blood stream while the oral version delivers 4% into the bloodstream. Additionally, due to its interaction with the gut, the oral medication has a dangerous side effect, the potential for hypertensive crisis (a severe elevation of blood pressure), and thus it is not possibly to give a high dose of selegiline orally to compensate for the poor rate of delivery into the bloodstream. The patch is unique and there are no equivalent alternative treatments.

Of note, Mr. Bankman-Fried has tried other antidepressants (SSRI and Wellbutrin) and they were ineffective for his symptoms. Additionally, there have been times when Mr. Bankman-Fried did not have access to the Emsam patch (typically when travelling/abroad) and exhibited symptoms of depression, including lethargy, anhedonia, low motivation, and increased ruminations.

For the past 3 years, Mr. Bankman-Fried has been prescribed Adderall 10mg tablet 3-4x/day (the medication is FDA-approved for doses up to 45mg/24hrs) for ADHD. This medication has been effective for treatment of Mr. Bankman-Fried’s inattention and ADHD-related rumination.

Without the aforementioned psychiatric medications, Emsam 9mg/24hrs patch and Adderall 10mg tablets, Mr. Bankman-Fried will experience a return of his depression and ADHD symptoms and will be severely negatively impacted in his ability to assist in his own defense.

I don’t want this to be declared a mistrial or be appealed, but I firmly believe that not being given your prescription medication when you’re in court, despite your doctor having told the judge a month and a half ago that it was necessary, should be grounds for both.