Podcasts about snri

Neste episódio do GeriPill, discutimos por que “a dose importa” na prescrição de venlafaxina para o idoso. Mostramos como escolher a dose certa — desde o efeito serotoninérgico até a ação dual SNRI, sempre equilibrando eficácia e segurança. Você vai aprender um passo a passo prático de titulação, além de dicas para evitar efeitos adversos como hipertensão e tremor.

Tässä jaksossa sukellamme masennuksen syihin, diagnoosiin ja hoitoon yhdessä psykologin ja kirjailijan Aku Kopakkalan kanssa. Mitä masennus oikeastaan on, ja miten se eroaa hetkellisestä surusta tai uupumuksesta? Käymme läpi yleisimmät masennuksen taustatekijät sekä sen, miksi tauti on yleistynyt niin merkittävästi Suomessa. Puhumme myös siitä, miten masennus luokitellaan ja diagnosoidaan ICD-tautiluokituksen avulla – kuka päättää, mitä sairauksia luokitukseen lisätään, ja miten ajantasainen se on vuonna 2025? Entä miten ”käypä hoito” -suositukset vaikuttavat masennuksen hoitoon ja millaisia hoitomuotoja Suomessa ensisijaisesti tarjotaan? Lääkkeiden rooli masennuksen hoidossa on keskeinen mutta kiistanalainen. Keskustelemme SSRI-lääkkeistä – toimivatko ne todella niin kuin väitetään, ja mitä hyötyjä ja haittoja niihin liittyy? Pohdimme myös lääketeollisuuden vaikutusvaltaa masennuksen hoidossa ja sitä, millaisia eettisiä kysymyksiä lääkekehitykseen ja hoitosuosituksiin liittyy. Lopuksi käännämme katseen yksilöön ja yhteiskuntaan: miksi ihmiset tekevät haitallisia valintoja, vaikka tietävät niiden seuraukset? Miksi masennus kroonistuu ja mitä yhteiskunnallisia muutoksia tarvittaisiin, jotta suomalaiset voisivat paremmin? Tämä jakso tarjoaa syvällistä tietoa ja kriittistä keskustelua masennuksen hoidosta ja sen tulevaisuudesta. Luettelo: 6.02 Mitä masennus on miten se määritellään psykologian näkökulmasta? 16.32 Miten masennus eroaa hetkellisestä surusta tai uupumuksesta? 19.44 Yleisimmät syyt ja riskitekijät masennuksen taustalla. 28.56 Miksei ihminen tee mitä tietää? 50.57 Mikä on ICD tautiluokitus ja mihin sitä käytetään? 55.31 Kuka vastaa ICD tautiluokituksen laatimisesta ja päivityksestä? 58.12 Miten diagnooseja lisätään tai muutetaan tautiluokitukseen?  1.06.32 Onko ICD tautiluokitus luotettava vuonna 2025?  1.08.59 Mikä on “käypä hoito suositus” ja kuka se määrittelee? 1.11.51 Miten käypä hoito suositus ohjaa masennuksen hoitoa Suomessa? 1.12.48 Mitä lääkkeitä Suomessa käytetään masennuksen hoidossa? 1.13.30 Mitä tilaa SSRI ja SNRI lääkkeillä pyritään korjaamaan ja toimivatko ne? 1.17.51 Onko väittämä neurovälittäjäaineiden epätasapainosta masennuksen aiheuttajana totta? 1.19.46 SSRI & SNRI lääkkeiden hyödyt ja haitat. 1.26.29 Onko ihminen laiska otus? 1.27.50 Millainen on lääketeollisuuden rooli masennuksen hoidossa? 1.32.50 Millaisen kehitystyön uusi masennuslääke käy läpi ennen kuin se pääsee markkinoille? 1.36.06 Kuka päättää pääseekö uusi lääke markkinoille? 1.38.51 Kuka järjestää ja valvoo lääkäreiden täydennyskoulutuksia koskien mielenterveyslääkkeitä? 1.43.17 Voiko tavallinen ihminen luottaa häntä hoitavaan järjestelmään ja lääketeollisuuteen? 1.51.54 Mikä valinnat ja rutiinit tukevat yksilön hyvinvointia mielenterveyden osalta? 1.56.14 Mitä on epigenetiikka ja miten se vaikuttaa meihin? 1.57.17 Millä tavoin ihmiset oikeuttavat itsellensä omia huonoja valintoja? 1.59.59 Onko ihminen haluton hyväksymään totuuksia, jotka haastavat hänen nykyiset uskomuksensa? 2.07.36 Miksi masennus kroonistuu Suomessa? 2.16.36 Mitä konkreettisia uudistuksia tarvitaan, jotta mielenterveys kääntyisi nousuun Suomessa?

Host: Darryl S. Chutka, M.D. Guests: Bruce Sutor, M.D. & Megan R. Leloux, Pharm.D., R.Ph., BCPP Depression is very common both in the U.S. and worldwide. It's estimated that major depression affects over 8% of American adults, representing over 20 million individuals. Fortunately, we now have a variety of pharmacologic options for the management of depression and they're much safer than what we had available in the past. However, we now have so many choices, how do we know which medication is best for our patient? What's the difference between an SSRI and an SNRI? Is there an anti-depressant that's also effective in treating anxiety? Are some medications better for our elderly patients? I'll be asking these questions and more to my guests, psychiatrist Bruce Sutor, M.D., and pharmacist Megan R. Leloux, Pharm.D., R.Ph., BCPP, from the Mayo Clinic as we discuss “Pharmacologic Management of Depression” as part of our “Holiday Stress and Wellness” podcast series. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Peripheral neuropathic pain is primarily influenced by the biology and pathophysiology of the underlying structures, peripheral sensory nerves, and their central pathways. In this episode, Kait Nevel, MD speaks with Miroslav Bačkonja, MD, an author of the article “Peripheral Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Bačkonja is the clinical director in the Division of Intramural Research at the National Institutes of Health in Bethesda, Maryland. Additional Resources Read the article: Peripheral Neuropathic Pain Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor in Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Miroslav Backonja about his article on peripheral neuropathic pain, which appears in the October 2024 Continuum issue on pain management and neurology. Welcome to the podcast.  Dr Backonja: Thank you.  Dr Nevel: Misha, can you please introduce yourself to the audience? Dr Backonja: Yes, I'm Miroslav Backonja, but everybody calls me Misha. So everybody knows me by that. I'm a training neurologist, and I also have training as well as certification in pain management. And most of my practice has been where neurology meets the pain, which is neuropathic pain. I spend some time basic science lab and then transition into clinical research. And I was in academia for a couple of decades and was most recently recruited by NCCIH National Center for Complementary and Integrated Health and have been there for two and a half years now.  Dr Nevel: That's wonderful. I would love to hear more about your career at the NCCIH, a little bit and what you do in your role now, and how that came to be. Dr Backonja: Yeah, I was recruited to help and provide clinical support to efforts at NCCIH in the phenotyping of pain and neurologists who've done research in quantitative sensory assessment and other quantitative means of assessment of pain. Coming to NIH was very rewarding and quite of a learning experience. After six months being there, I've discovered that NIH is the biggest secret in plain sight. They say in the plain sight because it's public institution and everything is open to public and it's a secret because we don't think about it. This is in particular in reference to biomedical research training, including clinical trainings. So, I would encourage everybody to think of NIH as a place to spend some time and learn. There are wonderful research opportunities as well as educational opportunities. Vast library of presentations, green rounds and different other types of courses - some of them open to public, and some of them are up to FAS, which is a foundation of advances in science education by discovering. I feel like being back in school and having fun.  Dr Nevel: That's wonderful. Can you share with us a little bit about how you became interested in peripheral neuropathy and pain management of peripheral neuropathic pain?  Dr Backonja: It actually goes back to my residency and fellowship. And actually, you know, I had the luck of being exposed to a couple of clinicians who actually became my mentors. First was Jose Ochoa, who was one of the first people to quote from a small fiber, C fiber specifically, and he also was pioneered in quantitative sensory testing. And the other one was Charles Cleland, who was a psychologist and who pioneered assessment of patient symptoms, developing the Brief Pain Inventory is one of the tools. That actually peaked my interest in the topic of pain and once when I started learning about pain, what is the kind of mysterious experience of humans' pain, turns out that we have learned a lot of science about the pain and can make the pain very accessible. And I hope some of this will come to the chapter that we've provided.  Dr Nevel: Thank you for sharing that. I think of peripheral neuropathy and I think most neurologists think of peripheral neuropathy as one of the bread-and-butter diagnosis within our field. For the practicing neurologist out there who might be listening, what do you think is the most important takeaway from your article that maybe they don't already know about peripheral neuropathic pain? Dr Backonja: When it comes to peripheral neuropathy and peripheral neuropathic pain, it goes back to my early experience and still holds the truth. Neuropathies don't kill people, they just maim them. They create- cause lots of disability and if you add a pain to it, it can be quite disabling. In some regards, it has been neglected the area of development in neurology in terms of scientific discoveries, although things are changing quite rapidly as of recently. Main take home messages, and especially when it comes to a sensory neuropathies and painful neuropathies, is that it's one of the skills that has not been well researched and then not well communicated to the vaccine neurologist in terms of what to do with it. But most neurologist sensory symptoms are just like a noise because, especially when it comes to pain and prosthesias and allodynia and hyperalgesias, like, what is that like? It's just not knowing what to make of it. Frequently associated also with emotional components in terms of the people are either depressed because of persistence of pain or anxious, not knowing what's going on. And that really can create quite a bit of a challenge in terms of what to do with it. But once anybody who's interested learns the fact that sensory neuropathies and fever neuropathies as well could be as well and is easily diagnosed by a neurologist who pays a little bit of attention and gains some skills in assessing not only negative sensory phenomena, because that's what he as a neurologist get trained to detect and quantify sensory deficits as well as motor deficits and loss reflexes. Also, if you pay attention to positive sensory phenomena, which is part of the repertoire of symptoms that patients with neuropathic pain experience, it's not whether patients would have either positive sensory phenomena like prosthesia and pain or negative sensory phenomena. Actually, they have all of them. And that's kind of puzzling for many patients. And lots of times, very patients say, like, how can I hurt when I don't feel like, let's say, like most commonly it's lower extremities. Like I don't feel my feet, but it hurts. I mean, how come? Oh, that's a cardinal feature of neuropathic pain, neuropathic painful neuropathy. Dr Nevel: Yeah, thanks for that. You know, I really thought that your Table 3-1 was really nice. It kind of lists through the common causes of peripheral neuropathic pain and just demonstrates the diversity of the different etiologies or other conditions that can cause neuropathic pain. And so, I encourage the listeners to review that table. But, on that topic, can you share with us what you think are the most important components of evaluating patients with neuropathic pain to maybe come to a diagnosis, to find what the underlying etiology or driver is?  Dr Backonja: When it comes to painful neuropathies, there are actually two problems you have to solve. So, don't forget that part. The first one is finding a pathological theology. Why a person has a neuropathy, what kind of neuropathy. And then second is, what's the nature of the sensory problems? What's the nature of the sensory symptoms, specifically pain, levodenia and hypogesia. So, figuring out the theology of the B12 deficiency or diabetic painful neuropathy, you can relatively quickly or hopefully one would relatively quickly come to that at theological diagnosis. But then the second part is the diagnosis of symptoms. What's the underlying metaphysiology of that. And again, just reminding colleagues that the specific sensory phenomena such as thermal hyperalgesia is now well established to be due to what's called peripheral sensitization of C fibers, which are the small unmyelinated fibers, expressed TP 1 receptors. So, patients who will report that taking a hot shower is very painful. An example of that or when conducting sensory exam and applying if you come to the point of examining the perception of warm and hot and patient affords the pain. That's just the hallmark of the C hurtful sensitizations to C fibrous sensitization. On the other hand, if somebody has mechanical ordinia like putting the shirt on hurts, putting the socks hurts. Well, that's evident to central sensitization. These are the simple, relatively simple but symptoms or signs that could have implication if those patients with central sensitization are more than likely to benefit from medications that restore descending inhibition, such as tricyclic antidepressants or SNRI's. And so just paying attention to that, it gives a clinician being a clinician or a neurologist, like, let me consider prescribing medication that have central A acting properties. Or if it's purpose sensitization, something we have like a sodium channel blocking property, things of that sort. Actually, there are some other strategies such as antagonist TRPV1receptors, the capsaicin base. Those are the kind of things that can help a neurologist kind of take the evaluation of painful neuropathies to the next level. Dr Nevel: Yeah, the- by getting a careful history and exam, that can influence what treatment you prescribe to patients. Understanding whether it's central or peripheral. On the topic of treating patients and talking with patients and evaluating them, what do you think is most important to counsel our patients about who we are treating for neuropathic pain? Dr Backonja: Number one: by getting good history and exam. Well, really in the coming to specific diagnosis is huge relief to the patients who thinks many themselves that they're just going nuts are crazy because nobody else understands these symptoms. So, validation in terms they have a real problem. Second important step is that for the most patients, there is probably reasonable degree of therapeutic interventions that can lead to relief of pain. And also, with applying the integrative approaches with complementary medicine is that patients are given tools to deal with what is otherwise underlying problem. Those two steps make a huge difference.  Dr Nevel: Absolutely. What's the most challenging aspect about managing patients with peripheral neuropathic pain? Dr Backonja: Actually, there are a couple. Number one thus far: we do not have a cure for any other neuropathies or painful neuropathies. So that's one of the big disappointing things one would need to communicate to the patient. The second challenge is actually the therapies that actually for neuropathic pain. There's a half a dozen- yeah, half a dozen FDA approved treatment. One thing that's interesting characteristic that all of them prove proven efficacy in clinical trials. If you scratch the surface, you find out that only 40% of patients obtain 30% pain relief. So, it's a rare patient that gets 100% pain relief, and even those, too, get what we call clinically significant, and then in studies, basically significant benefit. It's only partial penalty. But for the most those who do get the benefit, pain goes down probably enough for them to get some a semblance of normality in terms of having some control over the symptoms and their function. It's then the third challenge is really working through those available therapies to find what works for individual patients because we're not at the point yet where for example, other fields like oncology, you can quickly through the means of biomedical and other evaluation come to the patient specific therapy. So, at this point in time you're far from that. What we end up doing with when it comes to management for painful neuropathies is a trial. Sometimes patients say, well, trial and error. I would say, well, it's a treatment trials. We try one thing at a time, assess the risks and benefits and then there was many treatments that carry the benefit. If you carry it on when once, when they don't or if there's adverse events, side effects, we discontinue them. And then most of the patients end up with a combination of pharmacological and now pharmacological treatments and most of them can get some semblance of symptoms control. Dr Nevel: I really appreciate your point on preparing our patients and you know, expectations and things like that and working with them and looking for things that may help. But also having an understanding that the likelihood of complete pain relief is maybe not a super high chance of complete pain relief.  Dr Backonja: But if you're going back to the kind of preparing patients, it's a good to acknowledge or give a chance to express themselves because many times they patients are confused because they have symptoms that are confusing to them. And so just to have them express it. And for example, my alma mater, we developed the color paint drawing where the different sensory qualities are presented by different colors. And then on the body diagram, patients draw where they have symptoms. And this is probably one of the rare examples where you can literally see a pain because these neurologists can recognize the patterns. You can see the pattern of the motor, right, is multiplex or radiculopathy or the list goes on and on. So, this is one of the kind of tools that's very simple, but gives the patients another way to communicate because lots of times they really have difficulties expressing themselves. Dr Nevel: Right. So, the opposite of the most challenging, can you share with the listeners what you find the most rewarding about taking care of patients with peripheral neuropathic pain? Dr Backonja: What is rewarding is that with some work- and again, it's not easy work because it does require multiple visits and multiple assessments and the reassessments, most patients can get control over their symptoms to the point of coming to beginning some of the functional improvement and aspects of quality of life like sleep and work, they are definitely rewarding and most of the time it's fairly obvious. And again, pain management is definitely a team sport where really, it's important to gauge colleagues. Most of the places don't have what I have had when I was in academic institutions, easy access to health psychologist or physical therapist. Most communities do have those specialties. And many patients actually benefit from things that are what's considered a complementary medicine, such as Tai chi or yoga. And actually, in my practice, Tai chi was probably most common prescription for my patients because, as I tell them, there are multiple benefits. Number one: one of the risks of patients, especially prophyl neuropathies and lower extremities, is a loss of proprioception. Again, even those who have a reasonable preserved proprioception over welding, noise of pain actually makes the problem walking the at risk of falling. Actually, Tai chi one gets improvement in balance. There's also medicating component to it. So, mindfulness medication is kind of built in it and that all kind of gives the patients a better control of symptoms. So, some of those interventions are easily accessible in community. So, it's, again, it's a patient education that really takes important part. Dr Nevel: Yeah. And that Tai chi is maybe one of the answers to the next question that I have for you. But as the clinical director of the Division of Intramural Research at the National Center for Complementary and Integrative Health, I have to ask you, Misha, what sort of integrative and complementary type interventions do you counsel your patients about, maybe beyond Tai chi, and which ones do you think are the most helpful? Dr Backonja: To clarify, the NIH patients I see are all admitted per protocol. Actually, NIH has the largest research hospitals called clinical NIH Clinical Centre, which has a hospital and clinics. All the patients that come to our program, they come per protocol for the most part. They come for specific investigations. At the moment, we do not have intramural treatment protocols, although in near future one of my goals is to establish that. The NIH funds- 90% of funding from NIH goes extramurally to academic institutions and other healthcare organizations and so on, and only 10% goes for intermural research. So, what we do is much smaller in scope, much more focused. So, what do we support NCCIH actually support extramurally full range of anything from probiotics, research in microbiome related to health and pain all the way to interventions such as mindfulness meditation? Intramurally, once when patients come for protocol, we evaluated and it's unavoidable to be a question. So, what do we do now? What recommendations do we make? Again, we don't- with the present time, we have treatment protocols and then, most of the time, what I can do is provide recommendations to the patients when they go back to the treating community, to the treating providers. It's usually a fairly comprehensive list including pharmacological and non-pharmacological accommodations for those who have had experience with pharmacology. Sometimes I can just say yes, continue or change or whatever. But then when it comes to additional complementary accommodations, they always provide information. For example, why do I recommend Tai chi? Or, what's the benefit of yoga and why would one want to try to learn trying to behavioral therapy or mindfulness meditation? What's the benefit of turmeric and some other components of what's called anti-inflammatory diet and what's the rationale behind all of that? So rather than just giving a list of recommendations and leaving it that, I try to engage patients in terms of having to understand why something is recommended, whether the fits with their expectations and what fits with their lifestyle and so on. Dr Nevel: Yeah. So, what's coming up, what's next in painful peripheral neuropathy? What do you think is exciting? Where do you foresee some breakthroughs in this field? Dr Backonja: Probably what will make the most difference is application of some of the really molecular biology tools that are being applied to peripheral neuropathy. So hopefully one of these days you'll have a cure for neuropathy and pain and anything would come to that will be probably interaction between a nervous system and an immune system, in particular neuroinflammation. That's kind of my bias. They're probably that's- well, the answer will be, but many painful neuropathies - actually every painful neuropathy, because they come from, as a result, specific pathologies - are different in a sense of trajectory natural course that will have to be first addressed. And again, depending on the underlying disease and molecular biology of that and genetics of it will determine that. But on the other hand, there are some common denominators, as we talked, when it comes to painful neuropathies, which is drivers of peripheral and central sensitization. And maybe one of these days, we'll find what are those drivers and how to change the system so it does not produce pain and other associated symptoms. Dr Nevel: So once again, today I've been interviewing Dr Miroslav Misha Backonja, whose article on peripheral neuropathic pain appears in the most recent issue of Continuum on pain management in neurology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining us today. And thank you, Misha, so much for talking with me today about your article. I encourage all of the listeners to read it. It was very comprehensive and just really wonderful to read. Dr Backonja: Thank you. Enjoyed it. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Reglan (metoclopramide) is used for gastroparesis and inhibits gastric smooth muscle by blocking dopamine receptors. Relafen (nabumetone) is a non-selective inhibition of COX-1/COX-2 which leads to a reduction of inflammation via reduced prostaglandins. Keflex (cephalexin) is a 1st generation oral cephalosporin that covers common gram positive organisms like Staph and Strep species. Effexor (Venlafaxine) is an SNRI and inhibits both serotonin and norepinephrine reuptake. Primary uses include anxiety and depression. Boniva (ibandronate) inhibits osteoclasts which helps treat osteoporosis. Osteoclasts break down bone to help pull calcium into the bloodstream.

In this episode, Tristan J. Barber, MA, MD, FRCP, and Glenn J. Treisman, MD, PhD, discuss the importance of screening, diagnosing, and treating PTSD in people with HIV. They illustrate their discussion through a patient case and provide strategies for accomplishing this, sharing their own experiences and approaches to thinking about PTSD, structuring appointments, and integrating care. Presenters:Tristan J. Barber, MA, MD, FRCPConsultant in HIV MedicineRoyal Free London NHS Foundation TrustHonorary Associate ProfessorInstitute for Global HealthUniversity College LondonLondon, United KingdomGlenn J. Treisman, MD, PhDEugene Meyer III Professor of Psychiatry and MedicineJohns Hopkins University School of MedicineBaltimore, MarylandDownloadable slides:https://bit.ly/4dBu929Program:https://bit.ly/3WB2VCO

Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Mark A. Frye, M.D. We have a variety of antidepressant medications available to us including SSRI's, SNRI's and others, and for the most part they're very well tolerated by our patients. They are much better tolerated compared to some of our older options such as the tricyclic antidepressants and MAO inhibitors. These older products often produced cardiovascular and anticholinergic adverse effects, not commonly seen with our newer medications.  However, our newer antidepressants do have a relatively common adverse effect. They tend to produce weight changes, usually a weight increase. Which antidepressants tend to produce the most weight gain? How much weight does the typical patient gain from these medications? Is the weight gained typically maintained or lost when the medication is stopped? In this podcast, I'll be discussing these questions and more with Mark A. Frye, M.D., a psychiatrist at the Mayo Clinic. To learn more about this topic: https://pubmed.ncbi.nlm.nih.gov/38950403/ Join us at the Swissotel in Chicago for two days of learning, networking, and advancing patient care. Seats are limited, so visit our website to register now! National Network of Depression Centers Best Practices for Mood Disorders in Collaboration with Mayo Clinic 2024 | Mayo Clinic School of Continuous Professional Development | CME Course Conference Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

In this episode, Bradley N. Gaynes, MD, MPH, and Glenn J. Treisman, MD, PhD, discuss the importance of screening, diagnosing, and treating depression in people living with HIV. They illustrate their discussion through a patient case and provide strategies for accomplishing this, including creation of a virtual network and employment of measurement-based care.Presenters:Bradley N. Gaynes, MD, MPHRay M. Hayworth, MD and Family Distinguished ProfessorProfessor of Psychiatry and EpidemiologyDirector, Division of Global Mental HealthCo-Director, Physician Scientist Training ProgramDepartment of PsychiatryUniversity of North Carolina School of MedicineChapel Hill, North CarolinaGlenn J. Treisman, MD, PhDEugene Meyer III Professor of Psychiatry and MedicineJohns Hopkins University School of MedicineBaltimore, MarylandDownloadable slides: https://bit.ly/3YgqqSOProgram: https://bit.ly/3WB2VCOTo get access to all of our new infectious disease podcast episodes, subscribe to the CCO infectious disease podcast channel on Apple Podcasts, Google Podcasts, or Spotify.  

Christian is the owner of MN Nice Ethnobotanicals, the largest Amanita muscaria retailer, wholesaler and importer in the country. After Amanita healed his brain while going through a grueling benzodiazepine withdrawal, Christian formed MN Nice to bring Amanita to the states. He's collected thousands of anecdotal reports about amanita healing everything from anxiety, insomnia, and depression to more complex physical issues like neurological late-stage Lyme disease. He is dedicated to educating about the mushrooms' healing, spiritual, and practical potential, and giving people access to this most iconic, yet most misunderstood mushroom in the world.  Our website link is www.mn-nice-ethnobotanicals.com   Work With Me: Mineral Balancing HTMA Consultation: https://www.integrativethoughts.com/category/all-products  My Instagram: @integrativematt My Website: Integrativethoughts.com   Advertisements:   Valence Nutraceuticals: Use code ITP20 for 20% off https://valencenutraceuticals.myshopify.com/   Zeolite Labs Zeocharge: Use Code ITP for 10% off https://www.zeolitelabs.com/product-page/zeocharge?ref=ITP Magnesium Breakthrough: Use Code integrativethoughts10 for 10% OFF https://bioptimizers.com/shop/products/magnesium-breakthrough Just Thrive: Use Code ITP15 for 15% off https://justthrivehealth.com/discount/ITP15 Therasage: Use Code Coffman10 for 10% off https://www.therasage.com/discount/COFFMAN10?rfsn=6763480.4aed7f&utm_source=refersion&utm_medium=affiliate&utm_campaign=6763480.4aed7f   Chapters: 00:00 Introduction and Interest in Ethnobotanicals 03:01 Christian's Journey with Addiction 09:54 Discovering the Healing Power of Amanita Muscaria 26:05 The Importance of Using Whole Plant Extracts 46:52 Exploring the Different Forms of Amanita 54:24 Optimal Dosing for Amanita 57:57 Enhancing Dreams with Amanita 01:01:32 The Dream Herb: Colea zactichichi 01:01:45 Introduction to Dream-Enhancing Herbs 01:06:06 The Benefits of Kanna as a Natural Antidepressant 01:12:12 The Role of Intention and Consistency in Plant Medicine 01:18:56 Microdosing Amanita: A Beginner's Guide 01:27:07 MN Nice Ethnobotanicals: Where to Find Plant Medicines   Takeaways: Plant medicines like Amanita muscaria can be effective in helping individuals overcome addiction. Kratom, aquama, and high-dose vitamin C are potential solutions for getting off opiates and benzodiazepines. Breaking addictive cycles requires a strong desire for change and an energetic shift. Using whole plant extracts rather than isolated compounds can provide a more balanced and effective experience. Amanita is available in various forms, including capsules, sprays, gummies, and chocolates. Microdoses of Amanita range from 0.2 to 2 grams, while low doses range from 2 to 5 grams. Amanita can improve focus, emotional intelligence, and energy levels. Amanita can enhance dream recall and vividness, making it useful for dream enhancement and lucid dreaming. The Dream Herb, Colea zactichichi, is known for its potential to enhance dream recall and vividness. Silean Capensis, Blue Lotus, and Coleus zeylanicus are dream-enhancing herbs that can promote lucid dreaming. Silean Capensis is traditionally consumed in the morning by chewing a small stick of the root, while Blue Lotus is known for its calming and mood-lifting effects. Kanna is a natural antidepressant that works as an SNRI and has immediate effects. It is prescribed in South Africa and is known for its euphoric and mood-boosting properties. Consistency and intention are key when using these plant medicines, and microdosing Amanita is a good place to start for beginners. MN Nice Ethnobotanicals offers a variety of forms for these herbs, including extracts, powders, and gummies, to suit individual preferences.   Keywords: addiction, plant medicines, Amanita muscaria, opiates, benzodiazepines, kratom, aquama, vitamin C, energetic component, whole plant extracts, Amanita, herbal products, capsules, sprays, gummies, chocolates, dosing, microdoses, low doses, medium doses, strong doses, focus, emotional intelligence, energy levels, dream enhancement, lucid dreaming, Dream Herb, Colea zactichichi, dream-enhancing herbs, Silean Capensis, Blue Lotus, Coleus zeylanicus, Kanna, lucid dreaming, natural antidepressant, intention, consistency

Special guest Marshall E. Cates, PharmD, BCPP, FASHP, FCCP, FALSHP, Professor of Pharmacy Practice from the McWhorter School of Pharmacy at Samford University joins us to talk about pharmacotherapy for anxiety and depression.Listen in as we discuss pharmacotherapy for managing generalized anxiety disorder and major depression, with a focus on tailoring first- or second-line options to individual patient needs.You'll also hear practical advice from Craig D. Williams, PharmD, FNLA, BCPS, a member of TRC's Editorial Advisory Board and Clinical Professor of Pharmacy Practice at the Oregon Health and Science University.For the purposes of disclosure, Dr. Cates reports relevant financial relationships [psychiatry] with Biogen, Sage Therapeutics (honorarium); Otsuka (speakers bureau).The other speakers have nothing to disclose.  All relevant financial relationships have been mitigated.TRC Healthcare offers CE credit for this podcast. Log in to your Pharmacist's Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.The clinical resources mentioned during the podcast are part of a subscription to Pharmacist's Letter and Prescriber Insights: Chart: Pharmacotherapy of Anxiety Disorders in AdultsChart: Choosing and Switching AntidepressantsChart: Combining and Augmenting AntidepressantsIf you're not yet a Pharmacist's Letter or Prescriber Insights subscriber, find out more about our product offerings at trchealthcare.com. Follow or subscribe, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare' or clicking here. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.

In episode 247 of The Just Checking In Podcast we checked in with a man called Sean. Sean works for the PSSD Network, which is an organisation based in Australia, made up of people who suffer from a condition called Post-SSRI Sexual Dysfunction (PSSD). PSSD describes a debilitating condition which a subset of people live with and follows the use of SSRI and SNRI medication. A condition like this is an example of something called iatrogenic harm i.e. medical harm induced unintentionally by a physician or surgeon or by medical treatment or diagnostic procedures. Common symptoms of PSSD include, but are not limited to: genital numbness, a complete loss of libido, erectile dysfunction, vaginal dryness, anhedonia and emotional blunting. This condition is very controversial in medical circles and the mainstream mental health conversation because it goes against the established narrative that selective serotonin reuptake inhibitors (SSRIs) are all universally safe. The PSSD Network's goal is to increase awareness of PSSD, expedite research and offer support to patients and their loved ones as necessary. The PSSD Network's mission is to speed up research and find treatments or a cure for PSSD. Sean himself lives with PSSD after he was prescribed two SSRIs for long-term issues he had with anxiety. The first he was prescribed was Prozac by his GP which had no side-effects on him but didn't work for him and he came off it very quickly. However, he continued to suffer from anxiety and during his university degree, he went back to his GP and was prescribed an SSRI called Citalopram. It was whilst he was on Citalopram that he had these severe side-effects which included sexual dysfunction, genital numbness, emotional blunting and lost libido. He came off the citalopram but the side-effects didn't go away and he came to the eventual conclusion that he had PSSD. After not being believed by multiple doctors, he eventually found medical professionals who believed him and has been working out how to manage it and treat it for the last two years. In this episode we discuss how the SSRI caused him to develop PSSD, his self-awareness about the condition and the community he has found in the PSSD network to help him with it. We discuss the role of the pharmaceutical industry in pushing SSRIs onto medical professionals who then prescribe them to patients and what needs to change in order for patients to be given full, informed consent before taking any of these drugs. We also debate why critics of the PSSD network accuse them of being ‘anti-medication', why they argue that they don't fall into that camp, Sean's recovery journey and the various methods he's tried to manage the PSSD or heal from it. We finish by discussing the work he does with the PSSD network, the research that still needs to be done around SSRIs and what is the right route forward to ensure people who need medication and would be helped by taking them are given them and who doesn't need them and could be harmed. As always, #itsokaytovent You can find out more about the PSSD Network here: https://www.pssdnetwork.org/ You can follow them on social media below: Instagram: https://www.instagram.com/pssd_network/?hl=en-gb Twitter: https://x.com/pssdnetwork?lang=en Support Us: Patreon: www.patreon.com/venthelpuk GoFundMe: www.gofundme.com/f/help-vent-supp…ir-mental-health Merchandise: www.redbubble.com/people/VentUK/shop Music: @patawawa - Strange: www.youtube.com/watch?v=d70wfeJSEvk

This man went through a terrible experience after taking the SNRI, Cymbalta...

What is depression? Neil deGrasse Tyson and co-hosts Chuck Nice and Gary O'Reilly break down the neuroscience behind major depression, its treatments, and the factors that contribute to this pervasive condition with neuroscientist Heather Berlin, PhD.NOTE: StarTalk+ Patrons can listen to this entire episode commercial-free here: https://startalkmedia.com/show/why-we-get-depressed-with-heather-berlin/Thanks to our Patrons Geoff Malone, Neander Rowlett, Brial Teel, Baran Blaser, Maxwell Miller, Doug Litwin, and Edward Bally for supporting us this week.

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

Join us today for a discussion on Fetzima and Savella.

Join us as we discuss another medication in our SNRI series: Duloxetine, which goes by the brand name 'Cymbalta.'

Join us for our first SNRI episode! We will be discussing both Effexor and Pristiq!

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

Fibromyalgia is a condition which presents with symptoms of chronic widespread pain, fatigue, depression, lower abdominal pain, and other cognitive symptoms. Dr Irene explains the possible causes of this condition including the latest research, and details some of the available treatments. KEY TAKEAWAYS Sensitivity to pain is a variable factor influenced by the genetics, environment, stress hormones, sleep disturbance and previous life experiences such as accidents or injury. Fibromyalgia is described as a disorder of painprocessing due to how pain signals are processed in the central nervous system differently in each patient. In patients with fibromyalgia their spinal fluid has more Substance P, a neurotransmitter and a modulator of pain perception which alters cellular signalling pathways. Psychological treatments including Cognitive Behavioural Therapy help as well as lifestyle treatments such as increased exercise, relaxation and treatments for anxiety and depression. Vitamin treatments of benefit include Magnesium Glycinate, Coenzyme Q10, Boswellia, and Melatonin. Medications such as Amitriptyline, SNRI's and Tramadol can also be effective. BEST MOMENTS ‘We know in fibromyalgia there are familial predispositions.' ‘Our brain also has another pain switching off system as well. So when it's too heightened we've got a system that slowly inhibits by bringing it down.' ‘One of the major things about fibromyalgia is that it is really related to sleep dysfunction.' ‘When people do not go into stage 3 and stage 4 they do not get the restorative sleep where you get a lot of healing process going on.' VALUABLE RESOURCES Join Patreon : http://www.patreon.com/drireneching Instagram: irene.ching.777 Tiktok: @ireneching777 Youtube channel: Dr Irene Ching Twitter: @ireneching7777 Clubhouse: @ireneching1 https://www.facebook.com/irene.ching.735 LinkedIn : https://www.linkedin.com/in/irene-ching-742623219 ABOUT THE HOST Dr Irene Ching is a medical practitioner who specialises in Family Medicine, Wealth and Life Coach, Property/ Business Investor, Speaker, and Podcaster : Be Happy, Healthy and Wealthy. Dr Ching speaks on health, wellness and wealth in talks, workshops and events. She has her own coaching programme on money mindset - Quantum Wealth Creation Accelerator (online course with weekly coaching). She approaches health and well-being in a holistic way and encourages people to look at all the areas of their lives. In her coaching sessions, she works with emotional freedom techniques, energy works, NLP, Intuition/ Superconscious mind, Inner child healing, Timeline therapy, Self love works, behavioural change, goal settings and money attraction healing. Her motto: Reset Your Mind, Reset Your life. The podcast Be Happy Healthy and Wealthy is aimed at people who wants to be high achievers who perform at their peak performance in all aspects of life. It is about how we could be happy regardless of our circumstances, and to understand the secrets to real health and wealth; especially how to live a prosperous long life. She has been interviewing successful entrepreneurs, keynote speakers, influencers and millionaires on this important subject. So stay tuned to get the deep dive on how to be happy, healthy and wealthy- the million dollar questions!          

CME credits: 0.50 Valid until: 21-07-2024 Claim your CME credit at https://reachmd.com/programs/cme/novel-therapeutics-treating-the-adverse-events-from-ssri-and-snri-monotherapy/15802/ Many patients with Major Depressive Disorder (MDD) do not adequately respond to or fail first-line antidepressant therapy causing significant setbacks in patient care and dramatic decreases in QoL. The lack of agreement on approaching the next treatment step creates a significant gap, leading to suboptimally treated MDD. Clinicians have the option to augment therapy or switch to another class of antidepressants to improve the management of a patient's residual symptoms of MDD. This program will help highlight the appropriate treatment for individuals with MDD who are suboptimally treated and provide evidence-based best practices related to making a timely switch from a first-line to a second-line antidepressant or augmenting the current treatment option.

Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we analyze the 2013 psychological thriller "Side Effects." Did ya'll remember that Channing Tatum was in this movie becauwe we didn't and it was a nice surprise! Too bad he died. In this episode, we explore Rooney Mara's portrayal of what we initially believe is major depressive disorder but then discover is actually manipulative behavior more consistent with malingering of a sociopathic level. We also discuss all sorts of medications and their side effects, including antidepressants, mood stabilizers, and antipsychotics. We hope you enjoy! Instagram TikTok YouTube Website [00:10] Dr. Katrina Furey: Hi, I'm Dr. Katrina Fury, a psychiatrist. [00:12] Portia Pendleton: And I'm Portia Pendleton, a licensed clinical social worker. [00:16] Dr. Katrina Furey: And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows. [00:23] Portia Pendleton: Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriends. [00:28] Dr. Katrina Furey: There is so much misinformation out there, and it drives us nuts. [00:31] Portia Pendleton: And if someday we pay off our student loans or land a sponsorship, like. [00:36] Dr. Katrina Furey: With a lay flat airline or a major beauty brand, even better. [00:39] Portia Pendleton: So sit back, relax, grab some popcorn. [00:42] Dr. Katrina Furey: And your DSM Five and enjoy. [00:57] Portia Pendleton: Today we're going to be talking about side effects, which I had never seen before, which I think some people might find, like, shocking. This is like a movie about a lot. Therapy, mental health, medications. [01:10] Dr. Katrina Furey: Yeah. [01:11] Portia Pendleton: So we're going to be talking about that today. I'm really excited, and I kind of just wanted to say briefly, wow. Like, Channing Tatum was in it, and I was like, is this why everyone watches the movie? Hello, Andrew Law? [01:26] Dr. Katrina Furey: Yeah. [01:27] Portia Pendleton: How long did it take you to figure out who was running the show? [01:32] Dr. Katrina Furey: So I've seen this movie several times. The first time not till the very end. I remember being really surprised. What about you? [01:41] Portia Pendleton: Same. [01:41] Dr. Katrina Furey: Yeah, right. I didn't get it the first time I watched it, I thought I think I thought this was supposed to be a medication side effect. And that was like the whole premise. And then when they got into the insider trading and all this stuff, I was like, oh, whoa. Yeah, I didn't see that coming at all. And then when I rewatched it before recording this episode, I remembered the plot. And so I was really watching Rooney Mars character a lot more closely to see if I could pick up on sort of subtle things that would suggest she was malingering. And they even used that word correctly, which is kind of feigning symptoms for what we call secondary gain, which means, like, to get out of work or to get money in a settlement or to stay out of prison or stuff like that. What did you think about Rooney mara's portrayal of what we think at first is a woman with depression? [02:41] Portia Pendleton: I thought it was great. I thought it also shows how we can be, like, functional. [02:47] Dr. Katrina Furey: Yes. [02:48] Portia Pendleton: So she's working, she is dressed well, but behind the scenes, like someone who's really suffering with kind of it appears, maybe more like major depressive disorders. She's having these episodes versus kind of more persistent depressive disorder, which would just be like persistent depressive depression with periods that you can also have major depressive disorder popping into. [03:13] Dr. Katrina Furey: Right. And they allude to again, I think we'll talk about her before the twist. So when we think she's just depressed and I'm saying just depressed, not to minimize the depression, but because there's more that comes out later, but I thought her eyes. She just looks subdued. She looks sad. She looks flat. She's not really super joyful. Even when they get him out of prison, she hugs him and stuff, but there's not a lot of animation there. And again, maybe that's just her personality, but she does have this suicide attempt where she rams her car into a wall in a parking garage, and when Channing goes to the hospital, he's like, oh, I thought we moved past this to suggest, like, this has happened before. And that's where she meets Jude Law's character, Dr. Banks, in the Er as the psychiatrist evaluating her. [04:08] Portia Pendleton: So what did you think of that? [04:09] Dr. Katrina Furey: Who was he evaluating before her? [04:12] Portia Pendleton: Oh, the man who was kind of delusional. No, I'm sorry. He was not delusional. [04:17] Dr. Katrina Furey: He was Haitian. Yes. [04:18] Portia Pendleton: And so he had seen the ghost of his father driving a cab, and so he kind of attacked the cab. [04:26] Dr. Katrina Furey: I'm glad I brought that up, because I remembered that's a good portrayal. I think that's something we do learn about in our training is putting the symptoms of various mental health conditions within a cultural context, because sometimes what we might think of in the American culture as delusional, like seeing ghosts of relatives who have recently died in other cultures, is not it's, like, normal in those cultures. So that was an interesting depiction of that. And again, an interesting depiction of a black man in New York City coming in and speaking a language the officer can't understand and wanting to sort of restrain him or punish him or take him to jail. And the doctor, in this case, being able to apparently speak French or Creole I think it was French and get a sense for what's really going on and keep him out of jail. So that's an example of not malingering. That's not malingering. That's like the law psychiatry or mental health interface, like, working appropriately. [05:32] Portia Pendleton: That was really great, and I thought it was just, like, a good check mark for him, for his character. [05:40] Dr. Katrina Furey: Yeah. And then now that we're talking about it, like a really interesting juxtaposition to him then moving next door, wherever, and evaluating Emily. Again, a white woman, someone later calls her, like, a fragile bird, attractive and just I guess you're right. I do pick up a lot on the background or the setting. I didn't love that. He didn't close the curtain right away. He starts the interview standing over her. I didn't love that. Just, again, like, a man towering over you and you're feeling really emotional and vulnerable. I don't love sit down so you're level. Don't get too close, though. I like that he didn't get too close. I think eventually he sat. Eventually he closes the curtain. I thought his line of questioning was pretty good in the way that she was saying, like, oh, my head hurts. They said I might have a concussion. And he's like, well, we got to wait for the CT scan. How's your head been lately? That's kind of weird. That's kind of a clunky thing to say. He didn't introduce himself as a psychiatrist right away. I'm not sure why or if that was intentional to see again. Maybe he already suspected she'd withhold things. If he did so, maybe he wanted to see if she'd reveal anything before she knew. That. That, to me now that I'm saying it should have been his first sign that something was off here. He says to her, usually when someone's in a car accident, there's skid marks. You try to avoid hitting the wall, but you went right for the wall. So to us, that suggests a suicide attempt. I can't believe she wasn't hospitalized. [07:27] Portia Pendleton: Well, that was what I was thinking. I was like, she didn't come in with kind of a thought of suicide and now is presenting, after waiting in the air for many hours as safe and has a caregiver or a partner and is evaluated and is sent home and non hospitalized. That happens a lot. Maybe sometimes it shouldn't, but this was an attempt, and this was a really serious attempt. [07:52] Dr. Katrina Furey: Like she rammed her car into the wall. I thought, though, that they did a good job portraying what we sometimes look for, which is called future oriented, like having plans for the future. Like, oh, no, I can't be outside. I have to go to work tomorrow. My husband just got home. I can't do that. At the same time, when I was working in Ers with evaluating patients like this, I don't care how future oriented you are, when you ram your car into the wall, you need to be hospitalized. And the fact that she was able to talk him out of it when that was his first instinct to me is, like, in retrospect, red flag number one. Yeah, right. The fact that she's like, you have an office, right? I'll come see you a handful of times. [08:33] Portia Pendleton: And to me, that was red flag number two, because I don't think that that happens often. I don't know of the ethics behind it, but I just don't think that that's typically available. [08:46] Dr. Katrina Furey: No. Right. [08:47] Portia Pendleton: Like, you'd be referring to, like, a PHP partial hospitalization program, tense about patient program through your hospital. You know what I mean? That would be the treatment exit. [08:55] Dr. Katrina Furey: Not just like, I just ran my car into the walk. I'm going to go see an outpatient psychiatrist. That's not an appropriate level of care for that severe thing that just happened. I think you need at least a couple of days. But again, unfortunately, this should always happen, right? Unfortunately, there's not enough hospital beds. Patients wait and wait and wait in the Er forever. Sometimes insurance won't cover it, even after something like that. I'll never forget my training, working on the inpatient child unit and being told by insurance it was my job to do the peer to peer review because they were denying ongoing a hospitalization for like a twelve year old girl for suicidal thoughts and depression because she hadn't actually attempted anything. So they thought we should discharge her. And it was like, unreal that they told us they're not going to pay for it because she hadn't made an attempt drives me nuts. But anyway, she had made an attempt. She should have been hospitalized. So the fact that she was able to manipulate him into going against his better judgment by appealing to well, I'll see you in your practice. I couldn't tell if he was affiliated with the hospital. It didn't seem like it. It seemed like he was like what we call moonlighting or like picking up. [10:11] Portia Pendleton: Side shifts, which he does talk about later because he's working all these multiple jobs. [10:16] Dr. Katrina Furey: Right, exactly. So maybe he's like, oh, a patient, oh, a couple of times a week maybe it seems like he needs the money. And then we sort of start seeing her meeting with him. And again, the boundary crossings just continue our favorite. So, yeah, we see her starting to open up to him. He starts talking about medication, which again is is warranted. Yeah. When someone presents with significant symptoms of depression status post a suicide attempt, I think that's when she brings up Dr. Seabird's name, which is played by Katherine Zeta Jones, and she gives consent for them to talk to each other about her case, all of which is normal. And then somehow he sees Dr. Sebert at, like it looks like a pharma. By pharma I mean pharmaceutical company, like dinner or talk or something. And Dr. Sebert like, very casually mentions, oh, oblixa, I did write down, being a psychiatrist, the medications Dr. Sebert said she had tried Emily on, wellbutrin, Prozac affects her, and she apparently had problems with sleep and nausea. So that's interesting because those can be common side effects. And we have medications in different classes. We have Prozac, which is an SSRI, effects are an SNRI, and then Wellbutrin, which has a different mechanism of action in which we think of as sort of in this category of medications called like, atypical antidepressants, which just means, like other they work in different ways. So looking at that, my thought as a psychiatrist is did she have adequate trials on any of these? Like, could she tolerate them long enough to see did they really work because these medications take several weeks to kick in? Or did she stop them pretty early because of side effects? Problems with sleep and nausea are really common early side effects that usually go away if you can stay on it and you can prescribe things to sort of help with that in the early stages. It's weird to me that she was only on one SSRI. Then we jump and again, I'm assuming we started with Prozac because that's typical practice, but maybe we didn't. But then you jumped to an SNRI then you jumped to this other thing. It's pretty atypical to jump around so quickly. And then it sounds like she was taking, as prescribed by Jude Lav's character Zoloft, 100 milligrams, which is a pretty high dose. So pretty high to get to 100 so quickly. Those are kind of my thoughts. [12:47] Portia Pendleton: Is that dosage more like along the lines of an OCD patient? [12:53] Dr. Katrina Furey: Not quite. That's a great question. So usually, like with Zoloft, you start around 50. You could start lower if you've never been on medication before to help ease the side effects as you're starting them, or if it's like, a young person or really thin person, you might start lower. 100 is, like, a pretty good dose for depression. I think the way it was depicted in the movie, I just felt like they got there really quick, which, again, you might want to given the severity of her suicide attempt, but usually you might go a little slower. But maybe again, I'm just assuming this was, like her first dose was 100. OCD definitely responds to higher doses of SSRIs compared to things like anxiety and depression. So for Zoloft, the therapeutic windows anywhere from 50 all the way to, like, 400 milligrams for OCD. Oftentimes people with OCD end up somewhere between two to 400, depending on the situation, but 100 could do it. Okay. Some other early boundary crossings that we see between Emily and Dr. Banks first, not hospitalizing her. The second, I would say, is when she found him. It looks like in it looks like maybe like some common area. So his office must be near the hospital or something. Almost gave me the vibe of, like, a cafeteria or something like that atrium that's right where he was sitting with his wife, who was preparing for a job interview, and he gives her a Pranal, and I thought, oh, gosh, he doesn't have great boundaries. You should never prescribe for your spouse or for someone you know? I mean, do do doctors do that sometimes? I'm sure proprietary is a pretty benign medication, but I think it just speaks to his own poor boundaries and why a patient like Emily might be able to sort of sniff that out and use it to her advantage. So all of a sudden, he gets a call with Emily kind of rambling on the phone, I think after she had tried to maybe jump in front of the subway train. And then the officer saved her at the last minute. But then she shows up as he's. [15:09] Portia Pendleton: Trying to his wife staring at a poster of oblixa right in the train station for a while, just like looking at it. And then she kind of walks over. [15:18] Dr. Katrina Furey: To the edge and then toes it. I didn't notice that, but you're probably right, because we'd heard about Oblixa from Dr. Sebert, like, in the scene before, and they kept talking about how you see the ads. You see the ads, and I will say, I hear this all the time from patients. I remember when I started my training, Abilify, there were a lot of ads out there for Abilify, and I had a patient who was like, I want to switch from this medicine. I've been on and been stable on for 20 years to Abilify. So this does come up. I thought that was I wanted to. [15:49] Portia Pendleton: Ask you, so if a patient comes in and they have seen like, a new medication on TV and it looks and they're excited about it, does that typically make it work better at all? I think Placebo mentioned that in the movie a little bit. [16:06] Dr. Katrina Furey: Yeah, you're right, she did. She was like, I think with your positive endorsement, it could work better. I mean, so certainly we know that the placebo effect is real. So by the placebo effect, I mean, they've done studies and stuff where if you give patients, like a sugar tablet, but you say it's an antidepressant or something, then sometimes the patients start to feel better, like they believe in what you're giving them. And that is part of the art of prescribing medications, I think, is not necessarily using that to your advantage. But it's really important when you're prescribing a medication, whether it's for psychiatric issues or something else, to get buy in, right? Like, if you're prescribing a medicine to someone because they have high blood pressure and you want them to work on it with lifestyle modifications, like with diet and exercise, you want to get buy in that all three methods of targeting the problem are going to be effective. So I think that's the kind of thing where if you come to me and I'm like, well, we could give you Zola, but it doesn't really work, are you going to be like, sure, I'll take that. [17:15] Portia Pendleton: That makes sense. I feel like even with therapy, I think some protocols actually, I don't want to say require, but really you're supposed to kind of speak to the results that have been studied. You're supposed to really kind of like, I don't want to say Hype up the program, but Hype is effective. This works for people, really, to get the bind. So it sounds like it's almost along that line. It's not necessarily like placebo effect in our practice, right? That's a lot of in research trials and stuff like that. But you have to get people's kind of excited to what you're trying to have them do. [17:52] Dr. Katrina Furey: Right? And I think patients will show up having seen ads and commercials and stuff like that for newer medications and wonder about it and some I mean, gosh talk about like buy in. I mean, the the like people like, make these commercials with the goal of, like, kind of manipulating you into wanting to take this specific medication so they can make money from it. And some of these commercials are really intense. [18:18] Portia Pendleton: So I thought at this point, in the movie, this was where we were going. Right. I thought like big pharma was like trying to kind of push this pill. I almost felt like in a little bit of a way it was going to be like the oxy. We secretly know that it's not effective or there is this really bad side effect. We're brushing it on the rug, don't tell anyone. Prescribers. [18:39] Dr. Katrina Furey: Push it, push it. [18:40] Portia Pendleton: But that was not the way this movie ended. But at this point that's what I was thinking. [18:46] Dr. Katrina Furey: Yeah, that's what I thought too is it was going to be all about Big Pharma. And I think unfortunately, you're right. There are stricter laws now about you see, in the movie pharmaceutical reps taking doctors like out to lunch or dinner. And they talk about how back they could be a quote unquote spokesperson for a pill and be flown out to some conference in an exotic location, give a talk for 15 minutes and have their whole vacation comped. Those sorts of things did used to happen. I didn't get to do any of that because they have these stricter laws which are good. Which are good because they did find like surprise, surprise, doing stuff like that did in fact influence physicians prescribing practices. Which makes sense. [19:33] Portia Pendleton: Yeah. And I was thinking same along the lines of this used to be a big practice for residential treatment centers, doing kind of the same thing with big pharma as big Pharma. So they would invite you to come tour their facility in Palm Beach and then you're going to refer your patients with substance use disorders there. It really primarily was kind of a big business with substance use all around this kind of same time. [20:01] Dr. Katrina Furey: Right. [20:01] Portia Pendleton: I feel like this is really popular to do. They want kind of to push patients. And now we are seeing and have seen the effects of this. So specifically talk a little bit about the state of Florida kind of being famous for having a lot of rehab centers. There was kind of in the news, a lot of unethical drug testing. So they'd be billing at really high rates these really expensive complex blood tests and labs and that's kind of how they're getting paid. And all these people have ended up in Florida and then kind of like homeless and then using drugs. Again, like a halfway highland houses. There's this whole pipeline. [20:40] Dr. Katrina Furey: It's very interesting that's the thing is, unfortunately, there is a nefarious pipeline. Where? I don't remember all the details, but unfortunately there have been then, like, big business partnerships, I guess, between a rehab center and a halfway house or where the patient would go afterwards, where then the patient does rehab. They pay out the wazoo they charge for these tests, like you're saying. Then they go to this halfway house that's contracted with the rehab center. And then the halfway house, they get reintroduced to the drug, sometimes on purpose. I think that's the most nefarious egregious thing that's come out. I mean, how disgusting is that? And then they go back to the rehab and it's just a cycle, and it's all for money making, and that just makes me want to vomit. [21:25] Portia Pendleton: Yeah, I mean, it's horrible. And I think that's right. And we've seen that with Big Pharma too, and that's why we don't get this anymore. [21:33] Dr. Katrina Furey: But I thought this was going to be like a movie, like anti Big Pharma. Anyway, we got derailed, but hey, big Pharma. So Emily somehow finds where he is in the atrium again, like, how unclear? And interrupts his combo with his wife. You can tell his wife's annoyed. She's, like, wanting some emotional support from him. This is a really awkward conversation to have in public. Again. He's like, if this just she sort of makes a provocative comment alluding to, like, sort of happened again. And he's like, well, if that's the case, I need to admit you to the hospital. Yes, that's the right step. And then she's like, no, I just need five minutes. I have to get to work. Can we go talk somewhere? And the answer is no. The answer should be no. But she manipulates him or something. [22:24] Portia Pendleton: I thought that it was interesting that his wife was I understand why she was upset. Like, she needed support, and her husband was kind of getting called to this work duty. But I feel like I'm assuming that this doesn't happen ever. This is a strange thing, right? Like a patient coming up to him. So I felt like her reaction almost felt, like, a little strange. If I was out in public and out to dinner with my partner, and we're sitting there and a patient comes up to me and starts talking about what seems to be, like, active suicidality, that would be not normal. My partner would be like, what the **** is happening? [23:06] Dr. Katrina Furey: They wouldn't even get up and leave. [23:08] Portia Pendleton: Right? Sad or mad at me. They would just be like, this is strange. [23:14] Dr. Katrina Furey: Weird. Yeah. [23:15] Portia Pendleton: So I felt like her being mad. [23:17] Dr. Katrina Furey: Just, like, felt off. I think she was mad that he chose to go, but I feel like. [23:25] Portia Pendleton: Within the context, you have to handle that. You don't need to meet with him. You know what I mean? But you have to handle the situation. Whether it's like talking to them outside and saying, this is wildly inappropriate. [23:38] Dr. Katrina Furey: I don't know. Asking her wife, can you go get a security guard? [23:45] Portia Pendleton: Maybe she was pretty. [23:46] Dr. Katrina Furey: That's the thing. I was wondering if there was some competition and if that was intentional. I think now we know it probably was to stir up some feelings of jealousy and stuff. And then they have this mini session, like, on some couch somewhere, and there's that Victoria Secret. Yeah. So they're sitting, like, really close together. Their body language was interesting because she's, like, face toward him with her legs up on the couch. You can see her bare legs. She's just sort of talking to him and pulls out, like, a Victoria's Secret bag, saying, like, I'm really trying. And he acknowledges again, I was like, oh, ick, ick, ick, ick, ick. Yeah. [24:23] Portia Pendleton: And again, the boundary crossing is when he agrees to meet with her also, like, in this public place, so on and so forth, and just meeting with her. But besides that, what he's saying. He's not flirting with her. He's not doing anything, like, inappropriate. Inappropriate in that moment within that context. But I think then we learn later a picture gets taken of them in this moment where she is holding up this Victoria's Secret bag, and they're comfy, quote, unquote, on this couch. But it's like, that is not what was happening. [24:58] Dr. Katrina Furey: Right, exactly. That's why you always have to be so careful. Totally. And this is why boundaries are so important. And this is why it's important to listen to your own gut feelings when you're evaluating new patients, because I think you could pick up some of these subtle red flags really early on and see how this could unfold. And so again, he doesn't hospitalize her against his better judgment, and then things really unravel. So he's like that's when she, Emily, asks, can you start me on Oblixa? Like, my friend so and so is on it. I hear it works. And he'd heard that from Dr. Sebert, who then we find out is, like, really pushing Oblixa. I loved what Dr. Sebert was like. Oh, you can have an Oblixa pen. Yeah. I was like, we should make analyze script pen. [25:49] Portia Pendleton: I have a lot of residential treatment pens. [25:52] Dr. Katrina Furey: I bet you do, right? It's just so classic. So then he puts her on Oblixa instead of Zoloft. And getting back to one of your questions, certainly there are more and more new antidepressants out there. Oblixa. I thought it was so funny the way they picked this fake name because it was like a combo of Abilify. And I thought, like, Trntilix, which are both too. Abilify has been around longer. What about Selexa and Selexa oblixa? They just sort of, like, combined it all. [26:22] Portia Pendleton: And it sounds real. It totally sounds like a medication sounds. [26:26] Dr. Katrina Furey: Like a medicine name. So I thought that was funny. And then I think it kind of starts to work, but she starts having these quote, unquote, like, sleepwalking episodes, which seemed convincing right at first, and then that's why he eventually prescribes this new medicine deletrix or something, which, again, sounds like a convincing medicine name. And that's where he's now participating as a consultant with a pharma trial being paid being paid, like, $50,000, which, again, sounds like a lot. I would have cautioned Dr. Banks to say, okay, after taxes, how much are you really getting, and is it worth it? [27:07] Portia Pendleton: And he does disclose that he did it. Again, it seems some things pretty by the book he's with another patient who he's telling about this trial that he's in and that he is being compensated for it. And he gives her this information that she'll receive the medication at no cost. And it's like, that why people agree. [27:27] Dr. Katrina Furey: To the trial, right? And that's what I think the pharmaceutical industry uses to its advantage. They still provide free samples, which I. [27:35] Portia Pendleton: Think can be right on the one hand, a way to assist people who cannot pay for it initially, or there's just problems with that, too, but that still happens. People still do get free samples of lots of things. Birth control antibiotics, or, like, Vivams, like. [27:56] Dr. Katrina Furey: A new Stimulant, which is really expensive, works great. I prescribe it a lot, but it can be expensive if you don't have good health insurance coverage. So they might give you, like, a quote unquote drug coupon where you can get, like, the first month free, and then you have to pay $600 the rest of the time. Anyway, as we're thinking about this, shout out to Mark Cuban's Pharmacy because they are providing a lot of medications at very affordable rates. Mark Cuban, if you want to sponsor the podcast, please feel free. Anyway, so they add in this new medicine, and then it turns out she murders her husband, basically, right? Like, she again has another one of these quote unquote sleepwalking episodes, ends up stabbing him multiple times, and then goes to sleep and he dies. Before we saw the end of the movie. What did you think about that whole scene? [28:45] Portia Pendleton: I thought that it was I was shocked, but based on another episode of prior episode of her kind of sleepwalking, I was like, I don't want to say, like, it wasn't surprising, but that didn't shock me. Something was going to happen in the movie. I was like, okay, this is it. And then she's going to be like, how are they going to go after her? [29:04] Dr. Katrina Furey: Right? [29:06] Portia Pendleton: Are they going to blame the drug? Are they going to blame her? How will they do this? That's what I was thinking. I was sad to see Channing Tatum go. Martin is his name in the movie, right? [29:21] Dr. Katrina Furey: He's not a Martin. I'm always sad to see Channing Tatum go. Yeah. I like to watch him walk away. Yeah. [29:30] Portia Pendleton: But he you know, he did not walk away. He laid on the floor and blooded out. [29:35] Dr. Katrina Furey: So then she gets shirtless. I know. [29:37] Portia Pendleton: Like, come on, haven't they seen Magic Mike? [29:40] Dr. Katrina Furey: What did you think about Rooney Mara's acting in that scene? Did you buy it? [29:46] Portia Pendleton: I did. [29:46] Dr. Katrina Furey: Yeah. Too the first time. Totally bought it. And that's where I thought the movie was going. Let's see what happens here. And I thought, actually, their depiction of the whole legal process, the not guilty by reason of insanity, the NGRI, I thought that was actually pretty accurate. And again, I'm not a forensic psychiatrist. We hopefully will be having one on in. The next couple of months. But I thought overall, that was a pretty accurate depiction of how that process works. And thank God for things like not guilty by reason of insanity so that people who do commit crimes or murders or what have you when they are in the throes of a mental health episode instead of just being locked up in jail, which unfortunately has become how sad is this? The largest place where mental health treatment is delivered because we don't have enough mental health hospitals in the country. That's a whole other episode and issue. But anyway, those patients can go to, like, a forensic psychiatric unit and receive treatment. Unfortunately, I think oftentimes what then happens is once their sanity is restored sometimes, then they're tried again. I'm not a forensic psychiatrist. Do you understand that differently? [31:01] Portia Pendleton: Yeah. And I think it's interesting why it would go either way. Right. Some people are charged with not guilty by reason of insanity go on to serve their time in an inpatient unit and then are let out right into society. And other people are get off temporarily not guilty by reason of insanity, receive the care and then have to and then are tried. [31:25] Dr. Katrina Furey: Yeah, exactly. [31:25] Portia Pendleton: I'm curious what the differences are. I'm sure it's clear. I just don't know it. [31:29] Dr. Katrina Furey: Well, hopefully when we have her case. [31:31] Portia Pendleton: It sounded like she got the she was going to get R. Right. [31:35] Dr. Katrina Furey: And that's the part where I'm not sure. Does that actually happen? When we have dr. Tobias wasser on in a couple of months, we will ask him. [31:43] Portia Pendleton: And it was a really short time. Right. And I think they also had to kind of convince her because at first she was like, no, I don't want to have to go there. I'm not going to be able to leave. And they were like, no, this is the golden egg. You got the best offer. It's 1% that this actually works. [32:00] Dr. Katrina Furey: I thought it was really weird that the state and the defense both wanted her psychiatrist to be their expert witness and that he would agree either way. Didn't you think that was weird? [32:14] Portia Pendleton: So I thought at first, before the twist, that the state was involved somehow with big pharma. I thought it was very strange that he was being approached. That lawyer, that guy. [32:29] Dr. Katrina Furey: I just felt like that would, like. [32:31] Portia Pendleton: It seemed like he had some other motive. [32:34] Dr. Katrina Furey: And that's what I was just like. [32:36] Portia Pendleton: And I was wondering if they were trying to get him, the psychiatrist on board so that he could speak to that it's not the drug. Right. And try to get the drug off. That's what I was thinking. [32:47] Dr. Katrina Furey: But again, Dr. Banks, like, what a conflict of interest. I feel like that's pretty like Psychiatry 101 where you should not be you. [32:58] Portia Pendleton: Can'T be the actions treating and her psychiatrist. You have to be one or the other. [33:05] Dr. Katrina Furey: Not only her past treater. Like when this happened, but you continue to treat her while she's in the forensic unit. Again, that doesn't track for me. That's not really what happened. No, I think any psychiatrist who would unfortunately find themselves in this situation would a, call your malpractice, who will appoint your defense, and B you're not involved anymore. [33:28] Portia Pendleton: Right. [33:28] Dr. Katrina Furey: So the fact that he kept getting involved, I think speaks to how she kind of had her hooks in him and he felt compelled, do you think, to clear his own name? [33:37] Portia Pendleton: I think so. [33:38] Dr. Katrina Furey: I think it was both. [33:39] Portia Pendleton: I think he wanted to clear his own name because at this point, he was being harassed by people who were really unhappy with him. His wife seems unhappy with the situation. His practice seems unhappy with the situation. I think he was trying in half to clear his name and then on the other half, I think he felt sorry for her and wanted to help her. [34:03] Dr. Katrina Furey: And he probably felt like some degree of responsibility, having been the prescriber. And I think prescribing something that he's in getting a kickback for. And even though he's, like, upfront about it, I think maybe he had some guilt there. But in the real world, that's not what happens. Actually, this does happen where attorneys will try to get you to be their expert witness. That actually happens all the time. But you're taught pretty early on and pretty clearly that that's a really bad idea because it's such a conflict of interest. Even if it's like your patients involved in a lawsuit and you're not really related, but your testimony, I guess, could support they're getting more damages or something. That's such a conflict of interest because if you do it or you could just affect the therapeutic alliance and you don't want to mess with that. [34:54] Portia Pendleton: We only really do it if we are like, subpoenaed. And sometimes subpoenas, I think we really only have to follow through if it's like they're from the state. I think you can kind of fight sometimes a subpoena or push back on it for what they're asking for when it's like a private attorney. [35:12] Dr. Katrina Furey: And that's why you always just call your malpractice and they tell you what to do. So anyway, I don't think his malpractice. [35:18] Portia Pendleton: Would have advised him to do this. [35:20] Dr. Katrina Furey: You see his colleagues telling him, like, you need to stop. Get off the case. And then he asks his colleague for Adderall because he's kind of a mess. And I was like, oh, gosh, no. [35:38] Portia Pendleton: So then this twist happens, right? [35:40] Dr. Katrina Furey: So then, you know, we love a twist. Like, one day we'll have a boundaries jingle and then we'll also have, like, a twist. Yeah, that sounds like a tornado. [35:48] Portia Pendleton: So I feel like for me personally, I got a little confused initially. Like, I maybe I was doing two things at the same time. I wasn't totally engrossed in the movie. I don't know. It took me a couple of minutes to be like, okay, so we're going. [36:05] Dr. Katrina Furey: In a totally different direction here, right? Yeah. It felt like whiplash. Yeah. [36:09] Portia Pendleton: So Rudy Mara's character is Malingering. [36:12] Dr. Katrina Furey: Yeah. Turns out this whole time we see. [36:14] Portia Pendleton: That she is working with Katherazada Jones's character. Dr. Sebert was her old psychology and love interest. Yes. Which is very inappropriate, obviously. I feel like we don't even need to talk about that. It's obviously inappropriate. [36:27] Dr. Katrina Furey: And I feel like Hollywood loves to depict psychiatrists and patients boning. They just do. And it just really drives me nut. Yeah. [36:37] Portia Pendleton: It's really like any other really horrible thing to happen in any other field. Yes, it happens, but it's so rare, so bad. This isn't the norm. [36:50] Dr. Katrina Furey: So teacher thing. That's like, less, probably less. Right. But I did not see that coming. Like, the first time I saw this movie that turns out like they've been in cahoots the whole time and to get money. [37:08] Portia Pendleton: So that's their plan is to get this payout from causing which is kind of wild to think about all of these chain reactions to make them rich. That's how it is. So they apparently have been kind of planning to take down Dr. Banks. Right. They send him pictures. They send his wife pictures of him and her, Emily, together, which looks really sexually compromising. They float this past patient of his into his practice. So they want him out. It sounds like there was, like a death of a past patient. She took her life and she named. [37:46] Dr. Katrina Furey: Him right, in her suicide note. And he said, this is all delusional. This relationship never happened. [37:52] Portia Pendleton: Which I don't think it did. [37:54] Dr. Katrina Furey: I think he's telling the truth. And unfortunately, things like that do happen. Yeah. And so, gosh, what a lot of planning. [38:02] Portia Pendleton: It almost seems like too much, too. [38:05] Dr. Katrina Furey: Far fetched for it all to fall into place that way. [38:08] Portia Pendleton: But he starts to get, like he starts to figure it out. And he is appearing to be, like, crazy. Right. He's, like, staying up late. [38:15] Dr. Katrina Furey: He has this whole wall of all these pictures they always do with, like, a red pen and X's and, like, string taped up. And then he does give the sodium what is it? Ambutol? Truth serum. Basically. He supposedly gives her truth serum to. [38:31] Portia Pendleton: See if and at this point, we still think that he did. [38:34] Dr. Katrina Furey: Right. [38:35] Portia Pendleton: So we find out later that it was just like saline when he is telling the police or the lawyer for the state about it. And first of all, what he did is so unethical. Like unethical. And he can get in a lot. [38:48] Dr. Katrina Furey: Of trouble for it. [38:48] Portia Pendleton: So the lawyer is like, I don't. [38:50] Dr. Katrina Furey: Want to hear this. I don't want to know. [38:51] Portia Pendleton: You need to delete this. You need to get rid of it. [38:53] Dr. Katrina Furey: Because he films her. Right. [38:54] Portia Pendleton: And you can't be tried twice. So the lawyer is like, even if this is true, we have these laws that prohibit double jeopardy, I think it's called. Again, things are moving really fast, and we're starting to see that apparently she has concocted this plan with her old psychiatrist, and they were going to pin. [39:11] Dr. Katrina Furey: It on whoever evaluated her. It just happened to be him, and he just happened to have this history that sort of helped with their case. And then he's like, oh, no, you're not going to pin it on me. I'm going to pin it on you. And then it turns out that then Dr. Sebert and Emily are sort of pinning it on each other, but he starts lying and deceiving and manipulating almost as bad as Emily was to begin with. Yeah. So it's just really interesting. [39:37] Portia Pendleton: So it seems like they get her to wear a wire, emily, when she goes and meets with Dr. Sebert and gets her to kind of confess what's going on, and then Dr. Sebert feels because they're going to have sex. So she feels this pack on her back, and then the door opens and the police are there. [39:57] Dr. Katrina Furey: I know. [39:57] Portia Pendleton: And then I'm like, oh, Emily gets away. [40:00] Dr. Katrina Furey: Right? [40:01] Portia Pendleton: You think that she made this deal, she can't be tried again, and that's not the case. [40:08] Dr. Katrina Furey: So then you see they're all trying to pin it on Dr. Banks. They want her to be restored to sanity so that she can be discharged from the unit and sort of go live her happy life with Dr. Seabird. But she's supposed to keep seeing him to avoid being hospitalized. And she thought it was just going to be like, okay, let's pretend I'm seeing you, but not really. Like, you know the drill. I was malingering the whole time. I don't really need medications, blah, blah, blah. But then he's like, no, I'm going to prescribe you Thorazine and Depicote, both of which are they work. They're heavy hitters, man. Like, Thorazine is really sedating Depicode again, the side effects they mentioned from these meds were spot on. You can lose your hair with Depicode. You also gain a ton of weight. You're really sluggish cognitively. You can get a lot of acne. [40:57] Portia Pendleton: So who would be prescribed those? Like, what kind of a patient would be prescribed Thorazine and Depicote? Or either? [41:05] Dr. Katrina Furey: Yeah. So Depicote is under the class of medications called mood stabilizers, which we use for things like bipolar disorder. You do not use it in women of childbearing age because it has been shown to be associated with a birth defect, specifically neural tube defects, which lead to things like spina bifida. In pregnancy, you always take a high dose Folate, and you can take extra. If you have to be on Depicode, if that's, like, the only mood stabilizer that's ever stabilized your bipolar disorder, then by all means, you need to stay on it. But it's not the first one we use. Also, so many side effects, and there's newer mood stabilizers like lamctal. Lithium has been around forever. But it's like a really good one that's effective. It has low side effects, too. And then Thorazine is an older antipsychotic, which he does acknowledge and is true. It's what we call like a typical antipsychotic like Haldol that is used for psychotic disorders. So things like schizophrenia, we use it a lot in the emergency room and inpatient setting to also help with sedations. Like, if you're so psychotic or manic that you are unable to sleep, you'll often get Thorazine to sort of help promote sleep. So you can imagine how much fatigue goes along with it. Sluggishness. It can be very drying. Like your mouth is really dry. It's not pleasant. So he's basically, like putting her into a pharmacological prison is basically what he's doing and making sure that she has to go get drug tested to show that she's actually taking it or she's going to go back in the hospital. So he gets the final one over. [42:38] Portia Pendleton: So she is like, no, right, and runs out of there, tries to escape, and that's when she is not then right following. And I think he knows this, that she's going to have this reaction. So she kind of goes to get in the cabin, run away, and the police are waiting for her. He kind of knew all along. [42:55] Dr. Katrina Furey: I think he tipped him off that this is going to happen. He probably didn't say, like, I'm going to do this and she's going to do that. He probably was like, she's been acting odd. Can you be waiting? And then she goes back, I think to the forensic psych unit, which honestly, that's where she belongs. Yeah, that's where she belongs. Given everything that happened. Gosh, that movie had a lot of twists and turns, lots of ups and downs. I feel like there's probably so much more we could talk about, but this episode has already been really long. I thought it was interesting, Portia, that you didn't seem as into this movie as I was. Do you think it's because I prescribe? [43:30] Portia Pendleton: I don't know. What's funny, too, is that one of my friends who's not in the field at all, really loved this movie and recommended it. And I don't know, I feel like. [43:42] Dr. Katrina Furey: I was a little bored, actually. Yeah, you yawned a lot as we were recording this. [43:48] Portia Pendleton: I don't know what that says. [43:50] Dr. Katrina Furey: That's why I feel like I also. [43:51] Portia Pendleton: Missed things throughout it. [43:54] Dr. Katrina Furey: Do you think it's because we've been talking a lot about psychopaths, like with you, and maybe you're just kind of over it for right now. Maybe Tatum died. Yeah. Maybe this Zach grief is too much for you to bear. Maybe, yeah. [44:09] Portia Pendleton: I have no idea. I think that's interesting though. I was like bored. I feel like, oh, no, pay attention. Pay attention. [44:16] Dr. Katrina Furey: I know. And I couldn't wait for us to record this episode and watch it again. And you're like, over here, yawning. And I'm like, and then they got the side effect right, and then they did this right. Then they did this wrong. Maybe someday we'll have a patreon and we can record a bonus episode where we explore that reaction further. Maybe. [44:34] Portia Pendleton: This felt unbelievable to me. [44:36] Dr. Katrina Furey: I think it did. [44:37] Portia Pendleton: It did. And I think that's where I was. [44:39] Dr. Katrina Furey: Just like, this wouldn't really happen. No, it's totally I mean, again, I think once the twist came into play, then you're like, oh, God, that's what this movie is. That's so unbelievable. You know what? I think it's important that we do analyze scripts that we don't like. Yeah. All right, well, I don't want to hold you up any longer. We'll wrap up this episode. Thanks for listening. I hope that whoever's listening isn't Yawning. We'll see. Please don't forget to rate, review and subscribe follow us on Instagram at Analyze scripts. DM us. Send us an email, analyze Scriptspodcast@gmail.com and let us know what you want us to analyze next. Put you to sleep. Like this movie put portion to sleep. [45:23] Portia Pendleton: Thanks so much for listening. [45:25] Dr. Katrina Furey: See you later. Bye. [45:31] Dr. Katrina Furey: This podcast and its contents are a copyright of Analyzed Scripts. [45:35] Dr. Katrina Furey: All rights reserved. [45:37] Dr. Katrina Furey: Any redistribution or reproduction of part or all of the contents in any form is prohibited. Unless you want to share it with. [45:44] Dr. Katrina Furey: Your friends and rate, review and subscribe, that's fine. [45:47] Dr. Katrina Furey: All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended. [45:56] Dr. Katrina Furey: Or should be inferred. [45:58] Dr. Katrina Furey: This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time.

In this highlight from season 1, Helen Fisher discusses her research with couples deeply in love after 20 years of marriage. The clip also includes Fisher's 7 science-based tips for fostering romantic relationships, and a cautionary note on SSRI (not SNRI) antidepressants. Dig deeper To read more about the possible effects of SSRIs on sex drive and romantic love, see ⁠Tocco and Brumbaugh (2019)⁠. Below is a short list of some possible alternatives and/or complements to SSRIs (please consult with your doctor in all matters related to pharmaceuticals): Fisher herself suggested that SNRIs could be less risky than SSRIs. Theoretically, dopamine reuptake inhibitors, such as bupropion, could also counter the risks associated with SSRIs (for a review, see ⁠Zisook et al. 2006⁠). For alternative or complementary oral treatments of depression, see research on supplementation with a high dosage of Omega 3 (EPA and DHA, not ALA) (for a review, see ⁠Bhat & Ara 2015⁠).

This is the 7th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) therapies. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Michael Lang, MD, FACP, DFAPA & Monica Sharma, MD

My time at then Maitland Private Hospital was very much concerned with reducing the number of psychoactive medications I was having (with little benefit) and to go old school in the search of medications that may prove useful. This was achieved through the use of a Tricyclic Antidepressant known as Clomipramine. But since being discharged it has become apparent that the Clomipramine on its own isn't quite doing the job. So in this episode we look at where we have come from and what lies ahead.

This podcast, Elizabeth Hopfenspirger, DNP, a psychiatric and family practice nurse practitioner with Lakeview Clinic, discusses various mental health topics, primarily in the adult patient, but also touches on some pediatric issues. Today's discussion will focus on the following areas of mental health - depression, anxiety, mixed disorders, ADHD and psychosis. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe different implemention stratgies in how to better establish a therapeutic relationship with the patient. Recognize how many psychotropics medications are on a "spectrum". Realize that treatment choice depends on several variables - including presenting symptoms and underlying organic issues. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  The state of mental health care in the US is not ideal- Lack of resources - Lack of practitioners - social, physical, economic and environmental challenges CASE REVIEW #1- 18 year old female with predominantly anxiety - Respectful curiosity: listening and asking questions without judgement - Medication for generalilzed anxiety disorder- High intensity aerobic exercise can improve anxiety symptoms. - Trauma? ADHD/Learning difficulties? Sleep? Appette and restriction of food/eating disorders? Substance use/abuse? - SSRI: bupropion>fluoxetine?Sertaline?escitalopram>fluvoxamine>paxil (most activating to least activating) - For pure anxiety - Elizabeth prefers escitalopram, citalopram and sertaline - Trauma and trauma therapy: Trauma can be anything (death of a loved one, MVC, etc.)      - Trauma therapy (EMDR: eye movement desensitization reprocessing)      - IFS (internal family systems - recognizing and connecting with your own history and younger self)     - ART (acceleraed resolution therapy) - Substance use: What is the substance doing for the patient? Why are they using? Helps to direct therapy and arrive at diagnosis. - ADHD (attention deficit hyperactivity disorder)     - sometimes missed or ignored     - PCPs have discomfort treating at times     - trial of stimulant may be beneficial - Suicide ideation and other adverse effects while first starting certain meds is real, but rare- Article resources:        Walkup, et.al   (https://pubmed.ncbi.nlm.nih.gov/18974308/)       Wetherell, et.al  (https://pubmed.ncbi.nlm.nih.gov/23680817/)       Critz-Christoph, et.al  (https://pubmed.ncbi.nlm.nih.gov/21840164/)      Trauma therapy : https://www.emdria.org/ CASE REVIEW #2- 32 year old male with depression - Labs? Physical activity? Testosterone concerns? - Lifestyle and sexual function - Post-retirement? (identity and purpose has changed/gone) - Consider bupropion if no seizures or other contraindications. Consult with neurologist if significant history - Sexual dysfunction an issue? Vortioxetine can be an option wich may help enhance libido - Physical activity (natural endorphins) and exposure to nature are improtant - Screen time? Smart phone and other screen time has dopaminergic effects; too much 'negative' screen time can be detrimental  (If AHDH is poorly treated, screen addiction may increase.) CASE REVIEW #3- 65 year old male with mixed depression and anxiety, off meds for many months - Find as many of patient's historical records as possible - Meeting a patient "where they are at". How motivates is the patient to get better? - Are they coasting (teenagers)? Are they taking an active role in getting better?       - may need to wait to push/empower patient until after giving medication and psychotherapy some time        - where is the patient in their willingness to change and get better?  - Meds in this ager group (and many others) to avoid:  TCAs and MAOIs - IF DM, HTN, CAD and other co-morbidities, fluoxetine is less likely to have interactions and adverse effects- Article resources:       Prochasa and DiClemente - Stages of Change https://www.ncbi.nlm.nih.gov/books/NBK556005/) Psychosis- Caplyta (stimulating) if more depressed with psychotic features - Zyprexa (sedating) if more manic/psychotic Genetic testing for optimization of medications is an option - Serves as a 'guide' for medication choice - SLC6A4 gene, for instance, is responsible for serotonin reuptake into the presynaptic neuron What to do while waiting for SSRI and SNRI to "work"?- Hydroxyzine, benzodiazepine - Sleep medication:      - Doxylamine, Trazadone or Remeron (older patients)      - Sleep medication: lunesta, sonata Polypharmacy- Is polypharmacy present and patients feeling poorly with persistent symptoms? May need thoughtful/ careful deprescribing. Nontraditional/novel treatment options- Nontraditional/novel options for treatment resistant depression, PTSD treatment, chronic pain, etc. - Ketamine - Psilocybe Psychiatry & Primary Care- Incorporating psychiatry into our own primary care practices is anxiety provoking but inevitable in this day and age of healthcare - We can learn new things and leverage our existing resources to better help our patients - Time with our patients is a barrier - Ask the patient: what is the most pressing issue for you today? What is the most distressing thing for the patient? Then consider Maslow's Hierarchy of Needs and build up from there.- Article resources:       Maslow Hierarcy of Needs (https://www.simplypsychology.org/maslow.html) Please check out the additonal show notes for additional information/resources.

Being in your 20's is for having a favorite burner on the stove, getting excited about canceled plans, and getting on an SNRI (kidding, well kind of) Getting extremely vulnerable with you in this episode, Kayla shares her story about anxiety and how she has learned to overcome it in recent years. Whatever you are struggling with you are not alone! https://www.mentalhealth.gov/ Connect with me on: YouTube https://www.youtube.com/c/KaylaNelsonx Instagram https://www.instagram.com/sincerely.kayla/ TikTok https://www.tiktok.com/@kaylaobviously

Engilbert Sigurðsson, prófessor og sérfræðingur í geðlækningum, fer yfir þunglyndi í víðum skilningi. Hvað er þunglyndi, hvaða boðefni í heilanum koma við sögu og hverjir eru megin þættir í meðferð. Við ræðum helstu flokka þunglyndislyfja sem eru notuð í dag og einnig nýjungar á borð við segulörvun og psilocybin.Þessi þáttur er unnin í samstarfi við Læknadeild Háskóla Íslands og nýtist við kennnslu læknanema í lyfjafræði á 3. ári og geðlækningum á 5. ári. Magnús Karl Magnússon, prófessor í lyfjafræði og sérfræðingur í blóðlækningum heldur utan um verkefnið og er jafnframt gestaspyrill í þættinum.

Episode 117: Anxiety Screening. Adriana and Ikleel explain the new recommendation given by the USPSTF in October 2022 regarding screening for anxiety in children and adolescents 8-18 years old. Dr. Arreaza discusses the SCARED tool to screen for anxiety in pediatric patients. By Adriana Rodriguez, MS3, and Ikleel Moshref, MS3. Ross University School of Medicine. Moderated 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.Recommendation.The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. Grade of recommendation: B (offer this service to your patients)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger. Grade of recommendation: I (insufficient evidence, unknown benefits vs. harms)USPSTF concludes this new screening guideline for anxiety in this population has a moderate net benefit. For children 7 and younger, evidence is insufficient to determine screening tools accuracy and its effects, and benefit-to-risk balance. Anxiety. Anxiety disorder is characterized by excessive, persistent worry and or fear that is difficult to control, resulting in significant distress or impairment. Anxiety disorder manifests in psychological/emotional and physical/somatic symptoms. DSMV recognizes 7 types of anxiety disorders: GAD, social anxiety disorder, panic disorder, agoraphobia, specific phobias, separation anxiety disorder, and selective mutism. Comment: Anxiety is not your patient's fault. In some cultures, anxiety is seen as a weakness. America seems to be a highly stressful society.Epidemiology.Anxiety disorder is a common mental health condition in the United States. According to the National Survey of Children's Health in 2018-2019, 7.8% of people aged 3-17 yrs. old had an anxiety disorder that was current. In the adult population, past studies have shown ~3% past-year prevalence and ~5-12% lifetime prevalence of anxiety disorder in adults. Topic Importance.Anxiety disorders are the most common childhood-onset mental health condition. Childhood and adolescent anxiety disorder is associated with an increased likelihood of poor academic performance and co-occurring psychiatric conditions. It is also associated with future anxiety disorder, secondary depression, substance abuse, psychosocial functional impairment, chronic mental/somatic health conditions, and/or suicide. Screening anxiety disorder in youth may serve to improve potential prevent burdens in the future. Assessment of Risk. Although this new screening guideline is meant for children and adolescents aged 8-18 who have not been diagnosed with an anxiety disorder and without signs and symptoms, it is important to note what factors would increase their chances of developing any of the aforementioned anxiety disorders: Genetic, personality, and environmental factors: biopsychological vulnerability, attachment difficulties, child maltreatment, adverse childhood experience Demographic factors: poverty, low socioeconomic statusRacial and ethnic factors: racial discrimination, historic trauma, structural racismOther factors: LGBTQ youth, older adolescents 12-17Screening Tools.Although there are many screening tests for anxiety, two are widely utilized in clinical practice for screening purposes: (1) SCARED (Screen for Child Anxiety Related Disorders), and (2) Social Phobia Inventory. These screening instruments are insufficient for the actual diagnosis of any particular anxiety disorder listed earlier; if positive, however, a confirmatory assessment and follow-up is required to establish diagnosis using DSM V criteria for any of the recognized anxiety disorders (GAD, social anxiety disorder, panic disorder, agoraphobia, specific phobias, separation anxiety disorder, and selective mutism).SCARED (Screen for Children Anxiety Related Disorders): It is a 41-Item questionnaire, each question can be answered from 0-2 (0=not true or hardly true, 1=somewhat true or sometimes true, 2=very true or often true). A score greater than or equal to 25 is highly associated with anxiety disorder; panic disorder, significant somatic symptoms, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and significant school avoidance. SCARED is available online (here). There is a child version and a parent version. The only difference between the two is the different pronouns, for example, question 17 is “My child worries about going to school” vs “I worry about going to school”. Although the USPSTF could not find optimal screening intervals, these screenings may be best used in older adolescents aged 12-17 yrs. old with risk factors for anxiety disorder. Other anxiety screening tools have been assessed by the USPSTF but were insufficient for the purposes of this guideline because they were too specific to a specific anxiety disorder (for example, the Social Phobia and Anxiety Inventory for Children), were for a particular set of disorders, or were too long to use for screening in a primary care setting. In studies found by the USPSTF, social anxiety disorder and GAD were the most common detected anxiety disorder in children and adolescents. Fun fact: What is the most common phobia in the US? Public speaking, AKA glossophobia.Treatment. Anxiety disorders can be treated with medications, psychotherapy, a combination of both, or multidisciplinary care. Of the variety of psychotherapies available, cognitive behavioral therapy (CBT) is the most used. As for pharmacotherapy, US FDA has only approved duloxetine, an SNRI, for the treatment of GAD in children 7 yrs. and older. Off-label prescriptions of other drugs have been reported to treat anxiety in youth. Potential Harms.False-positive screening results may lead to an unnecessary burden on the patient and family from avoidable referrals, monetary costs, anxiety, the stigma of illness, and adverse effects of pharmacotherapy (weight loss, cholesterol, etc.)Bottom line: Anxiety is a treatable mental condition and detection in childhood is now recommended by the USPSTF. Screen if you have a way to treat (refer or treat yourself).____________________________Conclusion: Now we conclude episode number 117 “Anxiety Screening.” Adriana and Ikleel explained that screening for anxiety disorders in children between 8-18 is now a grade B recommendation by the United States Preventive Services Task Force. During this episode, you heard about “SCARED”, a useful screening tool to help in the diagnosis of anxiety disorders in children. Once diagnosed, anxiety is treated with psychotherapy, medications, or a combination of both. This week we thank Hector Arreaza, Adriana Rodriguez, and Ikleel Moshref. Audio edition by Adrianne Silva.Even 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! _____________________Links:Final Recommendation Statement, Anxiety in Children and Adolescents: Screening, United States Preventive Services Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents#fullrecommendationstart, accessed on Oct 11, 2022. Screen for Child Anxiety Related Disorders (SCARED), available online, for example: Oregon Health & Science University: https://www.ohsu.edu/sites/default/files/2019-06/SCARED-form-Parent-and-Child-version.pdfBennett, Shannon, et al. Anxiety disorders in children and adolescents: assessment and diagnosis, UpToDate, last updated: Aug 19, 2022. https://www.uptodate.com/contents/anxiety-disorders-in-children-and-adolescents-assessment-and-diagnosis.Baldwin, David, et al. Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis, UpToDate, last updated: Apr 18, 2022. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis.Craske, Michelle, et al. Generalized anxiety disorder in adults: Management, Up to Date, last updated Nov 12, 2021. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-management.Royalty-free music used for this episode: Real Live by Gushito, downloaded on October 1, 2022, from https://www.videvo.net/. 

Huzursuz bacak sendromu (HBS), nörolojik bir bozukluk olarak kabul edilir ve bacaklarda hissedilen hoş olmayan hisler ve bu hisleri gidermek için bacakları hareket ettirme isteği olarak tanımlanır. Willis-Ekbom hastalığı olarak da bilinmektedir. Hastaların bacaklarında görülen bu hoş olmayan hisler sıklıkla; yanma, ürperme, kaşınma, zonklama, iğne batması, çekilme veya bacaklar üzerinde böcek yürüme hissi olarak algılanır. Bu hisler sıklıkla baldırda olsa da uyluktan ayak bileğine kadar olan bölgenin herhangi bir yerinde hissedilebilir. Tek taraflı olabileceği gibi bilateral de görülebilir. Etkilenen uzvu hareket ettirmek geçici olarak bu rahatsız hisleri baskılar. Dolayısıyla hastanın bu rahatsız hislerden kaçınmak için bacaklarını hareket ettirme döngüsüne girdiği bir durum oluşur​1–5​. Amerika Birleşik Devletleri verilerine bakacak olursak toplumun %10'u bu sorundan muzdariptir. Kadınlarda daha sık görülür ve orta yaştaki kişiler daha ağır semptomlarla seyretme eğilimindedir. Yaş arttıkça semptomların şiddeti, sıklığı ve süresi genellikle artar.1 Bu sendroma sıklıkla diğer uyku problemleri de eşlik eder. Hastalığın kendi doğasından ötürü hastalar uykuya dalmakta zorluk yaşarlar ve hastaların çoğunluğunda gündüz yorgunluğu görülür. HBS patofizyolojisi hala net olarak aydınlatılamamıştır. Bazı vakalarda durumun genetik olduğu düşünülse de bazı vakalarda kronik hastalıklara (diyabet, böbrek yetmezliği, kronik alkolizm vb.) bağlı olarak sinir hasarı olduğu düşünülmektedir. Demir eksikliğinde de HBS'nin daha fazla görüldüğü bilinmektedir. Ve tabii ki her hastalıkta olduğu gibi bazı ilaçlar semptomları ağırlaştırabilmektedir. Antiemetikler (özellikle metpamid), antipsikotikler ve antidepresanlar (TCA'lar, SSRI'lar, SNRI'lar) ve antihistaminikler bunlardan bazılarıdır. Gebelik döneminde özellikle 3. trimesterde olmak üzere semptomlarda artış görülür ve sıklıkla doğumdan birkaç ay içerisinde bu semptomlar geçer. Alkol, sigara ve kafein kullanımı dolaylı olarak uyku düzenini bozabildiği gibi direkt olarak da hastalığın seyrini kötüleştirebilir. Hastalarda gelişen rahatsız edici hisler sıklıkla uzun süre oturma ya da uzanma sonucunda başlarlar. Bu uygunsuz hisler sonucunda hastalarda; Semptomları geçici olarak giderebilmek için bacakları hareket ettirme ihtiyacı:Germe veya bükme,Bacakları ovmak,Yatak içerisinde dönme,Kalkıp yürüme ihtiyacı.Özellikle geceleri uykuya dalmaya çalışırken, uzanırken ya da herhangi bir inaktif etkinlik sırasında kötüleşen semptomlar,Günün geç saatlerinde ve gece olmak üzere huzursuz hissetme görülür. Bu hastalarda tanı koymak bulgu ve belirtilere dayanır. Genişletilmiş anamnez ve fizik muayene önemlidir. Bazı durumlarda kan tetkikleri veya uyku testi yapılabilir. Fakat hali hazırda kesin bir tanı testi yoktur. Temel olarak tanı hikaye ve muayeneye dayandığı için çocuklarda tanı koymak daha zordur. Çocukların dikkat eksikliği-hiperaktivite bozukluğu ya da büyüme ağrıları şeklinde yanlış teşhis alması çok olasıdır.  Hastalığın tedavisi semptomların yoğunluğuna göre belirlenir. Hafif olgularda hayat tarzı değişiklikleri sıklıkla yeterli olmaktadır.2 Düzenli uyku, düzenli egzersiz ve hastalığı şiddetlendiren eden şeylerden (sigara, kafein, alkol vb.) uzak durmak tedavinin ilk basamağıdır.  Sıcak banyo, bacak masajı, bacaklara sıcak pedler ya da soğuk buz paket uygulamaları da denenebilir. Demir eksikliği, hastaların çoğunda altta yatan sebep olarak görüldüğünden tedavide demir replasmanı önemli bir yere sahiptir. Serum ferritin düzeyi 75 ng/mL'in altında olan kişilerde replasman önerilir. Tedavi ilk olarak oral başlar. Malabsorbsiyon, intolerans veya tedaviye yanıtsız olgularda intravenöz tedavi düşünülebilir. İntravenöz tedaviye yanıt 6 hafta içinde görülürken, oral tedaviye yanıt sıklıkla 2-3 ayda görülür. 3 Hayat tarzı değişikliklerine yanıtsız olgularda farmakolojik tedavilere geçilir. Her hasta medikal tedavilere aynı yanıtı vermemektedir.

Post-SSRI Sexual Dysfunction (PSSD) is a disorder that reduces sexual functioning despite stopping treatment with SSRI or SNRI medications. Lack of awareness and the nature of the issue most likely contributes to the underreporting of this condition. On today's podcast we welcome Yassie Pirani & Emily Grey to discuss PSSD.If you are in a crisis or think you have an emergency, call your doctor or 911. If you're considering suicide, call 1-800-273-TALK to speak with a skilled trained counselor.RADICALLY GENUINE PODCASTRadically Genuine Podcast Website Twitter: Roger K. McFillin, Psy.D., ABPPInstagram @radgenpodTikTok @radgenpodRadGenPodcast@gmail.comADDITIONAL RESOURCESCanadian PSSD SocietyPSSD NetworkPSSD Hilfe Deutschland e. V. - StartseiteYassie Pirani15:00 David Healy: Post-SSRI Sexual Dysfunction | RxISK17:00 Sexual Health Research Lab17:45 Post SSRI/SNRI Sexual Dysfunction (PSSD) | Sex[M]ed19:30 Anhedonia: Why does nothing feel good anymore?25:00 Finding and Learning about Side Effects (adverse reactions) | FDA32:00 Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin34:00 PSSD Doctors & Specialists | RxISK48:30 Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood - PMC

TRC Editor, Dr. Lori Dickerson, PharmD, FCCP talks with Douglas S. Paauw, MD, MACP, Professor of Medicine from the University of Washington School of Medicine about serotonin syndrome.Listen in as they discuss how to tease out which serotonin syndrome interaction alerts are clinically significant.You'll also hear practical advice from panelists on TRC's Editorial Advisory Board:Reid B. Blackwelder, MD, FAAFP, Associate Dean of Graduate and Continuing Medical Education at East Tennessee State UniversityAndrea Darby Stewart, MD, Associate Director, Family Medicine Residency at Honor HealthAnthony A. Donato, Jr., MD, MHPE, Associate Program Director, Internal Medicine from the Reading Health System, and Professor of Medicine at the Sidney Kimmel Medical College at Thomas Jefferson UniversityJoseph Scherger, MD, MPH, Family Physician, Primary Care 365, Eisenhower HealthCraig D. Williams, PharmD, FNLA, BCPS, Clinical Professor, Department of Pharmacy Practice at the Oregon Health and Science UniversityNone of the speakers have anything to disclose. Pharmacist's Letter offers CE credit for this podcast. Log in to your Pharmacist's Letter account and look for the title of this podcast in the list of available CE courses.If you're not yet a Pharmacist's Letter subscriber, find out more about our product offerings at trchealthcare.com. Follow or subscribe, rate, and review this show in your favorite podcast app. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com. 

Gut Immune Body Brain Axis.Dr Gundry:Leaky Gut, gut microbiome and dietRenowned Cardiovascular Surgeon who realised that all he was doing was treating thesymptoms so he studied the underlying causes.The lining of the gut is one cell thickAs bacteria break down the gut that is when ageing startsIbuprofen or roundup disastrous the bacteria populationSkin is a mirror of the lining of the gutJoints do not naturally wear out.Animal model C Elegans as bacteria begin to break down the wall of the gut that is whenageing starts105 year old people have a diverse set of bugs identical to a healthy 30 year old. It is notattacking the wall of the gut.Ecermansia musinophilia. Lives in the mucous layer whose job is to trap lectins plantproteins looking for sugar molecules and to protect the wall of the gut from harmful bacteria.Ecermansia musinophilia eats mucus which in turn makes more mucus.Metformin works by increasing mucous and this change in bacteria makes some peoplehave mild diarrhoea as the bacteria change.If we damage this lining eg ibuprofen or food with roundup destroys the bacteria populationand gut lining.Glyocosade an antibacterial damages Ecermansia Musinophilia even though it does notdirectly affect human cells.Antibiotics in food or direct prescription eg ladies who take low dose for UTI have a higherincidence of heart disease.Heart disease is an autoimmune disease starting in the gut.Cholesterol is an innocent bystander which gets sucked into the inflamed wall of a bloodvessel.Infants with heart transplants have coronary artery disease with pathology identical withtypical coronary artery disease.Lectins which are a foreign protein which can stick to sugar molecules on the surface ofblood vessels are the cause of atherosclerosis and removing lectins reduces those markers.Lectins are one of the plant defence systems. Sticky proteins that look for specific sugarmolecules to stick to which insights an inflammtory response.Joints do not normally wear out. Usually you can find bacterial particles in the joint fluid ofarthritisBecauseLectins broke down the wall of the gut. 65% of the immune system is behind the wall of thegut because the gut is where the outside word gets through. A reason why we store fat inthe gut is to provide energy to the immune system. Similarly fat on the outside ofatherosclerotcic blood vessles correlates with the severity of inflammation.Fat is not the cause . It is there because of the inflammation and the inflammation is theredue to the leaky gut.The immune system responds to antigens on bacteria of viruses. Lectins have antigens withcross reactivity with other proteins in the body. Eg thyroid.Nightshade vegetables or peanutsLectins disrupt the microbiome and break up the lining of the gut allowing entry by lectinsand by bacteria or bacterial particles.Hence if you inject a bacterial lipopolysaccharide into a person you can induce septic shock.Alzheimers Parkinsons is neuroinflammation.Most amyloid is produced by bacteria in the gut. Therefore 40 billion dollars invested inantiamyloid drugs has been a waste because amyloid is produced by the amyloid producingbacteria inthe gut fet by western diet. Then the amyloid has to get through the wall of the gut.Once they get through the gut wall and goto the brain it will produce more amyloid.Cholesterol and amyloid coexist in dementia in those with the apoE gene.The apo E gene codes for a carrier molecule because it is less efficient at transportingcholesterol. It cannot get out of the cell after it has been attracted by inflammation.Faecal microbial transplant:1970s broad spectrum antibiotics came out which made it much quicker to treat infectionsbut it also wiped out the gut bacteria. Normally 10000 species of bacteria.Pseudomembranous colitis was caused by Clostridium Difficile over growing. Initial studydone from the faeces of medical students.Faecal enemas treated the pseudomembranous colitis.Meat with animals treated by antibiotics can also cause problems.60% of faeces is bacteriaOral microbiome and cloud of bacteria around us –Holobiome . This defines our personalspace.Kissing is a human and ape characteristic. Exchanging oral microbiome. Bacteria decidewhether the other person's bacteria are compatible with them.Women have a gut feeling because they are more capable of listening to their microbiome. We inherit our microbiome from our mother. All of the mitochondria are involved with bacteriainherited from our mother. Bacteria communicate to their ‘sisters 'ie the body's mitochondria.Autism: kids have a different microbiome than ‘normal'The placental microbiome is important in educating the foetal immune system.Oral faecal transplants for 6 weeks in autistic kids. Almost immediately 50% autismsymptoms reduced.Ecermansia like tubers, mushrooms, -study in Asia find 90% reduction in Alzheimers withtwo cups of mushrooms a week.Inulin containing compounds eg chicory, radicchio, jerusalem artichoke.Exercise women who exercise routinely from midlife have a 90% reduction in Alzheimers. Inthose who get AD it happens 11 years later. Housework can be important part of exercise.Meditation and yoga also changes the gut microbiome.Lymph system in the brain in deep sleep -early in the sleep cycle-shrinks by 20% and thesebad proteins are squeezed out. You need a 3-4 hour window between sleep and dinnerbecause blood flow diverts to the gut.Olive oil /walnuts / mediterranean low fat diet: first two groups improved memory after 5years. 3rd group lost memoryThose with CVD had a 30% reduction in events, the low fat group continued CVS events.Polyphenos in olive oil grow proteinsTMAO is made by gut bacteria primarily from animal protein especially choline eg egg yolkand carnitine . TMAO damages blood vessels. Polyphenols in certain olive oil and red winebalsamic vinegar that paralyse enzyme systems in the bacteria so they do not make TMAO.However the logical error here is that eggs which are high in choline are not associated withincreased morbidity.Vitamin D at least 5000 units a day . Almost all cancer patietns and autoimmune pateitnshave low vitamin D. HIgher your VItamin D the longer your telomere. Stem cells in the gutare simulated by vitamin D.VItamin CLectins are present in most plant foods but especially high in:legumes, such as beans, lentils, peas, soybeans, and peanutsnightshade vegetables, such as tomatoes and eggplantdairy products, including milkgrains, such as barley, quinoa, and riceThe Roll of Inflammation in Depression and FatigueFrontiers In Immunology:CH Lee 2019:Immune system link to depression first noticed with immunotherapy eg INFa (which activates an inflammatory antiviral response) for Hepatitis C : associated with raised proinflammatory cytokines and depression and fatigue.20% of patients treated with INFa developed depression which resolved on discontinuationbut also increased the risk of depression in future.Also people with higher IL6 aged 9 were more likely to have depression aged 18 in a dosedependent manner.Innate immune system seems to be lower in depression eg NK cells and also less antiinflammatory regulatory T cells whereas inflammatory monocytes are activated.There is commonality in immune activation from autoimmune disorder such as multiplesclerosis or immune reactions in sepsis.Antidepressants reduce inflammation while a higher baseline level of inflammation predicts apoorer treatment response.People with depression have been shown to have higher inflammatory markers which canbe used to predict treatment efficacy and future recurrences of depression.Elevated inflammatory markets eg TNFa after an MI disrupt the blood brain barrier causingdepression.Inflammatory changes in the brain with raised TNFa in the hippocampus and striatumprecede development of depressive symptoms.Neurogenesis is inhibited by the kynurenine pathway which is rescued by both inhibitors ofthis pathway and traditional antidepressants.TNFa also increases glutamate release causing exocytotic damage to surroundingsneurones.Conditions associated with chronic immune activation such as asthma, atopy, diabetes mMS, RhA, SLE are all associated with raised levels of depression eg 36% of asthma havedepression who also had higher TNFa than those who were not depressed. 75% in RhAMS up to 50% risk of depression.Acute inflammation with sepsis also causes depression and raises the risk of depression infuture which in animal models can be reduced by using steroid during the acute sepsis.Antidepressants reduce inflammatory markers perhaps SNRI more effective than SSRI andalso ECT adds in return to normal of NK activity.Directly reducing the immune response eg anti TNF a or Caspase Inhibitors have beenshown to reduce depression. Rituximab which is an antibody that targets and depletes Bcells in the treatment of RhA also reduces depression.Aspirin can reduce depression but can also reduce the effect of an SSRI.

Coaching: Anxiety Disorder:We all have anxiety, not only is it normal it is essential for survival, in fact as a caveman themore anxiety you had the more likely you were to escape predators and achieve survivalneeds. The irony is that in todays society it these people that suffer the most as just like therest of us they are hard wired to continue escaping illusionary predators and acquireillusionary survival needs that marketing and social media imprison us with.We discussed stress last week which is mostly a normal response for an individual to asituation where they do not feel in controlHowever if severity of anxiety or duration exceeds what is reasonable then it may become aclinical disorder.Anxiety Disorder:33% life time prevalence of anxiety disorder often co morbid with depression or otheranxiety disorders, and 4% life time prevalence of GAD higher and more impairing in highincome countries. Females twice as likely as males.Generalised Anxiety Disorder: DSM V 300.02Generalised Anxiety Disorder: 8 studies of biological interventions:Current Psychiatry July 2022 Saeed MajarwitzGeneralised Anxiety Disorder usually starts in early adulthood and persists throughout life.Anxiety about a variety of events is excessive and unreasonable and causes distress andimpairs functioning.There is a big variability in the effectiveness of physical intervention for Generalised AnxietyDisorder.SSRI, SNRI, agomelatine (melatonin 1 and 2 R agonist and 5HT 2c R antagonist –antagonism increases noradrenaline and dopamine)- as effective as SSRI maybe with fewerside effects eg nausea and sexual side effects.Less used: Buspirone - 5HT 1a R agonist.Acute anxiety: Benzodiazepine.rTMS (FDA approval for Clinical depression 2008) right parietal cortex or right dorsolateralprefrontal cortex with reduced relapse after completion of treatment.CBT alone and improves response to medication.Plus:Diet exercise reduce alcohol and cigarettes, structure , self awareness , sleep with positivestudies for magnesium, chamomile extract and antioxidants.Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety DisorderAcross the GlobeAyelet Meron Ruscio, PhD1; Lauren S. Hallion, PhD2; Carmen C. W. Lim, MSc3; et alDialogues Clin Neurosci. 2015 Sep; 17(3): 327–335.Epidemiology of anxiety disorders in the 21st centuryBorwin Bandelow, MD, PhD*Ann Behav Med. Author manuscript; available in PMC 2016 Aug 1.Generalised Anxiety Disorder: 8 studies of biological interventions:Current Psychiatry July 2022 Saeed MajarwitzPublished in final edited form as:Ann Behav Med. 2015 Aug; 49(4): 542–556Exercise as Treatment for Anxiety: Systematic Review and Analysis

This episode talks about the thought process that took place while choosing to move to a new city and try a new anxiety medication. It talks about the role of connection, brain chemistry, communal support, and compassion when making hard decisions. Being open is the key here. Take a listen if you need a fresh perspective that will help encourage you to listen to your own intuitive guidance, whatever that may be.

In this episode I'm joined by my own psychiatric nurse practitioner Cecelia Howard PMHNP to talk in detail about the tricky subject of mental health medications. It's an area that still carries a ton of stigma, and it's a serious matter to go down the road of taking antidepressants, mood stabilizers or other psychiatric meds. We use my own very positive experience of working with Cecelia and taking a couple of different drugs (A mood stabilizer called Lamotrigine and an SNRI antidepressant called Pristiq) to highlight her unique approach to working with patients. We talk about her lengthy intake process which includes using DNA testing to assess what medications a patient might need. We cover how to know when you might need meds, why you should avoid any practitioner who writes you a prescription after a 15min consultation, and how to get off meds in the right way at the right time. There are quite a lot of scientific terms used so here are some links if you are not familiar with some of the neuroscience behind this. Neurotransmitter Overview. GABA Glutamate Dopamine Seratonin Norepinepherine Calcium and Sodium ION channels NAC SAMe L-Tryptophan Folate Melatonin Lamotrigine (mood stabilizer) SSRI (antidepressant) SNRI (antidepressant) Benzodiazepine Genomind Pharmacogenetic Testing Book - Blame it on the Brain This Way Up - Digital Mental Health Tools.

Fill up with delicious practice-changing knowledge food from #SGIM22 as The Curbsiders team discusses breast cancer survivorship, sexual dysfunction, How climate change will affect health, Are PT consults necessary in the hospital?, Do we need antibiotics for aspiration events?, bias in note writing, Are plant-based meats a healthy?, complications after breast implantation, how to get breast reduction approved, doxycycline for chlamydia, the metronidazole and alcohol myth, pearls for clinician-educators, telehealth, TEACHIM.org, CGMs help lower a1c, PT for rotator cuff disease, Is it safe to taper antidepressants? and how to treat methamphetamine use disorder!  Note: There is no CME for this episode, but claim CME for prior episodes at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Hosted by: Nora Taranto MD, Beth Garbitelli (about to be an MD!), Era Kryzhanovskaya MD, Justin Berk MD, MPH, MBA, Shreya Trivedi MD, Chris Chiu MD, Paul Williams MD, Matthew Watto MD Show Notes and Cover Art: Matthew Watto MD, FACP Showrunner: Matthew Watto MD, FACP Technical Production: Pod Paste Show Segments Intro A few ambulatory teaching models include the One Minute Preceptor, SNAPS (summarize, narrow, analyze, probe, plan, and select), PIPP (precepting in the presence of the patient) [see Community Preceptor Toolbox] Ikigai is a Japanese term indicating a motivational force or reason for living. It is associated with decreased mortality [Tanno, 2009]. Explore your ikigai here (PositivePsychology.com). Listening to podcasts while driving does not affect knowledge retention (Gottleib et al. 2021) Treatment of Hot flashes: Avoid paroxetine, fluoxetine, and sertraline in breast cancers survivors taking tamoxifen. Instead use venlafaxine (or another SNRI), citalopram, or escitalopram. Gabapentin given at bedtime is also an option.  (Clinical Update 2019: Tamoxifen and Antidepressants) Distress in patients with cancer can be measured using the NCCN screening tool [NCCN Distress Thermometer] Don't forget to ask for a Cancer Survivorship Plan from oncology [CDC Cancer Survivorship Care Plans] Ask about sexual dysfunction in cancer survivors. How will climate change impact our patient's health? NIH framework; CH2OPD2 environmental screening tool [CH2OPD2 ]; and the 15 steps of climate communication. Use the AM-PAC score cutoff of >18 to avoid a PT consult in hospitalized patients (Martinez 2021).  Early antibiotics after an aspiration event do not improve outcomes (Aga 2021).  Biased language is more common in notes about Black patients (Beach 2021). Be thoughtful about what you write and role model good behavior. While plant-based meats are more eco-friendly than animal-sourced meats, they are heavily processed foods (van Vliet 2021) and may have high sodium. Silicone breast implant rupture can be insidious. Guidelines recommend screening with MRI after 6 years, then every 2-3 years (FDA 2020, More FDA info) (Note: FDA's most recent guidance also recommends ultrasound as an alternative screening method, so always check with the patient's insurance about which modality will be covered) Document a trial of NSAIDs, physical therapy, attempted weight loss, and supportive bra usage before breast reduction surgery for macromastia.  Doxycycline is now first line for chlamydia rather than azithromycin [STI Treatment Guidelines Update], BUT the most effective treatment is the one your patient will take! Metronidazole does not cause a disulfiram-like reaction and is no longer recommended by the guidelines [STI Treatment Guidelines Update] More clinician-educator pearls from Era: Don't be afraid to brand yourself! Network with like-minded individuals (e.g. interest groups).  BST mode: bite-sized teaching pearls can help reduce extrinsic load and improve retention [Manning, 2021] A guided discussion based on Scrubs episodes can improve resident wellness [Holtzclaw 2021] Chris recaps some posters (click links to see them on Twitter!): Telehealth disparities and tech equity (poster 1, poster 2); TeachIM.org (poster) Continuous glucose monitors can help lower a1c in patients on basal insulin [Martens 2021] A single session of PT improved shoulder pain. The benefits of steroid injections were limited to 8 weeks in the GRASP trial [Hopewell 2021] There is a high risk of recurrence after tapering antidepressants [Lewis 2021] Methamphetamine use disorder can be treated with IM naltrexone every 3 weeks, plus oral bupropion 450 mg daily [Trivedi 2021]. Limitations include cost and co-use of opioids.  Outro Sponsor: Masterworks Get started at masterworks.art/curbsiders.   Sponsor: Ten Thousand Get 15% off at tenthousand.cc/curb Sponsor: Green Chef Go to GreenChef.com/curb130 and use code curb130 to get $130 off, plus free shipping! Sponsor: Blueland Get 20% off your first order at blueland.com/curb 

I'm sharing my journey with medication. 

On ep. 98 of Ask Kati Anything, Dr. Baland Jalal is our guest. He is a neuroscientist at Cambridge University and previously at Harvard University and considered one of the world's leading experts on sleep paralysis. Can you have sleep paralysis in places other than your bed? A member of our community recently felt like she had this happen in a car. What percentage of sleep disturbance is chemical or naturally formed and what percentage is trauma induced?What causes sleep paralysis? How can we get it to stop?Is sleep paralysis more common when you're young?Why do many experience sleep paralysis most often right as they are falling asleep?How much sleep should someone get every night? 7 or 8 hours?Can SSRI's or SNRI's cause sleep paralysis?--------------BooksTraumatized   https://geni.us/Bfak0jAre u ok?  http://bit.ly/2s0mULyOnline TherapyI do not currently offer online therapy.  My sponsor BetterHelp can connect you with a licensed, online counselor, please visit: https://betterhelp.com/katiPatreonHelp support the creation of mental health content? https://www.katimorton.com/kati-morton-patreon/Opinions That Don't Matter! (my afterhours podcast)https://opionstdm.buzzsprout.com/Business ContactLinnea Toney  linnea@underscoretalent.com Support the show (https://www.patreon.com/katimorton)

On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions. Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia. Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen. CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.

In this episode, Dr. Christopher Tookey is joined by Dr. Zach April to discuss the members of the SNRI class of medicines. This includes duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq) and others.  A disclaimer, we're providing general guidance but everyone is different and you should always discuss with your health care professional management of any disease and therapy before trying anything you discover from a source on the internet (including this podcast) 

First up, we address how funny old people can be (sorry, mom and dad!). After that, Loren admits to a problem she's having with her nightly dreams, and then we do Shout Outs. Afterwards, we discuss the childhood holiday traditions we are continuing today and round it out with Weirdness of the Week (which involves B Mo's adorable doggy, Zazu). PODCAST EPISODE SUMMARY-Old people are funny-Loren's dreams are bonkers-Shout Outs-Childhood holiday traditions-Weirdness of the Week Your hosts: The Millennial Prince (B Mo the Prince of TikTok fame) and The Badass Chick (radio's Loren Raye) chat about life, liberty and the pursuit of the 90s. Follow us on social! @bmotheprince + @lorenraye This episode is sponsored by Coast, the next-level wellness shot built for modern life, created by a cancer researcher. Visit www.coastdrink.com and use code “nonsense” to get 20% off. RECOMMENDED RESOURCESwww.bmotheprince.com@bmotheprince www.lorenraye.com@lorenraye www.coastdrink.com@coast_health

Shownotes for Amy Siedman Noble Profit founder and BFLO creator is an early pioneer of interactive media, Amy created technology experiences for companies like PacBell, Lotus, Sun, ValueClick Media, Disney, MGM, Warner Brothers, Fox, and launched design firm Creative Entity. Earlier, Amy's activism and passion for the environment expressed through award-winning photography, art, film, writing, music and education. Fusing her work, she formed Incredible Places, Made For the Media, and served as a NPS technology advisor, a scientific visualization artist fellow at SNRI in Yosemite, UNEP blockchain advisor and a myriad of NGO initiatives.   NOBLE PROFIT AND BFLO TECHNOLOGY Noble Profit is a sustainability information and technology company.   BFLO is a technology to help businesses and investors track, report and verify sustainability claims. Today we provide a toolset for transparency and connecting disconnected information. We are creating BFLO Commons, a shared decentralized information repository of the world's sustainability information.    BFLO offers a tool for transparency mapping climate and SDGs to support ESG reporting which connects information across silos.  Connected third party verifications offer proof of reputation as anchors of truth using smart contracts in an ever shifting digital landscape. For businesses, investors and agencies globally looking for transparency around sustainability, BFLO provides a blockchain protocol, network and decentralized solutions to deliver real-time reporting and trusted third-party verification of SDGs and climate information.   Unlike other sustainability reporting systems, BFLO NFTs unites disconnected information across value chains and makes it accessible and actionable via a decentralized network. Demonstrate your leadership in transparency and deepen the visibility of your ESG commitments using BFLO technology.   On today Show we Talk about: What were some of the lessons you learned when transitioning from a media company to a technology heavy startup? What is Environment, Social, and Corporate Governance(ESG) and what we should know about it, in our futures? What government groups or changes in laws should people be aware of?   Connect with Amy Website www.NobleProfit.com ~  Connecting Sustainable Business, Impact & Clean Tech www.BFLO.io ~ Decentralizing Sustainable Business and Investment  

.What's it like to live with non stop orgasms? We hear this and we think “oh I wish!” but really, if that was something you ACTUALLY had to deal with, what would your thoughts be? Would you be able to live your life normally? WouLtd it grow tiresome or what if it turned into pain? Ellie Simmons found herself in this situation and has struggled to find the support she needs and deserves. After taking a specific SNRI medication that had less than a 1% chance of developing this, one day she found herself not being able to stop the intense sensations that are paired when you're just about to have an orgasm. This is called Persistent Genital Arousal Disorder (PGAD) and Ellie is yet to find a doctor who will take her seriously and actually help. PSA: No one is a doctor on this podcast and therefore we aren't giving out medical advice, just a personal experience from an individual..Want to get in contact with Ellie? Send Nell a message and she will make the connection: nellwalker.mentorship@gmail.comWant that spiffy discount for Lorals? OHHH yeah! Use the code: NELL10 at www.my lorals.comWant to check out my website? Yeah you do! nellthepleasurecoach.com Hosted on Acast. See acast.com/privacy for more information.

.What's it like to live with non stop orgasms? We hear this and we think “oh I wish!” but really, if that was something you ACTUALLY had to deal with, what would your thoughts be? Would you be able to live your life normally? WouLtd it grow tiresome or what if it turned into pain? Ellie Simmons found herself in this situation and has struggled to find the support she needs and deserves. After taking a specific SNRI medication that had less than a 1% chance of developing this, one day she found herself not being able to stop the intense sensations that are paired when you're just about to have an orgasm. This is called Persistent Genital Arousal Disorder (PGAD) and Ellie is yet to find a doctor who will take her seriously and actually help. PSA: No one is a doctor on this podcast and therefore we aren't giving out medical advice, just a personal experience from an individual..Want to get in contact with Ellie? Send Nell a message and she will make the connection: nellwalker.mentorship@gmail.comWant that spiffy discount for Lorals? OHHH yeah! Use the code: NELL10  at www.my lorals.comWant to check out my website? Yeah you do! nellthepleasurecoach.com

In this podcast, we hear from the renowned clinician and researcher Dr. Giovanni Fava. Dr. Fava is a psychiatrist and professor of clinical psychology at the University of Bologna in Italy. He is also a clinical professor of psychiatry at the University at Buffalo School of Medicine and Biomedical Sciences. Since 1992, he has been the editor-in-chief of the peer-reviewed medical journal Psychotherapy and Psychosomatics. Dr. Fava has authored more than 500 scientific papers and is known for researching the adverse effects of antidepressant drugs. In a 1994 editorial, he argued that many of his fellow psychiatrists were too hesitant to question whether a given psychiatric treatment was more harmful than it was helpful. He recently released his latest book entitled “Discontinuing Antidepressant Medications” published by Oxford University Press. The book is designed to be a guide for clinicians who want to help patients withdraw from antidepressants. In this interview, we discuss the new book, approaches to antidepressant cessation and explore some of the concepts including novel psychotherapeutic approaches to withdrawal.

Living Well with MS is proud to welcome back Dr. Aaron Boster, an Ohio-based neurologist specializing in MS, who has featured on episodes that tackled exploring how to make the right medication choices and the impacts of lifestyle choices on MS. Now we tap his expertise to help us grapple with an important topic that isn't discussed as often as it should be – sex. Sex and sexuality are vital dimensions of a healthy life, but how are they impacted by MS? Our discussion with Dr. Boster digs into the science and practical implications behind this topic, so let's talk about sex and MS!   Dr. Aaron Boster's Bio:   Dr. Aaron Boster is an award-winning, widely published, and board-certified neurologist specializing in multiple sclerosis and related CNS inflammatory disorders. He currently serves as the Director of the Neuroscience Infusion Center at OhioHealth. Witnessing his uncle's diagnosis with MS when he was 12, he and his family came to see a lack of coherence in the way MS was treated at the time. That experienced informed Dr. Boster's drive to do things differently. At OhioHealth, he spearheads a revolutionary model in MS treatment and patient care drawing on interdisciplinary resources and putting patients and families first. Dr. Boster is also an Adjunct Assistant Professor of Neurology at Ohio University Heritage College of Osteopathic Medicine, and a former Assistant Professor of Neurology at The Ohio State University, where he also formerly headed the Neuroimmunology division. OMS has recently been pleased to welcome Dr. Boster as one of the newest additions to its Board of Trustees.   Dr Boster has been intimately involved in the care of people impacted by multiple sclerosis; he has been a principal investigator in numerous clinical trials, trained multiple MS doctors and nurse practitioners, and been published extensively in medical journals. He lectures to both patients and providers worldwide with a mission to educate, energize and empower people impacted by MS.    Dr Boster grew up in Columbus, Ohio and attended undergraduate at Oberlin College. He earned his MD at the University of Cincinnati College of medicine and completed an internship in Internal Medicine and Residency in Neurology at the University of Michigan, followed by a two-year fellowship in Clinical Neuroimmunology at Wayne State University.    He lives in Columbus, Ohio with his wife, Krissy, son Maxwell, and daughter Betty Mae.   Questions:   Aaron Boster, welcome back to Living Well with MS, and thanks for joining us again. Before we dig into this episode's main topic – sex and MS – there's a recent bit of news to mention. You've joined the Overcoming MS board of trustees. There is no doubt OMS is happy to have someone of your medical and clinical expertise on its board. How has the experience been so far and what compelled you to join in this capacity? Let's shift gear into our main topic – sex and MS. This is quite important and perhaps not discussed as often as it should be. First off, how would you define sexuality in the context of MS? Is it common for people with MS to experience sexual dysfunction or other challenges with having a normal sexual life? Do the types of sexual dysfunction differ depending on the types of MS you have? If a man is experiencing sexual dysfunction connected to his MS, what are his options for overcoming or managing it? What if you're a woman experiencing sexual dysfunction connected to your MS. What are your options for managing it? Some people with MS encounter some sort of physical impediments or disabilities. How might that affect your sexual life and what can you do about it? Is there any specific research currently going on that studies MS and its influence on a person's healthy sexual life? If there was one critical takeaway you could share with anyone in our audience experiencing sexual issues related to their MS, what would it be? Before we wrap up, and on a totally different note, I couldn't let someone of your expertise leave the guest chair without asking you a question of personal interest to me as well as many other members of our community – about supplements. There are many out there to choose from, from Co-enzyme Q10 and probiotics to things like Ginkgo Biloba, Echinacea, St. John's Wort, Valerian, Ginseng, and many more. Is there a general framework for deciding whether to try a supplement and are there any whose positive effects are supported by an evidence base?   Links:   Check out Dr. Boster's popular YouTube channel covering all aspects of MS. Boster is now a trustee of Overcoming MS.   Coming up on our next episode:   In just a few days, you can get another dose of our podcast with the premiere of the 24th installment of our Coffee Break series, as we travel (in the eco-friendly virtual sense) to Christchurch, New Zealand to meet another fascinating member of the OMS community, Lieza Vanden Broeke. Lieza has a remarkable personal backstory, and her experience with MS will provide insights and inspiration to our global community. Plus, she's also the ambassador of the OMS Circle in Christchurch. Thanks to Lieza for her candid interview, and to our listeners for being part of the OMS podcast family!   Don't miss out:   Subscribe to this podcast and never miss an episode. You can catch any episode of Living Well with MS here or on your favorite podcast listening app. Don't be shy – if you like the program, leave a review on Apple Podcasts or wherever you tune into the show.   S3E43 Transcript Let's Talk About Sex (and MS)   Geoff Allix (Intro) (2s): Welcome to Living Well with MS, the podcast for Overcoming MS for people with multiple sclerosis interested in making healthy lifestyle choices. I'm your host Geoff Allix. Thank you for joining us for this new episode. I hope it makes you feel more informed and inspired about living a full life with MS. Don't forget to check out our show notes for more information and useful links. You can find these on our website at www.overcomingms.org/podcast. If you enjoy the show, please spread the word about us on your social media channels. That's the kind of viral effect we can all smile about. Finally, don't forget to subscribe to the show on your favorite podcast platform so you never miss an episode.   Geoff Allix (Intro) (44s): Now without further ado, on with the show.   Geoff Allix (48s): Living Well with MS is proud to welcome back Dr. Aaron Boster, an Ohio-based award-winning, widely published, and board-certified neurologist, and the founder of the Boster Center for Multiple Sclerosis, who was featured on past episodes that tackled exploring how to make the right medication choices and the impacts of lifestyle choices on MS. Now we tap his expertise to help us grapple with an important topic that isn't discussed as often as it should be – sex. Sex and sexuality are vital dimensions of a healthy life, but how are they impacted by MS? Our discussion with Dr. Boster digs into the science and practical implications behind this topic. So, Dr. Aaron Boster, welcome back to Living Well with MS.   Geoff Allix (1m 28s): And let's talk about sex and MS.   Dr. Aaron Boster (1m 30s): Thank you so much for having me. I'm delighted to be back. And you're right, this is an underappreciated topic which needs to be discussed much more frequently. So, I'm glad that we're doing this today.   Geoff Allix (1m 41s): Before we dig into the main topic of sex and MS, there's two things I'd like to mention. Firstly, I just want to call out that your YouTube channel, which is very easy to find, if you just search for Aaron Boster on YouTube, you'll find it. In fact, if you search for MS on YouTube, I think it would come pretty high. It is personally, I think the single best resource for a person with MS.   Dr. Aaron Boster (2m 7s): Wow.   Geoff Allix (2m 8s): Hugely it is... I don't know how many videos you probably are much more aware than me, but I'd say hundreds. There are huge numbers.   Dr. Aaron Boster (2m 15s): Yes, 450 some.   Geoff Allix (2m 18s): Right. So, whatever topic there is an episode there, and I've found it incredibly useful, incredibly informative. So, I would –   Dr. Aaron Boster (2m 25s): So, nice of you to say thank you.   Geoff Allix (2m 27s): Well, yeah, I mean, I just think it's, I encourage everyone just going to have a look. It's just, you don't have to look at every topic. Recently, there's one on cannabis and MS. At which in the UK, the police would have different opinions. So, bits aren't going to be, you know, I mean appropriate for everyone. But yeah, there's such a wealth of resources there. So, the second thing, you've joined the Overcoming MS Board of Trustees.   Dr. Aaron Boster (2m 56s): Yes.   Geoff Allix (2m 56s): Yeah, I think everyone at OMS is happy to have you on board, and your medical and clinical expertise. So, what compelled you to join? And how has it been so far?   Dr. Aaron Boster (3m 9s): Thank you. Let me answer those in reverse order. Today, it's been awesome. There's a significant onboarding process, and I've had a great time meeting the other Board of Trustees members, getting to know the Chair, the CEO, and really starting to get to understand the organization. So far, I've participated in one formal board meeting. It's been pretty great so far. I am really excited for what's coming with Overcoming MS over the next couple years. So, the fact that I get to participate is really, really special to me. Now, what compelled me to do it? Really two things if I may. The first thing is, if you look at my style of MS, my brand of delivering MS care, and the tenets that I have developed and talk about and teach.   Dr. Aaron Boster (3m 58s): And you look at the tenets of Overcoming MS, they are remarkably convergent, like remarkably so. When I list out being five for five, when I talk about the importance of family, I mean, we just listed six of the seven. I mean, we're very, very converged. That was one thing that as I started to learn more about Overcoming MS, I said, “Wow, these folks are really thinking along the same lines as me.” The second thing is, getting an MS diagnosis is scary. And it's a moment in time when people aren't sure what to do. And in certain locations there's awesome resources to shepherd someone through an early diagnosis.   Dr. Aaron Boster (4m 41s): But in many locations, that's probably lacking, and access is a major issue. And so, if you're in a spot where you're recently diagnosed or you don't know what to do, reaching for something that is ready made and awesome is a beautiful thing. And I'll be transparent. In my religion, there are a set criteria of things that you're supposed to do when someone dies. Okay. So, if you don't know what to do when you're grieving the loss of a loved one, there's some set things you're supposed to do: You're supposed to grieve for a certain amount of time. The community helps you in a certain fashion. And really, in the absence of knowing how to cope in grief with a loss, that is an awesome structure to have.   Dr. Aaron Boster (5m 24s): And in many ways, I think for someone newly diagnosed with MS, this is a beautiful thing to say, “Sure do this.” So, for both of those reasons, I'm really, really excited to participate. It's been a great experience so far. So more to come.   Geoff Allix (5m 39s): And one thing I would say that you have that Overcoming MS doesn't, but should do, I think as an extra pillar would be drink more water. And that's not an Overcoming MS thing. So, we're on a podcast. You can't see me. I'm just picking up my glass this very moment.   Dr. Aaron Boster (5m 56s): Sure. And I've got water in my mug, yeah, yeah. So, I'm   Geoff Allix (5m 59s): And I think that's, I know we're going off-topic here, but I think that it should be. It's such a simple thing. And because a lot of us have bladder issues and things, and then you sort of say, “Okay, maybe drink less because that's a bladder buster.” I even know it. I know, if I didn't drink enough, then I feel worse. It's one of those instant things. So, some of the things with MS, slow burn as a summary instant. Stress is instant, dehydration is instant.   Dr. Aaron Boster (6m 27s): Absolutely spot on. And, you know, I like to challenge people sometimes because I'll say, you know, drink more water, and they'll say something to the effect of, "You sound like my mom." You know, or like, that's silly advice. I'll say, “Okay, but try it.”   Geoff Allix (6m 39s): Yeah.   Dr. Aaron Boster (6m 39s): Try drinking an adequate amount of water for like three days and see what happens. You know because people are shocked. They're like, “Oh, my gosh, I really do feel better.”   Geoff Allix (6m 45s): Yeah. And you've made it really simple as well. So, I just drink a pint or half liter with each meal, and then drink a pint or half liter between each meal.   Dr. Aaron Boster (6m 56s): Yeah, then you're done. You just did.   Geoff Allix (6m 59s): Yeah.   Dr. Aaron Boster (6m 59s): Spot on. Yeah. Then you're good for the day. And unfortunately, so many people, and you give a great example as to why they may shy away from water intake, and inadvertently make their situation so much worse.   Geoff Allix (7m 10s): Yeah, so I'd like to. Yeah, so on your next board meeting. So, can we add an extra? Drink more water.   Dr. Aaron Boster (7m 19s): Okay. I'll bring it up. As we talk about sex, this, we will come back to this whole bladder thing. It is very, very related.   Geoff Allix (7m 27s): I was going to think, yeah. I was thinking you can't say, drink water during sex, that wouldn't work. But anyway. So, let's get on to our main topic, sex and MS. So, it's a very important one. I mean, it's obviously very important for the survival of the species as much as anything, but it's an important topic. And probably not discussed often enough, often embarrassing. So, how would you define sexuality in the context of MS?   Dr. Aaron Boster (8m 2s): So, you know, sexuality arguably would be defined as humans' ability to experience sexual feelings. It's a really broad blanket term for a lot of things related to sex. So, my first comment is I don't think of sexuality in someone impacted by MS any different than I do in any other human. And I think that's actually a very, very important distinction because there's nothing unique about the sexuality of human being if they happen to have a chronic illness or not. Now, playing out sexual behaviors, intimacy, all these wonderful things, MS can risk interfering.   Dr. Aaron Boster (8m 46s): And that's where we get into a really important discussion. And that's where sometimes we really need to try to help educate and intervene.   Geoff Allix (9m 1s): So, is sexual dysfunction more common for people with MS? Does it increase the chances?   Dr. Aaron Boster (9m 7s): It certainly is. Now, you know, MS is a situation where the immune system can affect any part of the supercomputer that runs your body - the brain, and the superhighway - the spinal cord. And unfortunately, there's plenty of specific areas in the brain and spinal cord where if there's damage, it could interfere with sexual functioning. And so, the spinal cord is a really good example. Very commonly, when someone has a transverse myelitis, inflammation in their spinal cord, then they may find that their limbs are numb or kind of weak. But they also will very likely notice problems with the down theres – bowel, bladder, and sexual function. And this is, unfortunately, all too common in the setting of MS.   Dr. Aaron Boster (9m 48s): I would also say that it's oftentimes overlooked by the MS clinic, something that's kind of glossed over and not discussed. And given that it's somewhat of a taboo topic in casual conversation, I think patients are sometimes a little bit nervous to bring it up.   Geoff Allix (10m 8s): And does the type of MS you have whether it's relapsing or progressive, does that affect the types of sexual dysfunction you might have?   Dr. Aaron Boster (10m 16s): I would say no. I would rather think about the kinds of sexual dysfunction a little bit differently. Not so much related to the phenotype of MS. So, someone with relapsing MS, or Primary Progressive MS, Secondary Progressive MS, what have you, I don't see different kinds of sexual problems. I would run about it as follows: primary sexual dysfunction, secondary sexual dysfunction, and tertiary sexual dysfunction. So, just to share a couple quick definitions that helped me when I'm thinking about this. Primary sexual dysfunction is a problem with the circuitry and hormones of sex. So, when the down theres are stimulated, there's a lot of circuitry that goes on to assist in intercourse.   Dr. Aaron Boster (10m 58s): That message in the down there has to go all the way up to the brain, through the spinal cord, where the brain interprets the activities and says, “Ah, okay.” And then it sends messages from the brain back down to the down theres to do certain things. We're talking about arousal, orgasm… excuse me, arousal, either erection or lubrication depending on the gender, and then eventually orgasm. And so primary sexual dysfunction can result from MS damage in the brain and spinal cord. And what can happen is you can end up with problems in the circuitry. And so, you can have difficulties with any of those things - arousal, erection, maintaining an erection, ejaculating or arousal, lubrication orgasm.   Dr. Aaron Boster (11m 43s): The other piece to this when I think about primary sexual dysfunction is imbalances in hormones. And I have, for several years now started to routinely screen gentlemen, for example, looking at testosterone levels. Not just to help with sexual function, but there's also ramifications through other aspects of MS, believe it or not. So that's kind of primary sexual dysfunction. And we'll talk maybe a little bit later about how we overcome those things. Secondary sexual dysfunction is important and very often overlooked. And it's a situation where there's problems with sex, not because of the circuitry of sex, not because of hormones, but because of MS symptoms that make things not sexy.   Dr. Aaron Boster (12m 24s): For example, if you're having intercourse, and you lose your bladder, it may stop the activity. I mean, you know, that's like scary to a lot of people. They would think, “Oh my goodness, gracious.” And if you're having intercourse and your leg goes into an extensor spasm, it's extremely painful, you're not having sex anymore. Yet even things like motor fatigue can make it so that, you know the activity of intercourse can become challenging, and these are all secondary sexual dysfunction issues. This is where, to be honest, we can really gain a lot of ground. Now, tertiary sexual dysfunction, I would define as not so much the circuitry of sex or symptoms that interfere with sex, but it's more of a psychological phenomenon where the human being doesn't feel sexual.   Dr. Aaron Boster (13m 11s): They don't feel like a sexual being. They feel maybe like an they feel ill. They don't feel that they can be sexy. And so, when I think about sexual dysfunction, I find it most helpful to kind of try to bucket things into those categories. And oftentimes, we're dealing with all three.   Geoff Allix (13m 35s): And so, if we break it down into men and women, what options would a man have if he's experiencing sexual dysfunction connected with MS? Or how could that be managed or helped?   Dr. Aaron Boster (13m 50s): Absolutely. And so, if we first think about arousal, and this is actually true for both men and women. I'll make sure to give distinctions. When we think about arousal, the first thing I want to do is I want to look at their medicines. And I want to look and see if I have them on medicines that can impair arousal. And you'd be shocked at how many can. So, unfortunately, many of the SSRI and SNRI antidepressants, which are used very commonly in humans can impair libido. And so, you may have significant sexual dysfunction because of a high dose of Zoloft, for example. And so, we need to look at that. And there's a host of other medicines that could interfere with arousal.   Dr. Aaron Boster (14m 31s): Also in the setting of arousal, for gentlemen, we'll look at testosterone levels, and look and see if his testosterone, which I would like to be above 400 is down like in the 100s. And maybe that's a component as to why that's a problem. Another very, very, very common because of loss of arousal or interest in both men and women is depression. Now depression is twice as likely to be experienced by a person impacted by MS compared to the general population. And one of the hallmarks of depression is something called anhedonia. Where just stuff that you enjoy just isn't really that much fun anymore. Like if you do really like book club or watching TV, doesn't do it for you.   Dr. Aaron Boster (15m 10s): And so that can happen with sex, which is a major thing. And because depression is so common in MS, we would be foolish not to screen for that, or ask the question, could that be related to arousal? And so other things that we think about in both men and women, recent psychosocial stressors. You'll hear about a guy lose his job, and then he's not interested in intercourse, because he's really dealing with, he's kind of stressed out. So, I really require not just some laboratories, but also a careful history and some open honest communication when dealing with the gentleman's issues as it relates to arousal.   Dr. Aaron Boster (15m 56s): The women, I guess, if it's okay with you, let me answer the same question for women just really quick.   Geoff Allix (16m 2s): Yeah, it's okay.   Dr. Aaron Boster (16m 3s): So, with women, we will look at all the same things I just said. Right? Hormone levels included. And then in depression included in the like. With women, there's actually interestingly two FDA approved therapies to help women with low libido, which is really cool. And interestingly, not known by many, many people. So, there's a medicine which is approved in the United States of the trade name Addyi, A-D-D-Y-I. And I'm spelling it for you because I'm blanking as I talk to you about the generic name. So, I'm sorry. And that is a pill taken once a day, which in about half of our patients results in improving female libido quite substantially.   Dr. Aaron Boster (16m 46s): There's also an injection that's administered by urologist. And I don't, I've never prescribed it. It's called PT141. And this is also a therapy that can be very, very helpful in helping with female libido. So, there's actually more options to help with female libido than male. And so that's the first area. And I want to stress that you can't really skip over it. It is so terribly important. When we then talk about the second phase of things that would be erection for gentlemen. I like to divide my thoughts about erections into half. There is obtaining an erection and then maintaining an erection adequate for a penetration of vagina, anus, mouth, whatever it is that you're trying to accomplish that evening or day.   Dr. Aaron Boster (17m 28s): And so, with erections, we want to find out, are you able to -- do you have erections when you wake up ever? Like it is the physiology, the circuitry of erections, is that intact? Are you able to maintain an erection on your own, like through masturbation, for example? And during intercourse, what's going on? And this conversation is important because, again, we have to think about primary, secondary, tertiary options. Primary sexual dysfunction, most commonly occurs because of spinal cord involvement in MS. And what essentially happens is the down there are stimulated and as the message is going up the spinal cord it dies.   Dr. Aaron Boster (18m 9s): So, the message is never delivered to the brain. So, the brain is not informed of the dealio. So, in this situation, something that can be extremely helpful is a plug in the wall vibrator, right? So, I sometimes on podcasts and whatnot have talked about the vibrator trick, which I'll share now. In the vibrator trick is where you spend 60 bucks American and you purchase a plug in the wall vibrator. And my favorite brand is Hitachi Magic Wand. I don't have a contract. Though I would do a branding deal with them in a heartbeat until –   Geoff Allix (18m 43s): I believe, they're mentioned on the Sex in the City way back.   Dr. Aaron Boster (18m 47s): Yeah, certainly. Certainly. So, this is marketed as a back massager. And it's a plug in vibrator. And the reason it's so important is we need kind of like overdrive stimulation, right? A double D battery vibrator is not going to cut it for this purpose. And then what you do is you apply a water-based lubricant to the genitalia because that increases skin sensitivity. And then you apply the plug in the wall vibrator, you know, the hardcore power from the wall, and you apply it on the glands, penis, you apply to the head of the penis, you applied it under the testicles, you apply it somewhere where it feels good. And this is providing overdraft stimulation. Just to make the point clear, I'll use an example of us talking right now.   Dr. Aaron Boster (19m 29s): So, I'm talking using my indoor voice because there's no interference between essentially my mouth and your ear, even though we're across the continent, and there's microphones, and speakers and stuff involved. Now, let's say that we were having this exact same conversation during business hours. I'm in my lobby of my office. Today is Sunday. But if this was a busy business day, it would be super loud in here. And you wouldn't be able to hear me when I used my indoor voice. So, I would have to use overdrive stimulation. I would have to scream, and really project really loudly so that you could hear me. And that's what we're doing with a plug in the wall vibrator as it relates to intercourse. We're providing overdrive stimulation so down there can get the message to the brain and let the brain know what's up.   Dr. Aaron Boster (20m 13s): Now the advantage of a plug in the vibrator is there's no side effects. It's relatively inexpensive. And you can do it by yourself during masturbation. You can do it before intercourse as a form of foreplay. You can literally hold the device between you and your partner with continuous stimulation during intercourse. And it works well for both men and women. So, everything that I just said with regards to obtaining erection can be applied to maintaining an erection by using the vibrator. And we have taught some gentlemen, if they have difficulties they'll withdraw, and then they can apply the vibrator to the shaft of the penis, it will become adequately erect again, and they can continue having fun.   Dr. Aaron Boster (20m 55s): And so, this is a very helpful tool. Now, probably the most widely utilized tool is a little blue pill, right? So, Viagra, Cialis, and the like are very, very helpful medicines, in helping gentlemen obtain and maintain erection, pharmacologically, they're superb. And so, if there isn't a cardiovascular risk, why you can't handle the Viagra or Cialis, what have you, that's a very useful tool. Taken about an hour before intercourse works best on an empty stomach. You do have to worry about light-headedness, and there's some blood pressure concerns. And that can make a really big difference in a guy's life. You know, it's of note that if you want to make an adult miserable, mess up their ability to eat good food or have sex, and then we'll be miserable.   Dr. Aaron Boster (21m 41s): And MS risks interfering with sex for sure. And so, a little blue after dinner mint can really change a guy's outlook on life. Now, again, on the topic of obtaining and maintaining erection, testosterone level is very, very relevant. Now, there's a bunch of other things you can do. For example, intracavernous penile injections. So, before the era of pills, we had the shots on the side of the penis, and everyone listened going, “Ooh!” But in exchange for that route of administration, you have a fantastic erection. And sometimes when pills don't work, we still go back to those tried-and-true methods.   Dr. Aaron Boster (22m 24s): Other things that you can do if you're a gentleman, using a device, you can trap the erection. So, you can use a vacuum device, which can be very, very effective. And if you're really serious about an erection, and those things aren't working, urologists can actually do penile implants. I have some patients who have been very, very happy with penile implants because nothing else was really working for them. So, you know, you might say, how dedicated are you to your erection? Because if you're dedicated enough, we can guarantee that you'll be able to be erect.   Dr. Aaron Boster (23m 6s): Getting into the same questions with women, we're really dealing with lubrication, alright? And engagement of the tissue to allow adequate arousal. And so, that's kind of the equivalent for women as erections are to men. And there's several ways of addressing difficulties that a woman may have with lubrication. So, one thing you can do is apply a water-based lubricant. Very straightforward, very, very effective. Another option is to apply an estrogen cream to the vulva. If you're not taking systemic hormones, and there are reasons why some women may not be appropriate for taking systemic hormones, because of cancer risks. Applying a hormone cream topically is really great because it's just absorbed locally.   Dr. Aaron Boster (23m 51s): So, there's no systemic risks. But applying an estrogen cream can really help with engagement and with lubrication. We very commonly prescribe a compounded cream which is called scream cream. And it is what it sounds like. It's a compounded mix, which includes Viagra and theophylline and several other agents which help in increase blood flow and encouragement and help with lubrication. And so, someone may have a can of scream cream that they use in preparation for intercourse. And so those things can be very, very helpful. Obviously, adequate clitoral stimulation, or vaginal stimulation through the same plug in the wall vibrator is a really smart tool.   Dr. Aaron Boster (24m 32s): And that can help with lubrication. Now, the tips for orgasm, for achieving orgasm are all along the same lines. Really we have to bring, for both men and women - primary, secondary, and tertiary measures to the table to achieve orgasm. And sometimes we have to take extra measures depending on the specifics of the individual. But the point that I hope I'm conveying is, is that: number one, there are a lot of options to make this better if you're a boy or girl. And number two, it's worth it. Right? It's worth it to have an excellent sexual experience. Sorry, that was a little bit of a long-winded answer.   Dr. Aaron Boster (25m 14s): I got a little carried away there but talk about that.   Geoff Allix (25m 15s): No, no its good. And so, what you've talked to us about was very medical. But you mentioned especially the tertiary side of it.   Dr. Aaron Boster (25m 25s): Yes.   Geoff Allix (25m 25s): I love the thinking as well.   Dr. Aaron Boster (25m 26s): Yes.   Geoff Allix (25m 26s): So, is it worth getting counseling, maybe couples counseling? Because still, it's difficult to -- and this happens, whether you have MS or not. It's to convince the other person it's useful.   Dr. Aaron Boster (25m 34s): Super, super important. In fact, if you said, “Aaron, what's the number one tip?” The number one tip is none of the stuff I just mentioned. The number one tip is talking to your partner. So, let's discuss that. Very commonly, independent from having a chronic condition like MS. Very commonly, we have hang-ups about sex, and we have areas of concern or embarrassment, or topics that we're shy about. For example, many people are reluctant to flatulate in front of their spouse. Right? So, that's the thing. Like, you know, we don't want to do that. And so, talking about sex is not something that most of us are just completely at ease doing.   Dr. Aaron Boster (26m 20s): Even with our spouse, even with a monogamous partner of 30 years. And when you have a chronic condition, like multiple sclerosis, which can, as we've talked about interfere with the circuitry and the success of intercourse, it adds complexity. It doesn't make it easier, it makes it harder. What I have found in talking to families for over a decade and a half now. And I'm very, very open about this topic in that oftentimes, the two members of the couple would love to talk to the other person. They are dying to talk the other person about this, and they are nervous.   Dr. Aaron Boster (27m 4s): And when they broach a conversation, it's almost cathartic because together, they can game out an earth shattering, toe-curling, blood-curdling orgasm that would set land speed records and make the neighbors call to make sure everyone's still safe. And it's accomplished because of communication with the partner. Say, and let me be a little bit granular. One partner may really enjoy a particular position in sex because it's really fun for them, which might cause the other partner with MS to go into spasms. Or it may make the other partner develop truncal ataxia, or maybe it overheats that partner. And the person with MS might not be sharing that.   Dr. Aaron Boster (27m 46s): They may not be telling the spouse or the partner, “Hey, listen, when you lay on top of me like that, you're a heavy dude, my body gets heated up and I can't feel anything. Get off me!” You know, simply talking about changing something as simple as a sexual position might be the answer to really meaningful intercourse. So, you are very spot on in bringing this up. And if you are uncomfortable talking about the topic, let's game out several things that you can do to broach the situation. Okay. So you could, for example, do couples counseling. Couples counselors are very wonderful because they can help be sounding boards.   Dr. Aaron Boster (28m 27s): “Did you hear what he just said? Let me repeat it for you.” I mean, you know, they're fantastic kind of notes. I really like couples counseling myself. There are sex counsellors, alright? I mean, maybe another thing to do is just to have the person listen to our podcast that we're doing right now and say, “Hey, the little balding, hyper neurologist in Columbus, Ohio was saying we should talk about sex. I mean, what do you think?” And maybe that broaches a conversation. But if you can sit down and talk about sex, and really what I would want you to bring to the table is the following: What are your goals? Seriously. Is your goal to help your partner achieve orgasm? If that's a goal, state it. State that's a goal.   Dr. Aaron Boster (29m 6s): Is your goal to simply be intimate and touch one another? I mean, these are things that you should talk about. Are you going to orgasm? State the goals. If there are certain things that you really like, and really don't like sexually, particularly the don't like part. “You know, I know that you're really like doing blankety blank to me, and that's very sweet. Except I can't feel it. I can't feel it.” So, you doing that is awesome. I just want to let you know that like I don't even notice that you're doing. So, FYI. I mean that kind of communication is really valuable. Because then the partner will say “Well, geez, Louise, let me not do that. Let me do something different.” And I think what you'd find is if you have this conversation, it will improve your sex life.   Dr. Aaron Boster (29m 55s): The conversation will lead to a better experience. It really will.   Geoff Allix (30m 1s): And so, we've talked a lot about that there could be nerve damage between brain and sexual organs and that's affecting your ability to have an erection, lubrication, orgasms. But what if a person with MS has physical impediments or a disability? You know, apart from their sexual organs don't work properly.   Dr. Aaron Boster (30m 22s): Yes.   Geoff Allix (30m 22s): How could that affect their sexual life? What could they do about that side of things?   Dr. Aaron Boster (30m 30s): So that involves playing smarter, not harder. Let me give you an example. If we think about a traditional Western missionary position of sex, the guy on top in this like, misogynist example, I apologize. It's kind of doing push-ups, right? Which is a tremendous amount of physical activity, keeping the core body strong and the arms, it's a lot. So that might not be feasible for someone. Right? Now, instead, install in your bedroom an eye hook in the ceiling beam, and install a sex sling. The whole world changes now. You place a partner on a sex sling, you can move them around, spin them, pivot them, push them, thrust, move, up, down, left, right, and it takes almost no effort, right.   Dr. Aaron Boster (31m 20s): And so, by changing from good old-fashioned force of will to using something like leveraging a sex sling, or using a wedge, they make these awesome wedges, which is kind of like bringing a gymnastics room into your bedroom. Where you can position a partner on a wedge. If you have problems in certain positions, again, this goes back to the talking about planning, don't do those things. And if other positions are more successful, do those things. Let's use another example of bowel and bladder issues. Very common. Someone has such fear of incontinence of urine or stool, they will not have sex, which is a travesty.   Dr. Aaron Boster (32m 3s): So, what can you do instead? You can, if necessary, do an inner in self cath, and empty your bladder completely, 100% guaranteed prior to intercourse. If you are prone to urinary tract infections, have your neurologist give you antibiotics that you take before or after sex, alright? If you are having trouble with constipation, you can spend a day or two pre-sex emptying out and getting completely evacuated. Even if that involves an or you know, digital rectal stimuli, or whatever is necessary, you can prepare for that. Do you see what I mean? There's a bunch of things that we can do. You have dyspareunia, which is a terrible word.   Dr. Aaron Boster (32m 47s): It means pain with sexual sensation. So, the act of sex hurts. We have to look into, why you have dyspareunia? If it's because of spasms of the vaginal canal, we might use a rectal suppository of valium before intercourse. If it's because of neuropathic pain and burning sensation, we might use a numbing cream. Right? My point here, is if we can identify -- because in my mind what you're saying those are all secondary sexual dysfunctions. If we identify what the problem is, we can game out how to make it better. Then if you remember nothing from my answer, I simply want you to remember sex swing.   Dr. Aaron Boster (33m 28s): Sex swing. Okay.   Geoff Allix (33m 29s): And in the last few years, the amount of research in MS medication has just leapt forward. I mean, it's gone from -- so my father had MS. There are no real treatments. When I first was diagnosed. Not really, like what? Five years ago? There were treatments then but there must be 4, 5, 6, 10 times that many now. That seems to be it's really escalating. So, are there any treatments going on or studies going on for people with MS, and their ability to have a healthy sexual life?   Dr. Aaron Boster (34m 5s): So, in preparation for our discussion, I actually looked this up because I wanted to be able to answer this question if asked. So, yay. And I went, the way I look up information like that is at the clinicaltrials.gov, which is a site for any clinical trial that's registered by the United States government. And there were 125 hits for when I searched for multiple sclerosis sexuality. And I looked through the first 10 or 20. All over the world, France, Turkey, Louisiana, Cleveland. So, there were trials throughout. Now, almost all of these are investigator-initiated trials. You know, so a clinic running a small study.   Dr. Aaron Boster (34m 46s): But my point here is yes, there's a lot going on. Looking at testosterone levels, looking at various pharmacotherapies, looking at behavioral therapies, a lot of stuff. And so, I hope if you're listening to this, it's reassuring to know that clinic doctors and researchers alike recognize this is such a critically important aspect to life that we're investing resources to try to help you make it better.   Geoff Allix (35m 9s): And you mentioned about testosterone. So, getting testosterone checked is that part of blood test?   Dr. Aaron Boster (35m 13s): Yes. So, the way that I do it in clinic is I draw a morning level of testosterone. And the reason it needs to be morning, a gentleman's testosterone is highest in the morning, and it goes down throughout the day. So, if you tested in the evening and have a low value, you don't really know if it's just because of the diurnal, you know, the fact that it drops down. So, you want to get the best most accurate reading. You do that in the morning. You know testosterone level in the morning. I get it on two separate occasions. And if it's low, the total testosterone is low, that's a blood test, then that opens up the opportunity to treat with testosterone. Which in MS helps gentlemen not just with intercourse, not just with erectile function and ejaculation in the bedroom, but it also helps improve cognition, and slow disability progression, and improve fatigue with gentlemen with MS.   Geoff Allix (36m 9s): And is there an equivalent for women with estrogen?   Dr. Aaron Boster (36m 12s): It's not the same rules, interestingly. It's not the same set of variables. And now looking at hormone levels in women is important. And particularly surrounding times of menopause, when we can see an uptick of MS symptoms, and specifically related to intercourse, as I was mentioning with lubrication. So that is relevant, but for a different set of reasons.   Geoff Allix (36m 38s): So, men definitely worth getting checked out on testosterone, but women…?   Dr. Aaron Boster (36m 43s): Not as much. No, I don't routinely check women's testosterone levels in my clinic.   Geoff Allix (36m 49s): Okay, and if, so, if there's one takeaway you could share with the audience, if people are having sexual issues related to MS, what would that be?   Dr. Aaron Boster (36m 57s): That the one takeaway would be to have open communication with your partners and with your clinicians, because there are ways to make it better. We don't have to just accept this is now the new state of affairs. On the contrary, there are plenty of things that we can do. And you're worth it. It's worth exploring and improving because it is such an important aspect of life, that it's not okay, you just to say, "Well, too bad."   Geoff Allix (37m 27s): And there's no reason, I mean, the two of us, I think, are probably beyond wanting to have more children at our age.   Dr. Aaron Boster (37m 35s): Correct.   Geoff Allix (37m 36s): There's no reason that a person can't be fertile as well as…   Dr. Aaron Boster (37m 43s): Oh, absolutely. So, there's a whole separate conversation. But I actually love to come back and talk to you about this. But there's a whole separate conversation about fertility, and pregnancy, and gestation and delivery related to MS. The quick skinny is MS has no bearing on fertility whatsoever. None. And as it relates to our conversation, if you're having intercourse, we need to be thinking about the appropriate use of contraception to avoid unplanned events such as unplanned pregnancies and things like that.   Geoff Allix (38m 17s): And before we wrap up, there's something I wanted to ask you on a completely different tack.   Dr. Aaron Boster (38m 26s): Absolutely.   Geoff Allix (38m 27s): So, just as someone who's got a lot of expertise in this area, and something that is of personal interest. Because of the podcast, I get asked lots about different supplements. So, people say, “Have you tried Coenzyme Q10? Have you tried lion's mane mushroom, St. John's Wort, ginseng, ginkgo biloba?” There's countless things. And some of them, I'm fairly sure, yeah, if your magnesium is low that's, you know, if anything's not off the normal levels, then yeah, absolutely.   Geoff Allix (39m 7s): But there's always someone championing a supplement or other. So firstly, is there a framework that you would use to decide whether to try a supplement?   Dr. Aaron Boster (39m 18s): That's an awesome question. Thank you for asking me that question. And it's a multi layered answer. So, I have two criteria, if you will. So, the first criteria, there are three things that must be met, if I'm going to greenlight a supplement. The first one is it can't be too expensive. So, each individual family has to decide if the cost of something is too expensive or not for them. And I bring that up because sometimes you may find supplements where it's actually a big chunk of their weekly check, and that's not okay with me. Particularly, if I don't have hardcore science suggesting that I can guarantee it works. So, it can't be too expensive. The second thing is it can't be dangerous.   Dr. Aaron Boster (39m 59s): And sometimes supplements are dangerous. Now, oftentimes, they're not. But let me give you an example. If an immune booster actually boosted your immune system, it would be dangerous to take when you have MS. And, you know, just because it's natural doesn't mean it's safe. I mean, cyanide is natural. So, the second criterion is it can't be dangerous. And sometimes I have to do some investigations, digging through various ingredients to try to answer that question. The third is that it can't be instead of something I know works. So, if you tell me that you want to take CoQ10. CoQ10 is not dangerous. CoQ10 is not generally expensive.   Dr. Aaron Boster (40m 41s): And if you're going to take CoQ10, along with your disease modifying therapy, I have no issues with that. But if you have to take your CoQ10 instead of your disease modifying therapy, where I have good solid scientific evidence that it helps you, now I have an issue. So that's my first criterion. The second criterion is more rigorous in that scientific evidence, you know, properly studied science to prove or disprove that something's helpful. And that second one, you know, we don't have a lot of info. There is some info for some supplements, and I'm going to go over a couple with you right now. But that would be the second one. And you know, it's worthwhile sharing, at least here in United States where I practice.   Dr. Aaron Boster (41m 24s): The supplements and vitamins are not monitored by the American FDA. So, if there's a bottle of a prescription medicine, and it says it does something, they can prove that. It's been proven, it does something or they can't say it. You know, if there's a side effect on the bottle, or a dosage on the bottle, it has to be proven. Like that's not a suggestion, it's a proof. If you bottle a supplement that you get at a health food store, let's say. What they say on it isn't proven. It doesn't have to be proven. So, they could say, for example, it will make you grow 10 feet tall. And they're allowed to say that even if it's not true.   Dr. Aaron Boster (42m 6s): And as a result, it calls into question, and it creates challenges and knowing whether something's okay, but which is kind of I think your point. So, when you look at the evidence, to me, this is a conversation about nutrition, right? And I start with, as we talked about, maybe a little bit earlier, I start with increasing water intake, believe it or not. I think if you're going to change one thing, increasing water is actually more relevant than any other vitamin or mineral or something that we're going to talk about. But that's my first one, honestly. After that, I really would rather spend time talking about healthy eating than I would about supplements. And I would like to engage in a conversation about eating real food, whole food, and avoiding heavy processed foods and the like.   Dr. Aaron Boster (42m 54s): But let's move into some recommendations about vitamins. The first vitamin that I think is actually the most studied with the most evidence for benefit of MS is vitamin D3. And so low levels of vitamin D correlate with increased risk of developing MS. And if you have MS, low levels of vitamin D are correlated with worse outcomes. And so, I routinely check a blood level for vitamin D, and if it's below 50, I supplement. And I use D3, because I feel like it's better absorbed in the human body. And I want to push that level above 40 below 100, or excuse me, above 50 and below 100.   Geoff Allix (43m 32s): So, can I just interject that. Because we measured it in a different way in the UK, and I think Europe. So, it's actually four times the number you're talking about. So, when you say 50, we say 200.   Dr. Aaron Boster (43m 40s): Oh, okay.   Geoff Allix (43m 40s): I don't know why that is just, it's not even an imperial metric thing. It's just because it is exactly –   Dr. Aaron Boster (43m 46s): Thank you for bringing that up. That's a really, really important point. And you know, another important point is you and I, even though we don't live in the same continent, both live in areas where there's not a lot of sun for a good portion of the year. And so, taking a vitamin D supplement is important because we can't get it, you know, the good old-fashioned way. Now, I have through my involvement with Overcoming MS become turned on to the idea that it doesn't take a lot of sun to soak up vitamin D. So, if you go out and let's say shirtless, or, you know, wearing a halter top, or what have you with some exposed skin, for 15 minutes, you'll absorb 5,000 international units of D3.   Dr. Aaron Boster (44m 30s): And now in the winter, Ohio with a foot of snow on the ground very few Ohioans are going to do that. But it is good to know that. Yeah. You know, and during the summer months you certainly do consider that. So, vitamin D3, I think, is very relevant. Past vitamin D3, my next recommendation. And I have to tell you, it's becoming increasingly something that I recommend. I'm on the cusp of recommending it for all people with MS. That's probiotics. So, taking a probiotic is really interesting. And there's an entire fascinating discussion surrounding dysbiosis and the impact of abnormal gut bacteria on the immune system.   Dr. Aaron Boster (45m 16s): Although that's not why I'm recommending it. That's a discussion which is ongoing and still a work in progress. But the reason I'm recommending it is for gut health. People impacted by MS very commonly have significant constipation. And sometimes people with MS have significant diarrhea or incontinence. And so, probiotics pull someone who has constipation more towards the center. And probiotics pull similar diarrhea more towards the center. And so, I really think probiotics are a very, very helpful tool. The next supplement that I would recommend beyond that is added fiber. Because particularly where I practice in the United States, the very low fiber diets, which is a major problem for multiple things, and actually has an impact on MS, in my opinion. And so supplementing fiber, I think is important.   Dr. Aaron Boster (45m 57s): Now, I would like you to do that with pears, plums, apples, and green vegetables but if you can't or aren't able, or don't want to do it that way, you can purchase a supplement like a FiberCon or Metamucil, or what have you, and then you can do it that way. Now, after that, it really depends on the situation. I think it's very reasonable for humans to take a multivitamin because, you know, we're not eating enough salads and vegetables with different colors. But the American diet is normally not devoid of things. It's not typically a problem with excess.   Dr. Aaron Boster (46m 39s): And so, if you just add a multivitamin that kind of covers your bases. Now, I don't recommend mega doses of say, vitamin B12 routinely, or vitamin C routinely, unless there's deficiencies that I'm discovering. So, I'm not a physician that recommends as a priority that you take a B12 complex. Many people do, because it helps with energy in some cases. But I really find that if I'm not, if I can get you to eat a healthy diet, I'm going to take care of that through eggs and other things. Now, there's specifics that are recurrent low dose naltrexone.   Dr. Aaron Boster (47m 21s): You mentioned L-carnitine, things like that. And there's varying levels of evidence for them. Some of maybe the best evidence would be some of, I think L-carnitine has some good evidence for energy. I believe that. I think that helps a lot. I think that's one that I look at. Then when you get into some of the other things, you can find small trials. Turmeric, for example. Low dose naltrexone, for example. And really, I deal those in a one-off fashion where someone's coming to me saying, “Aaron, what about this?” And then together, we kind of look through it. We look at the data if it's in existence, or if it's not, we discuss that. We go through my three criteria and then someone may try it. And here's the important part. If they try it, I want them to tell me what they found.   Dr. Aaron Boster (48m 7s): You know, did it seem to help? Do they notice a difference? When they stopped it, did it get changed in any fashion? And that's anecdotally one of the ways that we have to kind of assess things.   Geoff Allix (48m 20s): Because on the turmeric there are basically no risks, cost is very low, and there's anecdotal evidence, because it's been taken --   Dr. Aaron Boster (48m 36s): Yeah.   Geoff Allix (48m 36s): And it's been used on the Indian subcontinent for centuries or millennia.   Dr. Aaron Boster (48m 39s): And it's delicious.   Geoff Allix (48m 43s): Yeah, that's right.   Dr. Aaron Boster (48m 43s): You know, if someone wants to take turmeric, how about it? That doesn't violate any of the discussions we've had, and it may help.   Geoff Allix (48m 56s): Yeah. And if it doesn't help, you still like the food and carry on.   Dr. Aaron Boster (49m 4s): You know, its still and its still delicious.   Geoff Allix (49m 4s): Yeah. I'll just add, just on a personal level. Because I'm fairly similar to what you're saying. So, I take vitamin D3 every day. I take a probiotic every day. And the other thing I take is - so probiotic gut health. But also, to reduce UTI, so there's something I came across that in Germany, they're routinely prescribed called D-mannose?   Dr. Aaron Boster (49m 25s): Yes.   Geoff Allix (49m 26s): And I found that I, and this may be -- because I think some of these things work in some people and some don't. And it's not expensive. It doesn't have a lot of risks. And so, I thought I'll give it a try. And literally within a week, I didn't have a UTI problem at all. Literally, I don't have UTI problems at all from having D-mannose.   Dr. Aaron Boster (49m 50s): That's fantastic. I think that's a really, really great tip to share with people. And it's what I'm going to think about when I start my clinic tomorrow - about whether or not I'm not recommending D-mannose enough to folks with recurrent urinary tract infections. That's a pro tip. Thank you for sharing that one today.   Geoff Allix (50m 12s): Well, yeah, I mean, but it may just be that worked for me. So, yeah. But then that's the same.   Dr. Aaron Boster (50m 16s): Well, again, it's nice to have a toolbox where we can consider different things. And that's a very good supplement to keep in mind.   Geoff Allix (50m 30s): So, with that, I'd like to thank you very, very much for joining us, and welcome you to the Overcoming MS Board and it's fantastic news. Giving some of your expertise towards the head of the organization. And I thank you for joining us, Aaron Boster.   Dr. Aaron Boster (50m 48s): It's my absolute pleasure. Again, I love talking with you. And I hope that we get to do it again soon.   Geoff Allix (50m 35s): Thank you.   Geoff Allix (Outro) (50m 36s): Thank you for listening to this episode of Living Well with MS. Please check out this episode's show notes at www.overcomingms.org/podcast. You'll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at podcast@overcomingms.org. We'd love to hear from you. You can also subscribe to the show on your favorite podcast platform, so you never miss an episode. Living Well with MS is kindly supported by a grant from the Happy Charitable Trust. If you'd like to support the Overcoming MS Charity and help to keep our podcast advertising free, you can donate online at www.overcomingms.org/donate.   Geoff Allix (Outro) (51m 22s): Thank you for your support. Living Well with MS is produced by Overcoming MS, the world's leading multiple sclerosis healthy lifestyle charity. We are here to help inform, support, and empower everyone affected by MS. To find out more and subscribe to our e-newsletter, please visit our website at www.overcomingms.org. Thanks again for tuning in, and see you next time.    

In this TRIPLE-sized episode, we conclude our recap and review of Mobile Suit Crossbone Gundam!  The series climaxes in an epic fashion as Tobia plunders Bernadette, we say farewell to the Mother Vanguard and hello to the Flints, Zabine's rage-o-meter hits critical mass during his duel with Kincade, Dogatie reveals himself to be a jerk with too many nukes, Bernadette was wrong all along, SNRI looks more like Anaheim every day, Admiral Trustworthington somehow screws up worse than Admiral Earl Grey at 0083's naval review, and Sherry saves the day.  There is also a lumberjack, an ape, plenty of aquariums, more Star Wars references, and MULTIPLE terrifying mobile armors known as the Divinidads.  These volumes slapped Isaac so hard he gave the series his highest score yet!     The only thing these two volumes don't have is the answer to the question - whatever happened to Dorel Ronah?  Seriously, Tomino, we want to know. 

We don't always want to hear that recovery from depression can take a long time. Some days, the pain feels unbearable and we want ways to get more immediate relief. If you feel that way, then this episode is for you! This week Alyssa sits down with Zack S. Rutledge, the author of The Official Depression Relief Playbook: Real-Life Strategies From a Guy Who Has Lived It. Tune in to hear Zack share about his own battle with depression as well as his inspiration to write a book. He provides some highly useful skills from his book that we can all use to get more immediate relief to what can feel like a long-term mental health battle. Find Zack's Book Here Zack's email: zacksrutledge@gmail.com   Support the Podcast   Transcript:   Alyssa Scolari [00:18]: Hello friends. Welcome back to another episode of the Light After Trauma podcast. I'm your host, Alyssa Scolari. Just taking a deep breath. I encourage you to take a deep breath with me. It is Friday, or at least it is Friday as I am recording this. When this comes out, it will be a Tuesday, but summer feels like it is upon us and life feels, it feels good. Even in the places that don't feel so good, it feels manageable. It has been a long time in locked down, and it's really adjusting to a new normal. I know people are starting to freak out a little bit about what that means and what that will look like. Right now I'm just riding the wave, which is very nice. I hope that you are doing your best to ride the wave as well, because there's definitely going to be an adjustment period. Just trying to get back to a new normal. I'm not sure if we can ever go back to normal. I think it's just going to be a new normal. So if you are enjoying the new found freedom that we have. I'm so happy for you. I'm enjoying it too. Today, we have with us a special guest Zack S. Rutledge. Zack is an ACE Certified Personal Trainer, an ACE Certified Fitness Nutrition Specialist, and a Certified Brain Health Trainer through The Functional Aging Institute. He has a black belt in karate and has practiced yoga for almost a decade, finishing up his Yoga Alliance Teacher Certification in August of 2021. Just in a couple months. That's awesome. He holds an MA from American University in Washington, DC, and starts his Licensed Professional Counselor program in January 2022. I'm really excited. One of the things that Zach did not mention is that he has a book out. I was so honored to be able to read the book and to go through it, because it's awesome. It's an incredible book and we are going to dive into it today. He really talks about ways to tackle depression. So let's just get right into it. All right. So hello, Zach. Welcome. How are you? Zack Rutledge [02:58]: I'm doing well. Thank you so, so much for having me. Alyssa Scolari [03:01]: I'm so excited that... I'm so happy for you to be here. I was just saying as I was recording, your introduction that it's this book is really, really important. I know we're going to talk about depression, and you did not mention the book in your bio. So I threw that in there. I'm like, oh, and there's also this... On top of all that he's doing, there's also this incredible book, it is the the Depression Relief Playbook. Zack Rutledge [03:34]: That's it. Alyssa Scolari [03:36]: So, oh, where do we even start? All right. So I think my first question that I have for you is like, how did you even develop a passion for this? How did you get to where you are now? I know you talk about it a little bit in the book, but if you could expand on it on here. Zack Rutledge [03:52]: Okay. So I will give the very abbreviated version of the first part of my story, so I can get to this second part. So what happened was, as a kid I went through some, I guess they could be called chemical depression issues, and we'll get more into that later. I'm sure. Because I had a very stable, loving childhood. It was great. But only in hindsight I noticed that there were some issues going on. So when I was 18, my best friend was killed, and then I went through a very deep depression. I promise I'll keep this part brief. Then what happened was, so how I got into, I guess helping people was I ended up becoming a personal trainer around the time I graduated from college. I graduated from college late because not extremely late, I was 26. But I graduated late because of some of my depression issues, and I was in a pretty serious place. So I got this personal trainer thing. It really, it was almost an ego thing. I was just looking for another thing to kind of fill that void, right? It was part of my journey as I say, building myself back up brick by brick. Then when I started actually working with clients, that was when the fire was lit, so to speak, and I just loved it. So I ended up, I mean, I had a regular full-time job, but I was doing that on the side. Then I said, "Hey, you know what, I really would like to expand on this." I became a fitness nutrition specialist. Again, the brief version is when I was working with clients with their nutrition issues, we weren't talking about nutrition. They were not bringing that up. They knew what to eat and they knew what not to eat, I mean, I would say 80% of the time. It was a lot of deep stuff and I wanted to work with them. I did what I could. That was what one of the things that ultimately led me to going, I can't believe I'm doing this to myself, going back for the second master's degree to become a therapist. So yeah, that's the very abbreviated version. Yeah. Alyssa Scolari [06:12]: Yeah. So it's like you want it to be a personal trainer to be able to help people, right? But then as you're talking to people, you're realizing that the nutritional problems are so much deeper than that surface level like, I don't know what to eat type thing, because that's really not the problem. You ended up talking to people about the stressors in their life, and the other things that are going on. That was sort of when it clicked for you that's like oh, I actually really want to be able to help people in this way. Zack Rutledge [06:41]: Yeah. Yeah. It's not just the nutrition stuff, of course, it pops in when I'm training people. Stuff pops up and it just turned into my primary passion, as opposed to my "side gig." I want it to make a healing, I guess, in a way my main thing. Alyssa Scolari [06:59]: Yeah. I love it. I love that, and then where did the inspiration to write this book come into play? Zack Rutledge [07:09]: So it happened, I put the book together because of COVID. So when I was in grad school, the first time I went for film, and I was doing the training on the side, but I was concentrating on film. At that point, I was a few years out of my deep depression, and I had people reaching out to me saying that they were extremely depressed. Because they knew my past and they wanted to know tips and tricks, and things that I did. So I would end up sending them emails, because I would tell them and they would forget. So I'd send these emails to them, or Facebook messages, or whatever. Then when COVID hit, the same thing kind of happened, I had a lot of people reaching out to me saying, "Hey, I'm having a really tough time." Because one thing I noticed was a lot of, let's just say quirks, things like OCD, or depression, or what have you, was kind of spike during the COVID for a lot of people. It was a really stressful time, obviously. So people were reaching out to me again. So I just, I kind of said to myself, you know what, it's just going to be easier for me to write a book and put this all together at one thing. Because I was constantly going back to all these old emails or thinking of new things. I said, you know what, yeah, let's put this book together. Then I can get this out to just hand it out to anyone who asks. That was kind of honestly how it started, it was a very organic thing. Yeah. Alyssa Scolari [08:32]: I love that. Okay. Here's what I love the most about your book is when people come into my office, or go into anybody's office, or anybody who's struggling with depression, right? A lot of times what we tell people, it's not a quick fix, and I think that that's true. It's not a quick fix. But I, somebody like myself and like other people want a quick fix, right? And I think that's- Zack Rutledge [09:02]: Yeah, of course. Alyssa Scolari [09:03]: Right. We all want a quick fix. I think that's why a lot of people turn to a numbing out through drugs, alcohol, food, whatever. We want that instant gratification. The thing I love about the book, and that is even so evident in the title is that it gives you the quick fix. It's like a quick fix feel to it where it's like, yes, depression is kind of a long-term thing, but there are things that you can actively do. Concrete changes you can make in your life to help ease that depression. For somebody like me and so many others, when we have those bouts of depression, or we're in a really bad way, we just need relief. The last thing we want to hear, especially when we're at a point where we're feeling suicidal, and we're considering taking our own lives. It's like, I need something and I need it now. I love that this book really, it covers all of that. Zack Rutledge [10:01]: Yeah. Thank you. First off, we should say it is short, because the last thing I wanted to do when I was in my deepest depression was to read 350 pages of something. Alyssa Scolari [10:11]: Who can do that, right, when you're depressed? Zack Rutledge [10:14]: So I got a couple of ideas. It's not going to happen. I couldn't get through one television program. I couldn't get through 30 minutes of a TV show when I was in my deepest, deepest bouts. So yeah. So what I did was I basically, like I said, when I built myself back up brick by brick, this took years and years and years. So what I wanted to do was get this book together. That was all of these little bricks in kind of in, like you said, it's these actionable things you can do. Because what I want to do is speed this up for people. I want to save them a few years of their lives trying to sort out what works for them. It's like, these are the things that I really found, and it's things that you can do. I think the hardest part for some people is actually getting up to do some of the things, which is why I have those first couple chapters on mindset. Well, I mean, I guess just my intro is just relating to people. Letting them know I understand what this is like. I totally get where you're coming from, but if you can just turn that little bit of a switch, just do one little thing, and then do one little next thing. You're going to slowly pull yourself out. Even if we don't get you to a perfect 10 human in that day, if we can get you from a two to a six or seven, that's a win, right? So yeah, I wanted to make it, thank you for pointing that out. I wanted to make it as actionable as possible. Yeah. Yes. I think you're exactly right. That is also, what's so important is even the length, right? It's concise. It's very clear. It's very relatable. I mean, it's truly a gift to people who are in the trenches, as some of my clients like to tell me. Sometimes my clients coming in and they're like, man, I'm really in the trenches this week. It's a great book for when you really are in the trenches. It's like, all right, this book is like, it's a comfort in itself. Because it's like, listen, you don't have to figure out all of this today, open up this book. I'm going to tell you one little tiny thing that you can do to make your life a little bit better. I love that. Then, stack them, that's the important thing. That's another important thing. Stack them. Alyssa Scolari [10:14]: Stack them or by brick. Zack Rutledge [12:30]: Yeah. Thank you so much, again for saying that. I mean, I should say I'm just completely honored to be here, right? Because this is really cool for me to be talking to somebody like you. I kept it short because I was thinking, what would I read as a 20-year-old, right? I want to say this the right way. Because it's not bragging, right? Because in no way am I a perfect person. Okay. It's in no way. But one of the really nice things somebody said to me was that, "This is a really good book. Even for people who aren't depressed," and I was like, "Oh, thanks." "For people who are just looking to improve their lives," I was like, "Oh wow. That's really nice. Thank you so much." Because a lot of times I joke that I wrote this book for the worst possible sales. I wrote this for an audience that is not going to go out and buy a book, right? They're not going to seek out for help. So in a way I kind of wrote it as a gift, but I didn't want it to seem like gimmicky. I didn't want to say, "Hey, buy this for somebody," because they didn't want to seem like a sales grab type thing. But in a way it really was written as a gift to, because I know it's tough to reach out for help sometimes. Alyssa Scolari [13:50]: It's so tough. It's so so tough. Actually, I love what you said about... I have so many questions on my mind and there are so many things I want to ask you. Zack Rutledge [14:00]: I'm here. Alyssa Scolari [14:01]: My brain is going a mile a minute, but that actually, it just clicked for me to write. This is a book that is great for somebody even who isn't struggling with depression, because it's almost like it's just, it's preventative. This is to me, this is a book truly... It's a genuine wellness book and listen, for the listeners out there, you all know how I feel about wellness and the wellness industry, and how fraudulent it is. I know we've talked about this, but this is a genuine wellness book. One that really is one size fits all for all people. So I just want to go back to something that you touched on, honestly 10 minutes ago at this point. But you started to talk about depression and the different types of depression. One that you talked about in the book that I really would like for you to expand on. Because I'm interested to hear your perspective on this is, you said that a lot of professionals tend to miss this idea that depression is more of a feeling rather than a result of something that has happened in your life specifically. Can you expand a little bit more on that, your viewpoint on the different types of depression? Zack Rutledge [15:20]: Sure. Yeah. So, and I'm sure you know this, and it absolutely happened in my life. Depression comes in different flavors, I call it. So I mean, and they can come from different... It can come from different causes. So some people are dysthymic, right? So for people who are listening, it's that low level, and then when something traumatic happens, you dip down into this deep trench. Which I think may have described to me, there could be things purely brought on by traumatic events, like a PTSD type depression. So there are different flavors. Interestingly, and again, I know you know this, but for your listeners, a lot of people are saying, treating gut health is a good way to work on your depression. They're giving probiotics, because you actually create more serotonin in your gut than you do your brain. Now, I say- Alyssa Scolari [16:16]: Yes. Thank you for saying that. Nobody has ever said this on the podcast before, and I am enamored. Can you please repeat that? Everybody listen to this loud and clear. Say that again. Zack Rutledge [16:27]: Okay. So I would argue that this is another reason to keep a good diet, right? That you create more serotonin in your gut than you do in your brain. So some people are actually giving depressed people probiotics in trying to get those bacteria back in a good balance. So yeah. So let's just say, now I personally believe that that could be the case, sometimes. I don't think that's the catch-all. I don't think there is a catch-all. Alyssa Scolari [17:01]: Yes. Zack Rutledge [17:02]: In that token... So that being said, right? So let's just say, if I had a traumatic event, giving me probiotics wouldn't be much of a help, right? So that's why I call it the D-Day approach. So we come at it from every angle. So whether it's a gut issue or it's a brain issue, because I even talk about medication in there. Whether it's a traumatic issue, I talk about therapy in there, right? We're trying to come at it with everything, right?. So that's kind of treating. So if we don't know exactly what's off, and you're teaming up with somebody like you, like an expert. You're eating the right things, and you're putting these things together. You're going to have a... I personally think you're going to have a much greater chance of success rather than relying on one silver bullet, right? Because there's no one cause. Alyssa Scolari [18:01]: I couldn't agree with you more. I also agree that it's definitely not, that is not one size fits all where it is different for everybody. But when we take what you have coined as, right, the D-Day approach, and we attack it from all angles. You're going to find what's going on and you're going to be able to heal. I know for me, I think my depression, it was a result of definitely PTSD, but over the last couple of months, and this is also part of why I'm so excited to talk to you about this stuff, is because I have had my own journey with realizing that what was going on in my gut was causing my depression. It took me a long time to get there, to even realize that until I started to learn that the majority of serotonin is actually like me, made in your gut. I went to a functional medicine doc, and she was able to help me identify which foods my body truly was hating. After cutting out these foods, giving my body the time and the space to heal, taking the appropriate supplements. I am in a better head space than I have ever been in my entire life. I feel like I see the world so much differently, because I cut out certain things and my gut is truly healthy. I used to sleep... I used to get 10 hours of sleep at night, and then I would wake up and not have the energy to walk downstairs. Zack Rutledge [19:49]: Wow. Alyssa Scolari [19:49]: I'm 29. Why am I acting like I'm 150? The change in what I was eating changed all of that. When I say change, just to be clear, I am not talking about being restrictive. That is not what I'm talking about here. I'm talking about, for me specifically, I had food allergies that I was truly unaware of dairy, gluten, garlic, honestly, everything. Zack Rutledge [20:22]: Which is really common, right? Alyssa Scolari [20:24]: So common, and so many people don't know it. Zack Rutledge [20:27]: Yeah. Yeah. I think I mentioned in the book too getting an allergy test because really, really helpful. I didn't need the allergy test because I know now, I mean, it's, it's very apparent. I think my body has become more sensitive to, it's funny, like certain dairies. A glass of milk will destroy me, but I can have butter or things like that. But it's funny, right? But yeah. Yeah. I would bet a lot of people, well, look, it's true. A lot of people have a lot of intolerances. Alyssa Scolari [20:57]: Yeah. Zack Rutledge [20:57]: It's not doing your body any favors. Yeah. Alyssa Scolari [21:00]: Yep, absolutely. So yes, you touch on all the different types of depression. So if you could give a synopsis of, can you walk us through the book? So you break down your story, you talk about depression, you go into the mindset, and then can you break down more of it from there? Zack Rutledge [21:26]: Sure. Well, let me say first, because the mindset's kind of like a weird thing to talk about. Just because it's not concrete, it's not concrete steps. If anybody wants that chapter, just shoot me an email and I'll send them that chapter, Because we're not going to talk, go to into depth on that today, because it's just a weird thing to talk about. So shoot me an email. I'll send you that chapter. All right. Alyssa Scolari [21:49]: I'll put your email in the show notes so that people have easy access to be able to reach out. Zack Rutledge [21:55]: Cool. Thank you so much. So anyway, as far as building back up brick by brick, like you said, there's the intro, there's the mindset, which is just to kind of light that fire under you is that relating to you. It's the getting you into gear, coming at us with the right approach, with the right intentions. So I like to start with the physical aspect. Okay. This isn't to look like a bodybuilder, this is getting your physical structure in order. I like it because it's the most concrete thing in the book, and you tend to... Oh, well, just like you said, you tend to notice things pretty quickly, right? If you get your... I think I have it in two separate chapters, but I have the fitness and nutrition. But if you get that dialed in first, that's going to kind of, I'm trying not to make too many battle references, but it's going to simplify the battlefield. I hate that. Alyssa Scolari [22:57]: Listen. I love it. I'm here for it. Zack Rutledge [23:01]: I regret calling it the D-Day approach, but that's just what pops to mind. But anyway, yeah you're just- Alyssa Scolari [23:05]: I think that's the perfect... It's the perfect Analogy. Zack Rutledge [23:09]: Okay. Alyssa Scolari [23:10]: I think it's perfect. Zack Rutledge [23:11]: Okay, great. We'll go with it. So yeah. So that's the first place I like to start. So we go with the fitness, we go with the diet, and then I actually have a section on supplements in there. Of Course, I have all the disclaimers, but it's good to repeat this. You always have to check in with your primary care physician, because we don't want any of these things interacting with anything you take, right? So one of my absolute favorites is turmeric, and I mentioned this in the book, taking a capsule of turmeric is like eating a thousand turmeric roots, right? So you're better off with the capsule. I know people cook with it, but the capsules are great, but you also want to have a little bit of black pepper in that capsule. About half of the capsules you find will have a little bit of black pepper in there, and if there's not, just put a little pepper on your food when you take the capsule. Because what happens is, that black pepper increases the bioavailability of that turmeric, the curcumin and then your body- Alyssa Scolari [24:10]: That's what it's called, right? [crosstalk 00:24:12]. Zack Rutledge [24:12]: It can be called... Yeah. You'll see it as either turmeric, curcumin, curcuminoids, it's all the same thing, right? Alyssa Scolari [24:18]: Yeah. Zack Rutledge [24:19]: It increases that bioavailability so you can absorb it way easier. Otherwise, it just passes through your system, not all of it, but a good portion of it. So yeah, I go into stuff like that, and like my favorite supplements. One of the reasons I really like turmeric is because it helps with inflammation. One of the theories on depression is that inflammation can really contribute to it, right? So, which is another reason, like you were just saying, getting the foods that don't agree with you sorted out, right? Alyssa Scolari [24:50]: Yeah. Zack Rutledge [24:52]: So I run through a bunch of different things, working on your relationships, and working on the right media. I go through that, there's actually a chapter in that. Then, I essentially ended with medication. I think there may be a chapter after that, but the medication I ended on, because that was my last step. Now, it took me years, and years, and years, but I'm glad I did it that way, and this is why. I built myself up, and I built up so many practices from my martial arts, like my meditation, and yoga, and the diet, and the working out, like you've said. I worked on everything to, I sharpen the sword as much as I possibly could. Then, I felt, okay, I still need something else. I still need something else, because at 8:00 at night, it was always 8:00 at night, things would spiral out. I'd be good all day, good all day, and then 8:00 at night, I don't know if it was a testosterone drop thing, because men's testosterone tends to drop later at night. I don't know what it was, but I needed that extra boost to get me the rest of the way. Yeah. So we talk about a lot of things. Sorry. I talk so much. You can just cut me off. Alyssa Scolari [26:03]: No. You are absolutely fine. I'm thinking to myself, I know that the nighttime, and especially for the trauma, any kind of trauma survivors or anyone who has been through any type of traumatic loss. The nighttime is always the hardest, it's just the absolute hardest. So I'm wondering when you say, I spiraled out, and if this is too personal of a question, please feel free to tell me to back off and I will. Zack Rutledge [26:35]: No. You can't offend me. You can ask me anything you want. Alyssa Scolari [26:41]: What did that look like for you? What did spiraling out look like for you? Because like you said, depression looks a little bit different on everybody. So what did that look like for you? Zack Rutledge [26:50]: So when I say that, when the 8:00 PM would get a little darker I'd spiral out, I should mention that. By that point, I was way, way, way better than I was when I was 19, and really struggling all day and then my nights would be way worse. So I'm just saying, things would turn negative. I was letting my brain run my mind, is kind of the way it felt. My thoughts would just turn dark. I would start looking at the negative sides of everything. I was fixating on things like death, I was fixating on these things that really were not serving anyone, with note and just seeing the dark side of everything. But I was still much, much, much better, it was just that I was dipping down lower than I should have. I'm on an SNRI, which was actually, I don't talk about it in the book, I don't think. It wasn't just the death of my friend that had me spiral out of control when depression was really deep. I actually dealt with some chronic pain issues. So the SNRI really helped with the nerve pain. They actually give it to a lot of people with fibromyalgia, for their nerve pain. Yeah. Yeah. Yeah. But yeah, it just topped it off. It felt, okay, now everything's a lot easier. Yeah. Alyssa Scolari [28:13]: That's so important because so many people, I think beat themselves up when they do "everything" that you're supposed to do to help aid with their symptoms. But still kind of like you said, when that sun goes down or when it turns 8:00, it still just feels unmanageable. It's just, people don't have to suffer. I love this idea and this phrase, I sure as hell did not coin it, but I've been reading on that line. People are making t-shirts now that's like, if your brain can't make it, store-bought is fine. I just love that, store-bought, serotonin, it's fine. An SSRI and SNRI. It is totally fine. So that's the other thing that's fantastic is that you're so open about all of the possibilities, right? That it is a possibility to do all these things and still need to take medication, and that that is okay. Zack Rutledge [29:29]: Yeah. Well, I mean, I wasn't always open about it. I had to be, to be honest. But yeah, because there was a lot of hesitancy and I wanted to be clear about that, and I wanted to clear up a lot of the myths too. Because there's a lot of misinformation out there. Yeah. So I'm hoping, well, of course, I'm hoping to read the book. People who read the book will read that chapter, but I'd hope people really take that one to heart too. Yeah. Alyssa Scolari [29:59]: Yeah. Yeah. Now, this book, so when you first hit your first major depressive episode, you said about like 19? Zack Rutledge [29:59]: 18. Alyssa Scolari [30:10]: 18, is this book, do you think that when you were 18, you would have really benefited from having a book like this? Zack Rutledge [30:22]: Yes. Alyssa Scolari [30:23]: Yeah. Zack Rutledge [30:24]: I was thinking... It was interesting thinking about myself at that age as I was writing this. Because I was like, what's going to resonate with that person who's in that deep of a hole, so to speak. Alyssa Scolari [30:37]: Yeah. Zack Rutledge [30:38]: Yeah. So it was interesting, but I mean, I wouldn't have released her. I wouldn't be doing podcasts like this, if I didn't believe in it so much, right? So yeah. Yeah. I really do believe it. Yeah. Alyssa Scolari [30:54]: Yeah. I asked that question because I bet, as I was going through the book, I think one of the things that I was thinking to myself is, how healing this must have been for you. Now that I'm talking to you, I'm kind of realizing it's almost like you're giving like 18-year-old you what you needed as well through writing this book, which I think is so powerful. Zack Rutledge [31:18]: Yeah. Thanks. To be honest, it was fun. I enjoyed it. It was just a good time because you know that eventually somebody is going to read the thing. So even if it helps two people, whatever. Somebody who's going to read it. So it was actually really fun to do it. Alyssa Scolari [31:35]: Yes. You're helping more than just two people, right? Even though, if two people was all you help, that's still an incredible and a job well done. But before we started recording, let's have this bragging moment. I'm totally going to bring this back up. Tell me the Canada story. Zack Rutledge [31:56]: So I actually had a psychologist reach out to me today. She's from Canada. She said that she loves the books so much that she's actually recommending it to her patients, to her clients. So yeah, pretty cool. Pretty cool. Alyssa Scolari [32:13]: It's so cool. Zack Rutledge [32:15]: Yeah. Alyssa Scolari [32:17]: I'm so happy for you. I'm so excited. This book it's almost... You can tell it's like, you talk about it almost it was effortless, and it seems maybe it's just years of you've been doing all this work for all these years, and now it just came out of you on paper. Zack Rutledge [32:38]: Yeah. Essentially condensed the best bits. Yeah. Alyssa Scolari [32:42]: Yeah. Yeah. So what is next for you? What's next for you? You've got a book out. You've got people in other countries contacting you. Where are we going next? Zack Rutledge [32:55]: So I told you that the personal training, all that was my part-time job. I didn't say my regular full-time job was video production. I went to grad school for film. I'm actually shooting my first full length film in October. No, no, I'm sorry, August. So yeah, I'm shooting a movie in August and then- Alyssa Scolari [33:15]: That's so cool. Zack Rutledge [33:16]: Yeah. Pretty exciting. Actually, you're not too far from me. If you want to be an extra. If you want to read a couple of lines, I can have you. Alyssa Scolari [33:24]: Hello. My dream come true. Let me know, day, time. I will be there with bells on. Zack Rutledge [33:30]: Awesome. We're shooting in the Princeton area. I'm sure you know where that is. So anyway- Alyssa Scolari [33:34]: Yes. That's like my favorite part of New Jersey. Zack Rutledge [33:36]: Cool. We'll talk about that after we record. Alyssa Scolari [33:39]: Yes. Zack Rutledge [33:39]: But yeah, so I'm shooting this movie, and then it's really... Well, I finished up my yoga teacher training in August, and I get ready for grad school in January. Yeah. Start my LPC. Yeah. Alyssa Scolari [33:55]: Then you, ultimately the goal for you is to become, you want to become a therapist and you want to be able to help people. Is there a specific niche of people that you want to help? Or is it kind of, well, I'm just going step by step, day by day seeing where life takes me type of thing? Zack Rutledge [34:13]: Well, as of right now, I think anxiety and depression would be a nice fit. That just feels natural to me, and that's kind of where my passion is right now, of course with the book and everything. But we'll see how it goes, we'll see. Alyssa Scolari [34:24]: Yeah. Yeah. You never know. You never know where you could end up. I know, I sure as hell did not seen myself ending up where I am. Zack Rutledge [34:35]: Right. That's what a lot of people tell me. They say that they're surprised at where they ended up. So I'm expecting the unexpected. Yeah. Alyssa Scolari [34:42]: Yeah. Expect the unexpected, and it's a beautiful thing. So where is your book sold? Where can people find it? Where can they buy it? Zack Rutledge [34:54]: Honestly, I did the laziest thing possible. It's up on Amazon and it's the only place you can get. I don't have a big social media, it's up on Amazon kind of doing the power of attraction thing, hoping that if the quality is there, people will find it. Yeah. So that's it. Alyssa Scolari [35:12]: I love it. So I will grab that link, and then if people have any questions or they want to reach out to you, and they want to ask anything. They can just use the email that I will include in the show notes as well. Zack Rutledge [35:24]: Great. Thank you so much. Yeah. They're more than welcome. Alyssa Scolari [35:26]: Perfect. I will put the link to your book and your email in the show notes for the listeners. To the lovely and wonderful listeners out there, I am also going to be posting the link to this book in the Light After Trauma Facebook group. Because I know a lot of the folks in that group are always asking for new books and great reads. This is one of them. This truly, truly is one of them. It's phenomenal. It is short. It's concise. It's clear. It's relatable. So highly recommend. We'll post that. If you are not in the Facebook group, what are you waiting for? Thank you so much, Zach, for coming on the show. It was truly an honor. Zack Rutledge [36:11]: No. Thank you. The honor is all mine, really. Thank you. Alyssa Scolari [36:15]: Of course. Thanks for listening everyone. For more information, please head over to lightaftertrauma.com or you can also follow us on social media, on Instagram we are @lightaftertrauma, and on Twitter it is @lightafterpod. Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over, again that's patreon.com/lightaftertrauma. Thank you, and we appreciate your support. [singing]

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.   This episode covers the psychiatric aspects of chronic pain with expert guest:   Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to Explore the role of psychiatry in the management of pain Discuss the epidemiology of psychiatric comorbidities in pain disorders. Outline the pathophysiology of pain and its relationship to psychiatric disorders. Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulation Discuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids). Discuss the intersection of pain medicine with somatic symptom and related disorders   Guest: Dr. Leon Tourian Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Episode Infographic by Dr. Luba Bryushkova     Interview Content: Introduction and learning objectives – 0:00 Role of psychiatry in management of chronic pain – 1:45 Psychiatric co-morbidities in patients with chronic pain – 5:45 Biological link between pain and psychiatric co-morbidities – 11:00 Psychological approach to understanding and management of chronic pain– 14:30 Central neuromodulation strategies for chronic pain – 21:00 General pharmacological approach to the management of chronic pain – 22:30 Pathogenesis of neuropathic and somatic visceral pain – 30:00 Antipsychotics in the management of chronic pain – 37:00 Cannabis in the management of chronic pain – 40:30 Somatic symptom disorder – 46:00 Stigma in chronic pain disorders – 53:10 Treatment of somatic symptom disorder – 58:30 Psychiatry and the stigma of chronic pain disorders– 61:00 Closing remarks – 65:15   Articles and Resources: Guideline for opioid therapy and chronic noncancer pain (CMAJ) Guideline The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (McMaster University) List of Pain & Opioid Initiatives (2017) (CFPC) Canadian Pain Task Force Report: June 2019   References: Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54   Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402   O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5   Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3   Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

In today's episode of the podcast, we'll be continuing our deep dive into duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI). In this second part, we'll be covering the approved indications and off-label uses of duloxetine.  Link to Blog. Link to Resource Library. 

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

In today's episode of the podcast, we will be doing a deep dive into duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI). In part one of this two-part series, we will cover the history of SNRIs as well as mechanisms of action, cytochrome P450 issues, side effects, and contraindications to consider when prescribing duloxetine and this class of medications. Link to Blog. Link to Resource Library. 

To help diagnose generalized anxiety disorder, your doctor or mental health professional may: Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition Order blood or urine tests or other tests, if a medical condition is suspected Ask detailed questions about your symptoms and medical history Use psychological questionnaires to help determine a diagnosis Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. https://drug-rehab-delray-beach.s3.amazonaws.com/ttc.htmlhttps://ttc-addiction-treatment.business.site/https://batchgeo.com/map/681ecafc169a47b7124bbe82fd1e775fhttps://batchgeo.com/map/7274655833ed942b86e23474567769e6https://goo.gl/maps/Fk81xaoUcU6YHTM99https://goo.gl/maps/KBCUSVVk1ivi3DB69https://goo.gl/maps/97VNE7ngfLahmGWq5https://t.co/qaKk40jNNS#anxiety-treatmenthttps://t.co/S4tBJeO3MP#mental-healthhttps://t.co/pedFQCDmQC#anxiety-disorderhttps://earth.google.com/web/data=Mj8KPQo7CiExRnlENnotbHdjUGtwMy04Mm9tbVVpWUtwd28zX3VsUHQSFgoUMDY2OUMyQzNBMTE4RUMyQTlFNjECognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.Through this process, your symptoms improve as you build on your initial success. Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments.Your doctor also may recommend other antidepressants. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. Transformations Treatment Center14000 S Military Trail, Delray Beach, FL 33484FV9H+MC Delray Beach, Floridahttps://www.transformationstreatment.center/treatment/Anxiety Disorder Treatment in FloridaFind Transformations on Google Maps!More information:https://transformationstreatment1.blogspot.com/2021/02/inpatient-anxiety-treatment-florida.htmlVideos:https://youtu.be/L-gI-oy2UNEhttps://vimeo.com/514026204Support the show (https://www.google.com/maps?cid=9720609399900639450)

Episode 40: Erectile Dysfunction Basics. Erectile dysfunction fundamentals, allergy to penicillin label removal, jokesToday is February 5, 2021. Question of the month: Diabetes managementThis is a reminder of our question for this month. Please answer before Feb 15, 2021. The best answer will receive a prize. Question: What is the first treatment approach for type 2 DM? For example, for a patient who had polydipsia, polyuria for a few weeks and at your office had a random BG of 210.Send your answer to RBresidency@clinicasierravista.org. Don’t miss this chance to win.Penicillin Allergy Study: How many times have you heard a patient say that they are allergic to penicillin? Exactly, a lot! Skin allergy testing continues to be the best test to diagnose penicillin allergy. All patients who have a negative penicillin allergy skin test should be challenged with penicillin in a medical setting for 1-2 hours to ensure that immediate reaction does not occur. Many patients labeled as “allergic to penicillin” may not be truly allergic. We recognize that true penicillin allergy exists, and allergic reactions range from mild rash to life-threatening anaphylaxis, but many patients needing penicillin may not get it because of a wrong diagnosis of penicillin allergy. Up to 15% of the US population are labeled as “allergic to penicillin”. The American Journal of Respiratory and Critical Care Medicine published in February 2020 a way to remove low-risk penicillin allergy labels in an ICU. The investigators created a risk-stratification tool after evaluating 318 patients in an allergy clinic. Low risk indicators include urticaria to penicillin >5 years ago, a self-limited rash, GI symptoms only, a remote childhood history, a family history only, avoidance from fear of allergy only, a known tolerance to penicillin since the reported reaction, or non-allergic symptoms. Using that tool, 216 patients admitted to the MICU labeled as “allergic to penicillin” were evaluated. 68 patients qualified as “low risk.” 54 patients agreed to be challenged with a single oral dose of 250 mg amoxicillin and observed for 1 hour. None of the challenged patients had any immediate or delayed reaction. Their penicillin allergy label was removed. Later, 41 of the 54 challenged patients received multiple doses of either penicillin’s (17 patients) or cephalosporins (24 patients) without any reaction. This tool has not been validated to be used in an outpatient setting yet, but it sets the foundation for further investigation in this matter.This is Rio Bravo qWeek, 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. ____________________________Erectile Dysfunction. Arreaza: Today our guest is Dr. John Ihejirika.  Ihejirika: My name is Dr. John Ihejirika. I am one of the third/Final-year residents at the Rio Bravo Family Medicine residency program, here in Bakersfield, California.  I am glad to be back on the podcast and thanks for having me again.Arreaza: What topic are you discussing today?Today I will be talking about Erectile dysfunction.Arreaza: What is Erectile dysfunction?Ihejirika: Erectile dysfunction [ED] can be defined as the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. It is very common, affecting at least 12 million men in the United States. The condition can be caused by vascular, neurologic, psychological, medications and hormonal factors. Arreaza: What are common conditions associated with ED?Ihejirika: Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment. Performance anxiety and relationship issues are common psychological causes. Medications and substance use can also cause or exacerbate EDMedications: Antidepressants are a common cause especially the SSRI and SNRI drugs.  Substances: Tobacco, alcohol, and illicit drugs can cause ED. Marijuana use may cause ED, although further study is needed.Arreaza: Is ED related to any other risks?Ihejirika: Cardiovascular risk: ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome. Initial treatment: Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions. Arreaza: Let’s talk about the “blue pill.”Ihejirika: Oral phosphodiesterase-5 inhibitors are the first-line treatments for ED. Second-line treatments include alprostadil and vacuum devices. Arreaza: Vaccum: No medication interaction.Ihejirika: Surgically implanted penile prostheses are an option when other treatments have been ineffective. Counseling is recommended for men with psychogenic ED.Arreaza: However, most cases have an organic cause. How is Erectile Dysfunction assessed?Ihejirika: The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, medication and psychosocial history. The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms. QUESTIONSSCORES12345Over the past six months:1. How do you rate your confidence that you could get and keep an erection?Very lowLowModerateHighVery high2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?Almost never or neverA few times*Sometimes†Most times‡Almost always or always3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?Almost never or neverA few times*Sometimes†Most times‡Almost always or always4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?Extremely difficultVery difficultDifficultSlightly difficultNot difficult5. When you attempted sexual intercourse, how often was it satisfactory for you?Almost never or neverA few times*Sometimes†Most times‡Almost always or alwaysFive-Item Version of the International Index of Erectile Function Questionnairenote: The score is the sum of the above five question responses. Erectile dysfunction is classified based on these scores: 17 to 21 = mild; 12 to 16 = mild to moderate; 8 to 11 = moderate; 5 to 7 = severe.* —Much less than one half the time.† —About one half the time.‡ —Much more than one half the time.     Summary of diagnosis and Treatment of Erectile Dysfunction.    Sources: I got this knowledge from the AAFP website, Up to Date, Review/Journal and from some my faculty. You can see our website for further details on theses references.Conclusion:  It is very important to be aware of this condition because as stated earlier It is very common, affecting at least 12 million men in the United States. Most male patients feel depressed or “incomplete” when experiencing ED and it is one of the most common reasons for male patients to visit the doctor, although most patients do not disclose the reason for the visit during the rooming process or with a female provider. Knowledge of the management of ED is also vital to have as a provider as it helps you restore your patients’ self-esteem and gives you reciprocal gratification in addition, so be ready to treat your patients. ____________________________For your Sanity: Jokesby Claudia Carranza, Gina Cha, an guest notary public-What do you call a bear with no teeth? A gummy bear.-How do you keep geese from speeding? Goose bumps.-Why do fish choirs always sign off-key? Because you can’t tuna fish.-Why did the toilet paper run down the hill? To get to the bottom.-How do make a slug drink? Stick it in the blender._____________________________Now we conclude our episode number 39 “Erectile Dysfunction Basics.” Today, Dr Ihejirika gave us the tools to address this common issue among our male patients. Diabetes and hypertension are to blame for ED in most cases. He taught us how to assess and treat our patients with many methods, including the famous “blue pill.” We also hope you enjoyed our goofy jokes. Don’t forget to participate in our contest by answering our question of the month and receive a prize. Our question is: What is the first treatment approach for type 2 Diabetes? For example, for a patient who had polydipsia, polyuria for a few weeks and at your office had a random blood sugar of 210. Send your answer to rbresidency@clinicasierravista.org before February 15, 2021.And remember… Even without trying, every night you go to bed being wiser than when you woke up. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email at RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, John Ihejirika, Claudia Carranza, Gina Cha, and a notary public guest. Audio edition: Suraj Amrutia. See you next week!    References:Stone CA Jr et al., Risk-stratified management to remove low-risk penicillin allergy labels in the intensive care unit. Am J Respir Crit Care Med 2020 Feb 21; [e-pub]. (https://doi.org/10.1164/rccm.202001-0089LE) https://www.jwatch.org/na51025/2020/03/25/approach-removing-penicillin-allergy-labels Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:322. Rew, Karl T. and Joel Heidelbaugh, MD, Erectile dysfunction, University of Michigan Medical School, Ann Arbor, Michigan. Am Fam Physician. 2016 Nov 15;94(10):820-827. https://www.aafp.org/afp/2016/1115/p820.html.  Khera, Mojit, MD, MBA, MPH, Peter J Snyder, MD, Michael P O'Leary, MD, MPH and Kathryn A Martin, MD, Treatment of male sexual dysfunction, Up To Date, accessed on February 1, 2021. https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction?search=erectile%20dysfunction&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 

Antidepressants: SSRI, SNRI, ATYPICAL, MAOI, TCA Antipsychotic (First Generation)

Meet pharmacist Dong Kim, PharmD in the 2nd part of his interview. We talk about the COVID-19 vaccine, biochemistry, and psychotropic medications to help you make better decisions about your overall healthcare.Dong is a patient-focused pharmacist with more than 15 years of experience. He has a doctor of pharmacy degree from the University of the Pacific. He also has a bachelor of science in biochemistry and cell biology from the University of California at San Diego.➤RESOURCESCenters for Disease Control and Prevention: https://www.cdc.gov/vaccines/covid-19/Free Worksheet: https://www.YourTruthRevealed.com➤SUMMARYHow can we put the COVID-19 vaccine in historical context? * We can compare it to the polio vaccine.* Polio is highly contagious with flu like symptoms, paralysis, and even death. It once seemed impossible to stop.* However, polio was eliminated in the U.S. in 1994 because people received the polio vaccine.* This is hopeful news for the possible elimination of COVID-19.What is biochemistry and how does it contribute to health?* Biochemistry, sometimes called biological chemistry, is the study of chemical processes within and relating to living organisms.* A sub-discipline of both biology and chemistry, biochemistry can be divided in three fields . . .* Molecular genetics, protein science, and metabolism* Over the last decades, biochemistry has become successful at explaining living processes.* Proteins, nucleic acids, carbohydrates, and lipids(fat) provide the structure of cells and perform many of the functions associated with life.What is a concern that you have about some customers you see every day?* A big concern is apathy. Apathy is defined as the lack of motivation or concern.* It comes from the Greek word “pathos,” which means passion or emotion.* Apathy is a lack of those feelings and could be a factor in having an unhealthy lifestyle.* Some tips are: Get plenty of sleep each night and try to exercise every day. Spend time with friends, do things you love, break big tasks into smaller ones so that you feel accomplished, and reward yourself whenever you finish an activity.Psychotropic drugs are any drug capable of affecting the mind, emotions, and behavior. Can you please explain how psychotropic medications work?* People need to know that these medications can open the door to change your life!* There are 5 main groups of psychotropic medications: antidepressants (SSRIs and SNRIs), antipsychotics, antianxiety, mood stabilizers, and stimulants.* SSRIs - selective serotonin reuptake inhibitors* SNRI - serotonin/norepinephrine reuptake inhibitors* The downregulation and upregulation of receptors. All living cells have the ability to receive and process signals that originate outside their membranes, which they do by means of proteins called receptors.* Signals interact with a receptor and direct the cell to allow substances to enter or exit the cell. Receptors can be increased (or upregulated) when the signal is weak, or decreased (downregulated) when it is strong.* Serotonin and norepinephrine are released, then stimulate the receptors, and then reuptake occurs.* SSRIs inhibit reuptake of serotonin. This results in increased levels of serotonin in the synapse.* SNRis inhibit reuptake of serotonin and norepinephrine. This results in increased levels of serotonin and norepinephrine in the synapse.* Information from one neuron flows to another neuron across a synapse. The synapse contains a small gap separating neurons.What is the most dangerous combination of drugs that somedoctors prescribe?* The most dangerous is a 3-drug cocktail for pain. This cocktail includes an opioid, witha benzodiazepine, plus a...

This is the 2nd part of an interview with pharmacist Dong Kim, PharmD. We talk about the COVID-19 vaccine, biochemistry, and psychotropic medications to help you make better decisions about your overall healthcare. Dong is a patient-focused pharmacist with more than 15 years of experience. He has a doctor of pharmacy degree from the University of the Pacific. He also has a bachelor of science in biochemistry and cell biology from the University of California at San Diego. ➤RESOURCES Centers for Disease Control and Prevention: https://www.cdc.gov/vaccines/covid-19/ Free Worksheet: https://www.YourTruthRevealed.com ➤SUMMARY How can we put the COVID-19 vaccine in historical context? * We can compare it to the polio vaccine. * Polio is highly contagious with flu like symptoms, paralysis, and even death. It once seemed impossible to stop. * However, polio was eliminated in the U.S. in 1994 because people received the polio vaccine. * This is hopeful news for the possible elimination of COVID-19. What is biochemistry and how does it contribute to health? * Biochemistry, sometimes called biological chemistry, is the study of chemical processes within and relating to living organisms. * A sub-discipline of both biology and chemistry, biochemistry can be divided in three fields . . . * Molecular genetics, protein science, and metabolism * Over the last decades, biochemistry has become successful at explaining living processes. * Proteins, nucleic acids, carbohydrates, and lipids(fat) provide the structure of cells and perform many of the functions associated with life. What is a concern that you have about some customers you see every day? * A big concern is apathy. Apathy is defined as the lack of motivation or concern. * It comes from the Greek word “pathos,” which means passion or emotion. * Apathy is a lack of those feelings and could be a factor in having an unhealthy lifestyle. * Some tips are: Get plenty of sleep each night and try to exercise every day. Spend time with friends, do things you love, break  big tasks into smaller ones so that you feel accomplished, and reward yourself whenever you finish an activity. Psychotropic drugs are any drug capable of affecting the mind, emotions, and behavior. Can you please explain how psychotropic medications work? * People need to know that these medications can open the door to change your life! * There are 5 main groups of psychotropic medications: antidepressants (SSRIs and SNRIs), antipsychotics, antianxiety, mood stabilizers, and stimulants. * SSRIs - selective serotonin reuptake inhibitors * SNRI - serotonin/norepinephrine reuptake inhibitors * The downregulation and upregulation of receptors. All living cells have the ability to receive and process signals that originate outside their membranes, which they do by means of proteins called receptors. * Signals interact with a receptor and direct the cell to allow substances to enter or exit the cell. Receptors can be increased (or upregulated) when the signal is weak, or decreased (downregulated) when it is strong. * Serotonin and norepinephrine are released, then stimulate the receptors, and then reuptake occurs. * SSRIs inhibit reuptake of serotonin. This results in increased levels of serotonin in the synapse. * SNRis inhibit reuptake of serotonin and norepinephrine. This results in increased levels of serotonin and norepinephrine in the synapse. * Information from one neuron flows to another neuron across a synapse. The synapse contains a small gap separating neurons. What is the most dangerous combination of drugs that some doctors prescribe? * The most dangerous is a 3-drug cocktail for pain. This cocktail includes an opioid, with a benzodiazepine, plus a muscle relaxer. * Some states have made it a schedule 2. Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

Benzodiazepines should be administered with extreme caution in the elderly due to the risk of excessive sedation, confusion, falls, and fractures. Mirtazapine (Remeron) and buspirone (Buspar; brand discontinued) are also efficacious in treating GAD in patients who do not respond to at least two SSRI or SNRI trials.https://recoverypartnernetwork.com/drug/benzodiazepine/benzodiazepine-addiction

Meet pharmacist Dong Kim, PharmD in the 1st part of his interview. We talk about the COVID-19 vaccine, biochemistry, and psychotropic medications to help you make better decisions about your overall healthcare.Dong is a patient-focused pharmacist with more than 15 years of experience. He has a doctor of pharmacy degree from the University of the Pacific. He also has a bachelor of science in biochemistry and cell biology from the University of California at San Diego.➤RESOURCESCenters for Disease Control and Prevention: https://www.cdc.gov/vaccines/covid-19/Free Worksheet: https://www.YourTruthRevealed.com➤SUMMARYHow can we put the COVID-19 vaccine in historical context? * We can compare it to the polio vaccine.* Polio is highly contagious with flu like symptoms, paralysis, and even death. It once seemed impossible to stop.* However, polio was eliminated in the U.S. in 1994 because people received the polio vaccine.* This is hopeful news for the possible elimination of COVID-19.What is biochemistry and how does it contribute to health?* Biochemistry, sometimes called biological chemistry, is the study of chemical processes within and relating to living organisms.* A sub-discipline of both biology and chemistry, biochemistry can be divided in three fields . . .* Molecular genetics, protein science, and metabolism* Over the last decades, biochemistry has become successful at explaining living processes.* Proteins, nucleic acids, carbohydrates, and lipids(fat) provide the structure of cells and perform many of the functions associated with life.What is a concern that you have about some customers you see every day?* A big concern is apathy. Apathy is defined as the lack of motivation or concern.* It comes from the Greek word “pathos,” which means passion or emotion.* Apathy is a lack of those feelings and could be a factor in having an unhealthy lifestyle.* Some tips are: Get plenty of sleep each night and try to exercise every day. Spend time with friends, do things you love, break big tasks into smaller ones so that you feel accomplished, and reward yourself whenever you finish an activity.Psychotropic drugs are any drug capable of affecting the mind, emotions, and behavior. Can you please explain how psychotropic medications work?* People need to know that these medications can open the door to change your life!* There are 5 main groups of psychotropic medications: antidepressants (SSRIs and SNRIs), antipsychotics, antianxiety, mood stabilizers, and stimulants.* SSRIs - selective serotonin reuptake inhibitors* SNRI - serotonin/norepinephrine reuptake inhibitors* The downregulation and upregulation of receptors. All living cells have the ability to receive and process signals that originate outside their membranes, which they do by means of proteins called receptors.* Signals interact with a receptor and direct the cell to allow substances to enter or exit the cell. Receptors can be increased (or upregulated) when the signal is weak, or decreased (downregulated) when it is strong.* Serotonin and norepinephrine are released, then stimulate the receptors, and then reuptake occurs.* SSRIs inhibit reuptake of serotonin. This results in increased levels of serotonin in the synapse.* SNRis inhibit reuptake of serotonin and norepinephrine. This results in increased levels of serotonin and norepinephrine in the synapse.* Information from one neuron flows to another neuron across a synapse. The synapse contains a small gap separating neurons.What is the most dangerous combination of drugs that some doctors prescribe?* The most dangerous is a 3-drug cocktail for pain. This cocktail includes an opioid, with a benzodiazepine, plus a muscle...

This is the 1st part of an interview with pharmacist Dong Kim, PharmD. We talk about the COVID-19 vaccine, biochemistry, and psychotropic medications to help you make better decisions about your overall healthcare. Dong is a patient-focused pharmacist with more than 15 years of experience. He has a doctor of pharmacy degree from the University of the Pacific. He also has a bachelor of science in biochemistry and cell biology from the University of California at San Diego. ➤RESOURCES Centers for Disease Control and Prevention: https://www.cdc.gov/vaccines/covid-19/ Free Worksheet: https://www.YourTruthRevealed.com ➤SUMMARY How can we put the COVID-19 vaccine in historical context? * We can compare it to the polio vaccine. * Polio is highly contagious with flu like symptoms, paralysis, and even death. It once seemed impossible to stop. * However, polio was eliminated in the U.S. in 1994 because people received the polio vaccine. * This is hopeful news for the possible elimination of COVID-19. What is biochemistry and how does it contribute to health? * Biochemistry, sometimes called biological chemistry, is the study of chemical processes within and relating to living organisms. * A sub-discipline of both biology and chemistry, biochemistry can be divided in three fields . . . * Molecular genetics, protein science, and metabolism * Over the last decades, biochemistry has become successful at explaining living processes. * Proteins, nucleic acids, carbohydrates, and lipids(fat) provide the structure of cells and perform many of the functions associated with life. What is a concern that you have about some customers you see every day? * A big concern is apathy. Apathy is defined as the lack of motivation or concern. * It comes from the Greek word “pathos,” which means passion or emotion. * Apathy is a lack of those feelings and could be a factor in having an unhealthy lifestyle. * Some tips are: Get plenty of sleep each night and try to exercise every day. Spend time with friends, do things you love, break  big tasks into smaller ones so that you feel accomplished, and reward yourself whenever you finish an activity. Psychotropic drugs are any drug capable of affecting the mind, emotions, and behavior. Can you please explain how psychotropic medications work? * People need to know that these medications can open the door to change your life! * There are 5 main groups of psychotropic medications: antidepressants (SSRIs and SNRIs), antipsychotics, antianxiety, mood stabilizers, and stimulants. * SSRIs - selective serotonin reuptake inhibitors * SNRI - serotonin/norepinephrine reuptake inhibitors * The downregulation and upregulation of receptors. All living cells have the ability to receive and process signals that originate outside their membranes, which they do by means of proteins called receptors. * Signals interact with a receptor and direct the cell to allow substances to enter or exit the cell. Receptors can be increased (or upregulated) when the signal is weak, or decreased (downregulated) when it is strong. * Serotonin and norepinephrine are released, then stimulate the receptors, and then reuptake occurs. * SSRIs inhibit reuptake of serotonin. This results in increased levels of serotonin in the synapse. * SNRis inhibit reuptake of serotonin and norepinephrine. This results in increased levels of serotonin and norepinephrine in the synapse. * Information from one neuron flows to another neuron across a synapse. The synapse contains a small gap separating neurons. What is the most dangerous combination of drugs that some doctors prescribe? * The most dangerous is a 3-drug cocktail for pain. This cocktail includes an opioid, with a benzodiazepine, plus a muscle relaxer. * Some states have made it a schedule 2. Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

FDA 连续批准2个单抗治疗视神经脊髓炎JAMA 服用维生素D3或阿斯匹林均不能降低抑郁症的风险Nature Neuroscience 夜间光照诱导的类抑郁行为在《神经科星期四 Episode 24》中，和大家介绍了抗补体蛋白C5单克隆抗体依库珠单抗（eculizumab），2019年6月被批准用于治疗水通道蛋白阳性的神经脊髓炎谱系障碍。2020年，又有两个新型的单克隆抗体上市用于治疗视神经脊髓炎。简单回顾一下：视神经脊髓炎谱系障碍（Neuromyelitis Optica Spectrum Disorder，NMOSD）是一种复发性自身免疫性炎症性疾病，通常影响视神经和脊髓。至少三分之二的病例水通道蛋白-4抗体（AQP4-IgG）和补体介导的中枢神经系统损伤有关。沙利珠单抗（satralizumab）沙丽珠单抗（satralizumab）是抗IL-6受体的单克隆抗体，当联用免疫抑制剂治疗时，可降低视神经脊髓炎谱系障碍患者复发的风险。2020年8月，沙利珠单抗被FDA批准用于治疗水通道蛋白-4抗体阳性的、视神经脊髓炎患者。《随机双盲对照研究：沙利珠单抗单药治疗视神经脊髓炎的安全性和有效性的3期试验》Lancet Neurology，2020年5月 (1)这项研究评估了沙丽珠单抗单药治疗视神经脊髓炎患者的安全性和有效性。在这个III期、双盲、安慰剂对照、平行组试验中，纳入了水通道蛋白-4抗体阳性或阴性的成年患者，参与者被随机分配（2:1）在第0、2、4周接受沙丽珠单抗120mg皮下注射或安慰剂，此后每4周接受一次注射。同时停止服用免疫抑制剂。共纳入168名参与者，随访期间，30%治疗组患者和50%对照组患者出现复发。两组间严重不良事件和导致停药的不良事件发生率相似。结论：与安慰剂相比，沙丽珠单抗单药治疗降低了视神经脊髓炎的复发率，具有良好的安全性。英必珠单抗（inebilizumab）英必珠单抗是CD19单克隆抗体，本研究旨在研究CD19单抗在降低视神经脊髓炎中的有效性和安全性。2020年6月，FDA已批准英必珠单抗上市，用于治疗视神经脊髓炎。《N-MOmentum研究：英必珠单抗治疗视神经脊髓炎谱系障碍的2/3期试验》Lancet，2019年10月 (2)这是一项多中心、双盲、随机安慰剂对照2/3期研究。参与者被随机分配到300mg 英必珠单抗或安慰剂组，在第1天和第15天接受用药。共招募230名参与者治疗组中12%的患者随访期间复查，安慰剂组39%出现复发（p < 0·0001）。治疗组中72%的患者和安慰剂组73%的患者出现不良反应。结论：与安慰剂相比，英必珠单抗降低了视神经脊髓炎的复发的风险，具有潜在的应用价值。出血性脑卒中出血性脑卒中一般来源于微动脉或小动脉，出血直接进入脑组织，形成局限性血肿。最常见的原因包括：高血压、脑外伤、全身出血倾向、淀粉样脑血管病及血管畸形。不常见的原因包括：肿瘤内出血、动脉瘤破裂及血管炎。《ARUBA研究：未破裂脑动静脉畸形的介入治疗与单独药物治疗的试验的最终随访》Lancet Neurology，2020年7月(3)是一项多国、多中心的随机试验，旨在评估被诊断为未破裂脑动静脉畸形的成年患者中，病变经过评估适合通过介入手术可以根除病变的情况下，介入治疗还是单独药物治疗效果更好。在预先指定的中期分析：显示在预防症状性卒中或死亡方面，单独药物治疗优于药物治疗和介入治疗的联合治疗组，在平均33·3个月的随访中停止了随机化。研究继续随访平均50.4个月后，单纯药物治疗组的死亡或症状性卒中发生率（3.39/每100人年）低于介入治疗的患者（12·32/100人年）。药物治疗组2例，介入治疗组4例死亡。与介入治疗相比，分配到药物治疗的患者的不良事件较少。结论：经过长期的随访，ARUBA显示在预防未破裂的脑动静脉畸形患者的死亡或症状性卒中方面，单纯的医疗管理仍优于介入治疗。《评论：未破裂的脑动静脉畸形的治疗策略》Lancet Neurology，2020年7月 (4)动静脉畸形是青壮年脑出血的主要原因。当它还没有引起癫痫、局灶性神经缺损的时候，有时偶然在影像学检查中被发现，在这些未破裂的病例中，通过介入治疗栓塞或切除动静脉畸形以及相关动脉瘤，可能可以降低颅内出血的长期风险，但是在随机试验中缺乏风险和收益平衡的证据。《随机对照研究：院外氨甲环酸治疗对中重度外伤性脑损伤患者神经功能预后的影响》JAMA，2020年9月 (5)研究的目的是评估中重度外伤性脑损伤2小时内，院外予氨甲环酸治疗对神经学结果的影响。研究纳入年龄≥15岁、Glasgow昏迷评分19mmHg与死亡率相关，而颅内压

Daniel took a medical leave during his first year of medical school from mental health challenges. He discusses his experiences with depression and anxiety, and why he decided to take a break from medical school to regroup. He shares changes he made in his life, and making his faith and religion a priority again. He also talks about the unique financial obstacles of taking a leave from medical school.

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Chronic pelvic pain has been redefined by the ACOG and includes a broader range of etiologies. There are 3 main categories of potential etiologies for chronic pelvic pain. In this episode, we will review the March 2020 practice bulletin ( 218) on the subject. What is the Carnett test? Do trigger point injections work? What is the role of SNRI medications in treating chronic pelvic pain? What about lysis of adhesions? We will address these questions and more in this episode!

Il Disturbo da Attacchi di Panico è un disturbo mentale davvero frequente nella popolazione generale e, come psichiatra clinico, mi ritrovo davvero frequentemente a diagnosticarlo e a trattarlo mediante farmaci, psicoterapia o interventi integrati e multimodali (CBT, psicoeducazione e mindfulness).In questo video ho intenzione di spiegare in maniera semplice e chiara qual’è la natura clinica dell’attacco di panico e quali sono le soluzioni possibili per un suo trattamento il più possibile rapido e radicale.#panico #attaccodipanico #psichiatriaISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJIl Dr. Valerio Rosso, su questo canale YouTube, si dedica a produrre delle brevi lezioni di psichiatria rivolte ai pazienti, agli operatori della salute mentale, a famigliari di pazienti ed a chiunque sia interessato alla psichiatria ed alle neuroscienze.

Il Disturbo da Attacchi di Panico è un disturbo mentale davvero frequente nella popolazione generale e, come psichiatra clinico, mi ritrovo davvero frequentemente a diagnosticarlo e a trattarlo mediante farmaci, psicoterapia o interventi integrati e multimodali (CBT, psicoeducazione e mindfulness).In questo video ho intenzione di spiegare in maniera semplice e chiara qual’è la natura clinica dell’attacco di panico e quali sono le soluzioni possibili per un suo trattamento il più possibile rapido e radicale.#panico #attaccodipanico #psichiatriaISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJIl Dr. Valerio Rosso, su questo canale YouTube, si dedica a produrre delle brevi lezioni di psichiatria rivolte ai pazienti, agli operatori della salute mentale, a famigliari di pazienti ed a chiunque sia interessato alla psichiatria ed alle neuroscienze.

Track 5: Effects of SSRI's and SNRI's good treatment for a depression is essential SSRI's 5975 people 7% did better on antidepressants than sugarpill (93%) so, VERY ineffective These drugs deplete the neurotransmitters - total opposite of Dr. Hinz's work "non" success rates of taking antidepressants for people over 65 years old "non" success rates of taking antidepressants for teenagers Antidepressants were tested on adults - so they never studied the effects on children May 2007 - warnings on blackbox : expanding to ages 18-24 What can interfere? Neurotoxins, Pesticides In adults : sex hormones

In our last episode of the season, we look at 5 recent publications in the field of toxicology.Steuer, A. et al. Identification of new urinary gamma-hydroxybutyric acid markers applying untargeted metabolomics analysis following placebo-controlled administration to humans. (2019) Drug Testing and Analysis. 11 (6):813-823Souza, R. et al. Validation of an analytical method for the determination of the main ayahuasca active compounds and application to real ayahuasca samples from Brazil. (2019) Journal of Chromatography B. 1124: 197-203 Snamina, M. et al. Postmortem analysis of human bone marrow aspirate - Quantitative determination of SSRI and SNRI drugs. (2019) Talanta. 204:607-612Fabresse, N. et al. Development of a sensitive untargeted liquid chromatography-high resolution mass spectrometry screening devoted to hair analysis through a shared MS2 spectra database: A step toward early detection of new psychoactive substances. (2019) Drug Testing and Analysis. 11 (5):697-708Sitasuwan, P. et al. Comparison of purified beta-glucuronidases in patient urine samples indicates a lack of correlation between enzyme activity and drugs of abuse metabolite hydrolysis efficiencies leading to potential false negatives.(2019) Journal of Analytical Toxicology. 43 (3):221-227Contact us at thetoxpod@sa.gov.auThe Toxpod is a production of Forensic Science SA and the South Australian Attorney General's Department. The opinions expressed by the hosts are their own and do not necessarily reflect the views of their employer.

Episode 16: Depression & Prevention of SuicideEmily Gard, LICSW, joins us to talk about depression and suicide. Emily is a Licensed Individual Clinical Social Worker and nationally certified mental health first aid trainer with over ten years of experience in the field of social work. Emily earned her undergraduate degree from Concordia College and a master’s degree in Social Work from the University of North Dakota. She initially worked as a chemical dependency social worker before pursuing graduate education. Currently Emily is employed by Sanford Health as an Integrated Health Therapist. She was named Sanford Health Employee of the Year in 2017. When Emily is not working, she enjoys spending time at the lake with her husband and five children.Depression - feeling down, depressed, hopeless, helpless. May come out of nowhere or be triggered by stressors. Symptoms include tearfulness, loss of interest, appetite and sleep changes, irritability, stomach aches, headaches. Symptoms can be physical - fatigue, diarrhea, upset stomach. Isolation, irritability, frustration, and slowed thinking can be seen in the older population. Sadness and bereavement generally do not last for more than a few months. Depression tends to be persistent and pervasive.Suicide is a side effect of depression. Warning signs include thoughts of being better off dead or not wanting to wake up. Talking to people who are depressed about suicide does not make them more likely to commit suicide. Many people experience ambivalence about suicide and want to be asked about how they are doing.Warning signs of suicide:- talking about death- statements like “people would be better off without me”- feeling like they’re a burden- feeling isolated- feeling disconnected- preparatory behaviors - giving away things, purchasing firearms, making sure will and/or insurance are in orderThe next step for friends/family/clinicians:- Ask how the affected person is doing- Make observations to the person- Using the word “suicide” is okPeople with depression need support just like people struggling with physical illness.Local support groupsNational Suicide Prevention Lifeline American Foundation for Suicide Prevention Columbia suicide severity rating scale - helps assess risk Protective factors- Valued relationships (pets, children, parents, close friends)- Futuristic thinking- EmploymentAs a friend, you can highlight protective factors and help them focus on these things. Do this without creating guilt by asking “what’s one thing that you’re living for?”Terminology - language is changing. In the past we would say “committed suicide” but just as people die of cancer, they die of/by suicide. This is more accurate and helps decrease stigma.The Columbia scale helps identify level of concern when someone is alluding to suicide. Preparatory behavior, plan for suicide, and suicidal intent predict suicide attempts.People can recover! Every emotion is temporary. Recovery is possible. If someone has had suicidal thoughts in their life, they don’t typically experience them again. People generally get better and are able to experience joy and quality of life again. People should know that they aren’t alone. Depression and anxiety are common and treatable.Treatment of depression:Non-medical includes therapy, behavioral activation: exercise, healthy eating, connecting with others.Medications include SSRI’s, SNRI’s, other antidepressants, sometimes antipsychotics- These increase hormones in our brain that create positive feelings and emotion.- Sometimes they have to be tried to find the right one. It can take a 4-6 weeks for these to reach their full effect.- Medications don’t necessarily have to be life-long.- Side effects: feeling emotionally “flat,” fatigue, nausea, weight changes, appetite changes, sexual side effects.- Avoid heavy alcohol consumption while taking antidepressants.Inpatient stays and partial hospitalization (PHP) can help individuals with suicidal intent. They help stabilize and facilitate mediation adjustments in addition to learning coping skills.Exercise can be equivalent to taking a medication to help elevate mood. This shouldn’t be done in isolation but can be a helpful part of a treatment program. Being outside, being mindful of different sensations can elevate mood as well.Cognitive behavioral therapy is a frontline approach for depression. Thoughts and behaviors are interconnected. Mindfulness, or the intention to pay attention, can be helpful in managing depression. Deep breathing can help regulate emotions.Headspace, Calm, and Breathe are good apps. Or search “Guided meditation” on Youtube.Health pearl of the week: Unplug! Technology can be enriching and helpful, but can also intrude into our lives. Think about having an hour of “unplugged” time per day (or even a day per week!).Follow us on Facebook and Twitter

Author: Dave Saintsing Educational Pearls: Poor sleep is an independent risk factor for development of health problems such as type 2 diabetes.  A 2019 study, randomized participants to 3 groups: 9 hours of sleep, 5 hours of sleep with weekend catch-up sleep, and 5 hours of sleep without catch-up sleep.  In the sleep deprived (5 hour) groups, there was significantly more insulin resistance, calorie intake, and weight gain regardless of catch-up sleep.  Tramadol is prescribed 25 million times a year in the USA, usually to avoid prescribing traditional opiates such as Percocet or Oxycodone. Tramadol has complex pharmacology in that is is both an SNRI and mu-opiate agonist after metabolism in the liver. The pharmacogenetics of this vary greatly between people. Many people have rapid metabolism that will lead to increased opiate effects. Other medications interfere with metabolism (such as SSRI’s). A recent study demonstrated increased risk of hypoglycemia in diabetics taking Tramadol. Use caution when prescribing this drug.  Sepsis resuscitation has traditionally been gauged by following lactate levels on the  presumption that lactate is an adequate marker of organ perfusion. Unfortunately, lactate levels are often elevated by medications and other health conditions such as kidney or liver disease, making lactate an often ineffective biomarker for perfusion. The Andromeda-Shock trial compared using capillary refill to lactate as guides for resuscitation with the primary endpoint of reducing 28-day mortality.  The capillary refill group had a 9% absolute risk reduction in mortality, but this did not reach statistical significance. However, capillary refill can be used as another data point while resuscitating your septic patients.  When should you start pressors for patients in septic shock? A 2019 study compared routine resuscitation (30cc/kg fluid bolus) to initiation of norepinephrine with the first 30cc/kg crystalloid. They found that the early pressor group had significantly more “shock control” (MAP>65) at 6 hours, compared to the control group. While there was a trend towards less mortality in the early pressor group, it was not statistically significant. Keep an eye out for more studies in this area!  A recent study in JAMA found that 88% of deaths from sepsis were unavoidable, due to severe chronic comorbidities. Remember that patients will still die from septic shock despite your best efforts and knowledge of the newest literature.    References Depner CM, Melanson EL, Eckel RH, Snell-Bergeon JK, Perreault L, Bergman BC, Higgins JA, Guerin MK, Stothard ER, Morton SJ, Wright KP Jr. Curr Biol. 2019 Feb 11. pii: S0960-9822(19)30098-3. doi: 10.1016/j.cub.2019.01.069. [Epub ahead of print]. PMID:30827911.   Fournier J, Azoulay L, Yin H, Montastruc J, Suissa S. Tramadol Use and the Risk of Hospitalization for Hypoglycemia in Patients With Noncancer Pain. JAMA Intern Med. 2015;175(2):186–193. doi:10.1001/jamainternmed.2014.6512 Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. Published online February 17, 2019321(7):654–664. doi:10.1001/jama.2019.0071   Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC.   Rhee C, Jones TM, Hamad Y, et al. Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Netw Open. Published online February 15, 20192(2):e187571. doi:10.1001/jamanetworkopen.2018.7571   Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD From CarePoint PA Academy, 2019

In questi ultimi anni, davvero in sordina, si è fatto strada il concetto di PSSD, ovvero di una disfunzione sessuale persistente dopo utilizzo di farmaci antidepressivi SSRI e SNRI. Di che cosa si tratta? È un fenomeno reversibile? Come si cura?La disfunzione sessuale post-SSRI (Post-SSRI Sexual Dysfunction, PSSD) è un disturbo iatrogeno causato dai farmaci SSRI, ovvero inibitori della ricaptazione della serotonina e SNRI, inibitori della ricaptazione di serotonina-noradrenalina. Questa disfunzione sessuale è caratterizzata da alterazioni della libido, difficoltà a raggiungere l’orgasmo, anorgasmia, difficoltà di erezione ed altro, spesso accompagnate da alterazioni emotive che si manifestano durante l'assunzione del farmaco antidepressivo e che possono persistere per un tempo indefinito dopo la sospensione del farmaco stesso.Per maggiori informazioni vi riporto i collegamenti che hanno ispirato questo video, oltre al contributo di alcuni pazienti e miei follower che lo hanno ispirato direttamente.#pssd #ssri #snriRxISK, Professor David Healy: https://youtu.be/GJrRemX5Q-cNell'ambito della seduta PRAC (Pharmacovigilance Risk Assessment Committee) del 29-31 ottobre 2018, l'Agenzia Europea per i Medicinali (EMA - European Medicines Agency) ha richiesto alle case farmaceutiche di SSRI e SNRI chiarimenti approfonditi rispetto alle Disfunzioni sessuali persistenti in seguito alla sospensione del farmaco, da presentare all'EMA entro 60 giorni.Il verbale e' consultabile al seguente link (pag. 15-16): https://www.ema.europa.eu/documents/m...Disfunzione sessuale post-SSRI su wikipedia: https://it.wikipedia.org/wiki/Disfunz...Il Fatto Quotidiano: https://www.ilfattoquotidiano.it/2017...La migliore Bibliografia che potrete trovare sull'argomento la trovate sul blog http://disfunzionisessualipostssri.bl...ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

In questi ultimi anni, davvero in sordina, si è fatto strada il concetto di PSSD, ovvero di una disfunzione sessuale persistente dopo utilizzo di farmaci antidepressivi SSRI e SNRI. Di che cosa si tratta? È un fenomeno reversibile? Come si cura?La disfunzione sessuale post-SSRI (Post-SSRI Sexual Dysfunction, PSSD) è un disturbo iatrogeno causato dai farmaci SSRI, ovvero inibitori della ricaptazione della serotonina e SNRI, inibitori della ricaptazione di serotonina-noradrenalina. Questa disfunzione sessuale è caratterizzata da alterazioni della libido, difficoltà a raggiungere l’orgasmo, anorgasmia, difficoltà di erezione ed altro, spesso accompagnate da alterazioni emotive che si manifestano durante l'assunzione del farmaco antidepressivo e che possono persistere per un tempo indefinito dopo la sospensione del farmaco stesso.Per maggiori informazioni vi riporto i collegamenti che hanno ispirato questo video, oltre al contributo di alcuni pazienti e miei follower che lo hanno ispirato direttamente.#pssd #ssri #snriRxISK, Professor David Healy: https://youtu.be/GJrRemX5Q-cNell'ambito della seduta PRAC (Pharmacovigilance Risk Assessment Committee) del 29-31 ottobre 2018, l'Agenzia Europea per i Medicinali (EMA - European Medicines Agency) ha richiesto alle case farmaceutiche di SSRI e SNRI chiarimenti approfonditi rispetto alle Disfunzioni sessuali persistenti in seguito alla sospensione del farmaco, da presentare all'EMA entro 60 giorni.Il verbale e' consultabile al seguente link (pag. 15-16): https://www.ema.europa.eu/documents/m...Disfunzione sessuale post-SSRI su wikipedia: https://it.wikipedia.org/wiki/Disfunz...Il Fatto Quotidiano: https://www.ilfattoquotidiano.it/2017...La migliore Bibliografia che potrete trovare sull'argomento la trovate sul blog http://disfunzionisessualipostssri.bl...ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Avete mai notato che quando si parla di psichiatria sembra che tutti ne sappiano più degli psichiatri? Il tema degli antidepressivi è poi un tema molto caldo e fonte di svariate polemiche. C'è chi dice che gli antidepressivi sono prescritti troppo e chi dice che sono prescritti troppo poco..... chi dice che hanno troppi effetti collaterali e chi dice che non ne hanno.... chi dice che sono efficaci e chi dice che non servono a nulla..... qual'è la verità sugli antidepressivi? Un buon punto di partenza è quello di far sempre riferimento agli studi migliori basati sulle evidenze e a provare ad analizzare i fatti per valutare se gli antidepressivi facciano bene o male.....ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questopodcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Avete mai notato che quando si parla di psichiatria sembra che tutti ne sappiano più degli psichiatri? Il tema degli antidepressivi è poi un tema molto caldo e fonte di svariate polemiche. C'è chi dice che gli antidepressivi sono prescritti troppo e chi dice che sono prescritti troppo poco..... chi dice che hanno troppi effetti collaterali e chi dice che non ne hanno.... chi dice che sono efficaci e chi dice che non servono a nulla..... qual'è la verità sugli antidepressivi? Un buon punto di partenza è quello di far sempre riferimento agli studi migliori basati sulle evidenze e a provare ad analizzare i fatti per valutare se gli antidepressivi facciano bene o male.....ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria e le Neuroscienze? Bene, allora iscrivetevi a questopodcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Dive deep into the psychopharmacology of depression with Dr Patrick Finley, PharmD at UCSF. Learn practical tips including how to switch from one antidepressant to another, what to expect with SSRI and SNRI withdrawal, and how to choose a second (or third) antidepressant for refractory depression. We also summarize the safety around antidepressants in the peripartum period. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. 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: Molly Heublein, MD CME questions by: Molly Heublein, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein, MD Edited by: Matthew Watto MD Guest Presenter: Patrick Finley, PharmD BCPP Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18. Time Stamps 00:00 Sponsor ACP’s MKSAP 18 00:25 Disclaimer, intro and guest bio 04:33 Guest one-liner, book recommendation, and first patient complaint 08:04 Picks of the week 12:10 Sponsor ACP’s MKSAP 18 14:03 Clinical case of depression; assessing target symtpoms to characterize depression; choice of initial SSRI 17:49 Discussion of iron, ferritin, folate and L methylfolate as they relate to treatment refractory depression 20:12 Postpartum depression, iron, genetics and environmental factors 22:35 How to switch from one SSRI to another; Cross-titration from SNRI to SSRI or from SSRI to SNRI 26:05 Withdrawal symptoms from SSRIs or SNRIs and a bit more on switching and cross titration 31:33 Is paroxetine ever a good idea? 33:03 Ultra-rapid metabolizers of SSRIs and pharmacogenomics 34:43 Postpartum depression and treatment with antidepressants during pregnancy and lactation 39:25 Monitoring response to therapy with antidepressants ie PHQ-9 40:53 Augmentation for partial response; bupropion for augmentation and sexual side effects; 43:58 Counseling patients about discontinuation of therapy 47:00 How to choose an agent for augmentation of antidepressant therapy 51:02 Mirtazapine 52:41 Vortioxetine 53:24 Atypical antipsychotics for augmentation 55:37 Pregabalin and gabapentin for augmentation 57:42 Dr Finley’s take home points 60:48 Outro

Fact or Fiction? Topic: There Is A Harmful Interaction Between Ketamine And Prescribed Antidepressant Medications When depression patients come to us seeking the therapeutic effects that Ketamine can provide, they are frequently prescribed to and utilizing antidepressant medications (SSRI,SNRI). A common question we get at KWC is whether there is a harmful interaction that may occur between the Ketamine and antidepressant medications. In other words, will the Ketamine be less effective? And are there harmful side effects to take into consideration for someone who is currently utilizing antidepressants? Clinical Administrator, John DelosSantos, tackles these questions and clears the air on this misunderstood issue. Special thanks to listener, Emily, for submitting this Fact of Fiction topic.

The Serotonin and Norepinephrine Reuptake Inhibitors are a class of medication used for various mental health disorder and pain syndromes.  I talk about the pharmacology of the SNRI's and how it relates to their adverse effect profile.  The pharmacology of SNRI's also plays an important role in why they are efficacious for treatment of pain compared to the SSRI's.  In addition to the adverse effects, I will outline some common drug interactions and which medications might be affected by the SNRI's. Enjoy the episode and I hope you pick up some clinical practice pearls with the SNRI's!  Don't forget to take advantage of our free giveaway as well, nearly 1,000 healthcare professionals and students have already done so!

Dr. Rosenblum returned from a the fantastic PainWeek conference and reviews, editorializes the PainWeek Journal Article. 2019 Examinee- 12 Month PainExam Discount Enter Coupon Code 12MONPE Download the PainExam App for iPhone and Android   Subscribe to our mailing list * indicates required Email Address *   DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2018 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

This episode covers medications including antidepressants and rapid review. The goal of this podcast is to help medical students study for high yield topics and actively test knowledge. Timestamp: 00:00 Intro 01:15 Antidepressants 19:10 Rapid Review Written, produced and recorded by Josh Bradford. Comments, constructive criticism, or questions please contact at medicalstudentstudycast@gmail.com Support by donating to anchor.fm/medical-student-studycast or patreon.com/medicalstudentstudycast Tags: SSRI, SNRI, bupropion, fluoxetine, serotonin, serotonin syndrome, depression, anxiety, PTSD, OCD, MAOI, tyramine crisis, tricyclic antidepressant, ECT, psychiatry clerkship, rotations, psychiatric, behavioral health, USMLE, COMLEX, step 2, level 2, clinical, shelf exam, medicine --- Support this podcast: https://anchor.fm/medical-student-studycast/support

Join Kristin Sunanta Walker, Melanie Vann, Dr. Paul Meier, and Grant Davis as they discuss depression and medication treatment on this weeks Round Table discussion. Melanie is the Program Director of MHNR Network.Dr. Paul Meier is the founder of www.meierclinics.com, a best-selling author and practicing psychiatrist. Grant Davis is new to the show and is a psychiatric nurse practitioner. Grant provides psychiatric medication management for children, adolescents, and adults. His approach to medication management is client focused and collaborative based on information shared between clinician and the client. Grant believes that a strong therapeutic relationship between clinician and patient is vital for positive mental health outcomes.

This week, Dr. Jeffrey Strawn and Dr. Norris continue their conversation by discussing SSRIs vs. SNRIs for pediatric patients. They also get into what to do when a pediatric patient with anxiety requires treatment for comorbid ADHD. MDedge Pediatric News recently published an ID Consult by David C. Rettew in which Dr. Rettew notes that there are “little systemic data to guide pharmacologic decision making,” beyond first and second-line SSRI followed by SNRI. You can check out a child psychiatric consult on ADHD and the role of wellness at MDedge Pediatric News. In the consult, Dr. Allison Y. Hall, MD outlines a treatment plan, ideas for parent training, and the role of sleep and exercise. Also, Dr. RK discusses what she calls a basic human right - voluntariness.

20% off PainExam AnesthesiaExam PedsAE.com Enter ASRA18 at checkout (Valid until June 1, 2018) Now Available At Amazon.com Welwyn Ardsley and the Cosmic Ninjas- Preparing your Child and Yourself for Anesthesia and Surgery Guidelines on Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications Aspirin use during spinal cord stimulator trial Serotonin reuptake inhibitors and bleeding risk Herbal and Dietary Supplements and bleeding risk Reference  https://www.asra.com/advisory-guidelines/article/10/interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoa AnesthesiaExam Podcast App For iPhone and Android Subscribe to our mailing list * indicates required Email Address *    DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. Copyright © 2015 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author. 
 


This episode of CRACKCast covers Rosen’s 9th Edition Chapter 146, Antidepressants. Continuing the section on toxicology, antidepressants make up one of the most commonly prescribed medications in the general population. The use and misuse of antidepressants can have serious consequences and having a high suspicion of overdose in suicidal patients can lead to timely antidote therapy.

This episode of CRACKCast covers Rosen’s 9th Edition Chapter 146, Antidepressants. Continuing the section on toxicology, antidepressants make up one of the most commonly prescribed medications in the general population. The use and misuse of antidepressants can have serious consequences and having a high suspicion of overdose in suicidal patients can lead to timely antidote therapy.

Ep. 251: Transitioning Out of Depression   In this episode, Stacy and Sarah talk about Stacy going off her anti-depressants and what these drugs even do. Plus, how can you support mental health in your diet? Click the picture above to be taken to iTunes If you enjoy the show, please review it in iTunes! The Paleo View (TPV), Episode 251: Transitioning Out of Depression Intro (0:00) News and Views (0:40) Go see Wonder Woman! It's awesome! Buy the soundtrack! Stacy and Sarah talk comic book movies?! What dorks! I approve How you didn't miss the video podcast last week! For more on Sarah's bedtime protocol, see her book Go To Bed! Today is an update on Stacy's health and mental recovery. Stacy had a devastating back injury detailed in podcast form here. She's also had some intense emotional blows in the past year including losing her brother-in-law and best friend Andrew She went on mediations, specifically an SSRI, which helps with eating disorders, which seemed to be coming back when she was depressed. Unfortunately it was disrupting her sleep! She also had an issue with mindless eating as well. So she switched to an SNRI, but she didn't feel any different. But she found that she felt okay, so she went off her medication. Sarah recommends looking at conventional medicine the same way we look at foods: see the pros and cons These medicines work by effecting neurotransmitters and and keeping the happy ones in circulation longer. In addition to SNRI and SSRI, there's also NDRI Treating chronic depression is a long term thing on these drugs: 6 months - 2 years. And discontinuing use is a tapering off process. Stacy knew she didn't need the medication because of how well she was able to deal with the selling of her house. Stacy and Sarah both recommend positive thinking and focusing on positivity to see you through. Stacy references the tragic story of Oprah endorsing The Secret and then having someone declare that she would use The Secret to fight cancer. This person later died. Of cancer. Stacy also did 45 days of super clean eating except for one occasion. This helped her very much. Plus she added collagen and veggies Big recommendation for Dr Sarah Ballantyne's Vital Veggies Blend from Vital Proteins! Remember: medication is never a failure, but there are ways to help yourself recover from mood disorders Sleep Exercise (and exercise outside is better than exercise indoors) Omega-3s (EPA and DHA, from fish and shellfish and some grass fed meat) Vitamin D B Vitamin deficiencies: folate, B9, especially. If you're not methylating properly because of a MTHFR mutation or otherwise, you'll build up homocysteine in the blood. Make sure you're B Vitamin sufficient, especially in B6, B9, and B12! Stacy takes the Vital Protein Liver Pills. Zinc is important as well. Some 70% are not sufficient in it. Shellfish and liver are the most plentiful in it and it is used in neurotransmitters. Amino acids: tyrosine and phenylalanine (precursor for norepinephrine), methionine (precursor for SAMe), glycine (reduces signs of schizophrenia) and taurine (reduces bipolar) More organ meat and more seafood to treat mental disorders! Remember the link between gut health and mental health! Our bacteria friends can help our brains! Rate and Review us! Goodbye! Outro (53:37)     Support us by shopping through links on our sidebars, please!

Welcome to PsychED, the educational psychiatry podcast for medical learners, by medical learners. This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto. In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression. Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009). The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009). Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS. Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise. The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to: Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features Apply the CANMAT Guidelines in discussing treatment options for MDD Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD Psychotherapy Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment Describe the efficacy of psychotherapy in relation to pharmacotherapy Pharmacotherapy Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression Explain the time of onset and side effect profile of SSRIs Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication Identify some factors to consider in choice of antidepressants Brain Stimulation Identify ECT, rTMS, and DBS as brain stimulation treatments for depression Criticize the cultural origins of stigma around ECT Describe the current practice of ECT, rTMS, and DBS Complementary and Alternative Therapies Describe Light Therapy as the only evidence-based complementary treatment strategy Recognize the limited data in support of other therapies including nutraceuticals and exercise Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto) For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.