Podcasts about maois

Methylene blue is widely marketed over the counter to the general public as well as to the natural health, health freedom, and freedom communities, often on the internet. It is flooding America.   Some sellers are touting methylene blue as a “miracle” tonic that improves “cognitive function”1 and boosts energy to previously unimagined heights. Some have given live demonstrations on TV and podcasts demonstrating how the oral form hyperactivates some people within 35 minutes of the first dose — a typical stimulant drug rush — which is actually a danger signal for potentially activating them into a dangerous manic episode during future exposures or even more deadly outcomes.   Read the full article here: Methylene Blue is highly neurotoxic to your brain and mind   In reality, methylene blue is a lethal neurotoxin, a poison to the brain. It has the same basic chemical composition and harmful clinical effects as the oldest and most neurotoxic “antidepressants,” the monoamine oxidase inhibitors (MAOIs). It also has similarities to the neurotoxic phenothiazine “antipsychotic” drugs, including the original Thorazine (chlorpromazine), but methylene blue is more stimulating or activating.   Methylene blue is not a miraculous new discovery. It is the opposite. Created in 1876 in a lab — it is the oldest manmade chemical to be used in medicine. But in well over a century, methylene blue has never been FDA-approved for psychiatric purposes. Later, its chemical structure was modified in labs for creating many of the earliest, most neurotoxic psychiatric drugs.   Methylene blue suppresses or destroys forms of the enzyme monoamine oxidase that are used by the brain for controlling or modulating four different powerful neurotransmitters — serotonin, dopamine, norepinephrine, and epinephrine. In short, by crushing monoamine oxidase, methylene blue causes overstimulation of four of the brain's major neurotransmitters, all of which profoundly impact the mind.   After the FDA was created in 1906, methylene blue was grandfathered into the market by the agency as an obscure antidote for methemoglobinemia, but it must be emphasized that the FDA has never tested the safety of methylene blue for any purpose. Furthermore, the FDA, based on its adverse reporting system and scientific reports, has published serious warnings about potentially lethal adverse reactions from methylene blue, especially when combined with numerous other drugs.2   The first MAOIs used as depressants were derived from methylene blue, and they turned out to be so toxic that the first two were quickly taken off the market by the FDA. One caused lethal liver disease, and the other caused hypertensive crises. Methylene blue is known to impair liver function tests and to cause hypertensive crises. Early on, all MAOIs were removed for a while from the international list of approved drugs. Please go to this endnote in my report  for a list of historical and scientific studies about the extraordinary history and the nature of methylene blue and the other MAOIs.3   Psychiatry and the psychopharmaceutical complex are so driven to impose neurotoxins upon our brains ⎯ some MAOI antidepressants remain on the market today. FDA Full Prescribing Information for the existing MAOI antidepressants, readily available online,4 provides quick access to the kinds of adverse effects caused by methylene blue. These FDA documents also provide lists of the foods and of some of the many, many drugs you cannot take with MAOIs, like methylene blue, without risking death from serotonin syndrome or a hypertensive crisis.   Meanwhile, all of America is being made a market for the original mother of them all, methylene blue, without requiring a prescription, with bizarrely distorted claims, and with unlimited supplies handed out as easily as a new caffeinated soda.   All of the three approved MAOIs, as well as methylene blue, carry repeated warnings at the FDA and in the scientific community about causing the two potentially crippling and lethal outcomes, serotonin syndrome and malignant hypertension (see below). These potentially lethal outcomes, as with all MAOIs, become much more serious and higher risk when methylene blue is taken with certain foods such as cheese and bananas, or literally with so many other drugs that it is impossible to memorize them or to keep track of them.   Here is one version of a short summary of the long list of dangerous interactions between MAOIs, including methylene blue, and other drugs and foods, taken from Goodman and Gilman's The Pharmacological Basis of Therapeutics (2018, p. 274):   Monoamine Oxidase Inhibitors   Serotonin syndrome is the most serious drug interaction for the MAOIs (see Adverse Effects). The most common cause of serotonin syndrome in patients taking MAOIs is the accidental coadministration of a SHT reuptake-inhibiting antidepressant or tryptophan. Other serious drug interactions include those with meperidine and tramadol. MAOIs also interact with sympathomimetics such as pseudoephedrine, phenylephrine, oxymetazoline, phenylpropanolamine, and amphetamine; these are commonly found in cold and allergy medication and diet aids and should be avoided by patients taking MAOIs. Likewise, patients on MAOIs must avoid foods containing high levels of tyramine: soy products, dried meats and sausages, dried fruits, home-brewed and tap beers, red wine, pickled or fermented foods, and aged cheeses.   I am presenting this detailed summary in the hope of gaining the immediate attention of people and businesses who are promoting methylene blue and anyone who is unfortunately taking it. Please share this summary or the entire document as widely as possible and with proper attribution.   An extensive article follows, detailing my professional experience in the arena of psychopharmacology. It includes a lengthy scientific analysis with more than two dozen endnotes containing an even greater number of scientific citations.   Read the full article here: Methylene Blue is highly neurotoxic to your brain and mind   End Notes   1 All stimulants from caffeine to Ritalin (methylphenidate) and on to methamphetamine and cocaine, and including MAOIs, can produce subjective feelings of improved concentration or memory, and some short-term studies show a brief improvement. This is caused by obsessive-compulsive mental focusing and is driven by a narrowing of general awareness and judgment.  No FDA-approved stimulants, for example, have been proven to help cognition or academic performance, and all harm the brain long-term.  Here is a study that is negligent in its claims and its lack of warnings about methylene blue that may have encouraged the current epidemic use: https://psychiatryonline.org/doi/full/10.1176/appi.pn.2016.pp8a5 I have researched these issues in multiple scientific papers and books, including Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Psychopharmaceutical Complex, second edition (2008).  For an easily accessible, comprehensive look at stimulant drug effects, also see my free resource center on children and stimulant medications: https://breggin.com/Childrens-Resources-Center   2 Drug Safety Communication: Serious CNS reactions possible when methylene blue is given to patients taking certain psychiatric medications | FDA and FDA Drug Safety Communication: Updated information about the drug interaction between methylene blue and Drug Safety Podcasts > FDA Drug Safety Podcast for Healthcare Professionals: Updated information about the drug interaction between methylene blue and serotonergic psychiatric medications (methylthioninium chloride) and serotonergic psychiatric medications | FDA and much more comprehensive coverage of methylene blue adverse effects with special warnings for professionals can be found at Methylene Blue Monograph for Professionals – Drugs.com   3 Half_a_century_of_antidepressant_drugs_-20151101-21548-vmvosk-libre.pdf. Also see Methylene Blue: The Long and Winding Road From Stain to Brain: Part 2 – PubMed and Methylene Blue in the Treatment of Neuropsychiatric Disorders – PubMed; and Iproniazid | Antidepressant, Monoamine Oxidase Inhibitor & Mental Health | Britannica; Methylene Blue: The Long and Winding Road From Stain to Brain: Part 2 – PubMed; Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today – PubMed. These cover the fascinating history of MAOIs and Methylene Blue.    4 The currently approved MAOI antidepressants are phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldpryl, Emsam, Zelapar)), and isocarboxazid (Marplan).     ______   Learn more about Dr. Peter Breggin's work: https://breggin.com/   See more from Dr. Breggin's long history of being a reformer in psychiatry: https://breggin.com/Psychiatry-as-an-Instrument-of-Social-and-Political-Control   Psychiatric Drug Withdrawal, the how-to manual @ https://breggin.com/a-guide-for-prescribers-therapists-patients-and-their-families/   Get a copy of Dr. Breggin's latest book: WHO ARE THE “THEY” - THESE GLOBAL PREDATORS? WHAT ARE THEIR MOTIVES AND THEIR PLANS FOR US? HOW CAN WE DEFEND AGAINST THEM? Covid-19 and the Global Predators: We are the Prey Get a copy: https://www.wearetheprey.com/   “No other book so comprehensively covers the details of COVID-19 criminal conduct as well as its origins in a network of global predators seeking wealth and power at the expense of human freedom and prosperity, under cover of false public health policies.”   ~ Robert F Kennedy, Jr Author of #1 bestseller The Real Anthony Fauci and Founder, Chairman and Chief Legal Counsel for Children's Health Defense.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is our inaugural book club episode centered around the novel Mind Fixers by Anne Harrington.Mind Fixers is by the Harvard historian Anne Harrington, and came out from Norton in 2022. It reframes the “biological turn” in later twentieth century psychiatry with a history of the discipline from the later nineteenth century forward. Harrington argues that the biological turn had relatively little to do with new scientific advances, and came instead from a need to separate psychiatry from the increasingly unpopular public image of the discipline's previous, “Freudian” age. To make this argument, she starts with the anatomic research of turn-of-the-century figures like Kraepelin, and how this generally failed to explain important mental illnesses. She traces the emergence of “Freudian” or psychological approaches to mental illness to the high point of their dominance in the mid twentieth century, and then their decline, as their inadequacy with respect to things like bipolar disorder and schizophrenia became increasingly clear, and their emphasis on childhood experience stigmatized families. Biological psychiatry is then a way to restore the fields's respectability as as branch of medicine, but according to Harrington, there is not much transformative innovation to go along with this rebrand; and she emphasizes that the psychopharmacology revolution which gave us the first antipsychotics, MAOIS, tricyclics, and the receptor model of mental illness, actually happened during the heyday of psychoanalysis.The members of our team involved in this discussion are:Sara Abrahamson - MS2 at the University of TorontoDr. Kate Braithwaite - Medical Doctor from South AfricaDr. Wendy MacMillan-Wang - PGY4 psychiatry resident at the University of ManitobaDr. Alastair Morrison - PGY1 psychiatry resident at McMaster UniversityDr. Gaurav Sharma - Staff psychiatrist working in Nunavut, CanadaThis episode was edited by Dr. Angad Singh - PGY1 psychiatry resident at the University of Toronto Our discussion was structured around four themes:(03:15) - Psychiatry and Economic Incentives(19:33) - Psychiatry and Parenting(28:40) - Biological Psychiatry and its Alternatives(52:05) - Psychiatry and Social ControlIf you enjoyed this episode, consider listening to our episodes about:History of Psychiatry with Dr. David CastleCritical Psychiatry with Dr. Elia Abi-Jaoude and Lucy CostaFor more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠), X (⁠@psychedpodcast⁠), and Facebook (⁠⁠PsychEd Podcast⁠⁠). You can provide feedback by email at ⁠psychedpodcast@gmail.com⁠. For more information, visit our website at ⁠psychedpodcast.org⁠.

Welcome back! Today, we will be discussing MAOIs, and we've picked out a few of our favorites for today's episode.

Did you know that the use of antidepressant drugs is all based on a hypothesis that has always been, and is becoming increasingly, questionable? Did you know that there are natural products that have a much broader effect than antidepressants, without the side effects? On this episode of Vitality Radio, Jared introduces you to the incredible benefits of Saffron - particularly a specific form. You'll learn how this beautiful herb can not only help with depression but also with cognition, weight, libido, and more! Jared also reviews the movie Protocol 7 about corruption in Big Pharma - a film everyone should see if they want true informed consent. Products:Terry Naturally Saffron LiftAdditional Information:REACT19Protocol 7 MovieVisit the podcast website here: VitalityRadio.comYou can follow @vitalityradio and @vitalitynutritionbountiful 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!Please also join us on the Dearly Discarded Podcast with Jared St. Clair.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.

What are the main reasons MAOIs are underutilized in psychiatric practice despite their proven efficacy for certain conditions? What are the key dietary restrictions patients must follow when taking MAOIs? What are the critical drug-drug interactions clinicians must be aware of when prescribing MAOIs? What clinical pearls or tips would you give to clinicians looking to become more comfortable using these agents?  Brought to you by the NEI Podcast, the PsychopharmaStahlogy Show tackles the most novel, exciting, and controversial topics in psychopharmacology in a series of themes. This theme is on underutilized psychotropic drugs.  Today, Dr. Andy Cutler interviews Dr. Thomas Schwartz and Dr. Stephen Stahl about factors that have led to the underutilization of MAOIs in psychiatry.  Let's listen to Part 2 of our theme: Underutilized Psychiatric Drugs.  Subscribe to the NEI Podcast, so that you don't miss another episode!  Resources  Email roundtable@maoiexperts.topicbox.com for guidance on prescribing MAO inhibitors  The Prescriber's Guide to Classic MAO Inhibitors (Phenelzine, Tranylcypromine, Isocarboxazid) for Treatment-Resistant Depression  Practical Guide for Prescribing MAOIs: Debunking Myths and Removing Barriers 

Medicine and wellness are evolving in interesting and surprising ways. Nowhere is this more evident than in pharmacy and plant medicine. Canadian longevity pharmacist Michael Forbes is here to discuss this.   Key Takeaways To Tune In For: [01:06] Traditional Plant Medicine in the Amazon [07:29] Modern Medicine Funding and Research Challenges [11:21] Wellness Retreats and Plant Medicine [21:51] Exploring Ayahuasca and MAOIs [24:55] Exploring Plant Medicines for Inner Healing   Resources talked about in this episode Website: https://agelessliving.com/team/ Social media handles: https://www.linkedin.com/in/michaelforbesvan https://www.instagram.com/ageless.living/ https://www.facebook.com/AgelessLivingInc/ https://www.youtube.com/@ageless.living  

Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end.  Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI:  initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness,  weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net

High Yield Psychiatric Medications Antidepressants Review for your PANCE, PANRE, Eor's and other Physician Assistant exams. Review includes SSRI's, SNRIs, TCAs, MAOIs, Atypical antidepressants, Serotonin modulators. TrueLearn PANCE/PANRE SmartBank:https://truelearn.referralrock.com/l/CRAMTHEPANCE/Discount code for 20% off: CRAMTHEPANCEIncluded in review: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Desvenlafaxine, Duloxetine, Levomilnacipran , Milnacipran, Venlafaxine, Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine, Desipramine, Nortriptyline, Protriptyline, Tranylcypromine, Isocarboxazid, Phenelzine Selegiline, Bupropion, Mirtazapine, Trazodone

Get my free mushroom trip checklist here: jamesxander.com/checklist ❤️ » 1:1 Integration Support & Psychedelic Guidance «» Unlock God Mode – A Course for Upgrading Your Hologram « YOUTUBE:• YouTube channel @emperorjames• YouTube channel @jamesxandertrip This is my personal guide for preparing for your first Ayahuasca trip. [Watch this episode on YouTube] What is Ayahuasca? Ayahuasca is a plant-based psychedelic. It is made by prolonged heating or boiling of the Banisteriopsis caapi vine with the leaves of the Psychotria viridis shrub, although there can be a variety of other plants included in the decoction for different traditional purposes. The active chemical in ayahuasca is DMT (dimethyltryptamine). It also contains monoamine oxidase inhibitors (MAOIs). Ayahuasca has been used for centuries by First Nations peoples from contemporary Peru, Brazil, Colombia and Ecuador for religious ritual and therapeutic purposes. Resources for your psychedelic trip: • YouTube channel • 4 Essential Touchstones for Your Mushroom Trip • The Mushroom Trip Guide: A Psychedelic Checklist • 1:1 Cosmic Guidance Call with James   Psychedelic Resources: • Top 20 Myths About Mushrooms & Psychedelics  • Lessons from a Deep Mushroom Trip  • How Psilocybin Opens the Door to Synchronicity • The Dark Tunnel of Mushrooms – How to Have a Smooth Trip • What Is the Right Dose for a Mushroom Trip (Safety Guide) • The Power of Surrender - What the Mushrooms Taught Me  • 8 Things You Must Do Before a Mushroom Trip  • 5 Life-Changing Benefits of Doing Mushrooms  Join the Tribe - jamesxander.com ❤️  Please subscribe to my YouTube channel for more episodes!  Listen to my in-depth psychedelic podcast: The James Xander Trip

Get my free mushroom trip checklist here: jamesxander.com/checklist ❤️ » 1:1 Integration Support & Psychedelic Guidance «» Unlock God Mode – A Course for Upgrading Your Hologram «YOUTUBE:• YouTube channel @emperorjames• YouTube channel @jamesxandertrip This is my personal guide for preparing for your first Ayahuasca trip. [Watch this episode on YouTube] What is Ayahuasca? Ayahuasca is a plant-based psychedelic. It is made by prolonged heating or boiling of the Banisteriopsis caapi vine with the leaves of the Psychotria viridis shrub, although there can be a variety of other plants included in the decoction for different traditional purposes. The active chemical in ayahuasca is DMT (dimethyltryptamine). It also contains monoamine oxidase inhibitors (MAOIs). Ayahuasca has been used for centuries by First Nations peoples from contemporary Peru, Brazil, Colombia and Ecuador for religious ritual and therapeutic purposes. Resources for your psychedelic trip: • YouTube channel • 4 Essential Touchstones for Your Mushroom Trip • The Mushroom Trip Guide: A Psychedelic Checklist • 1:1 Cosmic Guidance Call with James Psychedelic Resources: • Top 20 Myths About Mushrooms & Psychedelics  • Lessons from a Deep Mushroom Trip  • How Psilocybin Opens the Door to Synchronicity • The Dark Tunnel of Mushrooms – How to Have a Smooth Trip • What Is the Right Dose for a Mushroom Trip (Safety Guide) • The Power of Surrender - What the Mushrooms Taught Me  • 8 Things You Must Do Before a Mushroom Trip  • 5 Life-Changing Benefits of Doing Mushrooms  Join the Tribe - jamesxander.com ❤️  Please subscribe to my YouTube channel for more episodes!  Listen to my in-depth psychedelic podcast: The James Xander Trip

1:1 Integration Support & Psychedelic Guidance  » Join Unlock God Mode, a 30-day audio course for upgrading your relationship with reality. «  The Mushroom Trip Checklist (ebook)  Check out The James Xander Trip podcast ❤️  Subscribe to my personal YouTube channel This is my personal guide for preparing for your first Ayahuasca trip. [Watch this episode on YouTube] What is Ayahuasca? Ayahuasca is a plant-based psychedelic. It is made by prolonged heating or boiling of the Banisteriopsis caapi vine with the leaves of the Psychotria viridis shrub, although there can be a variety of other plants included in the decoction for different traditional purposes. The active chemical in ayahuasca is DMT (dimethyltryptamine). It also contains monoamine oxidase inhibitors (MAOIs). Ayahuasca has been used for centuries by First Nations peoples from contemporary Peru, Brazil, Colombia and Ecuador for religious ritual and therapeutic purposes. Resources for your psychedelic trip: • YouTube channel • 4 Essential Touchstones for Your Mushroom Trip • The Mushroom Trip Guide: A Psychedelic Checklist • 1:1 Cosmic Guidance Call with James Psychedelic Resources: • Top 20 Myths About Mushrooms & Psychedelics  • Lessons from a Deep Mushroom Trip  • How Psilocybin Opens the Door to Synchronicity • The Dark Tunnel of Mushrooms – How to Have a Smooth Trip • What Is the Right Dose for a Mushroom Trip (Safety Guide) • The Power of Surrender - What the Mushrooms Taught Me  • 8 Things You Must Do Before a Mushroom Trip  • 5 Life-Changing Benefits of Doing Mushrooms  Join the Tribe - jamesxander.com ❤️  Please subscribe to my YouTube channel for more episodes!  Listen to my in-depth psychedelic podcast: The James Xander Trip

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name hydralazine Trade Name Apresoline Indication hypertension Action arterial vasodilation by unclarified mechanism Therapeutic Class anti-hypertensive Pharmacologic Class vasodilator Nursing Considerations • may cause tachycardia, sodium retention, arrhythmias, angina • use caution with MAOIs • monitor blood pressure • instruct patient on how to take blood pressure

Stephen Stahl steps down from the industry-sponsored podium to remind us of 3 reasons to use an MAOI: Atypical depression, treatment-resistant depression, and social anxiety disorder.CME: Take the CME Post-Test for this EpisodePublished On: 06/12/2023Duration: 26 minutes, 24 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Hello and welcome back everybody. We are on Week 3 of the Sexual Health and Anxiety Series. At first, we talked with the amazing Lauren Fogel Mersy about sexual anxiety or sexual performance anxiety. And then last week, I went into depth about really understanding arousal and anxiety, how certain things will increase arousal, certain things will decrease it, and teaching you how to get to know what is what so that you can have a rich, intimate, fulfilling life.  We are now on Week 3. I have to admit, this is an episode that I so have wanted to do for quite a while, mainly because I get asked these questions so often and I actually don't know the answers. It's actually out of my scope. In clinical terms, we call it “out of my scope of practice,” meaning the topic we're talking about today is out of my skill set. It's out of my pay grade. It's out of my level of training.  What we're talking about this week is the sexual side effects of antidepressants or anxiety medications, the common ones that people have when they are anxious or depressed. Now, as I said to you, this is a medical topic, one in which I am not trained to talk about, so I invited Dr. Sepehr Aziz onto the episode, and he does such a beautiful job, a respectful, kind, compassionate approach to addressing sexual side effects of anxiety medication, sexual side effects of depression medication. It's just beautiful. It's just so beautiful. I feel like I want to almost hand this episode off to every patient when I first start treating them, because I think so often when we're either on medication or we're considering medication, this is a really common concern, one in which people often aren't game to discuss. So, here we are. I'm actually going to leave it right to the doctor, leave it to the pro to talk all about sexual side effects and what you can do, and how you may discuss this with your medical provider. Let's do it. Kimberley: Welcome. I have been wanting to do this interview for so long. I am so excited to have with us Dr. Sepehr Aziz. Thank you so much for being here with us today. Dr. Aziz: Thanks for having me. Kimberley: Okay. I have so many questions we're going to get through as much as we can. Before we get started, just tell us a little about you and your background, and tell us what you want to tell us. Dr. Aziz: Sure. Again, I'm Dr. Sepehr Aziz. I go by “Shepherd,” so you can go ahead and call me Shep if you'd like. I'm a psychiatrist. I'm board certified in general adult psychiatry as well as child and adolescent psychiatry by the American Board of Psychiatry and Neurology. I completed medical school and did my residency in UMass where they originally developed mindfulness-based CBT and MBSR. And then I completed my Child and Adolescent training at UCSF. I've been working since then at USC as a Clinical Assistant Professor of Psychiatry there. I see a lot of OCD patients. I do specialize in anxiety disorders and ADHD as well. Kimberley: Which is why you're the perfect person for this job today. Dr. Aziz: Thank you.  WHAT ARE THE BEST MEDICATIONS FOR PEOPLE WITH ANXIETY & OCD (IN GENERAL)? Kimberley: I thank you so much for being here. I want to get straight into the big questions that I get asked so regularly and I don't feel qualified to answer myself. What are the best medications for people with anxiety and OCD? Is there a general go-to? Can you give me some explanation on that? Dr. Aziz: As part of my practice, I first and foremost always try to let patients know that the best treatment is always a combination of therapy as well as medications. It's really important to pursue therapy because medications can treat things and they can make it easier to tolerate your anxiety, but ultimately, in order to have sustained change, you really want to have therapy as well. Now, the first-line medications for anxiety and OCD are the same, and that's SSRIs or selective serotonin reuptake inhibitors. SNRIs, which are selective norepinephrine reuptake inhibitors, also work generally, but the best research that we have in the literature is on SSRIs, and that's why they're usually preferred first. There are other medications that also might work, but these are usually first-line, as we call it. There are no specific SSRIs that might work better. We've tried some head-to-head trials sometimes, but there's no one medication that works better than others. It's just tailored depending on the patient and the different side effects of the medication. SSRI'S VS ANTIDEPRESSANTS DEFINITION Kimberley: Right. Just so people are clear in SSRI, a lot of people, and I notice, use the term antidepressant. Are they synonymous or are they different? Dr. Aziz: Originally, they were called antidepressants when they first were released because that was the indication. There was an epidemic of depression and we were really badly looking for medications that would work. Started out with tricyclic antidepressants and then we had MAOIs, and then eventually, we developed SSRIs. These all fall under antidepressant treatments. However, later on, we realized that they work very well for anxiety in addition to depression. Actually, in my opinion, they work better for anxiety than they do for depression. I generally shy away from referring to them as antidepressants just to reduce the stigma around them a little bit and also to be more accurate in the way that I talk about them. But yes, they're synonymous, you could say.  BEST MEDICATION FOR DEPRESSION Kimberley: Sure. Thank you for clearing that up because that's a question I often get. I know I led you in a direction away but you answered. What is the best medication for people with depression then? Is it those SSRIs or would you go-- Dr. Aziz: Again, these are first-line medications, which means it's the first medication we would try if we're starting medication, which is SSRIs. Other medications might also work like SNRIs again. For depression specifically, there are medications called serotonin modulators that are also effective such as vortioxetine or nefazodone, or vilazodone. But SSRIs are generally what people reach for first just because they've been around for a long time, they're available generic, they work, and there's no evidence that the newer medications or modulators work better. They're usually first line. Kimberley: Fantastic. Now you brought up the term “generic” and I think that that's an important topic because the cost of therapy is high. A lot of people may be wondering, is the generic as good as the non-generic options? Dr. Aziz: It really depends on the medication and it also depends on which country you're in. In the US, we have pretty strict laws as to how closely a generic has to be to a regular medication, a brand name medication, and there's a margin of error that they allow. The margin of error for generics is, I believe, a little bit higher than for the brand name. However, most of the time, it's pretty close. For something like Lexapro, I usually don't have any pressure on myself to prescribe the brand name over the generic. For something like other medications we use in psychiatry that might have a specific way that the brand name is released, a non-anxiety example is Concerta, which is for ADHD. This medication uses an osmotic release mechanism and that's proprietary. They license it out to one generic company, but that license is expiring. All those patients who are on that generic in the next month or two are going to notice a difference in the way that the medication is released. Unless you're a physician privy to that information, you might not even know that that's going to happen. That's where you see a big change. Otherwise, for most of the antidepressants, I haven't noticed a big difference between generic and brand names.   Kimberley: Right. Super helpful. Now you mentioned it depends on the person. How might one decide or who does decide what medication they would go on? Dr. Aziz: It's really something that needs to be discussed between the person and their psychiatrist. There are a number of variables that go into that, such as what's worked in a family member in the past, because there are genetic factors in hepatic metabolism and things like that that give us some clue as to what might work. Or sometimes if I have a patient with co-occurring ADHD and I know they're going to be missing their medications a lot, I'm more likely to prescribe them Prozac because it has a longer half-life, so it'll last longer. If they miss a dose or two, it's not as big of a deal. If I have a patient who's very nervous about getting off of the medication when they get pregnant, I would avoid Prozac because it has a long half-life and it would take longer to come off of the medication. Some medications like Prozac and Zoloft are more likely to cause insomnia or agitation in younger people, so I'll take that into consideration. Some medications have a higher likelihood of causing weight loss versus weight gain. These are all things that would take into consideration in order to tailor it to the specific patient. Kimberley: Right. I think that's been my experience too. They will usually ask, do you have a sibling or a parent that tried a certain medication, and was that helpful? I love that question. I think it informs a lot of decisions. We're here really. The main goal of today is really to talk about one particular set of side effects, which is the sexual side effects of medication. In fact, I think most commonly with clients of mine, that tends to be the first thing they're afraid of having to happen. How common are sexual side effects? Is it in fact all hype or is it something that is actually a concern? How would you explain the prevalence of the side effects? Dr. Aziz: This is a really important topic, I just want to say, because it is something that I feel is neglected when patients are talking to physicians, and that's just because it can be uncomfortable to talk about these things sometimes, both for physicians and for patients. Oftentimes, it's avoided almost. But because of that, we don't know for sure exactly what the incidence rate is. The literature on this and the research on this is not very accurate for a number of reasons. There are limitations. The range is somewhere between 15 to 80% and the best estimate is about 50%. But I don't even like saying that because it really depends on age, gender, what other co-occurring disorders they have such as depression. Unipolar depression can also cause sexual dysfunction. They don't always take that into account in these studies. A lot of the studies don't ask baseline sexual function before asking if there's dysfunction after starting a medication, so it's hard to tell. What I can say for sure, and this is what I tell my patients, is that this sexual dysfunction is the number one reason why people stop taking the medication, because of adverse effects.  WHAT MEDICATIONS ARE MORE PRONE TO SEXUAL SIDE EFFECTS?  Kimberley: Right. It's interesting you say that we actually don't know, and it is true. I've had clients say having anxiety has sexual side effects too, having depression has sexual side effects too, and they're weighing the pros and cons of going on medication comparative to when you're depressed, you may not have any sexual drive as well. Are some medications more prone to these sexual side effects? Does that help inform your decision on what you prescribe because of certain meds? Dr. Aziz: Yeah. I mean, the SSRIs specifically are the ones that are most likely to cause sexual side effects. Technically, it's the tricyclics, but no one really prescribes those in high doses anymore. It's very rare. They're the number one. But in terms of the more commonly prescribed antidepressants and anti-anxiety medications among the SSRIs and the SNRIs and the things like bupropion and the serotonin modulators we talked about, the SSRIs are most likely to cause sexual dysfunction. Kimberley: Right. Forgive me for my lack of knowledge here, I just want to make sure I'm understanding this. What about the medications like Xanax and the more panic-related medications? Is that underneath this category? Can you just explain that to me? Dr. Aziz: I don't usually include those in this category. Those medications work for anxiety technically, but in current standard practice, we don't start them as an initial medication for anxiety disorders because there's a physical dependency that can occur and then it becomes hard to come off of the medication. They're used more for panic as an episodic abortive medication when someone is in the middle of a panic attack, or in certain cases of anxiety that's not responding well to more conventional treatment, we'll start it. We'll start it on top of or instead of those medications. They can cause sexual side effects, but it's not the same and it's much less likely.  SEXUAL SIDE EFFECTS OF MEDICATION FOR MEN VS WOMEN  Kimberley: Okay. Very helpful. Is it the same? I know you said we don't have a lot of data, and I think that's true because of the stigma around reporting sexual side effects, or even just talking about sex in general. Do we have any data on whether it impacts men more than women? Dr. Aziz: The data shows that women report more sexual side effects, but we believe that's because women are more likely to be treated with SSRIs. When we're looking at the per capita, we don't have good numbers in terms of that. In my own practice, I'd say it's pretty equal. I feel like men might complain about it more, but again, I'm a man and so it might just be a comfort thing of reporting it to me versus not reporting. Although I try to be good about asking before and after I start medication, which is very important to do. But again, it doesn't happen all the time. Kimberley: Yeah, it's interesting, isn't it? Because from my experience as a clinician, not a psychiatrist, and this is very anecdotal, I've heard men because of not the stigma, but the pressure to have a full erection and to be very hard, that there's a certain masculinity that's very much vulnerable when they have sexual side effects—I've heard that to be very distressing. In my experience. I've had women be really disappointed in the sexual side effects, but I didn't feel that... I mean, that's not really entirely true because I think there's shame on both ends. Do you notice that the expectations on gender impacts how much people report or the distress that they have about the sexual side effects?  Dr. Aziz: Definitely. I think, like you said, men feel more shame when it comes to sexual side effects. For women, it's more annoyance. We haven't really talked about what the sexual side effects are, but that also differs between the sexes. Something that's the same between sexes, it takes longer to achieve orgasm or climax. In some cases, you can't. For men, it can cause erectile dysfunction or low libido. For women, it can also cause low libido or lack of lubrication, which can also lead to pain on penetration or pain when you're having sex. These are differences between the sexes that can cause different reporting and different feelings, really. Kimberley: Right. That's interesting that it's showing up in that. It really sounds like it impacts all the areas of sexual playfulness and sexual activity, the arousal, the lubrication. That's true for men too, by the sounds of it. Is that correct?  Dr. Aziz: Yeah.  Kimberley: We've already done one episode about the sexual performance anxiety, and I'm sure it probably adds to performance anxiety when that's not going well as well, correct? Dr. Aziz: It's interesting because in my practice, when I identify that someone is having sexual performance anxiety or I feel like somebody, especially people with anxiety disorders, if I feel like they have vulvodynia, which means pain on penetration—if I see they have vulvodynia and I feel that this is because of the anxiety, oftentimes the SSRI might improve that and cause greater satisfaction from sex. It's a double-edged sword here. COMMON SEXUAL SIDE EFFECTS OF ANTIDEPRESSANTS Kimberley: Yeah. Can you tell me a little more about What symptoms are they having? The pain? What was it called again? Dr. Aziz: Vulvodynia. Kimberley: Is that for men and women? Just for women, I'm assuming. Dr. Aziz: Just from vulva, it is referring to the outside of the female genitalia. Especially when you have a lack of lubrication or sometimes the muscles, everyone with anxiety knows sometimes you have muscle tension and there are a lot of complex muscles in the pelvic floor. Sometimes this can cause pain when you're having sex. There are different ways to address that, but SSRIs sometimes can improve that.  Kimberley: Wow. It can improve it, and sometimes it can create a side effect as well, and it's just a matter of trial and error, would you say? Dr. Aziz: It's a delicate balance because these side effects are also dose-dependent. It's not like black or white. I start someone on 5 milligrams, which is a child's dose of Lexapro. Either they have sexual side effects or don't. They might not have it on 5, and then they might have it a little bit on 10, and then they get to 20 and they're like, “Doctor, I can't have orgasms anymore.” We try to find the balance between improving the anxiety and avoiding side effects. SEXUAL SIDE EFFECTS TREATMENT Kimberley: You're going right into the big question, which is, when someone does have side effects, is it the first line of response to look at the dose? Or how would you handle a case if someone came to you first and said, “I'm having sexual side effects, what can we do?”  Dr. Aziz: Again, I'm really thorough personally. Before I even seem to start a medication, I'll ask about libido and erectile dysfunction and ability to climax and things like that, so I have a baseline. That's important when you are thinking about making a change to someone's medications. The other thing that's important is, is the medication working for them? If they haven't seen a big difference since they started the medication, I might change the medication. If they've seen an improvement, now there's a pressure on me to keep the medication on because it's working and helping. I might augment it with a second medication that'll help reverse the sexual side effects or I might think about reducing the dose a little bit while maintaining somewhere in the therapeutic zone of doses or I might recommend, and I always recommend non-pharmacological ways of addressing sexual side effects. You always do that at baseline. Kimberley: What would that be? Dr. Aziz: There's watchful waiting. Sometimes if you just wait and give it some time, these symptoms can get better. I'm a little more active than that. I'll say it's not just waiting, but it's waiting and practicing, whether that's solo practice or with your partner. Sometimes planning sex helps, especially if you have low libido. There's something about the anticipation that can make someone more excited. The use of different aids for sex such as toys, vibrators, or pornography, whether that's pornographic novels or imagery, can sometimes help with the libido issues and also improve satisfaction for both partners. The other thing which doesn't have great research, but there is a small research study on this, and not a lot of people know about this, but if you exercise about an hour before sex, you're more likely to achieve climax. This was specifically studied in people with SSRI-related anorgasmia. Kimberley: Interesting. I'm assuming too, like lubricants, oils, and things like that as well, or? Dr. Aziz: For lubrication issues, yes. Lubricants, oils, and again, you really have to give people psychoeducation on which ones they have to use, which ones they have to avoid, which ones interact with condoms, and which ones don't. But you would recommend those as well. Kimberley: Is it a normal practice to also refer for sex therapy? If the medication is helping their symptoms, depression, anxiety, OCD, would you ever refer to sex therapy to help with that? Is that a standard practice or is that for specific diagnoses, like you said, with the pain around the vulva and so forth? Dr. Aziz: Absolutely. A lot of the things I just talked about are part of sex therapy and they're part of the sexual education that you would receive when you go to a sex therapist. I happen to be comfortable talking about these things, and I've experienced talking about it. When I write my notes, that would fall under me doing therapy. But a lot of psychiatrists would refer to a sex therapist. Hopefully, there are some in the town nearby where someone is. It's sometimes hard to find someone that specializes in that. Kimberley: Is there some pushback with that? I mean, I know when I've had patients and they're having some sexual dysfunction and they do have some pushback that they feel a lot of shame around using vibrators or toys. Do you notice a more willingness to try that because they want to stay on the meds? Or is it still very difficult for them to consider trying these additional things? Are they more likely to just say, “No, the meds are the problem, I want to go off the medication”? Dr. Aziz: It really depends on the patient. In my population that I see, I work at USC on campus, so I only see university students in my USC practice. My age group is like 18 to 40. Generally, people are pretty receptive. Obviously, it's very delicate to speak to some people who have undergone sexual trauma in the past. Again, since I'm a man, sometimes speaking to a woman who's had sexual trauma can be triggering. It's a very delicate way that you have to speak and sometimes there's some pushback or resistance. It can really be bad for the patient because they're having a problem and they're uncomfortable talking about it. There might be a shortage of female psychiatrists for me to refer to. We see that. There's also a portion of the population that's just generally uncomfortable with this, especially people who are more religious might be uncomfortable talking about this and you have to approach that from a certain angle. I happen to also be specialized in cultural psychiatry, so I deal with these things a lot, approaching things from a very specific cultural approach, culturally informative approach. Definitely, you see resistance in many populations. Kimberley: I think that that's so true. One thing I want to ask you, which I probably should have asked you before, is what would you say to the person who wants to try meds but is afraid of the potential of side effects? Is there a certain spiel or way in which you educate them to help them understand the risks or the benefits? How do you go about that for those who there's no sexual side effects, they're just afraid of the possibility? Dr. Aziz: As part of my practice, I give as much informed consent to my patients as I can. I let them know what might happen and how that's going to look afterwards. Once it happens, what would we do about it if it happened? A lot of times, especially patients with anxiety, you catastrophize and you feel this fear of some potential bad thing happening, and you never go past that. You never ask yourself, okay, well now let's imagine that happens. What happens next? I tell my patients, “Yeah, you might have sexual dysfunction, but if that happens, we can reduce the medications or stop them and they'll go away.” I also have to tell my patients that if they search the internet, there are many people who have sexual side effects, which didn't go away, and who are very upset about it. This is something that is talked about on Reddit, on Twitter. When my patients go to Dr. Google and do their research, they often get really scared. “Doctor, what if this happens and it doesn't go away?” I always try to explain to them, I have hundreds of patients that I've treated with these medications. In my practice, that's never happened. As far as I know from the literature, there are no studies that show that there are permanent dysfunctions sexually because of SSRIs.  Now, like I said, the research is not complete, but everything that I've read has been anecdotal. My feeling is that if you address these things in the beginning and you're diligent in asking about the side effects of baseline sexual function beforehand and you are comfortable talking with your patients about it, you can avoid this completely. That's been my experience. When I explain that to my patients, they feel like I have their back, like they're protected, like I'm not just going to let them fall through the cracks. That has worked for me very well. Kimberley: Right. It sounds like you give them some hope too, that this can be a positive experience, that this could be a great next step. Dr. Aziz: Yeah, absolutely. Kimberley: Thank you for bringing up Dr. Google, because referring to Reddit for anything psychologically related is not a great idea, I will say. Definitely, when it comes to medications, I think another thing that I see a lot that's interesting on social media is I often will get dozens of questions saying, “I heard such and such works. Have your clients taken this medication? I heard this medication doesn't work. What's your experience?” Or if I've told them about my own personal experience, they want to know all about it because that will help inform their decision. Would you agree, do not get your information from social media or online at all? Dr. Aziz: I have patients who come to me and they're like, “My friend took Lexapro and said it was the worst thing in the world, and it may or not feel any emotions.” I'm explaining to them, I literally have hundreds of patients, hundreds that I prescribe this to, and I go up and down on the dose. I talk to them about their intimate lives all day. But for some reason, and it makes sense, the word of their friend or someone close to them, really, carries a lot of weight. Also, I don't want to discount Reddit either, because I feel like it's as a support system and as a support group. I find other people who have gone through what you've gone through. It's very strong. Even pages like-- I don't want to say the page, but there's a page that's against psychiatry, and I peruse this page a lot because I have my own qualms about psychiatry sometimes. I know the pharmaceutical companies have a certain pressure on themselves financially, and I know hospitals have a certain pressure on themselves. I get it. I go on the page and there's a lot of people who have been hurt in the past, and it's useful for patients to see other people who share that feeling and to get support. But at the same time, it's important to find providers that you can trust and to have strong critical thinking skills, and be able to advocate for yourself while still listening to somebody who might have more information than you. Kimberley: I'm so grateful you mentioned that. I do think that that is true. I think it's also what I try to remember when I am online. The people who haven't had a bad experience aren't posting on Reddit. They're out having a great time because it helped, the medication helped them, and they just want to move on. I really respect those who have a bad experience. They feel the need to educate. But I don't think it's that 50% who gave a great experience are on Reddit either. Would you agree? Dr. Aziz: Right. Yeah. The people who are having great outcomes are not creating a Reddit page to go talk about it, right? Kimberley: Yeah. Thank you so much for answering all my questions. Is there a general message that you want to give? Maybe it's even saying it once over on something you've said before. What would be your final message for people who are listening? WHEN SSRIs IMPACTS YOUR SEX LIFE: ADVICE FROM DR AZIZ Dr. Aziz: I just want to say that when SSRI's impact your sex life, it's really important for psychiatry, and especially in therapy, that you feel comfortable sharing your experiences in that room. It should be a safe space where you feel comfortable talking about your feelings at home and what's going on in your intimate life and how things are affecting you. Your feelings, positive or negative towards your therapist or your psychiatrist, whether things they said made you uncomfortable, whether you feel they're avoiding something, that room should be a safe space for you to be as open as possible. When you are as open as possible, that's when you're going to get the best care because your provider, especially in mental health, needs to know the whole picture of what's going on in your life. Oftentimes, we are just as uncomfortable as you. And so, again, a lot of providers might avoid it because they're afraid of offending you by asking about your orgasms. As a patient, you take the initiative and you bring it up. It's going to improve your care. Try not to be afraid of bringing these things up. If you do feel uncomfortable for any reason, always let your provider know.  I always tell my patients, I have a therapist. I pay a lot of money to see my therapist, and sometimes I tell him things I hate about him. He's a great therapist. He's psychoanalytic. Every time I bring something up, he brings it back to something about my dad. He's way older than me. But he's a great therapist. Every time I've brought something like that up, it's been a breakthrough for me because that feeling means something. That would be my main message to everyone listening. Kimberley: Thank you. I'm so grateful for your time and your expertise. Really, thank you. Can you tell us where people can get in touch with you, seek out your services, read more about you? Dr. Aziz: Sure. I work for OCD SoCal. I'm on the executive board, and that's the main way I like to communicate with people who see me on programs like this. You can always email me at S, like my first name, Aziz, that's A-Z-I-Z, @OCDSoCal.org. If you're a USC student, you can call Student Health and request to see me at the PBHS clinic. That's the Psychiatry and Behavioral Health Services clinic on campus at USC. Kimberley: They're lucky to have you. Dr. Aziz: Thank you. Kimberley: Yes. I love that you're there. Thank you so much for all of your expertise. I am so grateful. This has been so helpful.

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name butorphanol Trade Name Stadol Indication moderate to severe pain, labor pain, sedation Action alters perception and response to pain by binding to opiate receptors in CNS Therapeutic Class Opioid Analgesic Pharmacologic Class opioid agonists/antagonists Nursing Considerations • use caution with concurrent use of MAOIs • may cause confusion, hallucinations, sedation • monitor for CNS depression • assess blood pressure pulse and respirations during administration • administer slowly through an IV line

On this episode I go over a whole bunch of tools to take with you when entering a difficult conversation. It doesn't matter if you are breaking up, asking for a pay rise, talking to your parents about a sensitive topic, ANYTHING. This will help you feel more comfortable and confident approaching these kinds of conversations. Brain Fact: Monoamines and MAOIs as a treatment for depression Hosted on Acast. See acast.com/privacy for more information.

MAOIs rank high in efficacy and are pretty well tolerated too, as long as you watch for two critical interactions. CME: Take the CME Post-Test for this EpisodePublished On: 03/20/2023Duration: 22 minutes, 40 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Generic Name metoprolol Trade Name Lopressor, Toprol XL Indication tachyarrhythmias, HTN, angina, prevention of MI, heart failure management, may be used for migraine prophylaxis Action blocks the stimulation of beta1 receptors in the SNS, does not usually effect on beta2 receptors (cardioselective) Therapeutic Class antianginal, antihypertensive Pharmacologic Class beta blocker Nursing Considerations • monitor hemodynamics • may lead to bradycardia, pulmonary edema • use caution with MAOIs • assess I&Os and monitor for signs of CHF

Download the cheat: https://bit.ly/50-meds  View the lesson:     Generic Name sertraline Trade Name Zoloft Indication major depressive disorder, OCD, anxiety Action inhibits uptake of serotonin allowing for higher quantities available within synaptic cleft Therapeutic Class Antidepressant Pharmacologic Class SSRI Nursing Considerations • do not use with MAOIs • can cause neurolyptic malignant syndrome, suicidal thoughts, drowsiness, insomnia, diarrhea, dry mouth, tremors, serotonin syndrome, sexual dysfunction • monitor mood changes in patient • takes 1-4 weeks for therapy to be effective.

Download the cheat: https://bit.ly/50-meds  View the lesson:     Generic Name paroxetine Trade Name Paxil Indication major depressive disorder, OCD, anxiety, PTSD Action block reuptake of serotonin in CNS Therapeutic Class antianxiety agent, antidepressant Pharmacologic Class SSRI Nursing Considerations • do not use with MAOIs • can cause neurolyptic malignant syndrome, suicidal thoughts, serotonin syndrome, constipation, diarrhea, insomnia • decrease effectiveness of digoxin • increase bleeding with warfarin • assess for suicidal thoughts

Download the cheat: https://bit.ly/50-meds  View the lesson:     Generic Name oxycodone Trade Name Oxycontin Indication pain Action binds to opiate receptors in CNS altering the perception and sensation of pain Therapeutic Class Opioid Analgesic Pharmacologic Class opioid agonists, opioid agonists/nonopioid, analgesic combinations Nursing Considerations • may cause respiratory depression, constipation, confusion , sedation, hallucinations, urinary retention • use caution with increased intracranial pressure • don't use with MAOIs • assess hemodynamics • assess pain • may elevate pancreatic enzymes • can cause physical dependence • assess bowel function

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/NalbuphineNubainNursingConsiderations    Generic Name nalbuphine Trade Name Nubain Indication pain, analgesia during labor, sedation before surgery, supplement to balance anesthesia Action alters perception and response to pain, causes CNS depression Therapeutic Class Opioid Analgesic Pharmacologic Class opioid agonists/analgesics Nursing Considerations • use caution with head trauma • can cause dizziness, headache, nausea, vomiting, respiratory depression • do not use with MAOIs • assess pain • may cause respiratory depression in newborn • asses hemodynamic parameters • may elevate pancreatic enzymes • Narcan (naloxone) is the antidote

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: What it's like to dissect a cadaver, published by OldManNick on November 10, 2022 on LessWrong. Why I never thought I was a bio person. But then I overheard Viv talking about MAOIs at a party. I asked her: > - What are MAOIs? > - monoamine oxidase inhibitor > - What does that mean? > - It prevents reuptake of neurotransmitters. > - But what is a neurotransmitter? What does reuptake actually mean? > - ... > - So life uses chiral properties of space to implement things... Viv had the most important trait of a teacher: patience. I asked the most naive questions and they answered them. They walked with me, all the way down to the very beginning, rebuilding my understanding. It was amazing. I wanted to know more. Roadblock: finding lifeforms to study. I wondered if non-medical students could watch dissections. You can't get more information about an object than by directly interacting with it. The concrete world contains the abstract one. I even asked my doctor at a physical if she knew of any, and she said to look at community colleges. After some searching, I found this: Bio 848NV. Forget viewing the dissection, you're doing the dissection. 5 hour dissection for $60, free if you just watch. The only bureaucratic hangup is that you must pay by check. This is why I love the Bay Area: there's stuff like this and you can just do it. yes it's weird no they can't stop you. The boundary between scientist and serial killer is paper thin sometimes. Takeaways I've done this a few times now. Turns out that there's way way way too much information to understand it all in one 5 hour session. Each time, we pick out areas and focus on them. Seeing how everything fits together ‒and how big it is‒ makes understanding at different scales much easier. There's a common template to life. Seeing it in you hits different. Brain has interesting connections to fractals and graph theory. Maybe pan-psychism isn't totally wrong. What & how & why I tell my friend Leah and she says “This is the most appealing activity that I've ever seen you do”. Dunno whom that says more about. We arrive and there are 5 people around 3 cadavers. We get aprons and lab coats and start syringing what's mostly Downy fabric softener with a syringe. It prevents decay and smells sickly sweet. Corpses can last a long time. One of the corpses had been dead for 5 years. Many random observations There's a crazy amount of connective tissue, and it makes a creepy wireframe surrounding your skeleton. Even the space between the folds of the brain has it. If you exercise, we'll know. Their insides just look different. “It's who you are inside that matters” is a much creepier sentence now. Veins, arteries, and nerves all travel together, wound around each other by a bunch of connective tissue. Mnemonic: VAN. Cancer can turn your guts and lungs green, and it's this horrible bright moldy green. Metastasized tissue is hard but ultimately crumbly like overcooked chicken liver. The stomach and intestines have textures reminiscent of damp cardboard, but they're dry to the touch. I finally saw a lymph node. The body has a lot of drainage into the lymphatic system. There's a bunch of tiny nerves and you can't feasibly preserve all. The etymology of the word patience is “capacity for suffering”. This is apt. You can't rush the process, and believe me, it is a process. Exposing the VANs requires reflecting away the skin, and this takes a long time and much more physical effort than you'd think. You're basically scraping it off, and the best tool overall is your hands. Skin in particular is much tougher than it looks, and I ended up locking a pair of forceps against a shoulder and just leaning back to pull it taut. Speaking of the shoulder, I spent 2 hours working up through one. There are a lot of fiddly bits. I knew, but didn't understand, ...

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: What it's like to dissect a cadaver, published by OldManNick on November 10, 2022 on LessWrong. Why I never thought I was a bio person. But then I overheard Viv talking about MAOIs at a party. I asked her: > - What are MAOIs? > - monoamine oxidase inhibitor > - What does that mean? > - It prevents reuptake of neurotransmitters. > - But what is a neurotransmitter? What does reuptake actually mean? > - ... > - So life uses chiral properties of space to implement things... Viv had the most important trait of a teacher: patience. I asked the most naive questions and they answered them. They walked with me, all the way down to the very beginning, rebuilding my understanding. It was amazing. I wanted to know more. Roadblock: finding lifeforms to study. I wondered if non-medical students could watch dissections. You can't get more information about an object than by directly interacting with it. The concrete world contains the abstract one. I even asked my doctor at a physical if she knew of any, and she said to look at community colleges. After some searching, I found this: Bio 848NV. Forget viewing the dissection, you're doing the dissection. 5 hour dissection for $60, free if you just watch. The only bureaucratic hangup is that you must pay by check. This is why I love the Bay Area: there's stuff like this and you can just do it. yes it's weird no they can't stop you. The boundary between scientist and serial killer is paper thin sometimes. Takeaways I've done this a few times now. Turns out that there's way way way too much information to understand it all in one 5 hour session. Each time, we pick out areas and focus on them. Seeing how everything fits together ‒and how big it is‒ makes understanding at different scales much easier. There's a common template to life. Seeing it in you hits different. Brain has interesting connections to fractals and graph theory. Maybe pan-psychism isn't totally wrong. What & how & why I tell my friend Leah and she says “This is the most appealing activity that I've ever seen you do”. Dunno whom that says more about. We arrive and there are 5 people around 3 cadavers. We get aprons and lab coats and start syringing what's mostly Downy fabric softener with a syringe. It prevents decay and smells sickly sweet. Corpses can last a long time. One of the corpses had been dead for 5 years. Many random observations There's a crazy amount of connective tissue, and it makes a creepy wireframe surrounding your skeleton. Even the space between the folds of the brain has it. If you exercise, we'll know. Their insides just look different. “It's who you are inside that matters” is a much creepier sentence now. Veins, arteries, and nerves all travel together, wound around each other by a bunch of connective tissue. Mnemonic: VAN. Cancer can turn your guts and lungs green, and it's this horrible bright moldy green. Metastasized tissue is hard but ultimately crumbly like overcooked chicken liver. The stomach and intestines have textures reminiscent of damp cardboard, but they're dry to the touch. I finally saw a lymph node. The body has a lot of drainage into the lymphatic system. There's a bunch of tiny nerves and you can't feasibly preserve all. The etymology of the word patience is “capacity for suffering”. This is apt. You can't rush the process, and believe me, it is a process. Exposing the VANs requires reflecting away the skin, and this takes a long time and much more physical effort than you'd think. You're basically scraping it off, and the best tool overall is your hands. Skin in particular is much tougher than it looks, and I ended up locking a pair of forceps against a shoulder and just leaning back to pull it taut. Speaking of the shoulder, I spent 2 hours working up through one. There are a lot of fiddly bits. I knew, but didn't understand, ...

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/MethylphenidateConcertaNursingConsiderations    Generic Name methylphenidate Trade Name Ritalin, Concerta Indication ADHD, narcolepsy Action improves attention span in ADHD by producing CNS stimulation Therapeutic Class central nervous system stimulant Pharmacologic Class none Nursing Considerations • can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia • may decrease effects of Warfarin and Phenytoin • do not use with MAOIs • monitor cardiovascular system • monitor for behavioral changes • monitor for dependence • do not consume caffeinated beverages “Drug Holiday” used to assess dependence and status

Do Autistic people experience mental health differently? What is it like to live on a psych ward? What happens when you MASK in therapy? *Trigger Warning - Suicide, Self-Harm and Mental Health* Amelia is the creator of the Autistic Positivity instagram page, a page which focuses on illuminating the issues Autistic people face, as well as spreading awareness/acceptance of common Autism topics. In this episode of the Thoughty Auti Podcast, Thomas Henley talks to Amelia about their experiences of mental health, misdiagnosis, psych wards, suicide and the different ways Autistic people may experience mental health disorders. Kicking off the conversation, Thomas brings to light the poor QOL statistics around being Autistic, establishing that suicide is NOT an isolated and uncommon experience. Amelia explains to us her experience being misdiagnosed Borderline Personality Disorder, Depression and Anxiety and the subsequent issues with self-harm and suicide attempts - Thomas shares his experience with these as well. They talk about common medications they have used for depression, anxiety and psychosis and how they are often the wrong fit for Autistic people (SSRIs, MAOIs and sedatives), but also cover the ways they think Autistic people differ in their experience with mental health (Alexithymia, executive functioning, repetitive thoughts and MASKING both in therapy and life). They highlight the many barriers to Autistic people managing and getting effective support for mental health, highlighting lack of specialised psychotherapy, education and research into these areas. If you have an exciting or interesting story and want to appear on the next podcast, please contact me at: aspergersgrowth@gmail.com Amelia's Links:- Instagram - https://www.instagram.com/autisticpositivity/ All Links - https://linktr.ee/autisticpositivity Autism Suicide Prevention Journal - https://ko-fi.com/s/04f3a8e22c Song Of The Day (Listen Here) - https://open.spotify.com/playlist/5UDIyN5TSYN4zMcRoQPrG8?si=9255ed3480d840b5 ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ Website - https://www.thomashenley.co.uk ♫ THOUGHTY AUTI PODCAST - https://open.spotify.com/show/6vjXgCB7Q3FwtQ2YqPjnEV FOLLOW ME On Social Media ♥ - ☼ Facebook - Thomas Henley ☼ Twitter - @thomashenleyuk ☼ Instagram - @thomashenleyUK Support via Patreon! - https://www.patreon.com/thomashenleyUK --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/HydralazineApresolineNursingConsiderations    Generic Name hydralazine Trade Name Apresoline Indication hypertension Action arterial vasodilation by unclarified mechanism Therapeutic Class anti-hypertensive Pharmacologic Class vasodilator Nursing Considerations • may cause tachycardia, sodium retention, arrhythmias, angina • use caution with MAOIs • monitor blood pressure • instruct patient on how to take blood pressure

Nick talks to pharmaceutical microbiologist Dr. Dirk Hoffmeister, who is professor at the Hans Knöll Institute in Germany. Professor Hoffmeister has a background in botany and mycology, the study of fungi. His lab studies various aspects of fungal biochemistry & molecular biology, including the biochemistry and molecular genetics of psilocybin production in magic mushrooms. We spoke about various topics in mycology, mostly related to Psilocybe mushrooms. This included: how psilocybin is synthesized from the amino acid tryptophan; the ecological reasons for why some mushrooms produce psilocybin; why magic mushrooms turn a vibrant blue color when they are physically damaged; the production of monoamine oxidase inhibitors (MAOIs) by certain species; the ecology of Psilocybe mushrooms; other areas of mycology that his lab studies.Support M&M:Sign up for the weekly Mind & Matter newsletter[https://mindandmatter.substack.com/?sort=top]The Amino Co., shop science-back amino acids supplements. Use code ‘MIND' to save 30%.[aminoco.com/MIND]Follow Nick's work through Linktree:[https://linktr.ee/trikomes]Organize your digital highlights & notes w/ Readwise (2 months free w/ sub)[https://readwise.io/nickjikomes/]Learn more about our podcast sponsor, Dosist[https://dosist.com]Support the show

Episode 107: Weight Gain Meds. Medications that cause weight gain are also called weight positive medications. Sapna, Danish, and Dr. Arreaza mention some of those medications in this episode. Introduction: Some meds cause weight gainBy Hector Arreaza, MD.You will see patients who keep gaining weight regardless of their sincere efforts to eat better and exercise. Some people experience serious difficulties to lose weight. If you want to know how frustrating it can be, imagine your doctor telling you to add one more inch to your height when you are 35 years old. For some people, losing weight is just as hard. One important step you can take to help your patients lose weight is performing a detailed medication reconciliation. Review the medication list, and you may find some meds that are proven to cause weight gain. Today we will discuss some of those medications, but it takes practice to learn all of them. I hope this episode is helpful for you. This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________Weight Gain Meds. By Sapna Patel, MS4, and Danish Khalid, MS4. Ross University School of Medicine. Comments by Hector Arreaza, MD. S: Medications associated with weight gain: See Table 1.1 for medications associated with weight gain and alternatives. Antipsychotic agents:A: Ziprasidone is an antipsychotic medicine that causes the least amount of weight gain.Antidepressants:There are many antidepressants which are associated with weight gain, including the tricyclics, monoamine oxidase inhibitors (MAOIs), and some of the selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants, in particular amitriptyline, clomipramine, doxepin, and imipramine, are associated with significant weight gain.Selective serotonin reuptake inhibitors, paroxetine exhibited the greatest weight gain in its class. Whereas fluoxetine exhibited little to no weight gain and remains weight neutral in the class. Amongst the monoamine oxidase inhibitors, phenelzine had the greatest weight gain.  Antiepileptics/Antiseizure: Amongst the antiepileptic drugs used to treat seizures, neuropathic pain, or other psychiatric conditions,  valproate, carbamazepine, and gabapentin are associated with weight gain. Gabapentin is virtually used by all our diabetic patients. Antihypertensive agents: Beta BlockersBeta receptors, specifically beta-2 receptors, stimulate the release of insulin. Thus, patients on beta blockers may experience weight gain as a side effect. There are two beta blockers that cause the least amount of weight gain: Carvedilol (Coreg) and nebivolol (Bystolic). Hypoglycemic medications: Although intended to regulate blood sugar levels, several anti-diabetic medications are associated with weight gain, specifically sulfonylureas, Actos, and insulin. As mentioned earlier, metformin as well as GLP-1 agonists are associated with weight loss. Metformin can be considered weight neutral. Steroids: Steroid hormones such as corticosteroids or progestational steroids are associated with weight gain. Steroids may increase levels of cortisol, one of the end pathways in steroidogenesis. Cortisol, also known as the stress hormone, functions by increasing insulin resistance, and decreasing glucose utilization, thus causing weight gain.  Antihistamine Medications: Diphenhydramine (Benadryl): commonly used for allergies…or how my mom used it, puts you to sleep right before a flight. However, a side effect of using this medication includes weight gain.Cyproheptadine: an antihistamine, used for antidote to serotonin syndrome and migraines, has an appetite stimulant effect causing weight gain. It can be used off-label as an appetite stimulant in children who do not gain weight. Fun Fact: Although it is a common belief that combined oral contraceptives cause weight gain, data suggest that significant weight gain is not a common side effect of combined oral contraceptives. A good practice: Medication reconciliation: Weight positive, weight neutral, or weight negative. Weight positive: Deprescribe or change for another medication if possible. Weight neutral and weight negative: Keep them. Don't be afraid to prescribe anti-obesity meds. We should learn about them, become familiar with side effects, contraindications, dosing, and more, and prescribe them appropriately as part of a weight loss program. Also, don't forget that these medications are used in conjunction with a proper diet.        CategoryDrug ClassWeight GainAlternatives Psychiatric agentsAntipsychoticsClozapine, risperidone, olanzapine, quetiapine, haloperidol, perphenazineZiprasidone, aripiprazoleAntidepressants/mood stabilizers: tricyclic antidepressantsAmitriptyline, doxepin, imipramine, nortriptyline, trimipramine, mirtazapine Bupropion, nefazodone, fluoxetine (short term), sertraline (

Trade: LevophedClass: Adrenergic agonist, inotropic, vasopressor MOA: alpha 1, alpha 2, Beta 1 agonist. Primarily results in peripheral vasoconstriction resulting in increasing BP, and coronary blood flow. Beta adrenergic action produces inotropic stimulation of the heart and dilates coronary arteries.Indications: Cardiogenic Shock, septic shock, severe hypotension Contraindications: Patients taking MAOIs, use caution in hypovolemia Side Effects: Dizziness, anxiety, cardiac arrhythmias, dyspnea, asthma exacerbationDosing Adult: 2-4mcg/min IV/IO titrate to effect ( systolic BP greater then 80) Max dose is 30mcg/minPedi:  0.05 to 2mcg/kg/min IV/IO

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/ButorphanolStadolNursingConsiderations    Generic Name butorphanol Trade Name Stadol Indication moderate to severe pain, labor pain, sedation Action alters perception and response to pain by binding to opiate receptors in CNS Therapeutic Class Opioid Analgesic Pharmacologic Class opioid agonists/antagonists Nursing Considerations • use caution with concurrent use of MAOIs • may cause confusion, hallucinations, sedation • monitor for CNS depression • assess blood pressure pulse and respirations during administration • administer slowly through an IV line

Jake Crossman has spent the last four years studying health, wellness, and nutrition and currently is the managing director of USA Medical. A plant-based vitamin and supplement brand specializing in organic hemp extract products, including CBD and CBG. Tune in to hear this unbelievable conversation Jake and I had about all thing's health and wellness. Jake shares with us the difference between those highly advertised words as well as CBD and CBG. We also get into some new and not so popular plant medicines such as Kava, Ashwagandha, and Shilajit. I am a big fan of two of these which I am sure you have heard me speak on before. If not, tune back to episode 301. Jake has spent years in the research and science department before USA Medical launched which you hear more about as well as our in-depth conversations surrounding his trending TikTok videos. There is so much “junk” on the market when it comes to CBD products which is why I know you will love this episode. So much information you truly need to hear today. You'll hear more on MAOIs, how to properly calculate CBD dosages, and so much more about the body, brain, diet, disease, and gut health. Make sure to stay until the very end as Jake has an incredible gift that you will not want to miss out on. Did you love this episode? Let us know by leaving a review on Apple Podcasts. We would truly appreciate it! MENTIONED IN THE SHOW 35% off USA Medical Products. Use code “everythingismessy” on usamedicalshop.com. Everything is Messy Audiobook. Grab presale with bonuses at everythingismessy.com. CONNECT WITH JAKE WEBSITE: https://usamedicalshop.com/ TIKTOK: https://www.tiktok.com/@usamedical FACEBOOK: https://www.facebook.com/usamedicalshop TWITTER: https://twitter.com/USAMedicalShop INSTAGRAM: https://www.instagram.com/usamedicalshop/ LINKEDIN: https://www.linkedin.com/company/usamedical CONNECT WITH KELLY WEBSITE: kellyanngorman.com EVERYTHING IS MESSY COLLECTION: everythingismessy.com      LINKEDIN NEWSLETTER: https://www.linkedin.com/newsletters/6866512629620453376/ WEEKLY NEWSLETTER: https://kellyanngorman.com/business-mindset-organizational-tools/ LINKEDIN: https://www.linkedin.com/today/author/kellyanngorman/ MEDIUM: https://kellyanngorman.medium.com/ INSTAGRAM: @kellyanngormanofficial  YOUTUBE: https://www.youtube.com/kellyanngorman TIKTOK: https://www.tiktok.com/@kellyanngormanofficial? https://www.tiktok.com/@everythingismessy SUPPORT THE SHOW SHOP EVERYTHING IS MESSY COLLECTION: everythingismessy.com SHOP WITH KELLY'S BRAND PARTNERS: https://kellyanngorman.com/shop/  DONATION: https://www.paypal.com/paypalme/kagenterprises

The name "Ayahuasca" or "aya huasca" comes from the Kichwa word "Ajawaska", which, when translated means "Vine of the soul". It is a sacred vine used for thousands of years by the indigenous tribes of the Amazon for spiritual cleansing and healing. Ayahuasca is considered "The Mother of all plants" that mediates connection between man & Mother Gaia. The Ayahuasca ceremony is a special journey that involves visions, purging, and revelations that lead to healing and being in harmony with yourself. The name “ayahuasca” is made up of two words- aya and wasca-derived from the Quechua language, where aya means soul or ancestors, and wasca (huasca) means vine or rope. Most people of South America also refer to it as “vine of the soul.” I do not advise taking Ayahuasca willy nilly, at a festival or weekend party. I believe it is best used in sacred ceremonies with experienced, legit healers/medicine men/women. All of the ceremonies I've attended since 2017 have been with ayahuasceros with decades of experience. There are psychological and medical contraindications to use of Ayahuasca — so you must be medically cleared before entering ceremony. People suffering from Parkinson's disease, schizophrenia or other mental health disorders should absolutely avoid taking Ayahuasca. It may also react with antidepressants, cough and weight loss medications How is it made? The traditional Ayahuasca tea is prepared from two main ingredients- Banisteriopsis caapi and Psychotria viridis. Both are native plants to South America and can have hallucinogenic properties. Psychotria viridis contains N, N-dimethyltryptamine (DMT), a psychedelic substance that occurs naturally in the plant and has strong hallucinogenic properties. But it has low bioavailability and is broken down rapidly. For DMT to work properly, Banisteriopsis caapi is used that contains MAO inhibitor (MAOIs). When brewed together they turn into a powerful psychedelic Excessive intake of this herbal drink may also lead to some serious side effects and in the worst case, it can even turn fatal. After drinking the tea, a person may experience the following symptoms. Anxiety Diarrhea Nausea Panic Paranoia Vomiting High blood pressure Check out the PenningtonMedia YouTube channel for my video talking about my ayahuasca experiences for more info. Feel free to check out my bio link for info on psychedelic prep & integration groups. And stay tuned for upcoming trip reports & future visits to ayahuasca retreats in countries where it is fully legal and medically supervised! http://sleekbio.com/drandrea #plantmedicine #thankyouplantmedicine #ayahuascaceremony #plantmedicine #medicinewoman #psychedelicintegration #psychedelicintegrationcoach Music: Maipen Lei Musician: Beltone Site: https://icons8.com/music/ Music: Swallow Curious to know whether you're at increased risk of illness due to early childhood experiences? Take our short quiz to ind out your ACE score free: ☞ https://bit.ly/GetYourACEScore My New TEDx is LIVE!

Murchadh Martainn a searmonachadh air Ecsodus 19: 3 Agus chaidh Maois suas a dh' ionnsuidh Dhe, agus ghairm an Tighearn' air as an t-sliabh, ag radh, Mar so their thu ri tigh Iacoib, agus innsidh tu do chlann Israeil: 4 Chunnaic sibh na rinn mi ris na h-Eiphitich, agus cionnus a ghiùlain mi sibhse mar air sgiathaibh iolairean, agus a thug mi do'm ionnsuidh fein sibh.

This podcast features a discussion on the need to highlight anhedonia and anergia as core symptoms of depression. We also cover the clinical utility of MAOIs in treating patients with melancholic or biological depression and Parkinson's disease. Guest: Ken Gillman, M.D.; Interviewer: Wegdan Rashad, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Dopamine and Depression: Clinical Considerations - Interview with Ken Gillman, M.D.

Obsessive compulsive disorder (OCD) can often be effectively treated with cognitive behavioral therapy or serotonin reuptake inhibitors. About one-third of patients, however, do not receive adequate symptom relief. Jon E. Grant discusses the potential of monoamine oxidase inhibitors (MAOIs) in treatment-resistant OCD. In an article in the journal, Dr. Grant and his coauthors present new data from a case series of nine patients; three had marked improvement on phenelzine and three had some improvement. Large-scale trials are needed to fully assess the benefits and risks of the therapy in this population group.

Erectile Dysfunction: Common Causes and natural solutions – Dr. Jason Jones Elizabeth City NC, Chiropractor Erectile dysfunction (ED) is one of the common health conditions recorded among men. In fact, According to the Urology Care Foundation, it is estimated that 30 million Americans experience ED. Many patients in our Chiropractic Office at Elizabeth City, NC have reported how erectile dysfunction has affected their sex drive, and how it resulted in depression and low self-esteem. So it is important that we discuss this problem, which is common in men. What is Erectile Dysfunction? Erectile dysfunction (ED) is simply the inability to get or maintain a firm enough erection to have sexual intercourse. This condition is sometimes referred to as “impotence.”   Many men experience ED during times of stress, but when it becomes frequent, it is a clear sign of health problems that need medical attention. An erection is normally achieved when there is an increased blood flow into your penis. And this happens when a man is sexually excited. The muscles in your penis relax and blood flows into your penile arteries, resulting in the filling of two chambers inside the penis. This makes the penis grow hard. What are the causes of Erectile Dysfunction? There are many possible causes of ED, including physical and emotional conditions. However, the common causes of ED include: Cardiovascular disease High blood pressure Diabetes Obesity Kidney disease Anxiety Stress Depression High cholesterol Low testosterone levels Increased age Sleep disorders Certain prescription medication Prescription Medications that Can Cause Erectile Dysfunction Numerous prescription medications have been implicated in erectile dysfunction. That's why it is important to always consult your doctor before changing or stopping your medications. Some medications that can cause erectile dysfunction include: Heart medications such as digoxin Drugs that work on the central nervous system, including amphetamines and sleeping pills Drugs to control high blood pressure Anxiety treatments Some diuretics Prostate treatment drugs Opioid painkillers Antidepressants, including monoamine oxidase inhibitors (MAOIs). Tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) Anticholinergic drugs Some cancer drugs The peptic ulcer medication cimetidine Hormone drugs Natural Solutions for Erectile dysfunction There are many treatment options available for ED such as drugs, surgical treatments, and more. But the natural solutions are advisable to avoid unpleasant side effects. Here are some natural solutions that have been used to treat erectile dysfunction: Exercises Certain exercises have been shown to help with erectile dysfunction. You can try the following: Kegel exercises: These exercises involve simple movements that help to strengthen your pelvic floor muscles. Start by stopping your pee midstream to identify your pelvic floor muscles. Contract these muscles for at least 3 seconds, and then release them. You can do this exercise three times a day, and 10 to 20 times in a row. Aerobic exercise: You can try moderate to vigorous exercises like swimming and running. These exercises increase your blood flow and improve your overall health Yoga: This helps to relax your mind and ease every form of stress and anxiety. Eating a healthy diet You can prevent or treat erectile dysfunction by eating a healthy diet. This helps to maintain your blood vessels and increase your blood flow. Eat whole grains, fruits, and vegetables Limit your consumption of processed sugars, full-fat dairy, and red meats Limit or quit alcohol consumption Natural herbs You can improve erectile dysfunction by using certain herbs, including: Asparagus racemosus Ginseng, such as Korean ginseng Dehydroepiandrosterone (DHEA) Yohimbe Horny goat weed Acupuncture Acupuncture is a traditional treatment measure that involves inserting needed at specific parts of the skin. This method works for erectile dysfunction through nerve stimulation, and it has an effect on the release of neurotransmitters. Prostatic massage A prostatic massage is an effective form of massage used for ED. During this method, the practitioner massages the tissue in and around the groin to promote the flow of blood to your penis. You may need to undergo this massage several times a week, but it all depends on your symptoms. In conclusion, erectile dysfunction is one of the most common health conditions in men. It is sometimes called impotence and its risk increases with age. There are several factors that can cause ED, including prescription medications. This condition can lead to depression, lower, sex drive, low self-esteem, and stress. Several treatment measures are available for ED, including medical interventions, lifestyle changes, and natural remedies. We however recommend the natural solutions listed above. However, you should consult your doctor before using any of those methods.

“Where do the Australian psychoactive acacia species fit into the contemporary, local psychedelic scene, and how does interaction with these species inform a deeper connection to this land and its dreaming?” That's the question we are discussing in this episode of the podcast, psychedelic cafe #5. We talk about the history, pharmacology, and phenomenology of drinking the psychedelic acacia trees of Australia. As well as their conservation, challenges of learning there being no known history of their ceremonial use, and the complications of using them in the context of colonialism. We also talk about plant intelligence, interspecies communication, and encounters with “the unseen realm” of spirits that exist beyond the human mind. Our Guests For This Episode: Nick Sun Jef Baker Rohan B. Dr. Liam Engel Julian Palmer For links to our guests' bios and work, full show notes, and to watch this episode in video, head to https://bit.ly/PsyCafe5   ***Full Topics Breakdown Below***     SUPPORT THIS PODCAST   ► Patreon: https://patreon.com/jameswjesso ► Donations: https://www.paypal.com/biz/fund?id=383635S3BKJVS ► Merchandise: https://www.jameswjesso.com/shop/ ► More options: https://www.jameswjesso.com/support/   ► Newsletter: https://www.jameswjesso.com/newsletter   *** Extra BIG thanks to my patrons on Patreon for helping keep this podcast alive! Especially, Andreas D, Clea S, Joe A, Ian C, David WB, Yvette FC, Ann-Madeleine, Dima B, Eliz C, Chuck W, Nathan B, & Nick M     Episode Breakdown Communicating with psychedelic acacia trees of Australia Connecting to the spirit of the land A growing language between humans and the acacia Conservation of Acacia in the face of wild harvesting The modern cultural context of acacia drinkers Australian Psychedelic Acacia spirituality is an unexplored area of psychedelic anthropology Acacia species that are orally active without separate MAOIs? Psychedelic alkaloids in Acacia other than nn, DMT—e.g. NMT, 5-MeO-DMT, and other undiscovered alkaloids Why plants produce alkaloids (beyond survival) Experiential differences between psychedelic acacias problems and concerns for conversation and preservation DMT and Acacia general usage patterns in Western Australia Ask not what the plant can do for you, but what you can do for the plant Finding a sustainable commercial source for  the psychedelic acacia trees of australia The complexity of drinking acacia in the context of colonialism Will drinking the plants reconnect us with the land Asking for permission Learning the plants and how to take them with integrity without a culture to guide us Psychedelic encounters with spirits — DMT, acacia, and “the unseen realm” You can’t just chalk entity experiences up to 'just a trip' All non-human life has intrinsic value Grow plants Existence is just a joke but you have to take it seriously or it isn’t funny Learn to en-joy The message DMT is attempting to give humanity Different plants from different lands, consumed on different lands, invite different insight   ************** SUPPORT THIS PODCAST   ► Patreon: https://patreon.com/jameswjesso ► Donations: https://www.paypal.com/biz/fund?id=383635S3BKJVS ► Merchandise: https://www.jameswjesso.com/shop/ ► More options: https://www.jameswjesso.com/support/   ► Newsletter: https://www.jameswjesso.com/newsletter   ► Or, you can buy a copy of one of my books! Decomposing The Shadow: https://www.jameswjesso.com/decomposing-the-shadow/ The True Light Of Darkness: https://www.jameswjesso.com/true-light-darkness/

Dr. Erica Marini discusses drug interactions between MAOIs and antidepressants

Benjamin Malcolm, aka The Spirit Pharmacist, joins us on to explore and compare the pharmacological actions of antidepressant psychotropics with the actions of the classical psychedelics, ayahuasca, MDMA, and ketamine. We also explore the risk of combining psychedelics, MDMA, and/or ketamine with the different classes of antidepressants, including SSRIs, SNRIs, and MAOIs, and even NDRIs like Wellbutrin and Strattera. This episode is chock full of very specific information about pharmacology. Get your notepad ready. ... For links to Malcolms's work, full show notes, and to watch this episode in video, head to https://bit.ly/ATTMind140   ***Full Topics Breakdown Below***     SUPPORT THIS PODCAST   ► Patreon: https://patreon.com/jameswjesso ► Donations: https://www.paypal.com/biz/fund?id=383635S3BKJVS ► Merchandise: https://www.jameswjesso.com/shop/ ► More options: https://www.jameswjesso.com/support/   ► Newsletter: https://www.jameswjesso.com/newsletter   *** Extra BIG thanks to my patrons on Patreon for helping keep this podcast alive! Especially, Andreas D, Clea S, Joe A, Ian C, David WB, Yvette FC, Ann-Madeleine, Dima B, Eliz C, Chuck W, Nathan B, Nick M, & Wes p     Episode Breakdown The difference between antidepressants and psychedelics as treatments for mental health disorders How antidepressant psychotropics address mental health disorders How psychedelics address mental health disorders Psychedelic psychotherapy is suffering under the weight of trying to fit in with psychiatry Psychedelics help you heal yourself, by helping to heal your brain How the classical psychedelics affect the brain—Lsd, psilocybin, MDMA, Ayahuasca, and Ketamine Neurotrophic factors and psychedelic induced neuroplasticity Combining tricyclic antidepressants and psychedelics (including MDMA, ketamine, and ayahuasca) What are MAOIs (a vs b, reversible vs irreversible) and their interaction with psychedelics (and ayahuasca) An explanation of serotonin syndrome Combining MAOIs with psilocybin and LSD Combining MAOIs with MDMA (as well as other stimulants) SRI’s and SNRI’s— what are they and how do they interact with psychedelics SSRIs reduce the effects of MDMA Is it a good idea to use Prozac for MDMA hangover NRI and NDRI–what are they and how do they interact with psychedelics (including ayahuasca) Mixing Wellbutrin or Straterra with psychedelics Why anecdotal evidence for drug reactions doesn't amount to much Combining SARI (trazodone) with psychedelics   ************** SUPPORT THIS PODCAST   ► Patreon: https://patreon.com/jameswjesso ► Donations: https://www.paypal.com/biz/fund?id=383635S3BKJVS ► Merchandise: https://www.jameswjesso.com/shop/ ► More options: https://www.jameswjesso.com/support/ ► Newsletter: https://www.jameswjesso.com/newsletter

Ritalin can have drug interactions with over the counter medication, such as decongestants, cold and cough medication, seizure medication, blood thinners, Monoamine oxidase inhibitors (MAOIs), and antidepressants.https://recoverypartnernetwork.com/drug/stimulants/methylphenidate-addiction

This interview discusses the use of MAOIs and tricyclic antidepressant combinations, adjunctive benzodiazepines and trazodone, and the use of psychostimulants as adjunctive agents in managing major depressive disorder. Faculty: Michael Thase, M.D. Learn more about Premium Membership here Earn 0.75 CMEs - "Top 10 Drug Combinations in MDD - Interview with Prof. Michael E. Thase"

Dr. Erica Marini discusses MAOIs.

Help spread the word of MAOIs Join MAOI advisory consultancy group: https://forms.gle/wyVL54T4hryfKrQk6 MAOI open letter: https://psychotropical.com/maoi_short... Dear Dr letter: https://psychotropical.com/wp-content... MAOI food interactions long letter: https://psychotropical.com/wp-content... Support: A petition to end the shortage of Nardil created by a Nardil patient: https://www.change.org/p/end-the-shor...

SSRIs, MAOIs etc Music 'Normalize' by Bipolar Project

An t-Urramach Seamus Maciomhair a searmonachadh air Aireamh 14:13 Agus thubhairt Maois ris an Tighearn', An sin cluinnidh na h-Eiphitich e, (oir thug thusa nios an sluagh so le d' chumhachd o bhi 'n am measg.) 14 Agus innsidh iad e do luchd-àiteachaidh an fhearainn seo: oir chual' iad gu bheil thusa, a Thighearn'. am measg an t-sluaigh seo; gu bheil thusa, a Thighearn', air d' fhaicinn aghaidh ri h-aghaidh; agus gu bheil do neul a' seasamh os an ceann; agus gu bheil thu ag imeachd romhpa, ann am meall neoil 's an latha, agus ann am meall teine 's an oidhche.   

In this episode, Cameron Kiani interviews Ken Gillman, MD, on using Monoamine Oxidase Inhibitors in clinical practice.   Dr. Gillman is a Queensland-based psychiatrist considered to be one of the world's leading experts on MAOIs. He recently published a statement “Revitalizing monoamine oxidase inhibitors: a call for action” in the journal CNS Spectrums.    Cameron Kiani is a fourth year medical student at Icahn School of Medicine at Mount Sinai with an interest in treatment-resistant mood disorders.    “Revitalizing monoamine oxidase inhibitors: a call for action”   https://www.cambridge.org/core/journals/cns-spectrums/article/revitalizing-monoamine-oxidase-inhibitors-a-call-for-action/32497C0FE4F08D0D4C07E6350A91B0EE

This episode is the starter pack for the use of monoamine oxidase inhibitors in psychiatry practice. We learn the mechanism of action, food-related instructions and MAOI drug interactions. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute

Susan Bratton is a sex and relationships expert who first appeared on the podcast in the episode  Her fresh approach to sex techniques and bedroom communication skills help millions of people—of all ages and across the gender spectrum—transform sex into passion. Her straight-forward lovemaking advice is rooted in her personal experience of watching her marital intimacy wither as she and her husband pursued dynamic careers. When her relationship hit a crisis point, Susan made a fierce commitment to doing whatever it took to hold her family together and revive the passion in her marriage. Today, she and her husband have the kind of dream relationship most people stopped believing was even possible—until they discover her practical tips. After 15 years and over 30k hours of research, practice, teaching, and testing, Susan distilled the six simple essentials that ignite passionate lovemaking into her latest #1 international best-selling book, . I also recently appeared in Susan's wildly popular "" to discuss natural testosterone enhancement methods for men. In this special two-part episode, I'm going to dish out to you my top sixteen bedroom and sex biohacking tips, then turn things over to Susan for her solosode lecture on Libido, Desire and Arousal! In this special episode with Ben and Susan, you'll learn... -Ben Greenfield's bedroom and sex biohacking tips [3:00] Weightlifting specifically for one's genitals Get the right amount of sleep Watch your body fat % Overnight fasting Train for testosterone Control your stress Eat adequate calories (slight surplus) Eat more carbs at dinner Eat adequate protein Remember amino acids Collagen, glycine, bone broth Hydrate properly Increase androgen receptor density Electrical muscle stimulation Red light therapy JOOVV light Cold therapy Jet Pack Minerals Pulsed Electromagnetic Field Therapy (PEMF) Sex-specific exercises Embrace masculine activities Book: Libido, Desire and Arousal featuring Susan Bratton [23:20] -Libido Desire and Arousal Libido is body-based Desire is relationship-based Arousal is when the two come together Arousal Ladders Relaxation, Sympathetic and Parasympathetic Bullseye Touch Seduction (Small Offers, Erotic Vigilance, Vision, Vulnerability) Lightswitch vs. Fire “She Never Initiates” Transport Her -Understanding our genital anatomy ED, Premature ejaculation, painful sex and anorgasmia Engorgement Yoni Massage Crossing the ‘Gasm Orgasm is a learned skill Penetration orgasms Sexual soulmates are co-created -The 6 essentials to connected sex are: Presence Loverspace Soulmate Pact Polarity Embodied Sexuality Erotic Playdates -The Sexual Soulmate Pact -15 Types of Male and Female Orgasm -Supplements: Vitamins and Minerals, Boron! -Vitamin A is essential for both male and female sex hormone production. -Vitamin B3 is necessary for short, intense bursts of energy and the sexual flush that increases blood flow to your genitals and intensifies your orgasm. -Vitamin B6 is a libido enhancer... Because it helps in controlling elevated prolactin. It also aids in estrogen and testosterone function, as well as the production of red blood cells, serotonin, and dopamine. For men with low sperm count, Vitamin B6 has been shown to help increase these levels. -Vitamin B12 heightens your sex drive... Which enhances erectile function by enlarging blood vessels. It also stimulates the secretion of histamine needed for orgasm. -Vitamin C is important for the synthesis of androgen, estrogen, and progesterone... That are involved in your sexuality, fertility, and aiding in arousal. -Vitamin E increases blood flow and oxygen to your genitalia... It also is a key player in the production of your sex hormones to give you that sex drive boost. -Magnesium helps in the production of androgen and estrogen that regulates libido... This mineral has documented aphrodisiac effects that can improve your libido and sexual performance. It also helps to calm and relax you so that you can have an increased sex drive. -Selenium is essential to sperm production. Nearly half, 50%, of the selenium in your or your partner’s body is in the testes and seminal ducts. Guys lose selenium in their semen when they ejaculate. The importance of Selenium is its role in the antioxidant activity of Vitamin E, the “Sex Vitamin”. Having optimal levels of Selenium is essential for your virility. -Zinc is required for the production of testosterone and the production of sperm... Healthy testosterone levels in both men and women are important to a healthy sex drive. Zinc also aids in prostate health. Your prostate has a large amount of zinc, which helps regulate prostatic fluid. When there is a deficiency of zinc this hurts your prostate. Without a healthy prostate, you can’t have a healthy sex life. Studies show that women with greater sex drive have higher levels of testosterone. To increase your testosterone, add zinc to your diet. Zinc blocks the enzyme that converts testosterone to estrogen. -Aphrodisiacs: Ancestral Wisdom + PubMed Maca root powder 1.5 - 3 g a day (really great for those on SSRI’s) Significantly helps with libido compared to placebos Does not interact with hormones Helps with ED and needs at least two months to build up in the system. Cacao 30g cocoa powder or 40 g dark chocolate with 75% cocoa content -- epicatechins and flavonoids support NO Yohimbine, do not use with anti-depressants such as MAOIs or Tricyclic anti-depressants, no for  , no for anxiety, no for heart issues -- , , is a fertility enhancer, supports hormones, 300 mg of a 100:1 extract concentrated for eurycomanone daily - preferably in two separate doses. Tribulus Terrestris libido and hormone production 300 mg increases libido and sexual satisfaction. Causes bodily fluids to smell like maple syrup. Has coumarin, a blood-thinning compound contraindicated for those on warfarin. Take fenugreek standardized for 300 mg saponins. Resources from this episode: - Susan Bratton's - Book: by Susan Bratton - My new book that has a hefty section on sex, love and relationships   Do you have questions, thoughts or feedback for Susan or me? Leave your comments below and one of us will reply!

Host: Matt Birnholz, MD Guest: Joel L. Young, MD Please click for Full Prescribing Information. INDICATION AND LIMITATIONS OF USE MYDAYIS® (mixed salts of a single-entity amphetamine product) is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients ≥13 years. Patients ≤12 years experienced higher plasma exposure at the same dose and higher rates of adverse reactions, mainly insomnia and decreased appetite. IMPORTANT SAFETY INFORMATION WARNING: ABUSE AND DEPENDENCE CNS stimulants, including Mydayis, other amphetamine-containing products, and methylphenidate, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy. Contraindications Known hypersensitivity to amphetamines or other ingredients of Mydayis. Angioedema and anaphylactic reactions have been reported with other amphetamines. Use with monoamine oxidase inhibitors (MAOIs) or within 14 days of last MAOI dose, due to increased risk of hypertensive crisis. Warnings and Precautions Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, coronary artery disease, and other serious heart problems. Sudden death, stroke and myocardial infarction have been ...

Host: Matt Birnholz, MD Guest: Catherine Poulos, PMHNP- BC Please click for Full Prescribing Information. INDICATION AND LIMITATIONS OF USE MYDAYIS® (mixed salts of a single-entity amphetamine product) is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients ≥13 years. Patients ≤12 years experienced higher plasma exposure at the same dose and higher rates of adverse reactions, mainly insomnia and decreased appetite. IMPORTANT SAFETY INFORMATION WARNING: ABUSE AND DEPENDENCE CNS stimulants, including Mydayis, other amphetamine-containing products, and methylphenidate, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy. Contraindications Known hypersensitivity to amphetamines or other ingredients of Mydayis. Angioedema and anaphylactic reactions have been reported with other amphetamines. Use with monoamine oxidase inhibitors (MAOIs) or within 14 days of last MAOI dose, due to increased risk of hypertensive crisis. Warnings and Precautions Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, coronary artery disease, and other serious heart problems. Sudden death, stroke and myocardial infarction have been ...

Dominate perioperative medication management with tips from Kashlak’s newly minted Chief of Perioperative Medicine, @aoglasser, Avital O’Glasser MD, FACP, FHM (OHSU). We cover perioperative anticoagulation, why “bridging is dead”, aspirin, dual antiplatelet therapy, DMARDS, diabetic medications, buprenorphine, and much more! Be sure to check out Dr. O’Glasser’s previous episode #135 Perioperative Medicine: Assess and Optimize Risk to get a full overview of perioperative medicine. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Avital O’Glasser MD, FACP, FHM and Matthew Watto MD, FACP  CME Questions: Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP  Editor: Matthew Watto MD, FACP Guest: Avital O’Glasser MD, FACP, FHM Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liner 04:46 Picks of the Week*: A Moment of Lift (book) by Melinda Gates; Crawl (film); Rich Roll (podcast) episodes w/Valter Longo and David Sinclair 09:35 Avi’s mantras for perioperative management and other core tenants 14:40 NPO and The Consult Guys 17:23 Medical cannabis (marijuana) in perioperative medicine 19:24 Case #1 Ms. Bridge - perioperative anticoagulation: to bridge or not to bridge 25:00 Low bleeding risk surgeries and anticoagulation 27:25 Moderate to high bleeding risk surgeries and anticoagulation; What about the CHA2DS2 Vasc of 7? 28:42 Bridging for venous thromboembolism (VTE) 31:30 How to give instructions for holding warfarin 32:30 Bridging a DOAC 36:16 Recap on bridging VKAs and use of DOACs 37:48 Neuraxial anesthesia and anticoagulation 39:49 Biologic DMARDS; Nonbiologic DMARDS 43:48 Supplements and herbals 48:40 Case #1 wrap up 50:16 Case #2 -Mr. DAPT; Perioperative Aspirin; DAPT -dual antiplatelet therapy 57:20 Summary of perioperative antiplatelet therapy 63:18 Statins 64:45 Beta blockers 67:21 ACEI and ARB; Diuretics 69:17 Oral hypoglycemics and newer diabetes agents (SGLT2 inhibitors, GLP1 agonists); What about metformin? 72:04 Insulin 74:40 Case #2 wrap up 75:35 Case #3 Ms. GB Stone who takes lithium and buprenorphine 77:30 NSAIDS, Buprenorphine 81:45 ART, transplant meds, Lithium, MAOIs, Levothyroxine; Watch out for lithium 86:34 Case #3 wrap up 87:25 Take Home Points 88:45 Outro 90:15 Avi and Mr. Rogers  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goals Listeners will develop a practical approach to perioperative medication management and review special considerations for the various drug classes. Learning objectives After listening to this episode listeners will... Frame perioperative medication management decisions as another type of patient-centered, surgery-specific perioperative “risk/benefit” decision Discuss guideline recommendations for the perioperative management of multiple classes of medications Examine more nuanced or challenging medications to manage in the perioperative setting Explore professional, patient-centered and multidisciplinary communication techniques when disagreements arise regarding best medication management recommendations Disclosures Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation O’Glasser A, Williams PN, Watto MF. “#174 Perioperative Medication Management”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 23, 2019.

An t-Urramach Seamus Maciomhair a searmonachadh air Deuteronomi 5:1 Agus ghairm Maois air Israeil uile, agus thubhairt e riu, Eisd, O Israeil, ris na reachdaibh agus na breitheanais a labhras mi 'n 'ur cluasaibh air an là 'n diugh, a chum gu foghlum sibh iad, agus gu'n gleidh agus gu-n dean sibh iad. 2 Rinn an Tighearna ur Dia coimh-cheangal ruinn ann an Horeb. 3 Cha d' rinn an Tighearn' an coimh-cheangal so r' ar n-aithrichibh, ach ruinne, eadhon ruinne a tha uile beò an so air an là 'n diugh. 4 Aghaidh ri h-aghaidh labhair an Tighearna ribh 's an t-sliabh, a meadhon an teine. 5 Sheas mise eadar an Tighearn' agus sibhse 's an àm sin, a nochdadh dhuibh focail an Tighearn': oir bha eagal oirbh roimh an teine, agus cha deachaidh sibh  suas do'n t-sliabh, ag ràdh, 6 Is mise an Tighearna do Dhia, a thug a mach thusa a tìr na h-Eiphit, a tigh na daorsa.

An t-Urramach Seumas Maciomhair a searmonachadh air Ecsodus 24:9 Agus chaidh Maois suas agus Aaron, Nadab, agus Abihu, agus tri fichead 's a deich de sheanairibh Israeil. 10 Agus chunnaic iad Dia Israeil: agus fo a chosaibh bha mar gu-m bitheadh obair de chloich shaphir, agus mar na nèamhan fein ann an soillse. 11 Agus air maithibh chloinn Israeil cha do chuir e a làmh: agus chunnaic iad Dia, agus dh'ith iad agus dh'òl iad.

Introduction to PTR a not-for-profit website https://psychotropical.com regarding effective use of MAOIs to treat depression.

An t-Urramach Seamus Maciomhair a searmonachadh air Ecsodus 17:5 Agus thubhairt an Tighearna ri Maois, Imich roimh 'n t-sluagh, agus thoir leat cuid de sheanairibh Israeil; agus do shlat leis an do bhuail thu an amhainn gabh a d' laimh, agus bi 'g imeachd: 6 Feuch, seasaidh mise romhad an sin, air a' charraig ann an Horeb, agus buailidh tusa a' charraig, agus thig uisge mach aisde, a chum gu'n òl an sluagh. Agus rinn Maois mar sin ann an sealladh sheanairean Israeil.

An t-Urramach Seumas Maciomhair a searmonachadh air Aireamh 6:22 Agus labhair an Tighearna ri Maois, ag radh, 23 Labhair ri Aaron agus r’a mhic, ag radh, air a mhodh seo beannaicheadh sibh clan Israeil, ag radh riu, 24 Gu’m beannaicheadh  an Tighearna thu, agus gu-n gleidheadh e thu. 25 Gu-n tugadh an Tighearna air ‘aghaidh dealrachadh ort, agus bitheadh a gràsmhor dhuit. 26 Gu-n togadh an Tighearna suas a ghnùis ort, agus gu-n tugadh e sìth dhuit. 27 Agus cuiridh iad m’ainm air cloinn Israeil, agus beannaichidh mise iad. 

An t-Urramach Seumas Maciomhair a searmonachadh air Ecsodus 16:14-15 Agus an uair a dh'eirich an drùchd, a bha'n a luidhe, suas, feuch, bha air aghaidh an fhàsaich ni beag cruinn, beag mar an liath-reodh air an talamh. 15 Agus an uair a chunnaic clann Israeil e, thubhairt iad gach aon ri cheile, Mana: oir cha robh fios aca ciod e. Agus thubhairt Maois riu, So an t-aran a thug an Tighearna dhuibh r'a itheadh.

Ecsodus 17:8 An sin thàinig Amelec, agus chog e ri Israel ann an Rephidim. 9 Agus thubhairt Maois ri Iosua, Tagh a mach dhuinn daoine, agus falbh a mach, cog ri Amelec: am màireach seasaidh mise air mullach an t-sleibh, agus slat Dhe a'm làmh. 10 Agus rinn Iosua mar a thubhairt Maois ris, agus chog e ri Amelec. Agus chaidh Maois, Aaron, agus Hur, suas gu mullach an t-sleibh. 11  Agus an uair a thog Maois suas a làmh , an sin bhuadhaich Israel, agus an uair a leig e sìos a làmh , bhuadhaich Amelec 12 Ach bha làmhan Mhaois trom, agus ghabh iad clach , agus chuir iad foidhe i, agus shuidh e oirre: agus chum Aaron agus Hur suas a làmhan , fear dhiubh air aon taobh, agus fear air an taobh eile: agus bha a làmhan seasmhach gu luidh na greine. 13 Agus chlaoidh Iosua Amelec agus a dhaoine le faobhar a' chlaidheamh. 14 Agus thubhairt an Tighearna ri Maois, Sgrìobh seo mar chuimhneachan ann an leabhar, agus aithris e ann an cluasaibh  Iosua; oir dubhaidh Mise as gu tur cuimhne Ameleic o bhi fo nèamh. 15 Agus thog Maois altair, agus thug e Iehobhah-Nisi mar ainm oirre: 16 Oir thubhairt e, do bhrìgh gu'n do mhionnaich an Tighearna, gu-m bi cogadh aig an Tighearna ri Amelec o linn gu linn.

We are revisiting psychopharmacology in our second psychopharm series. We will kick things off by talking about the “older antidepressants”- tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). While these medications are used less frequently than SSRIs due to their side effect profiles, both TCAs and MAOIs have their select uses in psychiatry (i.e. treatment […]

SSRIs, MAOIs, TCIs, and Lithium Music 'Normalize' by The Bipolar Project

Hey hey guys and gals! It's time for another PodQuiz and this one is a doozy! Maybe you've noticed that studying depression in nursing school is really tough...it's a complex topic that requires all your critical thinking skills.  This PodQuiz covers some of the basics you'll need to know to rock that mental health exam and take really good care of patients with depression during your mental health clinical rotation (and anywhere else you might encounter them). Major depressive disorder vs. dysthymia disorder Communication strategies Suicide NEED TO KNOW facts and interventions Drug therapies for depression SSRIs, MAOIs and more Electroconvulsive therapy (ECT) If you've never done a PodQuiz, here's how it works. You'll hear a question...then a pause. This pause is so you can actually ANSWER the question! Then, you'll hear the answer. It is basically like doing flashcards for your ears. So cool, right? So...grab your walking shoes, get the leash on Fido, and GET OUTSIDE while you study! No sitting at your desk...deal? And, when you DO get back to your desk, supplement your learning with these awesome notes! (if your'e on your podcast app...visit the website and choose Mental Health in the drop down menu under study guides). On a side note, nursing students suffering from depression is a really big problem. For resources and help, please reach out to your health care provider, your family and your friends. You can find support right here: http://www.dbsalliance.org P.S. I care

Generic Name hydralazine Trade Name Apresoline Indication hypertension Action arterial vasodilation by unclarified mechanism Therapeutic Class anti-hypertensive Pharmacologic Class vasodilator Nursing Considerations may cause tachycardia, sodium retention, arrhythmias, angina use caution with MAOIs monitor blood pressure instruct patient on how… The post Hydralazine: Apresoline (anti-hypertensive) appeared first on NURSING.com.

Musician Tony Moss, who has 18 years experience drinking ayahuasca, explains what this medicinal brew from the Amazon rainforest is in his eyes. Moss says the most common ailments he's seen healed during an ayahuasca experience are depression and any kind of trauma related mental or physical illness. Moss says the ayahuasca somehow safely brings the user back to the original trauma, allows them to move into a safe space and process it. To learn more about how ayahuasca and other natural therapies are healing trauma worldwide, please visit http://www.reset.me . Ayahuasca is a South American psychedelic tea containing the potent psychedelic chemical N,N-dimethlytryptaime (DMT), which is a human neurotransmitter. The ayahuasca vine (Banisteriopsis caapi) is combined with the leaves from the shrub Psychotria viridis (or other DMT containing plants) to create the tea. Ayahuasca is the name given to the Banisteriopsis caapi vine and also the foul-tasting tea. It is quite remarkable that the Indians discovered this powerful combination hundreds of years ago considering there are more than 40,000 plant species in the Amazon. The ayahuasca vine contains chemicals known as monoamine oxidase inhibitors (MAOIs) that allow the body to absorb the DMT from the leaves. Without the MAOI, the DMT would be destroyed by monoamine oxidase in the gut and no effects from the DMT would be felt. The word 'ayahuasca' translates to 'vine of death' or 'vine of souls'. This powerful tea induces intense hallucinations and introspection. The entire ayahuasca experience lasts for approximately 8 hours, with the strongest effects lasting 1-3 hours. Vomiting and occasionally diarrhea, which the natives call 'la purga' (the purge), are considered part of the experience. This purging process is medically beneficial, as it clears the body of worms and other parasites . Ayahuasca has shown great success as a treatment for addiction, depression, and cancer. A study combining ayahuasca use and psychotherapy for addiction treatment yielded positive results in two thirds of the patients . Research indicates that ayahuasca has antidepressant qualities. Blood tests of long-term ayahuasca users have shown an increased density of serotonin receptors compared to those who do not use ayahuasca. It should be mentioned that the SSRI class of antidepressants (Prozac, Zoloft, Paxil, etc.) actually reduce the density of serotonin receptors in users over time, which can lead to chronic depression . Ayahuasca is non-addictive and is not neurotoxic, or poisonous to nerve tissue such as the brain or spinal cord, in any way.

Welcome to Episode 44!  Learn this week's Psychiatric Secret Word from Dr. Julie (Nelson-Kuna, PhD).  Dr. Mike (Kuna, MD) will keep you informed with Psychiatry In The News.  Our expert Dr. Tom (Sharma, MD) talks about a special group of antidepressants, the MAOIs. www.GenesisClinicalServices.com  www.KunaLand.com  drmike@kunaland.com