Podcasts about benzodiazepines

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, Peter dives into the pharmacology of sleep, exploring where sleep medications fit within the broader framework of achieving healthy, restorative sleep. He explains why sleep is a biological imperative, why behavioral and environmental interventions must remain the foundation of good sleep, and how medications can serve as useful tools when carefully matched to a person's specific sleep problem. Peter examines the major classes of prescription sleep medications, including how they work, their effects on sleep architecture, their duration of action, side effects, and risks of tolerance and dependence. He also discusses the dangers of using sleep drugs without a clear understanding of the underlying problem being treated, the role of medications as short-term bridges during periods of acute stress, pain, or anxiety, and the promise that newer drugs like DORAs may hold for Alzheimer's prevention in high-risk individuals. Finally, Peter reviews the evidence for select off-label medications and supplements commonly used for sleep. We discuss: The biological foundations of sleep, the major drivers of sleep dysfunction, and the role sleep medications can play when appropriately matched to specific sleep problems [1:00]; Sleep hygiene, circadian alignment, and the medical causes of insomnia: building the foundation for effective sleep treatment [7:15]; Understanding insomnia: hyperarousal, CBT-I, paradoxical insomnia, and why different sleep problems require different treatments [12:45]; The difference between sedation and physiologic sleep: sleep architecture, restorative sleep stages, and matching medications to specific sleep problems [17:00]; Benzodiazepines for insomnia: mechanisms, effects on sleep architecture, and the risks of long-term use [18:45]; Z-drugs for insomnia: how Ambien, Sonata, and Lunesta work, and the ongoing risks of sleep medications targeting GABA systems [23:00]; Dual orexin receptor antagonists (DORAs) and the future of sleep medicine: orexin signaling, sleep architecture, and the emerging connection between sleep and Alzheimer's disease [27:15]; Melatonin for circadian timing: how timing signals differ from sedatives in the treatment of sleep disorders [36:30]; Trazodone for insomnia: preserving deep sleep while minimizing the risks of traditional sedative-hypnotics [42:00]; First-generation antihistamines for sleep: short-term sedation, anticholinergic risks, and concerns about long-term cognitive health [44:00]; Sleep supplements and the evidence behind them: glycine, magnesium, ashwagandha, phosphatidylserine, and more [45:45]; Takeaways: supplement quality, individualized sleep treatment, and the importance of matching interventions to the biology of insomnia [52:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Does GABA Actually Help With Sleep? What the Research Says for Brain Injury Recovery Someone in our community recently asked me about GABA for sleep. They’d seen it recommended online, understood that sleep was critical for their recovery, and wanted to know whether the supplement was worth exploring or just noise. It’s a genuinely good question. And it deserves a proper answer. In this post, I’m going to walk you through what GABA is, what the clinical research actually shows about its effect on sleep, why the blood-brain barrier debate matters (and why it might not derail the whole argument), and what the evidence says about the relationship between sleep and brain recovery. By the end, you’ll have enough to have an informed conversation with your medical team. I’m not a doctor. I’m a three-time haemorrhagic stroke survivor who has spent years researching the science of brain recovery and interviewing hundreds of clinicians and survivors on the Recovery After Stroke podcast. What I offer is a careful read of the evidence, not a clinical prescription. What Is GABA and Why Does It Matter for Sleep? GABA (gamma-aminobutyric acid) is the brain’s primary inhibitory neurotransmitter. If your nervous system were a car, GABA is the brake pedal. It reduces neuronal excitability, quiets cortical arousal, suppresses the brain’s primary arousal centre (the locus coeruleus), and modulates the HPA axis, the stress-response system that drives cortisol. Most sedative medications work by amplifying GABA activity. Benzodiazepines, for instance, bind to GABA-A receptors to increase chloride channel opening, producing their calming effect. GABA isn’t doing something unusual here – it’s doing something fundamental. The question with supplemental oral GABA is more specific: Does taking GABA as a capsule or powder actually produce meaningful neurological effects? What Does the Research Show? Finding 1 — Oral GABA Reduces Sleep Latency (and EEG Can Measure It) A 2015 clinical trial published in the Journal of Nutritional Science and Vitaminology by Yamatsu and colleagues used EEG measurement, actual brainwave monitoring, rather than self-reported sleep questionnaires. One hundred milligrams of oral GABA shortened sleep latency (time to fall asleep) by 5.3 minutes compared to placebo. That might sound modest. But for someone lying awake for 30–40 minutes each night, it’s a meaningful shift. Crucially, this was objective neurophysiological data, not a survey response. (PMID: 26052150) Finding 2 — A 90-Day RCT Showed Improved Sleep Efficiency and Mood A 2024 randomised double-blind placebo-controlled trial published in the Journal of Dietary Supplements (Guimarães et al.) gave 200 mg of GABA daily for 90 days to sedentary overweight women also undergoing an exercise program. The GABA group showed significantly improved Pittsburgh Sleep Quality Index (PSQI) scores, significantly reduced depression scores, and improved heart rate variability, a marker of parasympathetic nervous system activity. The HRV finding is particularly interesting. It suggests GABA may be doing something broader than simply reducing sleep latency – it appears to support the overall physiological state that makes rest restorative. (PMID: 38321713) Finding 3 — But a High-Dose RCT Found No Effect Here’s where intellectual honesty matters. A 2023 Dutch RCT (de Bie et al.) published in the American Journal of Clinical Nutrition gave participants 500 mg of GABA three times daily, 1,500 mg/day total, and found no significant effect on self-reported sleep quality. Fasting plasma GABA wasn’t significantly elevated either, raising real bioavailability questions at that dose. This isn’t a reason to dismiss GABA entirely. It is a reason to pay attention to the dose. The evidence base supports 100–300 mg, not 1,500 mg. Higher is not better, and the non-linear dose response is clinically important. (PMID: 37495019) The Blood-Brain Barrier Debate — and Why the Gut May Be the Point The most common objection to oral GABA supplementation is this: GABA is a zwitterion at physiological pH, meaning it has low lipophilicity and poor predicted ability to cross the blood-brain barrier via passive diffusion. So if it can’t get into the brain directly, how does it produce neurological effects? The emerging explanation involves the gut-brain axis. The enteric nervous system, your gut’s own neural network, has GABA receptors. When oral GABA activates these enteric receptors, it can signal the brain via vagal afferents without needing to cross the BBB at all. Think of it as a side door rather than the front entrance. Supporting this: a 2024 RCT (Li et al.) found that a probiotic strain engineered to increase gut GABA production significantly improved objective sleep duration as measured by wearable devices, alongside reduced cortisol and suppressed HPA axis activity. The mechanism wasn’t direct CNS access – it was gut-brain signalling. (PMID: 39385735) The BBB debate doesn’t negate the clinical effect. It changes how we understand the mechanism. Why Sleep Is Not Optional in Brain Recovery This is the part that I think gets underweighted in recovery conversations — and the research is unambiguous. A 2026 large retrospective cohort study (Muhtar et al., Sleep Medicine) matched over 35,000 stroke patients and found that post-stroke insomnia was associated with a 29% higher risk of post-stroke cognitive impairment and a 30% higher risk of all-cause dementia. The association with Alzheimer’s disease was also significant. (PMID: 41924789) A 2024 observational study from Monash University and Alfred Health (Smith et al.) found that in stroke rehabilitation patients, poor sleep quality was significantly associated with higher fatigue severity and lower salivary BDNF gene expression. BDNF (brain-derived neurotrophic factor) is one of the primary molecular drivers of neuroplasticity. Less BDNF means a less receptive environment for the neurological rewiring that rehab is trying to build. (PMID: 38802847) And then there’s the glymphatic system: the brain’s waste-clearance mechanism that is most active during deep sleep. Poor sleep means reduced clearance of metabolic byproducts, including proteins associated with neurodegeneration. This is not a theoretical risk. It is an active, ongoing process. Sleep is not passive recovery. It is one of the primary mechanisms of recovery. What to Do With This Information Here are three practical steps if you’re exploring GABA for sleep: 1. Measure your sleep baseline first. Use the Pittsburgh Sleep Quality Index (freely available online) before you make any changes. Understanding whether you’re struggling with latency, duration, or quality will determine what you actually need to address. 2. If you trial GABA, choose the right form and dose. Look for PharmaGABA — naturally fermented GABA, derived from Lactobacillus hilgardii, which has the strongest clinical evidence base. A dose of 100–300 mg taken 30–60 minutes before bed is consistent with the positive studies. Avoid very high doses; the null result at 1,500 mg/day is important context. Important drug interaction note: If you are taking benzodiazepines, anticonvulsants (gabapentin, pregabalin, valproate), or any other GABAergic medication, discuss GABA supplementation with your prescriber before adding it. The additive sedative effect is a real risk. The same applies if you drink alcohol regularly. 3. Don’t skip the foundation. Sleep hygiene interventions, consistent sleep and wake times, a dark and cool room, and no screens in the 60 minutes before bed, are consistently among the highest-leverage sleep interventions in the literature. GABA may provide a genuine incremental benefit. But it cannot compensate for a fundamentally disrupted sleep environment. The Bottom Line The evidence for GABA and sleep is more substantive than I expected when I started researching it. The EEG data is real. The 90-day RCT showed meaningful clinical outcomes. The gut-brain axis mechanism is biologically plausible and now has direct RCT support. And the consequences of poor sleep in neurological recovery are not trivial – they are quantifiable, significant, and, to a degree, addressable. GABA is not a guaranteed fix. Individual responses vary. The research is not yet definitive at the level of large multi-centre trials in neurological populations. But as one tool in a comprehensive approach to sleep quality alongside good sleep hygiene, appropriate medical support, and consistent rehabilitation, the case for cautious exploration is reasonable. The next step is a conversation with your neurologist, GP, or rehab physician. Take the research with you if it’s useful. Research References All studies cited in this post are retrievable via PubMed: Yamatsu et al. — GABA sleep latency EEG clinical trial (2015) — PMID: 26052150 Guimarães et al. — GABA 200mg RCT, sleep efficiency + mood (2024) — PMID: 38321713 de Bie et al. — GABA high-dose RCT, null sleep result (2023) — PMID: 37495019 Li et al. — Gut-brain GABA axis and sleep RCT (2024) — PMID: 39385735 Muhtar et al. — Post-stroke insomnia and cognitive decline cohort (2026) — PMID: 41924789 Smith et al. — Sleep, BDNF, and fatigue in stroke rehabilitation (2024) — PMID: 38802847 This post is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making changes to your supplementation or treatment plan. If you or someone you care about is recovering from a stroke, brain injury, or any neurological condition, the Recovery After Stroke podcast and this blog exist for you. Subscribe on YouTube @BillGasiamis, or visit Recovery After Stroke to find episodes, resources, and community. The post GABA, Sleep, and Brain Health – Neurological Recovery appeared first on Recovery After Stroke.

Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses, hearing aids, and dentures Avoid excessive lines such as foleys Minimize restraints and other forms of immobilization Reassure the patient frequently and have the family check in with the patient What are the best options if medications are required? If the patient is unsafe or non-pharmacologic measures fail, consider a second-generation ("atypical") antipsychotic using the lowest effective dose: Olanzapine Risperidone Quetiapine One special consideration is Dementia with Lewy Bodies, which can be very sensitive to antipsychotics. In this case, Quetiapine is the preferred agent. Avoid when possible: Diphenhydramine and other anticholinergics, which can worsen delirium (including urinary retention and sedation) Benzodiazepines, which may worsen confusion, falls, and respiratory depression Haloperidol, which has a higher risk of extrapyramidal symptoms and QT prolongation than many atypicals References Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol. 2022 May;35(3):255-261. doi: 10.1177/0891988720988916. Epub 2021 Jan 19. PMID: 33461372. Kurlan R, Cummings J, Raman R, Thal L; Alzheimer's Disease Cooperative Study Group. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007 Apr 24;68(17):1356-63. doi: 10.1212/01.wnl.0000260060.60870.89. PMID: 17452579. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145. doi: 10.1016/j.annemergmed.2019.07.023. Epub 2019 Sep 26. PMID: 31563402; PMCID: PMC7945005. Summarized and edited by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

A world-famous academic disappears from public life - and Jordan Peterson’s daughter revealed has a "catastrophic" neurological injury. Plus, Treasurer Jim Chalmers warns that Australia's economy is now "hostage" to decisions made by the White House and Tehran, and Barnaby Joyce brushes off One Nation’s Newspoll slump. Read more: Jordan Peterson’s daughter reveals psychologist has ‘catastrophic’ medication-related neurological injury Australia ‘hostage’ to US-Iran war with potentially ‘severe’ consequences, warns Jim Chalmers Sean Black saga to blame for One Nation’s stumble in polls: Barnaby JoyceSee omnystudio.com/listener for privacy information.

We discuss this ominous complication of providing local anesthesia. Hosts: Elaine Jonas, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption. Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue. Agent Profile: Bupivacaine (High Risk) Highly lipophilic with high protein binding. “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole. Myocardial Depression: Direct inhibition of Ca2+ release from the sarcoplasmic reticulum, impairing contractility. Low CC:CNS Ratio: The dose required for cardiac collapse is very close to the dose that triggers seizures (narrow safety margin). Contributing Factors: Acidosis/Hypercapnia: Increases the fraction of free drug and promotes ion trapping in the brain/heart; shifts the LA-binding curve toward higher toxicity. Hypoxemia: Exacerbates myocardial depression and lowers seizure threshold. II. Risk Assessment & Prevention Patient-Specific Risk Factors Extremes of Age: Neonates (low α-1-acid glycoprotein) and elderly (reduced clearance). Body Composition: Low muscle mass/frailty (decreased volume of distribution). Organ Dysfunction: Hepatic: Reduced metabolism of amide LAs. Renal: Accumulation of metabolites; risk of metabolic acidosis lowering seizure threshold. Cardiac: Reduced cardiac output slows hepatic delivery/clearance; heart failure patients are more sensitive to Na+ channel blockade. Pregnancy: Increased sensitivity to cardiotoxicity. Procedural Risk Factors Vascularity of Site (Highest to Lowest Risk): Intercostal blocks (highest absorption rate). Caudal/Epidural. Interfascial plane blocks (e.g., TAP block). Psoas compartment/Sciatic. Brachial plexus. Technique: Large volume infiltration, lack of ultrasound, lack of incremental injection. Prevention Mandates Weight-Based Dosing: Lidocaine (Plain): Max 4.5 mg/kg. Lidocaine (with Epi): Max 7 mg/kg. Bupivacaine: Max 2.5–3 mg/kg. Incremental Injection: 3–5 mL aliquots with frequent aspiration. Intravascular Marker: Use Epinephrine (1:200,000) to detect accidental IV placement (HR increase >10 bpmor SBP increase >15 mmHg). III. Clinical Presentation Neurologic Phase (Early to Late) Subjective: Metallic taste, tinnitus, circumoral numbness/tingling. Objective: Visual disturbances, agitation, confusion, tremors. Critical: Generalized tonic-clonic seizures, rapid progression to CNS depression, coma, and apnea. Note: Early phases are often masked in patients receiving midazolam or propofol. Cardiovascular Phase Initial: Hypertension and tachycardia (if epi used) or transient stimulatory phase. Conduction Defects: PR prolongation, QRS widening (classic sign), bundle branch blocks. Dysrhythmias: Bradycardia (most common), VT/VF, PEA, asystole. Contractility: Profound, refractory hypotension and cardiogenic shock. IV. Immediate Management Algorithm Goal: Prevent hypoxia/acidosis and sequester the toxin. 1. Initial Actions Stop Injection: Immediately halt all LA administration. Call for Help: Specify “LAST Protocol” and “Intralipid Kit.” Airway Management: 100% O2​. Hyperventilate slightly if needed to counter respiratory acidosis. Low threshold for intubation (hypoxia/acidosis rapidly worsen LAST). 2. Seizure Control First-line: Benzodiazepines (e.g., Midazolam). Avoid: Propofol if hemodynamically unstable (exacerbates cardiac depression). Neuromuscular Blockers: May be needed for ventilation, but remember they do not stop CNS seizure activity. 3. Lipid Emulsion Therapy 20% Indications: Start at first sign of serious toxicity (airway compromise, seizures, or CV instability). Bolus: 1.5 mL/kg IV over 1 minute. Infusion: 0.25 mL/kg/min immediately following bolus. If Instability Persists: Repeat bolus (up to 2 times). Increase infusion to 0.5 mL/kg/min. Upper Limit: ≈12 mL/kg total dose. 4. Modified ACLS Epinephrine: Use low doses (

Benzodiazepines can feel like flipping a switch: panic quiets, sleep finally comes, your body unclenches. But what happens when that “off switch” starts rewiring the system you rely on to stay calm in the first place? Dr Andrew Rizzo joins me to dig into the biology behind chronic benzodiazepine use and why so many clinicians now recognize benzodiazepine-induced neurological dysfunction (BIND) as a real, patient-altering condition rather than a vague catch-all for “rebound anxiety.” We walk through the GABA receptor in plain language, including why benzodiazepines act as positive allosteric modulators, how the brain chases homeostasis by downregulating inhibition and upregulating glutamate, and why tolerance is structural not moral. Then we connect the molecular story to the clinical reality: why abrupt benzo cessation can be life-threatening, how seizure risk emerges, what “kindling” means for repeat withdrawal attempts, and why a slow benzodiazepine taper often takes months, not weeks. We also spend time on what patients and families actually need during recovery: validation, steady follow-up, and a plan that treats this like a fragile neurobiological injury. If you're a clinician, a patient, or someone supporting a loved one, you'll leave with clearer language, sharper warning signs, and a better mental model for why symptoms like photophobia, tinnitus, tremor, and cognitive fog can persist long after the last pill. Subscribe, share this with someone who needs it, and leave a review with your biggest question about benzos and withdrawal.To contact Dr. Grover: ammadeeasy@fastmail.com

For many of us, this coming weekend marks the start of Daylight Saving Time, when we “spring forward” and move our clocks ahead by an hour. While the extra evening daylight can be one of the joys of the summer months, the time change has been known to disrupt our sleep.  Last year we sat down with neurobiologist Jamie Zeitzer, a leading expert on sleep, to talk about practical strategies for getting a better night's rest. As we approach this transition, it's the perfect time to revisit that conversation. We hope you'll add this episode to your podcast queue and give it another listen this weekend. Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu. Episode Reference Links: Stanford Profile: Jamie Zeitzer Connect With Us: Episode Transcripts >>> The Future of Everything Website Connect with Russ >>> Threads / Bluesky / Mastodon Connect with School of Engineering >>> Twitter/X / Instagram / LinkedIn / Facebook Chapters: (00:00:00) Introduction Russ Altman introduces guest Jamie Zeitzer, professor of psychiatry and behavioral sciences at Stanford University. (00:02:01) Understanding Circadian Rhythms How the biological clock regulates sleep and other body functions. (00:03:45) The Mystery of Sleep's Purpose What is still unknown about the fundamental need for sleep. (00:04:49) Light & the Circadian Clock The impact light exposure has on the body's internal sleep timing. (00:07:02) Day & Night Light Contrast The importance of creating a light-dark contrast for healthy rhythms. (00:10:06) Phones, Screens, & the Blue Light Whether blue light from screen use affects sleep quality. (00:12:37) Defining & Diagnosing Sleep Problems How stress and over-focus on sleep quality worsen insomnia. (00:14:50) Sleep Anxiety & Wearables The psychological downsides of sleep data from tracking devices. (00:16:03) CBT-I & Rethinking Insomnia Mentally reframing sleep with cognitive behavioral therapy for insomnia (00:19:50) Desynchronized Sleep Patterns Studying student sleep patterns to separate circadian vs. sleep effects. (00:22:37) Shift Work & Circadian Misalignment The difficulty of re-aligning circadian clocks in rotating shifts. (00:25:14) Effectiveness of Sleep Medications The various drugs used to promote sleep and their pros and cons. (00:28:34) Circadian “Sleep Cliff” & Melatonin The brain's “wake zone” before sleep and the limited effects of melatonin. (00:31:41) Do's & Don'ts for Better Sleep Advice for those who want to improve their sleep quality. (00:33:44) Alcohol and Caffeine Effects How metabolism influences the effects of alcohol and caffeine on sleep. (00:36:13) Conclusion Connect With Us:Episode Transcripts >>> The Future of Everything WebsiteConnect with Russ >>> Threads / Bluesky / MastodonConnect with School of Engineering >>>Twitter/X / Instagram / LinkedIn / Facebook Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Opioids, Methamphetamines & Benzodiazepines In Part 2 of our evidence-based series on substance use in pregnancy, we're diving into substances that often come with the most fear—and the most misinformation. In this episode, we cover: Opioids (including prescription pain medications, heroin, and fentanyl) Stimulants, including methamphetamine Benzodiazepines (such as Xanax, Ativan, and Klonopin) We break down what the medical research actually shows about how these substances can affect pregnancy, the fetus, and the newborn—without judgment, shame, or scare tactics. We also talk about neonatal abstinence syndrome, treatment options during pregnancy, and why supportive, medically guided care leads to better outcomes for both parent and baby. Whether you're pregnant, supporting someone who is, or simply want reliable information, this episode is about replacing fear with facts and stigma with science.

Contributor: Alec Coston, MD Educational Pearls: BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia. Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true physiologic improvement). Low-dose fentanyl is a useful alternative when patients cannot tolerate BiPAP despite coaching. Opioids blunt the perception of dyspnea and are well established for treating air hunger. When carefully titrated, fentanyl provides anxiolysis without significant respiratory suppression. It is rapidly titratable (e.g., 25 mcg IV every 5 minutes). Evidence primarily comes from palliative and oncology literature, but growing clinical experience supports its use in severe asthma to improve BiPAP tolerance. Failure of fentanyl should prompt escalation to ketamine, often signaling impending need for intubation. References Pang GS, Qu LM, Tan YY, Yee AC. Intravenous Fentanyl for Dyspnea at the End of Life: Lessons for Future Research in Dyspnea. Am J Hosp Palliat Care. 2016 Apr;33(3):222-7. doi: 10.1177/1049909114559769. Epub 2014 Nov 25. PMID: 25425740. Summarized and edited by Meg Joyce, MS2 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Psychogenic nonepileptic seizures (PNES) are common, often misunderstood, and increasingly encountered in pediatric emergency care. These events closely resemble epileptic seizures but arise from abnormal brain network functioning rather than epileptiform activity. In this episode of PEM Currents, we review the epidemiology, pathophysiology, and clinical features of PNES in children and adolescents, with a practical focus on Emergency Department recognition, diagnostic strategy, and management. Particular emphasis is placed on seizure semiology, avoiding iatrogenic harm, communicating the diagnosis compassionately, and understanding how early identification and referral to cognitive behavioral therapy can dramatically improve long-term outcomes. Learning Objectives Identify key epidemiologic trends, risk factors, and semiological features that help differentiate psychogenic nonepileptic seizures from epileptic seizures in pediatric patients presenting to the Emergency Department. Apply an evidence-based Emergency Department approach to the evaluation and initial management of suspected PNES, including strategies to avoid unnecessary escalation of care and medication exposure. Demonstrate effective, patient- and family-centered communication techniques for explaining the diagnosis of PNES and facilitating timely referral to appropriate outpatient therapy. References Sawchuk T, Buchhalter J, Senft B. Psychogenic Nonepileptic Seizures in Children-Prospective Validation of a Clinical Care Pathway & Risk Factors for Treatment Outcome. Epilepsy & Behavior. 2020;105:106971. (PMID: 32126506) Fredwall M, Terry D, Enciso L, et al. Outcomes of Children and Adolescents 1 Year After Being Seen in a Multidisciplinary Psychogenic Nonepileptic Seizures Clinic. Epilepsia. 2021;62(10):2528-2538. (PMID: 34339046) Sawchuk T, Buchhalter J. Psychogenic Nonepileptic Seizures in Children - Psychological Presentation, Treatment, and Short-Term Outcomes. Epilepsy & Behavior. 2015;52(Pt A):49-56. (PMID: 26409129) Labudda K, Frauenheim M, Miller I, et al. Outcome of CBT-based Multimodal Psychotherapy in Patients With Psychogenic Nonepileptic Seizures: A Prospective Naturalistic Study. Epilepsy & Behavior. 2020;106:107029. (PMID: 32213454) Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski, and today we are talking about psychogenic non-epileptic seizures, or PNES. Now, this is a diagnosis that often creates a lot of uncertainty in the Emergency Department. These episodes can be very scary for families and caregivers and schools. And if we mishandle the diagnosis, it can lead to unnecessary testing, medication exposure, ICU admissions, and long-term harm. This episode's gonna focus on how to recognize PNES in pediatric patients, how we make the diagnosis, what the evidence says about management and outcomes, and how what we do and what we say in the Emergency Department directly affects patients, families, and prognosis. Psychogenic non-epileptic seizures are paroxysmal events that resemble epileptic seizures but occur without epileptiform EEG activity. They're now best understood as a subtype of functional neurological symptom disorder, specifically functional or dissociative seizures. Historically, these events were commonly referred to as pseudo-seizures, and that term still comes up frequently in the ED, in documentation, and sometimes from families themselves. The problem is that pseudo implies false, fake, or voluntary, and that implication is incorrect and harmful. These episodes are real, involuntary, and distressing, even though they're not epileptic. Preferred terminology includes psychogenic non-epileptic seizures, or PNES, functional seizures, or dissociative seizures. And PNES is not a diagnosis of exclusion, and it does not require identification of psychological trauma or psychiatric disease. The diagnosis is based on positive clinical features, ideally supported by video-EEG, and management begins with clear, compassionate communication. The overall incidence of PNES shows a clear increase over time, particularly from the late 1990s through the mid-2010s. This probably reflects improved recognition and access to diagnostic services, though a true increase in occurrence can't be excluded. Comorbidity with epilepsy is really common and clinically important. Fourteen to forty-six percent of pediatric patients with PNES also have epilepsy, which frequently complicates diagnosis and contributes to diagnostic delay. Teenagers account for the highest proportion of patients with PNES, especially 15- to 19-year-olds. Surprisingly, kids under six are about one fourth of all cases, so it's not just teenagers. We often make the diagnosis of PNES in epilepsy monitoring units. So among children undergoing video-EEG, about 15 to 19 percent may ultimately be diagnosed with PNES. And paroxysmal non-epileptic events in tertiary epilepsy monitoring units account for about 15 percent of all monitored patients. Okay, but what is PNES? Well, it's best understood as a disorder of abnormal brain network functioning. It's not structural disease. The core mechanisms at play include altered attention and expectation, impaired integration of motor control and awareness, and dissociation during events. So the patients are not necessarily aware that this is happening. Psychological and psychosocial features are common but not required for diagnosis and may be less prevalent in pediatric populations as compared with adults. So PNES is a brain-based disorder. It's not conscious behavior, it's not malingering, and it's not under voluntary control. Children and adolescents with PNES have much higher rates of psychiatric comorbidities and psychosocial stressors compared to both healthy controls and children with epilepsy alone. Psychiatric disorders are present in about 40 percent of pediatric PNES patients, both before and after the diagnosis. Anxiety is seen in 58 percent, depression in 31 percent, and ADHD in 35 percent. Compared to kids with epilepsy, the risk of psychiatric disorders in PNES is nearly double. Compared to healthy controls, it is up to eight times higher. And there's a distinct somatopsychiatric profile that strongly predicts diagnosis of PNES. This includes multiple medical complaints, psychiatric symptoms, high anxiety sensitivity, and solitary emotional coping. This profile, if you've got all four of them, carries an odds ratio of 15 for PNES. Comorbid epilepsy occurs in 14 to 23 percent of pediatric PNES cases, and it's associated with intellectual disability and prolonged diagnostic delay. And finally, across all demographic strata, anxiety is the most consistent predictor of PNES. Making the diagnosis is really hard. It really depends on a careful history and detailed analysis of the events. There's no single feature that helps us make the diagnosis. So some of the features of the spells or events that have high specificity for PNES include long duration, so typically greater than three minutes, fluctuating or asynchronous limb movements, pelvic thrusting or side-to-side head movements, ictal eye closure, often with resisted eyelid opening, ictal crying or vocalization, recall of ictal events, and rare association with injury. Younger children often present with unresponsiveness. Adolescents more commonly demonstrate prominent motor symptoms. In pediatric cohorts, we most frequently see rhythmic motor activity in about 27 percent, and complex motor movements and dialeptic events in approximately 18 percent each. Features that argue against PNES include sustained cyanosis with hypoxia, true lateral tongue biting, stereotyped events that are identical each time, clear postictal confusion or lethargy, and obviously epileptic EEG changes during the events themselves. Now there are some additional historical and contextual clues that can help us make the diagnosis as well. If the events occur in the presence of others, if they occur during stressful situations, if there are psychosocial stressors or trauma history, a lack of response to antiepileptic drugs, or the absence of postictal confusion, this may suggest PNES. Lower socioeconomic status, Medicaid insurance, homelessness, and substance use are also associated with PNES risk. While some of these features increase suspicion, again, video-EEG remains the diagnostic gold standard. We do not have video-EEG in the ED. But during monitoring, typical events are ideally captured and epileptiform activity is not seen on the EEG recording. Video-EEG is not feasible for every single diagnosis. You can make a probable PNES diagnosis with a very accurate clinical history, a vivid description of the signs and appearance of the events, and reassuring interictal EEG findings. Normal labs and normal imaging do not make the diagnosis. Psychiatric comorbidities are not required. The diagnosis, again, rests on positive clinical features. If the patient can't be placed on video-EEG in a monitoring unit, and if they have an EEG in between events and it's normal, that can be supportive as well. So what if you have a patient with PNES in the Emergency Department? Step one, stabilize airway, breathing, circulation. Take care of the patient in front of you and keep them safe. Use seizure pads and precautions and keep them from falling off the bed or accidentally injuring themselves. A family member or another team member can help with this. Avoid reflexively escalating. If you are witnessing a PNES event in front of you, and if they're protecting their airway, oxygenating, and hemodynamically stable, avoid repeated benzodiazepines. Avoid intubating them unless clearly indicated, and avoid reflexively loading them with antiseizure medications such as levetiracetam or valproic acid. Take a focused history. You've gotta find out if they have a prior epilepsy diagnosis. Have they had EEGs before? What triggered today's event? Do they have a psychiatric history? Does the patient have school stressors or family conflict? And then is there any recent illness or injury? Only order labs and imaging when clinically indicated. EEG is not widely available in the Emergency Department. We definitely shouldn't say things like, “this isn't a real seizure,” or use outdated terms like pseudo-seizure. Don't say it's all psychological, and please do not imply that the patient is faking. If you see a patient and you think it's PNES, you're smart, you're probably right, but don't promise diagnostic certainty at first presentation. Remember, a sizable proportion of these patients actually do have epilepsy, and referring them to neurology and getting definitive testing can really help clarify the diagnosis. Communication errors, especially early on, worsen outcomes. One of the most difficult things is actually explaining what's going on to families and caregivers. So here's a suggestion. You could say something like: “What your child is experiencing looks like a seizure, but it's not caused by abnormal electrical activity in the brain. Instead, it's what we call a functional seizure, where the brain temporarily loses control of movement and awareness. These episodes are real and involuntary. The good news is that this condition is treatable, especially when we address it early.” The core treatment of PNES is CBT-based psychotherapy, or cognitive behavioral therapy. That's the standard of care. Typical treatment involves 12 to 14 sessions focused on identifying triggers, modifying maladaptive cognitions, and building coping strategies. Almost two thirds of patients achieve full remission with treatment. About a quarter achieve partial remission. Combined improvement rates reach up to 90 percent at 12 months. Additional issues that neurologists, psychologists, and psychiatrists often face include safe tapering of antiseizure medications when epilepsy has been excluded, treatment of comorbid anxiety or depression, coordinating care between neurology and mental health professionals, and providing education for schools on event management. Schools often witness these events and call prehospital professionals who want to keep patients safe. Benzodiazepines are sometimes given, exposing patients to additional risk. This requires health system-level and outpatient collaboration. Overall, early diagnosis and treatment of PNES is critical. Connection to counseling within one month of diagnosis is the strongest predictor of remission. PNES duration longer than 12 months before treatment significantly reduces the likelihood of remission. Video-EEG confirmation alone does not predict positive outcomes. Not every patient needs admission to a video-EEG unit. Quality of communication and speed of treatment, especially CBT-based therapy, matter the most. Overall, the prognosis for most patients with PNES is actually quite favorable. There are sustained reductions in events along with improvements in mental health comorbidities. Quality of life and psychosocial functioning improve, and patients use healthcare services less frequently. So here are some take-home points about psychogenic non-epileptic seizures, or PNES. Pseudo-seizure and similar terms are outdated and misleading. Do not use them. PNES are real, involuntary, brain-based events. Diagnosis relies on positive clinical features, what the events look like and when they happen, not normal lab tests or CT scans. Early recognition and diagnosis, and rapid referral to cognitive behavioral therapy, change patients' lives. If you suspect PNES, get neurology and mental health professionals involved as soon as possible. Alright, that's all I've got for this episode. I hope you found it educational. Having seen these events many times over the years, I recognize how scary they can be for families, schools, and our prehospital colleagues. It's up to us to think in advance about how we're going to talk to patients and families and develop strategies to help children who are suffering from PNES events. If you've got feedback about this episode, send it my way. Likewise, like, rate, and review, as my teenagers would say, and share this episode with a colleague if you think it would be beneficial. For PEM Currents: The Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.

Per aquest Menys és Més us portem una recomanació de l’Essencial que ens diu que en les persones grans, el delírium no s’hauria de prevenir ni tractar de manera rutinària amb benzodiazepines, excepte en els casos en què sigui causat per la privació d’alcohol o de sedants. Transcripció de l’àudio

Send us a text**CAUTION** This episode discussed suicide, suicidal ideation, drug dependency. PROCEED WITH CAUTION.This is a chronology of my serious health scare in 2025 and my subsequent dependency on Xanax. During this time I suffered suicidal ideation. I was aware of the resources available to me and I didn't reach out. Please don't make the same mistake and suffer needlessly.Here are some trusted mental health resources: National Suicide Hotline: Dial 988Crisis Text LineNational Alliance on Mental HealthSubstance Abuse and Mental Health ServicesAlso in this episode is my 2026 line-up of guests!Contact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comYour review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast I've partnered with RNegade.pro! You can earn CE's just by listening to my podcast episodes! Check out my CE library here: https://rnegade.thinkific.com/collections/conversing-nurse-podcast Thanks for listening!

In this episode of Your Health University, Jamie sits down with Dr. Jimmie Williamson, Chief Behavioral Health Officer at Your Health, to break down why behavioral health belongs inside primary care—not outside it. Jimmie explains how telehealth lowered stigma, how mental health diagnoses (“F codes”) often correlate with frequent ER use, and why Your Health moved from intuition to data-driven referral models using tools like Power BI. They also map the full behavioral health ecosystem—from psych nurse practitioners to therapists to the psych pharmacist—and clarify when and how teams should refer patients for the right level of support. The takeaway is simple: earlier behavioral health intervention can improve lives, reduce hospital visits, and strengthen value-based care outcomes system-wide. www.YourHealth.Org

Dr. Roger McFillin was interviewed by Renaud Beauchard from Tocsin Media—France's leading independent media platform with 30 million monthly views. In this unflinching conversation, Dr. Roger McFillin exposes what he calls a deliberate psychological operation on the American people: a system designed not to heal but to create lifelong customers, sever your connection to God, and make you dependent on medical authority for problems that were never diseases in the first place. The chemical imbalance theory? Born in pharmaceutical marketing rooms, not laboratories. ADHD? A label that stops investigation into the real causes poisoning our children. This isn't incompetence. It's an attack on human consciousness itself. And the first step to freedom is understanding exactly how they did it to you. Visit Center for Integrated Behavioral HealthDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)10% off Lovetuner click here

I am thrilled to have Dr. Olivera Bogunovic and Holly Hardman with me on the show today. Dr. Bogunovic is an assistant professor of psychiatry at Harvard Medical School and the medical director of the alcohol, drug, and addiction outpatient program at McLean Hospital. and Holly directed the documentary As Prescribed. In today's discussion, we dive into the ongoing benzodiazepine crisis in the United States, with over 92 million prescriptions written each year for medications like Ativan, Valium, Xanax, and Klonopin. We discuss the origin of those drugs in the 1970s as treatments for anxiety and how they lead to tremendous physical dependency. Holly shares her experience with the neurological effects she suffered after long-term use of Klonopin, and we examine challenges in psychiatric care, the need for informed consent, and the impact of social media. We also cover the role of lifestyle, the need for psychotherapy and psychosocial support, and the significance of hope. This conversation is truly invaluable! Given how frequently benzodiazepines get prescribed, everyone must understand their associated risks and considerations. IN THIS EPISODE YOU WILL LEARN: How prescribing practices have evolved over the last two decades The significant consequences older adults face when they suddenly stop using benzodiazepines  Holly shares how doctors misinformed her when she began taking Klonopin.  Holly describes the benzodiazepine-induced symptoms and cognitive issues she experienced Why people must get informed about the long-term effects of benzodiazepines when consenting to take them How benzodiazepines work in the body and impact the brain Why benzodiazepines are ineffective when used long-term for insomnia The challenges certain people face when accessing psychiatric care What is BIND, and what are its symptoms? The significance of diet and holistic approaches for managing mental health, and why community support is essential in the recovery process Why As Prescribed is an educational documentary for everyone Connect with Cynthia Thurlow   Follow on X ⁠Instagram⁠ ⁠LinkedIn⁠ Check out Cynthia's ⁠website⁠ Submit your questions to ⁠support@cynthiathurlow.com⁠ Connect with Dr. Olivera Bogunovic ⁠The McLean Hospital⁠  The documentary, As Prescribed, is available in the United States and Canada on Prime Video, Apple, Kanopy, Tubi, and Google.

Today, we are talking about a very popular, yet controversial class of medications - the Benzodiazepines . Let's look at their mechanism of action, clinical indications, pharmacology, risks, withdrawal syndromes, and prescribing guidance. And of course, we'll be tackling the question: what are the risks and benefits of long-term use? References: https://pubmed.ncbi.nlm.nih.gov/30098211/https://pubmed.ncbi.nlm.nih.gov/32252539/https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rateshttps://aapp.org/guideline/benzohttps://pubmed.ncbi.nlm.nih.gov/40526204/https://pmc.ncbi.nlm.nih.gov/articles/PMC6097846/https://www.ncbi.nlm.nih.gov/books/NBK470159/https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/benzodiazepines-for-anxiety-disorders-maximising-the-benefits-and-minimising-the-risks/43A366723CD1B3616BAB08F69FF65A88

Your doctor just became your worst enemy. When the medical establishment brands chronic dizziness conditions like PPPD, MDDS, and vestibular migraines as "incurable," they're not just wrong, they're actively destroying lives through calculated ignorance. Dr. Yonit Arthur, a board-certified audiologist with a doctorate from Purdue University, drops a bombshell: patients experiencing 24/7 sensory collapse, paralyzing terror, and complete disorientation aren't suffering from permanent damage. They're trapped in a fear loop that doctors reinforce with every "learn to manage it" prescription. After watching the medical system fail hundreds of desperate patients who've seen 20, 30, even 40 specialists, Dr. Arthur launched The Steady Coach a popular YouTube channel with free courses to expose an uncomfortable truth. These "chronic" conditions persist because patients have been programmed to believe they're broken. We discuss the way out. https://thesteadycoach.com/https://www.youtube.com/@thesteadycoach Visit Center for Integrated Behavioral HealthDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)10% off Lovetuner click here

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus Topic IntroductionFocus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus MattersTeaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and EvidenceReview of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and DiagnosisConvulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and WorkupAcute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED ManagementAirway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnosticsLaboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment ApproachFirst-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial PopulationsPregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management PitfallsNon-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon't assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical PathwayStepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusionRecap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Dr. Casey Grover explores the challenging world of benzodiazepines, explaining why these commonly prescribed medications can create more problems than they solve for patients struggling with anxiety and other conditions.• Benzodiazepines work like alcohol in pill form, enhancing the brain's natural "downer" chemical GABA• Long-term use leads to tolerance, dependence, and potentially Benzodiazepine-Induced Neurological Dysfunction (BIND)• The four most commonly prescribed benzos are diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax)• Benzodiazepine withdrawal can cause seizures months after the last dose, making it particularly dangerous• Unlike opioid addiction, there are no specialized medications to treat benzodiazepine addiction• Tapering from benzodiazepines is extremely challenging, often taking months or years with patients experiencing severe rebound symptoms• Modern medical understanding now recognizes benzos as inappropriate for long-term anxiety treatment• Case studies demonstrate how patients prescribed benzos for anxiety often never learn proper coping skills and suffer increasingly worse symptomsThanks for listening and remember treating addiction saves lives.To contact Dr. Grover: ammadeeasy@fastmail.com

Margaret Cho is my guest on this episode of That's How I Remember It. Margaret is, of course, a comedy legend, but she's so much more - a writer, an actor, a singer/songwriter, etc. I met her over a decade ago at a tribute to Bob Mould out in LA, and I was thrilled that we reconnected on this episode. We talked about Lucky Gift, her record from last year, as well as Benzodiazepines, perfume memories, ditto machines, going to see the GoGos on the Vacation tour, her early act, Lilith Fair, pub rock, and so much more. Really a fantastic talk, Margaret is truly a joy to speak with and I'm so glad she spent the time. Listen and subscribe.

Join Jay Gunkelman, QEEGD (the man who has analyzed over 500,000 brain scans), Dr. Mari Swingle, Dr. Andrew Hill, Anthony Ramos, John Mekrut, and host Pete Jansons for another engaging NeuroNoodle Neurofeedback Podcast episode discussing neuroscience, psychology, mental health, and brain training.✅ Autism & GI Problems: Exploring why nearly 70% of people with autism also experience gastrointestinal issues — and the overlooked neurological links.✅ Botox & Mental Health: From migraines to facial expressivity, how Botox may affect empathy, parenting, and even autism phenotypes.✅ Neurofeedback & White Matter: Can brain training actually influence myelination and improve cognitive function? Research findings discussed.✅ Additional Topics:

Does psychiatric medication withdrawal exist — or is it just a myth?For anyone who's lived through it, the question alone can feel insulting.Psychiatric drug withdrawal is real. While the experience varies widely, for many, it's not “brief and mild” as many guidelines state it is. It can be intense, destabilizing, and often misunderstood. One of the most painful challenges is trying to determine whether what you're experiencing is withdrawal or relapse.Unfortunately, current clinical guidelines don't help. They often frame withdrawal as short-lived and minor, dismissing anything more severe as a return of illness. A potentially dangerous oversimplification that can leave patients feeling gaslit or unsupported.In this interview, Dr. Mark Horowitz, a psychiatrist and researcher who's both studied and experienced withdrawal firsthand, unpacks a new JAMA study that exemplifies the problem: guidelines built on inadequate evidence.In this episode, you'll hear:Why current drug withdrawal guidelines fall shortOverview of the new JAMA paper Incidence and Nature of Antidepressant Discontinuation SymptomsThe critical distinction between withdrawal and relapseThe truth about psychiatric drug withdrawalHow to design better research that reflects real-world experiencesWhy this information is often not reaching cliniciansHow we can conduct research that can better inform patient supportDr. Horowitz's story is one of courage and insight. As a clinician, he had no idea how wrong the guidelines were, until he tried coming off medication himself. What he discovered was far more complex than anything he'd been taught.To those navigating psychiatric medication withdrawal — especially in the face of oversimplified headlines and a healthcare system not yet equipped to support you — our hearts go out to you. You deserve care that is informed, compassionate, and grounded in lived experience as well as science. We won't stop until you have this.Expert Featured:Dr. Mark HorowitzX: @markhoroWebsite: https://markhorowitz.org/Resources Mentioned:Incidence and Nature of Antidepressant Discontinuation Symptoms A Systematic Review and Meta-Analysishttps://jamanetwork.com/journals/jamapsychiatry/article-abstract/28362623 Long-Term Psychiatric Medication Studieshttps://www.biologicalpsychiatryjournal.com/article/S0006-3223(98)00126-7/abstracthttps://journals.lww.com/intclinpsychopharm/abstract/2002/09000/discontinuation_symptoms__comparison_of_brief.2.aspxhttps://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/interruption-of-selective-serotonin-reuptake-inhibitor-treatment/F0241958CB073C51F366E2AABE636B5DOutro Clinichttps://www.outro.com/The Maudsley Desprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

Q-BANK: https://patreon.com/highyieldfamilymedicineIntro (0:35),Definitions (1:37),Alcohol (2:45),Opioids (9:47),Stimulants (14:32),Tobacco (16:16),Cannabis (18:59),Benzodiazepines (19:59),Hallucinogens (21:23),Phencyclidine (21:15),Inhalants (23:03),Club drugs (23:59),Practice questions (26:37),

This episode originally aired as #327 on 5/20/23. It's an oldie but goodie so we are sharing it again! Mental Health is a mounting issue in America today.  Pharma prescriptions are higher than ever before, more people are in therapy than ever before and more than ever, people are searching for alternatives to those methods. On today's episode Jared runs through what he considers to be the foundational things that you should consider to improve your mental health. You will learn about the gut brain connection, deficiencies that impact mental health, the value of breath, sleep, water,  sunshine and more.Products:Precision Probiotic Vital SporesVital 5 Magnesium BisglycinateVital 5 Ultimate Vitality Multi-VitaminBioCoenzymated Active B ComplexVital 5 Omega 3 + AntioxidantsUltra Strength RX Omega 3Sensoril AshwagandhaAnxiety ReleaseVital SleepL-Theanine chewables Additional Information:Episode #164: Psychobiotics - Unique Probiotics for Depression, Anxiety and More Part 1Episode #166: Psychobiotics - Unique Probiotics for Depression Anxiety and More Part 2Episode #306: The Great Debate in Probiotics: Human Strains vs. SporesEpisode #258: Your Magnesium Users GuideEpisode #264: Jen's Story: How One Woman Fought Through Addiction, Mental and Physical Illness to Find Vitality.Episode #265: Sleep! Your Guide to Falling Asleep, Staying Asleep and Deeper and More Restful SleepVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

Dr. Casey Grover breaks down psychiatric medications and their role in addiction treatment, explaining how different medications work, when they're most appropriate, and which ones to avoid. He provides a practical overview based on his extensive experience treating patients with substance use disorders.• Psychiatric medications get developed through research on brain receptors and undergo rigorous testing before FDA approval• Medications often have "off-label" uses that weren't originally intended but provide benefits in certain situations• Antidepressants like SSRIs and SNRIs serve as the foundation for treating depression in people with addiction• Using non-addictive options like hydroxyzine, clonidine, and buspirone is crucial when treating anxiety in recovery• Trazodone and mirtazapine are preferred for sleep issues over benzodiazepines and "Z-drugs" that can create dependence• ADHD treatment requires careful consideration when patients have stimulant use disorder histories• Benzodiazepines should be avoided when possible as they paradoxically worsen anxiety over time• Medication selection should consider urgency of conditions, past medication responses, and potential side effects• Some psychiatric conditions may improve with therapy allowing medication reduction, while others require long-term treatmentThank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Remember, treating addiction saves lives.To contact Dr. Grover: ammadeeasy@fastmail.com

Neurobiologist Jamie Zeitzer is an expert on sleep – or, more accurately, an expert on why so many can't sleep. He notes that, ironically, it's often anxiety about sleep that prevents good sleep. In short, we lose sleep over lost sleep. Wearables and other tools can help but only to a point, and medications do not induce natural sleep. Instead, he counsels consistent routines, less stimulation at bedtime, and cognitive behavioral therapy to reduce worry about insomnia. Unfortunately, you can't work harder to get better sleep – you have to learn to relax, Zeitzer tells host Russ Altman on this episode of Stanford Engineering's The Future of Everything podcast.Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.Episode Reference Links:Stanford Profile: Jamie ZeitzerConnect With Us:Episode Transcripts >>> The Future of Everything WebsiteConnect with Russ >>> Threads / Bluesky / MastodonConnect with School of Engineering >>> Twitter/X / Instagram / LinkedIn / FacebookChapters:(00:00:00) IntroductionRuss Altman introduces guest Jamie Zeitzer, professor of psychiatry and behavioral sciences at Stanford University.(00:03:12) Understanding Circadian RhythmsHow the biological clock regulates sleep and other body functions.(00:04:57) The Mystery of Sleep's PurposeWhat is still unknown about the fundamental need for sleep.(00:06:00) Light and the Circadian ClockThe impact light exposure has on the body's internal sleep timing.(00:08:13) Day and Night Light ContrastThe importance of creating a light-dark contrast for healthy rhythms.(00:11:18) Phones, Screens, and the Blue LightWhether blue light from screen use affects sleep quality.(00:13:49) Defining and Diagnosing Sleep ProblemsHow stress and over-focus on sleep quality worsen insomnia.(00:16:02) Sleep Anxiety and WearablesThe psychological downsides of sleep data from tracking devices.(00:17:14) CBT-I and Rethinking InsomniaMentally reframing sleep with cognitive behavioral therapy for insomnia.(00:21:21) Desynchronized Sleep PatternsStudying student sleep patterns to separate circadian vs. sleep effects.(00:23:49) Shift Work and Circadian MisalignmentThe difficulty of re-aligning circadian clocks in rotating shifts.(00:26:26) Effectiveness of Sleep MedicationsThe various drugs used to promote sleep and their pros and cons.(00:29:46) Circadian “Sleep Cliff” and MelatoninThe brain's “wake zone” before sleep and the limited effects of melatonin.(00:32:52) Do's & Don'ts for Better SleepAdvice for those looking to improve their sleep quality.(00:34:55) Alcohol and Caffeine EffectsHow metabolism influences the effects of alcohol and caffeine on sleep.(00:37:24) Conclusion Connect With Us:Episode Transcripts >>> The Future of Everything WebsiteConnect with Russ >>> Threads / Bluesky / MastodonConnect with School of Engineering >>>Twitter/X / Instagram / LinkedIn / Facebook

In this episode, we explore the challenges and current guidelines for benzodiazepine use in pregnancy, breastfeeding, and adolescence. When is it appropriate to continue benzodiazepines during pregnancy, and what alternatives should clinicians consider? Faculty: Alexis Ritvo, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Understanding Benzodiazepine Prescribing: A Clinician's Guide Consequences of Benzodiazepine Use in Pregnancy, Breastfeeding, and Adolescence

In today's episode of The Root Cause Medicine Podcast, Dr. Kate Kresge sits down with Dr. Ellen Vora to discuss a revolutionary framework for understanding anxiety—not as a disorder, but as a message from the body or soul. They explore the difference between false anxiety, which stems from physiological imbalances like blood sugar crashes, sleep disruption, and inflammation, and true anxiety, which often points to deeper emotional or existential truths. You'll hear them discuss: - Why anxiety is the beginning of an inquiry—not a final diagnosis - The difference between “false” (body-based) and “true” (purpose-driven) anxiety - How nutrient deficiencies and gut imbalances can mimic psychiatric symptoms - The surprising mental health effects of hormonal birth control - How to use food as medicine to support neurotransmitter balance and calm - The dangers of benzodiazepines—and how to taper with the help of functional medicine - The power of psychobiotics, circadian rhythm, and inflammation reduction - Why GABA, inositol, and phosphatidylcholine are key to recovery - How to approach anxiety with both compassion and curiosity

In this episode, we explore benzodiazepine use disorder, distinguishing between physical dependence and addiction while examining practical strategies for safe prescribing. Did you know only 1.5% of benzodiazepine users actually develop a use disorder? Faculty: Alexis Ritvo, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Understanding Benzodiazepine Prescribing: A Clinician's Guide Benzodiazepine Use Disorder

In this episode, we explore the dangerous risks of benzodiazepine use, focusing on the potentially lethal combination with opioids, cognitive impairment, increased accident risk, and fall hazards. Did you know that benzodiazepines combined with opioids increase overdose risk fivefold in the first 90 days? Faculty: Alexis Ritvo, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Understanding Benzodiazepine Prescribing: A Clinician's Guide Understanding the Major Risks of Benzodiazepine Use

This is not your typical real estate episode. In one of the most raw and vulnerable conversations ever, Chris Arnold shares his harrowing journey through burnout, betrayal, benzo withdrawal, and near-suicide, and how he emerged on the other side with a radically new sense of self. Whether you're thriving or silently struggling, this conversation might be the wake-up call you didn't know you needed.   KEY TAKEAWAYS How high-achieving men often suppress the emotional wounds driving their success The silent formula that's destroying entrepreneurial men from the inside out impact of benzo withdrawal and how it nearly ended Chris's life Why emotional pain lives in the body and what to do about it The controversial but life-saving role ayahuasca played in Chris's recovery RESOURCES/LINKS MENTIONED Ayahuasca TWEETABLES “True leadership begins in your life, and your passion, destiny, calling, and unique contributions from the fact that you wake up every day and you get to do you.”- Chris Arnold “The more we share our story, the less of a hold it has on us.” - Chris Arnold   ABOUT CHRIS ARNOLD  Chris Arnold is a co-founder of The Multipliers Brotherhood and COSA Investments, one of the largest wholesale companies in the DFW Metroplex. He also founded Arnold Elite Realty, a modern boutique brokerage, and created REI Radio, a coaching program that teaches real estate wholesalers how to find motivated sellers through radio. Operating his companies entirely virtually allows him the freedom to work from anywhere, yet he chooses the beautiful Tulum, Mexico, as his base.   CONNECT WITH CHRIS Website: Simplifiers Brotherhood

Dr. Roger McFillin challenges standard treatments that keep patients trapped in fear cycles. He reveals why panic disorder—one of the most common presenting mental health concerns—is HIGHLY treatable without drugs, and provides actionable steps to transform your relationship with anxiety. Discover the fundamental principles that could free you from panic attacks and learn why conventional approaches might be blocking your recovery. This foundational episode delivers the evidence-based perspective needed to understand what's really happening during panic and how to overcome it for good.Dr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)10% off Lovetuner click here

In this episode, I address two deeply personal listener questions that highlight the complex nature of anxiety and emotional healing in relationships. The first question comes from a listener who has struggled with anxiety for most of their life, recently facing severe limitations due to Generalized Anxiety Disorder and medication changes. We talk about the genetic components of anxiety, the risks of benzodiazepines in older adults, and the importance of advocating for the right care—even if that means seeking new providers or considering higher levels of treatment. The second question dives into the emotional fallout after infidelity. A listener is working to rebuild their marriage after their wife's emotional and physical affairs but finds themselves overwhelmed by anger and trauma in the aftermath. I explore the importance of time, trauma-informed coping strategies, and how rebuilding trust is possible with consistent effort and support. Whether you're dealing with anxiety yourself or navigating complex relationship dynamics, this episode offers validation, practical advice, and hope. Key Discussion Points Question 1: Genetic Anxiety and Benzodiazepines Anxiety can be partially genetic—up to 50% of risk may be inherited. Environmental factors, early life experiences, and chronic stress also play key roles. Long-term anxiety can even change brain structures like the amygdala. Benzodiazepines such as Xanax and Klonopin can be risky for older adults, but abrupt changes in medication are harmful and inappropriate. Importance of finding the right provider—psychiatric care may be more appropriate than primary care in severe cases. Options like partial hospitalization, intensive outpatient programs, or even voluntary hospitalization if suicidal thoughts worsen. Consideration of alternative treatments like TMS, ketamine therapy, EMDR, or comprehensive medical workups. Encouragement and validation that meaningful change is possible—even later in life. Question 2: Healing from Infidelity Emotional and physical infidelity can lead to feelings of inadequacy and intense emotional reactivity. The resurfacing of past wounds during present-day arguments is a trauma response. Healing takes time; both partners must commit to rebuilding trust. Grounding, breathing, and self-regulation tools are essential in emotional moments. Individual therapy and journaling can help process complex feelings and trauma. Couples therapy with a specialist in infidelity recovery can provide structure and support. It's possible to rebuild a stronger relationship—but it takes honest effort from both sides. Timestamps 00:00 – Intro 01:12 – Listener question: Is anxiety genetic? 03:22 – Genetics vs. environment in anxiety development 05:10 – Medication history and benzodiazepine concerns for older adults 08:45 – Advocating for appropriate psychiatric care 12:30 – Suicidal thoughts and higher levels of support 14:50 – Exploring alternative and emerging treatment options 17:15 – Words of encouragement and validation 19:45 – Listener question: Coping with infidelity and feeling inadequate 21:20 – Emotional fallout and trauma from betrayal 24:10 – Regulating emotional responses during arguments 26:00 – The role of time, patience, and couples therapy 28:20 – Journaling and individual processing for long-term healing 31:10 – Rebuilding a stronger relationship after infidelity 33:00 – Closing thoughts and takeaways Resources & Links Website: http://duffthepsych.com Email: duffthepsych@gmail.com YouTube: https://www.youtube.com/@duffthepsych Instagram: https://instagram.com/duffthepsych If today's episode resonated with you, consider leaving a review or sharing it with someone who could use the support. Your stories and questions continue to make this podcast what it is—thank you for being here. Until next time, take care and keep pushing forward. You've got this.

It's a stressful world out there. And one way some people quiet it down is taking medications like Lorazepam, Xanax, or Valium. They're called Benzodiazepines and their use and misuse has become a plotline in the popular TV series The White Lotus and The Pitt. University of British Columbia's clinical assistant professor and addictions medicine specialist Dr. Paxton Bach explains the benefits and risks of taking benzos. For transcripts of The Dose, please visit: lnk.to/dose-transcripts. Transcripts of each episode will be made available by the next workday. For more episodes of this podcast, click this link.

Story at-a-glance Benzodiazepines (benzos), the go-to treatment for anxiety, cause several issues, especially for the elderly, like cognitive impairment, lightheadedness, poor coordination, and fatigue, all of which increase the risk of accidents and falls When used for the correct type of anxiety and combined with other therapeutic interventions, benzodiazepines can greatly help anxiety Unfortunately, the fast-paced, insurance-driven healthcare system often leads to rushed 15-minute appointments, preventing doctors from properly evaluating whether benzodiazepines are right for a patient As a result, many people who should not be on benzodiazepines end up being put on them for years, if not decades, without proper oversight or treatment of their underlying illness One of the biggest problems with benzodiazepines is how quickly they create a physical dependence, leading to widespread addiction. They can also harm fetuses, worsen symptoms like insomnia and anxiety, and, in the worst cases, lead to deadly overdoses, especially when combined with opioids

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Benzodiazepines⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Neurology section.Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets

In this episode, we explore the pharmacological management of agitation in emergency settings, focusing on benzodiazepines and the novel medication dexmedetomidine. Did you know there's now a sublingual option that works through an entirely different mechanism than traditional anti-agitation medications? Faculty: Scott Zeller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: The Psychopharmacology of Agitation: Managing Behavioral Emergencies The Role of Benzodiazepines and Dexmedetomidine in Managing Agitation

In this engaging conversation on the Crazy Wisdom podcast, Stewart Alsop talks with neurologist Brian Ahuja about his work in intraoperative neurophysiological monitoring, the intricate science of brainwave patterns, and the philosophical implications of advancing technology. From the practical applications of neuromonitoring in surgery to broader topics like transhumanism, informed consent, and the integration of technology in medicine, the discussion offers a thoughtful exploration of the intersections between science, ethics, and human progress. Brian shares his views on AI, the medical field's challenges, and the trade-offs inherent in technological advancement. To follow Brian's insights and updates, you can find him on Twitter at @BrianAhuja.Check out this GPT we trained on the conversation!Timestamps00:00 Introduction to the Crazy Wisdom Podcast00:21 Understanding Intraoperative Neurophysiological Monitoring00:59 Exploring Brainwaves: Alpha, Beta, Theta, and Gamma03:25 The Impact of Alcohol and Benzodiazepines on Sleep07:17 The Evolution of Remote Neurophysiological Monitoring09:19 Transhumanism and the Future of Human-Machine Integration16:34 Informed Consent in Medical Procedures18:46 The Intersection of Technology and Medicine24:37 Remote Medical Oversight25:59 Real-Time Monitoring Challenges28:00 The Business of Medicine29:41 Medical Legal Concerns32:10 Alternative Medical Practices36:22 Philosophy of Mind and AI43:47 Advancements in Medical Technology48:55 Conclusion and Contact InformationKey InsightsIntraoperative Neurological Monitoring: Brian Ahuja introduced the specialized field of intraoperative neurophysiological monitoring, which uses techniques like EEG and EMG to protect patients during surgeries by continuously tracking brain and nerve activity. This proactive measure reduces the risk of severe complications like paralysis, showcasing the critical intersection of technology and patient safety.Brainwave Categories and Their Significance: The conversation provided an overview of brainwave patterns—alpha, beta, theta, delta, and gamma—and their connections to various mental and physical states. For instance, alpha waves correspond to conscious relaxation, while theta waves are linked to deeper relaxation or meditative states. These insights help demystify the complex language of neurophysiology.Transhumanism and the Cyborg Argument: Ahuja argued that humans are already "cyborgs" in a functional sense, given our reliance on smartphones as extensions of our minds. This segued into a discussion about the philosophical and practical implications of transhumanism, such as brain-computer interfaces like Neuralink and their potential to reshape human capabilities and interactions.Challenges of Medical Technology Integration: The hype surrounding medical technology advancements, particularly AI and machine learning, was critically examined. Ahuja highlighted concerns over inflated claims, such as AI outperforming human doctors, and stressed the need for grounded, evidence-based integration of these tools into healthcare.Philosophy of Mind and Consciousness: A recurring theme was the nature of consciousness and its central role in both neurology and AI research. The unresolved "hard problem of consciousness" raises ethical and philosophical questions about the implications of mimicking or enhancing human cognition through technology.Trade-offs in Technological Progress: Ahuja emphasized that no technological advancement is without trade-offs. While tools like CRISPR and mRNA therapies hold transformative potential, they come with risks like unintended consequences, such as horizontal gene transfer, and the ethical dilemmas of their application.Human Element in Medicine: The conversation underscored the importance of human connection in medical practice, particularly in neurology, where patients often face chronic and emotionally taxing conditions. Ahuja's reflections on the pitfalls of bureaucracy, private equity in healthcare, and the overemphasis on defensive medicine highlighted the critical need to prioritize patient-centered care in an increasingly technological and administrative landscape.

Julia Britz is a licensed naturopathic doctor who received her training from Bastyr University in San Diego, CA. She specializes in supporting people who are struggling with mental health issues such as OCD, disorders eating and psychiatric medication tapering. Her passion for working with individuals suffering from these lonely conditions is that she too was a “hopeless case”, but got better.Dismissed by doctors, she was told over and over there was nothing else she could try beyond pharmacotherapy, and so was inspired to create myocddiary.com, a site dedicated to documenting the daily life of OCD and related disorders. Through this project and holistic therapies, she found new levels of wellness, and in 2014 did a TED talk called “MyOCDdiary: an imperfect story.” She utilizes natural and integrative modalities including targeted amino acid therapy, peptide therapy, micronutrient therapy, bioresonance, botanical medicine and epigenetic analysis. Most recently she was the director of naturopathic medicine at Alternative to a meds Center in Arizona and now practices telemedicine. SHOWNOTES:

I am thrilled to have Dr. Olivera Bogunovic and Holly Hardman with me on the show today. Dr. Bogunovic is an assistant professor of psychiatry at Harvard Medical School and the medical director of the alcohol, drug, and addiction outpatient program at the McLean Hospital, and Holly directed the documentary As Prescribed. In today's discussion, we dive into the ongoing benzodiazepine crisis in the United States, with over 92 million prescriptions written each year for medications like Ativan, Valium, Xanax, and Klonopin. We discuss the origin of those drugs in the 1970s as treatments for anxiety and how they lead to tremendous physical dependency. Holly shares her experience with the neurological effects she suffered after long-term use of Klonopin, and we examine challenges in psychiatric care, the need for informed consent, and the impact of social media. We also cover the role of lifestyle, the need for psychotherapy and psychosocial support, and the significance of hope. This conversation is truly invaluable! Given how frequently benzodiazepines get prescribed, everyone must understand their associated risks and considerations. IN THIS EPISODE YOU WILL LEARN: How prescribing practices have evolved over the last two decades The significant consequences older adults face when they suddenly stop using benzodiazepines  Holly shares how doctors misinformed her when she began taking Klonopin.  Holly describes the benzodiazepine-induced symptoms and cognitive issues she experienced Why people must get informed about the long-term effects of benzodiazepines when consenting to take them How benzodiazepines work in the body and impact the brain Why benzodiazepines are ineffective when used long-term for insomnia The challenges certain people face when accessing psychiatric care What is BIND, and what are its symptoms? The significance of diet and holistic approaches for managing mental health and why community support is essential in the recovery process Why As Prescribed is an educational documentary for everyone Connect with Cynthia Thurlow   Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Olivera Bogunovic The McLean Hospital (in Boston) The documentary, As Prescribed, is available in the United States and Canada on Prime Video, Apple, Kanopy, Tubi, and Google.

Anxiety can seep into our lives like an uninvited guest, disrupting our relationships, altering our moods, and even impacting our physical health. The struggle to recognize and address the roots of this pervasive issue often leaves us feeling overwhelmed and helpless. What if we could reframe our understanding of anxiety, seeing it not as a problem to be suppressed, but as a messenger of deeper, underlying issues? Could this shift in perspective transform not only our personal well-being but also our interpersonal connections? In this episode, we dive deep into the nuances of anxiety, exploring its complex relationship with our bodies, minds, and interactions with others. We discuss practical strategies for setting personal limits to prevent burnout, share insights from groundbreaking research on anxiety and trauma, and introduce step-by-step algorithms that empower you to uncover and heal root causes. You'll discover how integrating biological and psychological knowledge can lead to a more holistic approach to mental health, paving the way for healthier, more fulfilling relationships. Tune in to learn how you can turn your symptoms into powerful access points for healing and personal growth. Nicole Cain, ND, MA, is a pioneer in integrative approaches for mental and emotional wellness. With a degree in clinical psychology, training in EMDR, and being licensed as a naturopathic physician in the state of Arizona, her approach to mental health is multidisciplinary: medical, psychological, and holistic. Check out the transcript of this episode on Dr. Jessica Higgin's website. In this episode 08:03 Can anxiety be healed or just managed? 12:34 How medications like SSRIs and Benzodiazepines can impact relationships. 21:45 How trauma triggers persistent protective responses. 25:06 High-functioning individuals often mask internal struggles. 32:17 How understanding anxiety as data can transform healing and relationships. 36:48 How emotional adaptations from trauma protect us but can also cause issues. 40:08 Identifying root causes rather than just treating symptoms. 46:20 Expert guidance for calming the nervous system and optimizing health recovery. 55:49 Reflecting growth in relationships: Navigating subjective feedback and personal reactions. Mentioned Panic Proof: The New Holistic Solution to End Your Anxiety Forever (*Amazon Affiliate link) (book) Relationship Map To Happy, Lasting Love ERP 423: How to Transcend Trauma (And the Effects Experience in Relationship) — An Interview with Dr. Frank Anderson Connect with Dr. Nicole Cain Websites: drnicolecain.com Facebook: facebook.com/DrNicoleCain YouTube: youtube.com/channel/UCe-hcFYhi5QMmXcR_kNippQ Instagram: instagram.com/drnicolecain Podcast: podcasts.apple.com/us/podcast/holistic-inner-balance-natural-mental-health-podcast/id1506869161 | drnicolecain.com/podcast Pinterest: pinterest.com/drnicolecain Connect with Dr. Jessica Higgins Facebook: facebook.com/EmpoweredRelationship  Instagram: instagram.com/drjessicahiggins  Podcast: drjessicahiggins.com/podcasts/ Pinterest: pinterest.com/EmpowerRelation  LinkedIn: linkedin.com/in/drjessicahiggins  Twitter: @DrJessHiggins  Website: drjessicahiggins.com   Email: jessica@drjessicahiggins.com If you have a topic you would like me to discuss, please contact me by clicking on the “Ask Dr. Jessica Higgins” button here.  Thank you so much for your interest in improving your relationship.  Also, I would so appreciate your honest rating and review. Please leave a review by clicking here.  Thank you!   *With Amazon Affiliate Links, I may earn a few cents from Amazon, if you purchase the book from this link.

In this interview with Dr. Bret Scher, Dr. Mark Horowitz, a leading clinician and researcher in anti-depressant withdrawal and de-prescribing, delves into the complex world of de-prescribing anti-depressants. Dr. Horowitz shares his personal journey with antidepressant withdrawal, which led him to dedicate his career to understanding safe tapering practices. He discusses the challenges that patients face when coming off medications, the withdrawal effects often mistaken for relapses, and how the current psychiatric guidelines may fall short in helping people safely taper. Dr. Horowitz emphasizes the importance of individualized tapering plans and the need for slower, more gradual reductions in medication, challenging the traditional approach of quick tapers over a few weeks. *Key Topics Covered* • The difference between withdrawal symptoms and relapse • The effects of long-term antidepressant use • Dr. Horowitz's personal experience with tapering off Lexapro • The role of clinicians and peer support in the de-prescribing process *Experts Featured* Dr. Mark Horowitz X: @markhoro https://markhorowitz.org/ Resources: Safe tapering resources: https://www.outro.com/ _The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series)_ https://www.amazon.com/Maudsley-Guidelines-prescribing-Prescribing/dp/111982298X Metabolic Mind's Families & Peers page: https://www.metabolicmind.org/families-and-peers Clinician Directory: https://www.diagnosisdiet.com/directory Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/ About us: Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them. Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. #MetabolicMind #MetabolicNeuroscience #KetogenicMetabolicTherapy #NutritionalKetosis#AlternativeTreatment#PsychiatricMedication#KetogenicTherapy #Tapering#Deprescribing

In this episode, we explore the complex relationship between benzodiazepine use and suicide risk, examining a groundbreaking French study that challenges our understanding of this connection. Is our go-to anxiety treatment potentially increasing suicide risk? Faculty: Paul Zarkowski, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 57 Risk for Suicide Attempts and Suicide Associated With Benzodiazepines

#192 In this episode of 'Chemistry for Your Life,' hosts Melissa and Jam introduce special guest Claire Caballero, a pharmacology and neuroscience PhD student, to discuss how antidepressants work. Claire explains the role of neurotransmitters like serotonin, dopamine, and GABA in mental health, the mechanisms of various antidepressants such as SSRIs, tricyclic antidepressants, and monoamine oxidase inhibitors, and touches on the effects and side effects of drugs like Wellbutrin. The episode provides an insightful look at the chemistry and neuroscience behind how these medications help manage depression and anxiety. 00:00 Introduction and Special Guest Announcement 00:52 Meet Claire: Our Expert in Pharmacology and Neuroscience 01:32 Understanding Pharmacology and Neurotransmission 05:16 The Role of Neurotransmitters in Anxiety and Depression 14:16 Deep Dive into Neurotransmitters: GABA, Dopamine, and Serotonin 17:10 Exploring the Mechanisms of Depression and Anxiety 22:21 Ready to Learn About Antidepressant Drugs? 33:20 Understanding SSRIs and Their Uses 34:14 How SSRIs Work in the Brain 36:23 Challenges and Side Effects of SSRIs 43:08 Exploring Tricyclic Antidepressants 48:35 Monoamine Oxidase Inhibitors: The First Antidepressants 54:59 Benzodiazepines: Uses and Risks 01:00:01 Other Notable Drugs: Bupropion and Beta Blockers 01:05:07 Conclusion and Final Thoughts   References from this episode: https://www.ncbi.nlm.nih.gov/books/NBK554406/ https://www.ncbi.nlm.nih.gov/books/NBK557791/ https://www.ncbi.nlm.nih.gov/books/NBK539848/ https://www.ncbi.nlm.nih.gov/books/NBK470159/#:~:text=Benzodiazepines%20are%20effective%20for%20sedation,potential%20to%20develop%20physical%20dependence. https://www.nami.org/about-mental-illness/mental-health-conditions/anxiety-disorders/#:~:text=Anxiety%20disorders%20are%20the%20most,develop%20symptoms%20before%20age%2021. https://mhanational.org/conditions/depression#:~:text=Major%20depression%20is%20one%20of,are%20affected%20by%20major%20depression. https://www.cdc.gov/nchs/products/databriefs/db377.htm https://www.ncbi.nlm.nih.gov/books/NBK470212/ https://www.jneurosci.org/content/28/28/7040 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303399/ https://www.ncbi.nlm.nih.gov/books/NBK551683/#:~:text=Anxiety%20disorders%20such%20as%20panic,with%20decreased%20levels%20of%20GABA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684250/#:~:text=Neuroendocrine%20and%20Neurotransmitter%20Pathways&text=Well%2Ddocumented%20anxiolytic%20and%20antidepressant,of%20mood%20and%20anxiety%20disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950973/#:~:text=The%20monoamine%2Ddeficiency%20theory%20posits,in%20the%20central%20nervous%20system. https://www.health.harvard.edu/depression/depression-chemicals-and-communication https://www.ncbi.nlm.nih.gov/books/NBK539894/ https://www.sciencedirect.com/science/article/pii/S1476179306700246?via%3Dihub https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/ We want to give a special thanks to Bri McAllister for illustrating molecules for some episodes! Please go check out Bri's art, follow and support her at entr0pic.artstation.com and @McAllisterBri on twitter!   Thanks to our monthly supporters Scott B Jessie Reder Ciara Linville J0HNTR0Y Jeannette Napoleon Cullyn R Erica Bee Elizabeth P Sarah Moar Rachel Reina Letila Katrina Barnum-Huckins Suzanne Phillips Venus Rebholz Lyn Stubblefield Jacob Taber Brian Kimball Emerson Woodhall Kristina Gotfredsen Timothy Parker Steven Boyles Chris Skupien Chelsea B Bri McAllister Avishai Barnoy Hunter Reardon ★ Support this podcast on Patreon ★ ★ Buy Podcast Merch and Apparel ★ Check out our website at chemforyourlife.com Watch our episodes on YouTube Find us on Instagram, Twitter, and Facebook @ChemForYourLife

Dr. Hoffman continues his conversation with Dr. Mark Horowitz, co-author of "The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs."

Dr. Mark Horowitz, a Clinical Research Fellow in Psychiatry from the UK and co-author of “The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs,” delves into the complexities of deprescribing psychiatric medications such as antidepressants, benzodiazepines, and sleep aids. Dr. Horowitz outlines the origins and importance of the deprescribing movement, explaining how polypharmacy and overprescription have necessitated a careful approach to reducing medication loads safely. He discusses the physiological and withdrawal challenges faced by patients on long-term psychiatric medication, emphasizing the vital role of slow and individualized tapering processes. He covers the substantial influence of pharmaceutical companies on prescription guidelines in the US compared to the UK, shedding light on the differences in medication usage and prescribing cultures. Dr. Horowitz also debunks the chemical imbalance theory of depression, arguing for a more nuanced understanding of mental health issues and their treatment. He introduces Outro, a new clinic founded by Dr. Horowitz in California, aimed at supporting individuals through the deprescribing process.

Melissa Bond is a narrative journalist, poet, and matriarch of Salt Lake City's Slam Scene. The Salt Lake Tribune and the New York Post have both done features on Bond's book Blood Orange Night, her memoir about becoming dependent upon and then withdrawing from Benzodiazepines. Blood Orange Night was published by Simon & Schuster in June 2022 and was selected by the New York Times as one of the best audiobooks of 2022. Bond has been featured on PBS Story in the Public Square, Radio West, the podcasts Risk!, Endeavors, Psychology Unplugged, The New York Times  Podcasts, RadioWest and Moms Don't Have Time to Read Books. Listen in to hear Melissa share: How a very common medical prescription for insomnia led to full physical dependence on benzodiazepines that led to her rapid physical and mental downward spiral How she was able to begin to put together the pieces around her unforeseen medication dependence after narrowly escaping harming herself and her daughter in a fall Her discovery that her myriad of strange physical and mental health symptoms were actually her going through medication withdrawal every single day Her decision to confront the doctor who massively overprescribed benzodiazepines to her How the Benzo Harmed Community relates differently to common terminology around addiction  How the “shadow of shame” impacts people's recoveries from substance use, substance dependence, and substance abuse Her advice to moms who are mentally or physically suffering with the demands of motherhood and how they can get help from medical professionals in the most safe and trusting way Links mentioned: Connect with Melissa: www.melissaabond.com Melissa's Book: Blood Orange Night Melissa on Instagram Melissa on Facebook We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website: https://shamelessmom.com/sponsor Interested in becoming a sponsor of the Shameless Mom Academy? Email our sales team at sales@adalystmedia.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Contributor: Aaron Lessen MD Educational Pearls: Lorazepam (Ativan) is dosed at 0.1 mg/kg up to a maximum of 4 mg in status epilepticus Some ED protocols only give 2 mg initially The maximum recommended dose of levetiracetam (Keppra) is 60 mg/kg or 4.5 g In one retrospective study, only 50% of patients received the correct dose of lorazepam For levetiracetam, it was only 35% of patients Underdosing leads to complications Higher rates of intubations More likely to progress to refractory status epilepticus References 1. Cetnarowski A, Cunningham B, Mullen C, Fowler M. Evaluation of intravenous lorazepam dosing strategies and the incidence of refractory status epilepticus. Epilepsy Res. 2023;190(November 2022):107067. doi:10.1016/j.eplepsyres.2022.107067 2. Sathe AG, Tillman H, Coles LD, et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019;26(8):940-943. doi:10.1111/acem.13811 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit  

In this conversation, Rav Arora and Dr. Matt Johnson discuss the current state of mainstream pharmaceutical solutions for mental health issues such as ADHD, depression, and anxiety. They highlight the limitations and potential harms of traditional medications, including overuse of ADHD stimulant medications and the simplistic narrative of depression being caused by low serotonin levels. They also discuss the importance of considering the complexity of mental health disorders and the need for a holistic approach that includes therapy and addressing root causes. They touch on the potential benefits of psychedelic therapy as a complementary tool in the treatment of mental health issues. The conversation explores the lack of long-term evidence for the effectiveness of medications in treating mental health disorders. Psychopharmacology, the field of medication for mental health, faces challenges in finding effective treatments for complex psychological problems. Medications like SSRIs and benzodiazepines have limitations in terms of long-term efficacy and side effects. The use of psychedelics, such as ketamine, has shown promise in providing immediate relief for depression and anxiety. However, the field of psychopharmacology still lacks major breakthroughs and relies on medications that may not fully address the complexity of psychological issues. The development of non-psychedelic compounds that mimic the effects of psychedelics without the visionary experience may not be as effective. The conversation highlights the need for innovative approaches to mental health treatment.Takeaways* Mainstream pharmaceutical solutions for mental health issues like ADHD, depression, and anxiety have limitations and potential harms.* Overuse of ADHD stimulant medications is a concern, and the narrative of depression being caused by low serotonin levels is overly simplistic.* Mental health disorders are complex and require a holistic approach that includes therapy and addressing root causes.* Psychedelic therapy shows promise as a complementary tool in the treatment of mental health issues, offering the potential for long-term benefits and addressing deep-seated trauma. There is a lack of long-term evidence for the effectiveness of medications in treating mental health disorders.* Individual experiences with antidepressants vary, with some reporting significant benefits while others do not.* The influence of pharmaceutical companies on prescribing practices and the need for better regulation and transparency in the industry are important considerations.* Psychotherapy, such as cognitive behavioral therapy, can be highly effective in treating anxiety disorders and depression.* Benzodiazepines are commonly prescribed for anxiety but can have negative long-term effects and should be used with caution. Psychopharmacology struggles to find effective treatments for complex psychological problems.* Medications like SSRIs and benzodiazepines have limitations in terms of long-term efficacy and side effects.* Psychedelics, such as ketamine, show promise in providing immediate relief for depression and anxiety.* The field of psychopharmacology lacks major breakthroughs and innovative approaches to mental health treatment.* Non-psychedelic compounds that mimic the effects of psychedelics without the visionary experience may not be as effective.Titles* The Importance of a Holistic Approach to Mental Health* The Potential of Psychedelic Therapy as a Complementary Tool The Varying Experiences with Antidepressants* The Cautionary Use of Benzodiazepines for Anxiety The Limitations of Medications in Mental Health Treatment* Non-Psychedelic Compounds: Can They Mimic the Effects of Psychedelics?Sound Bites* "There are major issues with some traditional medications"* "The narrative of depression being caused by low serotonin is overly simplistic"* "Psychedelic therapy offers the potential for long-term benefits"* "What you really want are studies that have randomized people and maintain that randomization and that blind for those long-term outcomes."* "SSRIs were the most important part of it, not the psychedelics."* "Raising just a point or two on one of the standard depression inventories, every point counts, man."* "Nothing compares to the GABA-Urgic drugs because they have their primary button on just relaxing your motor system."* "Psychopharmacology medications for the mind don't seem to work the same way as other classes of medicine."* "There's a real danger associated with being on benzodiazepines chronically."‘Chapters00:00 Introduction and Background09:20 Mainstream Pharmaceutical Solutions for Mental Health32:00 Exploring the Root Causes of Mental Health Disorders46:30 The Limitations of Psychopharmacology57:43 The Complexity of Mental Health and Treatment01:08 Debunking the Serotonin Model of Depression01:29 The Limitations of Medications for Anxiety01:58 Closing Remarks and Future Directions This is a public episode. 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In this solo episode Craig shares his current thoughts on MDMA medicalization, sleep meds, ADD, motivation vs self-discipline, benzos, how long to stay on psych meds, a change and a proposed addition to his top 10 med list, borderline vs bipolar, and marriage.Bringing Therapy into Med Management-- An intensive training with Dr.  Hhttps://www.craigheacockmd.com/training/BFTA on IG @backfromtheabysspodcasthttps://www.instagram.com/backfromtheabysspodcast/BFTA/ Dr. Hhttps://www.craigheacockmd.com/podcast-page/